[rehab] proposal

[RJ Sandefur]

Here's what they're trying to do here in Florida.
Single Department Concept

A New Service Delivery System for the 21st Century

 

The purpose of this proposal is to illustrate a method by which Florida can create a single, efficient, consumer driven and community - based service delivery system to provide services to the over 6 million persons with disabilities in Florida.  The ultimate goal is to reduce administrative costs and increase access to services and service dollars; create a more efficient, fraud resistant billing system and create an economic stimulus creating new private sector jobs. 

  

  a.. Combining all of the programs and services for persons with disabilities, including the Florida Medicaid Waiver programs, under one department will enable the State to move precious resources to actual service delivery for persons with disabilities and seniors across the disability spectrum and lifecycle.    
 

  a.. This department can have one point of entry with a standardized application, eligibility criteria, provider qualifications, and provider rates for all services and programs.
 

  a.. Creation of new jobs in the areas of community - based service delivery and fraud prevention methods.  This would mean the recruitment of new entrepreneurial minded providers into the system statewide. 
 

To accomplish this goal, certain units can be removed from current departments and placed in the new departmental structure.  Personnel requirements will then be determined, based on the overall organization. Departments effected:

  a.. Agency for Healthcare Administration (AHCA), the
  b.. Department of Health (DOH), the 
  c.. Department of Children and Families (DCF), the 
  d.. Department of Elder Affairs(CARES), the 
  e.. Department of Education (Vocational Rehabilitation and Division of Blind Services), and
  f..  The Agency for Persons with Disabilities 
 

As this new department is being physically formed, a new philosophy will also be nurtured.  A philosophy of ingenuity, creativity, and an entrepreneurial spirit, where employees are encouraged to think "outside of the box" to solve the problems we will face in the coming years.  We must encourage unique, public - private partnerships at every level, in order to maximize our precious resources. This includes private entity investment into not only service provision but employment opportunities for persons with disabilities.  It is only through this "rebirth" of the physical and philosophical can we have a department that is truly responsive to our citizens. 

 

In Florida, every day over 6 million persons, with identified or self-reported disabilities study, live, play, and work.  The vast majority of persons with disabilities can secure and maintain full or part - time competitive employment. They exhibit more courage and fortitude daily than some people do in a lifetime. These Floridians do not want a hand out but a hand up, a chance to maximize their individual independence and to be as included in their community as they wish.  This untapped resource of ready and willing potential employees should not be ignored.

 

v  Having all disability programs and services, including Medicaid Waivers located within one department, will:

 

Ø  Streamline the application, eligibility, and acceptance process for consumers and providers. 

 

Ø  Eliminate the "silo" effect, bringing all state organizations working with persons with disabilities under one organizational plan and chain of command.

 

Ø  Reduce redundant administrative costs to include office space and other such equipment. 

 

Ø  Create new private sector opportunities for persons who become disabled as adults. Require anyone wishing to file for federal disability programs to register with Vocational Rehabilitation.  Begin early working with the person focusing on ways to maximize his/her abilities. In many cases, it may be possible for the person with the disability to emerge with a better, more lucrative career. 

 

v  The department will maximize existing resources, such as using the Clearinghouse on Disability Information to:

 

Ø  Maintain one website for all information on disabilities. 

Ø  Operate a single toll-free phone number with accessibility built into the system.

Ø  Have a dedicated information referral system that not only serves consumers, but providers and other state agencies. 

 

v  Allow the department to standardize the processes to determine eligibility (one assessment instrument), provider qualifications and enrollment, service limitations, rates of pay, nursing home transition initiatives, etc.  

 

v  Reduce or maintain turnaround time in billing to enable providers to receive pay for services in a timely fashion, while cutting down on potential fraud.

 

v  Through a coordinated, functional needs based system, all individuals with disabilities will have their needs assessed and identified by a Global Assessment with a single Case Plan. 

 

v  Adapt the existing iBudget algorithm across the disabilities spectrum to ensure a consistent and efficient distribution of scarce resources. 

 

v  Serve consumers and providers will be served in a timelier and more consistent manner statewide.  

Ø  One standardized assessment instrument to determine risk of institutionalization and eligibility for waiver services would ensure services are provided to those most in need and would reduce the number of individuals currently on wait lists for the various waivers.  

Ø  Provider qualifications and rate of pay will be consistent and allow them to serve all populations without having to apply to work with multiple waivers and organizations.  

Ø  The Legislature will only need to deal with one budget to fund all the waivers.  

Ø  The processes for being placed on a wait list will be standardized throughout all the individual waivers. 

Ø  Funding for community-based, long-term care services would be more equitable for each of the disability groups competing for limited resources.

 

 

Note: Some agencies may be reluctant to relinquish administration of their waiver programs.  Consumers and providers currently being served by the various waivers may be impacted if service limitations and rates of pay are standardized.  Use of the iBudget algorithm will ensure a person's needs are met in an effective manner.  Some individual disability groups may be concerned about any change in the current structure which can be mitigated through an appropriate public information program.

 

 

Evidence to Support Single Department 

 

The states of Illinois and Vermont have already gone to the single entity system with good results. Real Choice Systems Change Grant Program, Third Year Report: Progress and Challenges of the FY 2002 and FY 2003 Grantees: (October 1, 2003 - September 30, 2004) Final Report. 

 

 

Consolidation 

 

The Governor's Commission on Disabilities, along with personnel from the effected departments, advocates, and providers could work towards the planning, development, and implementation of this single department. 

 

 

 

 

Planning & Timeline 

 

Planning could begin to consolidate all programs and services, including waivers under one department in the 2010 - 2011 fiscal year, with implementation occurring in an on-going basis. Full consolidation could take until the 2011 - 2012 fiscal year.

 

 

Estimated Potential Savings

 

v  A coordinated waiver program would require fewer administrative staff, intake and referral staff, provider enrollment staff and fiscal staff to monitor expenditures.

 

v  There would be a reduction in allocated office space, expenses, and equipment allocations for personnel due to consolidation into one agency.  

 

v  Multiple websites dedicated to the various waivers would be reduced to one. This would also create a more user friendly, accessible system of delivering information.

 

v  Consolidating multiple call-centers for consumers and providers would still allow calls to be channeled from one line directly to the appropriate waiver specialist.  

 

 

Creation of Private Sector Jobs

 

Florida currently has a great need for more community - based service providers.  Partnerships with Colleges of Business at our State Universities, as well as the Chamber of Commerce for Persons with Disabilities, can promote an entrepreneurial effort to create these small provider businesses.  

To reduce fraud, a "call and verify" system can be included as part of the billing cycle.  When a provider bills the department, a random verification system will identify a consumer to be called and asked if he/she has received the items or services as billed. This process will help prevent discrepancies and false claims as are potential risks under the current system.  The department can either decide to use one or multiple verifying agencies.  This can be performed by workers from home (enabling persons with disabilities, seniors, or others who are transportation disadvantaged) or a central location.