Self- Direction in Long Term Care Reform

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Self- Direction in Long Term Care
Reform

• Wisconsin Transition Conference

January 22, 2009 Wisconsin Dells, Wisconsin
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Our Compliments to IRIS
September 24, 2008 Now that she is in IRIS, our
daughter is very excited to finally be allowed to
make decisions for her life, decisions that
affect her every day. It is truly the best thing
that could have happened to her. It relieves much
of the stress and frustration that comes with
never having your opinions count, having others
steer the course of your life, and having someone
else tell you what is best for you. Thank You all
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IRIS Simple Equation

• ELIGIBLE PERSONS
• SUPPORT AND ASSISTANCE
• PUBLIC FUNDING

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IRIS Self-Determination Principles

• Freedom to decide how you live your life
• Authority over a monthly budget allocation
• Support to organize resources in ways that are
  enhancing and meaningful to you
• Recognition of your wise use of public dollars
• Confirmation of your important role of
  self-advocate

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IRIS Program Features

• Restores power to participants
• They lead, self-manage and direct as desired
• They employ staff directly, share employment or
  hire an agency
• Sensible approaches and creativity tackle
  problems
• Connect people, communities and natural support
• Simplify and demystify publicly funded
• long-term care

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IRIS PERSONAL EXPERIENCE OUTCOMES
Individual Outcomes Priority
Participant wisely chooses own outcomes and
creates plan to help meet outcomes
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IRIS Personal Experience Outcomes

• I decide where and with whom I live
• I make my own wise decisions regarding my
  supports and services
• I decide how I spend my day including if I work
  and where I work
• I have relationships with family and friends I
  care about
• I do things that are important to me
• I am involved in my community
• My life is stable
• I am respected and treated fairly
• I have privacy
• I have the best possible health
• I feel safe
• I am free from abuse and neglect

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IRIS Customized Goods and Services

• definition
• Help achieve outcome related to living
  arrangement OR relationship OR community
  inclusion OR work, OR medical or functional
  status.
• Listed on plan, allowable per Fed/State rule, no
  other fund obligation, not experimental
• AND also either
• Safety in home or community maintained or
  increased OR
• Reduce Medicaid service dependence or prevents
  increase, OR
• Skill improves or loss prevented, OR
• Community access or involvement increased or
  maintained.

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IRIS Funding

• Simpler blends long-term support funding
• Federal, state and county dollars (same sources
  as for managed care)
• New System saves money
• Right service, right amount, right time
• Keeps people healthier
• Maintains Improves abilities
• Reduces need for institutional care
• No waiting lists permitted

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Why IRIS

• CMS requires State must provide choice to all
  persons in how their publicly funded long term
  care is delivered
• Managed care expansion approved contingent on
  alternate choice
• IRIS is available in counties where Family Care
  operates
• IRIS operates outside of managed care
• IRIS participants self-manage

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IRIS Stakeholder Involvement

• Fed (CMS) approves IRIS as alternate option for
  all
• IRIS began 7/1/08 in all counties with Family
  Care
• DHS IRIS Implementation Advisory Committee

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IRIS Design
WISCONSINDEPARTMENT OF HEALTH SERVICES(DHS)
AGING DISABILITY RESOURCECENTER (ADRC)
COUNTY SUPPORT SERVICE COORDINSATOR/ CARE
MANAGER
IRIS participant
IRIS INDEPENDENT CUNSULTANT AGENCY (ICA)
IRIS FINANCIAL SERVICE AGENCY (FSA)
IRIS INDEPENDENT CONSULTANT (IC)
Long Term Care transition role
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IRIS Eligibility

• Three target groups (may include persons with
  brain injury)
• Adults with developmental disabilities
• Adults with physical disabilities
• Elders with frail health
• Level of Care assignment verifies nursing home or
  ICF-MR admission criteria met
• Long Term Care Functional Screen (LTCFS)
  calculates IRIS monthly budget allocation
• Local ADRC completes annual LTCFS re-screen

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IRIS Monthly Budget Allocation

• Individualized monthly amount for each person
• Predicted ongoing services cost
• Matches MCO spending for similar persons
• Geographic adjustment
• Medicaid Card Services and infrequent use
  services excluded
• Significant change in condition adjusts
  allocation
• Annual cost of living adjustment
• No reduction due to under-spending
• DHS process to adjust allocation

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IRIS Students with EEN

• Natural transition from student/family-directed
  IEP
• ADRC completes Long Term Care Functional Screen
  (LTCFS) at17 years, 9months
• IRIS eligible 18-year olds no longer qualify for
  DHS Child Waiver programs.

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Accessing IRIS

• Managed Care members
• County long term care transition plan
• Current Waiver participants
• Persons on Wait list

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Accessing IRIS

• Local Aging and Disability Resource Center
  (ADRC)
• Completes Long Term Care Functional Screen
  (LTCFS)
• Provides non-biased enrollment counseling
• Informs of monthly budget allocation
• Offers IRIS to all
• Person chooses between IRIS and managed care
• Refers to IRIS Independent Consultant Agency
• Helps County Income Maintenance verify/establish
  Medicaid eligibility

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IRIS Funding
A Participant chosen Goods and Services IRIS
participant chosen goods and services paid by
individual budgets
A
B Administrative Costs IRIS Independent
Consultant Agency and IRIS Financial Service
Agency Contract Costs
B
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IRIS Other Services List

• Adaptive Aids
• Adult Day Care
• Adult Family Home
• Certified Residential Care Apartment Complex
  (RCAC)
• Communication Aids/Interpreter Services
• Community-Based Residential Facility (CBRF)
• Consumer Education and Training
• Counseling and Therapeutic Resources
• Customized Goods and Services
• Daily Living Skills Training
• Day Services

• Home Delivered Meals
• Home Modifications
• Housing Counseling
• Personal Emergency Response Services
• Prevocational services
• Relocation Services
• Respite
• Support broker
• Skilled Nursing Services
• Specialized Medical Equipment and Supplies
• Supported Employment
• Supportive Home Care
• Transportation
• Vocational Futures Planning

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IRIS Medicaid Card Personal Care Update

• DHS working on including Self Directed MA
  Card-funded Personal Care for IRIS choosers
• IRIS participants access Personal Care through
  Medicaid Card until Personal Care is included

2009
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IRIS Two Statewide Contractors

• Independent Consultant Agency (ICA)
• The Management Group INC. (TMG)
• Financial Services Agency (FSA)
• Milwaukee Center for Independence INC. (MCFI)
• DHS pays cost for both ICA and FSA outside of
  participant monthly allocation amount

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IRIS Independent Consultant Agency (ICA)

• Day-to-day IRIS administration
• data systems
• quality management
• Partner with DHS, IRIS FSA on program operation,
  process and development
• Daily interaction with ADRC and other
  stakeholders
• Program development, outreach and materials
• Oversee independent consultants who work with
  participants

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IRIS ICA Call Center

• IRIS ICA hub, 24hrs/day 7days/week
• Field phone calls, emails
• Central point for all new referrals and
  eligibility issues
• Information center for independent consultants
• Solve problems, answers to IRIS questions
• Central point of all plan approval
• Information Center for participants, Families,
  DHS, IRIS FSA, ADRC, School, and county staff
• 1-888-515-4747
• www.wisconsin-IRIS.com

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IRIS Independent Consultant

• Meet participant at home or in community
• Provide IRIS orientation, explain process roles
• Learn what is important to participant, strengths
  they bring, challenges they face
• Problem solving LTC support and service needs
• Help participant create and implement plan
• Help identify providers as requested
• Help assure health safety, back up plans

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IRIS Additional ICA Roles

• Prepare and submit DHS requests for allocation
  adjustments or infrequent expenses when costs
  exceed current monthly allocation
• Assures consultants are well informed
• Assists to maintain program eligibility
• Medicaid financial eligibility
• IRIS functional eligibility
• Close coordination with FSA DHS
• Outreach and education to county, ADRC, schools
• and potential participants

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IRIS ICA Start-Up Process

• ADRC or County refers to ICA.
• ICA Call Center welcomes to IRIS and helps person
  select their IRIS Independent Consultant (IC)
• Consultant provides IRIS orientation and plan
  development begins
• Participant creates plan with help they choose
  (consultant assists if requested)
• Select plan start date, ICA approves plan. Old
  plan continues until new plan begins
• Coordinate with ADRC and County or MCO regarding
  start dates
• DHS/ICA IRIS start letter to participant, cc
  FSA, ADRC, IM

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IRIS DHS Monthly Allocation/Extraordinary
Expense Review Process

• Monthly Allocation Insufficient
• OR
• Monthly Allocation Insufficient to pay
  infrequent/one time service cost example home
  modification
• process
• IC helps participant create plan prior to DHS
  request
• ICA prepares request for DHS panel review
• Pre-established criteria govern decision-making
  
• Prompt and Responsive

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IRIS Financial Services Agency (FSA)
Collections, Invoice and Payroll Payments

• Collect required Medicaid cost share and
  spend-down payments
• Process worker time sheets, pay wages and also
  garnishment and levy orders
• Process invoices write provider payments/checks
  twice per month
• Pay only after participant authorizes and based
  on approved plan
• Track plan under-spending when saved for future
  purchases
• Review bills for goods exceeding 2,500
  separately
• Funds transfer request to DHS twice per month

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FSA Employer and Employee Set Up

• Assists participants with hourly employee
  determinations
• Caregiver and criminal background checks
• New employee set up forms, documentation and
  instruction
• Provides samples of completed invoice documents
  and teaches how to complete forms

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FSA Reporting and Recordkeeping

• Employer paperwork for participants that serve as
  employer
• All payroll tasks, withholding and required tax
  reporting such as W-2
• Monthly expense reports to IRIS Participant and
  ICA
• Contacts ICA, and DHS, regarding significant
  variations or suspected fraud
• Completes DHS required ENCOUNTER reports on all
  services received and paid

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IRIS Plan Examples

• Creative exercising
• Building a business
• Getting around

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IRIS Quality Management

• Quality Discovery, Remediation and Verification
• DHS Quality Management Plan
• FSA Quality Management Plan
• ICA Quality Management Plan
• CMS required quality areas
• Level of Care, Individual Support and Service
  Plan, Participant Health and Welfare, Qualified
  Providers,Financial Monitoring

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Summary IRIS Participants

• Choose the IRIS option
• Decide whether there is a team who is on it
• Have more choices of goods supports
• Have help managing services if desired (including
  a broker)
• Create their own support service plan (with
  help if desired)
• Define own outcomes and how best to meet them
• Determine the support they receive, how, when
  provided, and for how much money
• Retain and exercise right to decide what is
  important to them

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Getting the IRIS Word Out

• Presentations at ADRC meetings statewide
  conferences
• Presentations to Councils, Advisory Committees
• Answer questions at ICA and FSA Call Centers
• Participant Handbooks to all ADRCs and counties
• Brochure distribution DHS, ICA,FSA
• Website development

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More Compliments to IRIS
November 20, 2008 Im delighted with IRIS. We
have been in other programs over the years and
have begun to realize what opportunity we have
in IRIS.   Being out from under the control of
case managers is no small feat!  We are now able
to make decisions as a family on what works best
for our son without first having to get
everything approved by a case manager.  Our IRIS
Independent Consultant has been superb.  We know
what works best for our son it is so nice to be
recognized as a respected source of opinion of
what makes sense for him. Thank You
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IRIS Contact Information

• IRIS ICA and Call Center
• www.wisconsin-IRIS.com
• 1-888-515-4747
• Shanna Jensen [phone]
• Shanna.jensen_at_tmg-wis.com
• IRIS FSA and Call Center
• http//www.mcfi-fiscalagent.com/iris/default.html
• 1-888-800-5599
• Pat Keefer [phone]
• pkeefer_at_mcfi.net

• Wisconsin Department of
• Health Services
• Bureau of Long Term Support
• www.dhs.wisconsin.gov/bdds/IRIS
• John OKeefe IRIS Manager
• (608)-261-6749
• DHSIRIS_at_wisconsin.gov
• Or
• John.OKeefe_at_wisconsin.gov