ibudget Florida Rule Development Workshop

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Brendan O’Brien’
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1 ibudget Florida Rule Development Workshop June 21, 2011 all content subject to change 1

2 Overall Goals Simplify the system Enhance: Self-direction Sustainability Equity all content subject to change 2

3 ibudget Paradigm Needs met through waiver AND state plan, natural supports and community resources Waiver Support Coordinators freed to help get other resources Consumers have lots of flexibility for spending up to individual ibudget maximum amount Requests for additional funding require thorough review all content subject to change 3

4 Overview of Proposed System Budgets determined through formula Service array revised to increase flexibility Waiver Support Coordination better match to family needs, shift to emphasis on service coordination from service approval processing Service review more limited, focused, & streamlined, focusing on health & safety issues all content subject to change 4

5 Overview of Proposed System Consumer and family training and tools for managing budgets Policies for limiting risk of overspending and addressing budget mismanagement Reviews to ensure appropriate spending Process for determining budgets for consumers with extraordinary needs all content subject to change 5

6 Overview of Proposed System Electronic/automated as much as possible virtually paperless Online ibudget Florida system will automate service review process for many all content subject to change 6

7 Overview of Proposed System Unlike in current waiver, budget & services are separate decisions Individual decides how much to spend on each service Can be pre-approved for a service you don t spend budget on (may be exceptions where health & safety may be at risk) all content subject to change 7

8 Starting Up on ibudget Florida APD sends individuals a welcome packet Explains ibudget Florida Gives instructions for next steps Waiver support coordinator schedules appointment all content subject to change 8

9 Starting Up on ibudget Florida Individual & waiver support coordinator meet Waiver support coordinator gives overview Waiver support coordinator provides notice with budget amount & pre-approved services all content subject to change 9

10 Starting Up on ibudget Florida Individual & waiver support coordinator meet Individual makes decisions, signs paperwork if necessary Selects support coordination level Whether to use online system all content subject to change 10

11 Starting Up on ibudget Florida Gets training on online system use Individual & waiver support coordinator create cost plan Individual/Representative MAY use website OR Waiver support coordinator creates plan in online system Can apply for additional services all content subject to change 11

12 Rule Components Definitions General Provisions Funding Allocations and Processes Service Approval Cost Plan Development Process Overview all content subject to change 12

13 Rule Components Review of Cost Plans Supplemental Funding Request & Review Review of Service Logs and Claims Rate Negotiation Online Access by Individuals and ibudget Florida Representatives all content subject to change 13

14 Definitions Key definitions include: Actuarial funding category Algorithm Budget allocation Conflict of interest Designated representative Extraordinary needs all content subject to change 14

15 Definitions Key definitions include: ibudget Florida Immediate, serious jeopardy Individual Serious jeopardy Service family Supplemental funding Temporary basis all content subject to change 15

16 General Provisions Reference to Coverage and Limitations (services/provider) Handbook (promulgated by the Agency for Health Care Administration) General authority for online system, agency staff, and/or contracted reviewers to request information on enrollees to process their requests for services and/or funding all content subject to change 16

17 General Provisions Timeframes for decisionmaking pended while APD awaits requested additional information List of ibudget Florida rules from which Consumer Directed Care Plus (CDC+) Program participants are exempted. all content subject to change 17

18 Funding Allocations and Processes Available funding divided between: Actuarial funding categories (general funding, extraordinary need funding, temporary and permanently changed needs funding, and one-time expenditure funding) Support coordination Geographic differentials all content subject to change 18

19 Funding Assumptions Standard ibudgets Extraordinary Need Temporary/Permanent Increases One-time Expenditures all content subject to change 19

20 Algorithm run for all Funding Allocations and Processes Add in waiver support coordination funding and geographic differentials to individuals allocations Pro-rate if transitioning other than 1 st day of fiscal year all content subject to change 20

21 Funding Allocations and Processes During first year, individuals will not receive more than a 50% reduction in cost plan APD can adjust budget allocations mid-year to ensure spending remains within appropriations Individual s budget allocation is reduced if situation changes (for example, individual moves from congregate care to a family home) all content subject to change 21

22 Service Approval Individuals will be pre-approved for services on approved cost plan immediately prior to transition Individuals may apply for additional preapproved services through waiver support coordinator & the online ibudget Florida system all content subject to change 22

23 Service Approval Approval will be ended for services for which the individual no longer qualifies Waiver support coordinator responsible for notifying APD all content subject to change 23

24 Cost Plan Development All services must be on agency-reviewed and approved cost plan to be paid for with waiver funds. All plans shall be created through online ibudget Florida system. all content subject to change 24

25 Cost Plan Development Individuals/representatives can create plans and submit to their waiver support coordinator, or choose for waiver support coordinator to create their plans all content subject to change 25

26 Cost Plan Development An individual may be approved for services up to the amount of her budget allocation. Unused funding can be shifted from past to future months during a single fiscal year. Funding cannot be carried forward to another fiscal year (except for CDC+ participants). all content subject to change 26

27 Cost Plan Development An individual can t increase funding for a specific service retroactively. If funds are shifted from past to future months, the individual and his waiver support coordinator must make sure that enough funding is left to pay for services already provided. all content subject to change 27

28 Cost Plan Development Submitted cost plans must show funding through entire fiscal year or portion of year the individual is enrolled in ibudget Florida, regardless of when plan is submitted. all content subject to change 28

29 Cost Plan Development Waiver is payer of last resort; all other resources must be used before using waiver funds. Funds must be budgeted for waiver support coordination each month. all content subject to change 29

30 Cost Plan Development Individuals must ensure their health and safety needs are met throughout the year. Individuals must reserve funding for health and safety needs until need is met if these are being met through natural/community supports. all content subject to change 30

31 Cost Plan Review Initial plan is reviewed by agency staff. Subsequent plans reviewed first by online system, which approves if possible; if not, system sends to agency staff for review. all content subject to change 31

32 Supplemental Funding Request & Review At beginning of plan year: If individuals believe they, caregivers, or public are in immediate, serious jeopardy without funding increase AND They meet other statutory eligibility criteria: They may apply for extraordinary need funding. all content subject to change 32

33 Supplemental Funding Request & Review Additional funding available during year to address, if all criteria met: Temporary change in need Permanent change in need One-time purchase need all content subject to change 33

34 Supplemental Funding Request & Review Additional funding available during year: Health and safety of individual, caregiver, or public must be in serious jeopardy without the increase AND Must meet statutory criteria. all content subject to change 34

35 Funding Determination Supplemental Funding Extraordinary need supplemental funding: For individuals whose situation is so unique that the algorithm is not able to determine their budget amount. Small number of consumers would qualify all content subject to change 35

36 Funding Determination Supplemental Funding Requirements to receive funding Eligible under law/rule for supplemental funding. Has sought non-waiver supports to meet needs within budget but they are not sufficient. all content subject to change 36

37 Funding Determination Supplemental Funding Requirements to receive funding Cannot adjust budget to meet needs. Qualify for specific waiver services requested to meet needs all content subject to change 37

38 Funding Determination Supplemental Funding Determination Process Use system similar to APD s current process for determining increases to cost plans all content subject to change 38

39 Funding Determination If an individual ends up not using supplemental funding within a reasonable amount of time, it may be reallocated to another individual in need. all content subject to change 39

40 Review of Service Logs & Claims Waiver support coordinators and individuals should review service logs and claims at least on a quarterly basis (though monthly reviews are encouraged) and let APD know of any inaccuracies. all content subject to change 40

41 Rate Negotiation Rates for Personal Supports and Family and Legal Representative training may be negotiated but must be at least minimum wage. Specifics of the rate and service shall be documented on a form. Handbook requirements must be met unless specifically allowed to be exempted. all content subject to change 41

42 Online Access People accessing on an individual s behalf must have a specified relationship or designation depending on individual s age or competency. Only one other person besides the individual may access the system on his or her behalf. S/he may not be a paid support or have a conflict of interest. all content subject to change 42

43 Online Access Waiver support coordinators shall verify the person qualifies for access of behalf of the individual and maintain the supporting documentation in the central record. People accessing must complete training and agree to terms & conditions of use before receiving a log-in name and password. all content subject to change 43

44 Online Access APD may revoke a user s access for misuse of the system. Other consequences for misuse may include but not be limited to recovery of funds, termination of waiver provider agreement, and referral to law enforcement. all content subject to change 44

45 Comments may be ed to: all content subject to change 45

46 Thank you! all content subject to change 46

9/16/ The WSC will meet with the individual and conduct the Allocation Implementation Meeting (AIM) and document this using the AIM Worksheet.

9/16/ The WSC will meet with the individual and conduct the Allocation Implementation Meeting (AIM) and document this using the AIM Worksheet. ibudget Rule Implementation Waiver Support Coordinator (WSC) Process Steps Rules 65G-4.0213 through 4.0218, Florida Administrative Code became effective on July 7, 2016. The ibudget rule establishes the