July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only...

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only

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iBudget FloridaStakeholders’ Group Meeting

July 1, 2010

Workgroup on Services, Providers, Waiver Support Coordinators &

Administrative Issues

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only 2

Introductions• Workgroup members

• Staff

• Guests


Review of Minutes from Previous Meeting


Meeting Objectives

• Share information

• Receive input on preferred options, potential improvements, implementation considerations, and other relevant issues


Overall Goals

Simplify the system

Enhance:

– Self-direction

– Sustainability

– Equity


• Needs met through waiver AND state plan, natural supports and community resources

• Waiver Support Coordinators freed to help get other resources

• Service review limited for many consumers, for spending up to individual iBudget maximum amount

• Requests for additional funding require thorough review

iBudget Paradigm


• This is a starting point

– We’ll be testing the system through an initial phase-in.

– Intend to refine system over time

• Are seeking the best solution among the alternatives

– All have pro’s and con’s

Keep in mind . . .


• Waiver submitted by early August

• Draft rules by mid-July

• Draft operating procedures by late July

• Training developed by late August; begin training in early September

Target Implementation Plan


• Collect baseline data for evaluation by late September

• IT system implemented by early October

• Start communicating w/ phase in area consumers, WSC’s, providers, and staff as soon as phase-in site announced

Target Implementation Plan


• Completed initial review of rules and operating procedures that need revising and development.

• Phase-in area not final. – Will have a coordinated system of publicizing to

ensure accurate information.

• IT system design progressing; coding beginning soon.

Updates


• Waiver drafting in progress

• Hired iBudget Florida Operations Project Manager.

• Will release RFQ for evaluation soon.

• Initial flowcharting/system design completed

Updates


Overview of Proposed System

• Budgets determined through algorithm • 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



• Consumer and family training and tools for managing budgets• Policies for limiting risk of overspending and options for corrective action plans• Behind-the-scenes reviews for health & safety, provider manipulation, and fraud• Process for determining budgets for consumers with exceptional needs



• Electronic/automated as much as possible—virtually paperless• Phase-in over a reasonable time period—e.g., number of consumers (say by geography) and budget amounts


Topics for Today

• Policy on Waiver Support Coordination services

• Rate/service negotiation guidelines

• Service family groupings

• Provider use of technology

• Obtaining timely service information


Service Families

• Groupings: – Issues:

• Facilitating functioning of online system to streamline approval of requested services


Service Families

• Groupings: – Plan:

• Listed 8 service families– Law:

• Did not mention service families


Service Families

• Groupings: – See handout for suggested revised

groupings


Waiver Support Coordination

• Issues:– Match rate to work required – Match work and responsibility to needs of

consumer, and allow to change as needs change

– Ensure health and safety



• Levels of support coordination available:– Current situation:

• Limited—all children and adults who choose

• Full—all adults, unless they choose limited

• Transitional—consumers who are transitioning from an ICF/DD



– Plan: • Levels of support coordination available:

–Limited–Full–Enhanced

• Funding in consumer’s iBudget:–Adults funded at full–Children funded at limited



– Plan:

• Consumer or caregiver must receive orientation:

–For adult to move to limited

–For child to stay at limited



– Plan: • Adults:

–Required to use full during 1st 6 months on iBudgets

–May choose limited thereafter and shift funds to other services if individual or caregiver gets iBudget Orientation



– Plan: • Children:

–Receive limited support coordination during first six months

–Required to use full support coordination thereafter if caregiver does not get iBudget Orientation



• Service elements: – Contacts with consumer– Contacts with providers– Consumer/family training– Coordination of community and natural

supports



• Service elements: – Support planning– Service review/approval responsibilities– Assess service quality– Budget management



• Service elements: – 24/7 on call– Ongoing eligibility determination– Advocacy on consumer’s behalf



• Defining levels of support coordination: – See handout

• A: Define by tasks• B: Define by hours



• Limitations on Choice of WSC level: – Plan: consumers required to use full WSC:

• Are newly-enrolled in the waiver.• Have had forensic involvement.• Have complex medical needs.• Have complex behavioral needs.




• Will soon be or are transitioning from school.

• Are changing their residential setting to group home or supported living from a different setting.




• Have a recent alcohol or drug abuse history.

• Are having difficulty managing their care or funding.



• Limitations on Choice of WSC level: – Discussion: consumers required to use full

WSC:• Living in licensed homes • In supported living



• Orientation requirement for receiving limited WSC : – Current situation:

• No orientation/training required



• Orientation requirement for receiving limited WSC : – How administered?

• A: Online.• B: By waiver support coordinator.• C: By area staff.



• Orientation requirement for receiving limited WSC : – Topics covered:

• Types of waiver services offered• Use of iBudget system• Emergency backup planning and

procedures• Community and natural supports



• Orientation requirement for receiving limited WSC: – What if caregiver refuses to take

orientation/training, but funding is insufficient to receive full WSC?


Waiver Services

• Rate/service negotiation:– How might consumers and providers be

able to tailor services to consumers’ needs?


Waiver Services

• Rate/service negotiation: eligible services– Plan: Review on a case-by-case basis.– Law: APD may allow negotiation for “any or

all” services except for residential habilitation.


Waiver Services• Rate/service negotiation:

– Current situation: • Most consumers do not negotiate rates;

however, CDC+ consumers can.• Nearly all rates are set by rule.• WSC’s may negotiate rates for

consumable medical supplies or adaptive equipment.


Waiver Services

• Rate/service negotiation: – Issues:

• Want to provide flexibility to tailor services better to consumers’ needs and budgets

• Want to ensure quality services, particularly for residential services and professional services



– Services for which consumers should be able to negotiate rates• A: Higher-cost non-facility-based, non-

licensed services (supported employment, supported living)

• B: Any 1:1 non-facility based, non-licensed service except waiver support coordination.

• C: Any service except residential habilitation and waiver support coordination.



– Service elements that are negotiable• A: None.• B: Documentation requirements• C: Availability of service (may fill in if

cancellation, or may not be on call)• D: Specific content of service


Waiver Services

• Rate/service negotiation: – Documentation required

• A: “Job description”/contract; area approval required.

• B: “Job description”/contract, in file.• C: None.


Waiver Services

• Billing units: – Should we maintain quarter-hour billing for

all services in which it’s currently used?


Waiver Services• Billing units:

– Should we maintain quarter-hour billing for all services in which it’s currently used?

• Issues:–Simplicity of billing and documentation–Flexibility for families


Waiver Services


all services in which it’s currently used?

• Current situation: see chart.


Waiver Services


all services in which it’s currently used?• Plan and law: did not discuss


Waiver Services• Billing units:

– Should we maintain quarter-hour billing for all services in which it’s currently used?• Options:

–A: Keep all quarter-hour billing.–B: Use only for therapies/nursing;

discontinue use for non-professional services.

–C: No quarter hour billing.


Providers

Communication– Short and long-term, what are reasonable

expectations for providers’ technology infrastructure (email, fax, use of computers, etc.)


ProvidersCommunication

– What are reasonable expectations for providers’ technology infrastructure (email, fax, use of computers, etc.)• Current situation:

–Varies among providers (online billing access?)

–APD does not require use


Providers

Communication– What are reasonable expectations for

providers’ technology infrastructure (email, fax, use of computers, etc.)• Plan:

–Highlights use of technology to speed work and facilitate tracking and analysis



– What are reasonable expectations for providers’ technology infrastructure ?

– Issues:–Maintaining providers to facilitate

consumer choice–Efficient functioning and simplicity of

system–Security of data



– What are reasonable expectations for providers’ technology infrastructure?

– Issues:–Timeliness and accuracy of records–New quality assurance system may

require provider data entry



– What are reasonable expectations for providers’ technology infrastructure (email, fax, use of computers, etc.)• Options:

–A: Require email address–B: Require fax –C: Require online submission of

forms


Providers

Communication– Short-term, how do we get accurate

information on expenditures within current system?


Consumer & Family Control• Budget Management

– Short-term, how do we get timely, accurate information on expenditures within current system? • Issues:

–System sustainability requires accurate budget tracking

–Providers are at varying levels of sophistication


Consumer & Family Control

• Budget Management– Short-term, how do we get timely, accurate

information on expenditures within current system?

• Issues:–APD technology still in development–Will have to rely at minimum on

combination of encumbrances through service authorizations and billing data




information on expenditures within current system? • Current situation: use a combination of

billing information, service logs, and personal contacts with providers.




information on expenditures within current system? • Plan: described need for such

information but acknowledged technical challenges




information on expenditures within current system? • A: Rely solely on encumbrances and

billing data (up to a year lag), along w/ telephone contacts




information on expenditures within current system? • B: Require basic service information to

be submitted within 15 days of quarters’ end (by telephone/IVR, fax of paper to WSC’s, online form, ???)




information on expenditures within current system? • C: Encourage submission of bills close

to date of service


Questions?Suggestions?Comments?


Thank you for your time!

July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only...

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Transcript of July 1, 2010 iBudget Florida Stakeholders’ Group Workgroup Meeting—For Discussion Purposes Only...