Wisconsin IRIS

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IRIS Foundations and Fundamentals
Wisconsin Department of Health Services
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Whats in a Name?
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AJs IRIS Story

• 28 years old
• Values his family, his computer and his tub
• AJ and his mother have both found new
  opportunities in IRIS

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IRIS is a 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
• Responsibility for the wise use of public dollars
  
• Confirmation of your important role of
  self-advocate

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IRIS Basics

• Federally required alternative to Managed Care
• Available where Family Care is offered
• Current plan remains in place until IRIS starts
  No gaps in service
• People can switch between IRIS and Family Care
• People dont have to do this alone

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IRIS is Catching On
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IRIS Eligibility

• Three target groups
• Adults with developmental disabilities
• Adults with physical disabilities
• Elders with frail health

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IRIS Design
WISCONSIN DEPARTMENT OF HEALTH SERVICES(DHS)
AGING DISABILITY RESOURCECENTER (ADRC)
COUNTY SUPPORT SERVICE COORDINATOR/ CARE
MANAGER
IRIS participant
IRIS INDEPENDENT CONSULTANT AGENCY (ICA)
IRIS FINANCIAL SERVICE AGENCY (FSA)
IRIS INDEPENDENT CONSULTANT (IC)
Long Term Care transition role
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How to Access IRIS

• Local Aging and Disability Resource Center
  (ADRC)
• Completes Long Term Care Functional Screen
  (LTCFS)
• Verifies correct level of care
• Calculates IRIS monthly budget allocation
• Medicaid eligibility established
• Non-biased enrollment counseling. Choice is
  between IRIS or managed care
• Refers to IRIS Independent Consultant Agency
• Early referrals are a great idea

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PERSONAL EXPERIENCE OUTCOMES
Individual Outcomes Priority
Participant wisely chooses own outcomes and
creates plan to meet their outcomes
safety
home life
friends
involvement
privacy
fairness
stability
respect
choice
in charge
work
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Monthly Budget Allocation

• Individualized for each person
• Predicted ongoing services cost
• Matches MCO spending for similar persons
• Geographic adjustment (urban/rural)
• Medicaid Card Services and infrequent use
  services excluded
• Significant change in condition adjusts
  allocation
• No reduction due to under-spending

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Monthly Allocations
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Allocation Adjustment/Extraordinary Expense
Review

• Reviews Types
• Insufficient Allocations
• Infrequent Service Costs (example home
  modification)
• IC helps participant create a plan prior to DHS
  request
• ICA completes request for DHS panel review
• Pre-established criteria govern decision-making

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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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Possible 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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Ryans IRIS Story

• 19 years old
• Values connections with people
• Scrapbooking gives him a common language to
  speak and helps him remember people
• FM System has opened up his life

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Self-Directed Medicaid Personal Care Update

• Currently MAPC is only available through an
  agency
• DHS adding Self-Directed, Medicaid Personal Care
  for people who choose IRIS
• IRIS dollars go farther
• Provides more options for participants
• Can bill for Personal Care provided outside the
  home
• Can hire a spouse to provide Personal Care

Fall 2009
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Independent Consultant Agency (ICA)The
Management Group Inc. (TMG), Madison, WI

• Day-to-day IRIS administration
• Data Management
• Program and Process Development
• Quality Management
• Outreach and Education
• Primary functions
• Operating a comprehensive Service Center
• Overseeing Independent Consultants

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ICA Service Center

• IRIS ICA hub, 24hrs/day 7days/week
• Process all new referrals, initial plans and plan
  updates
• Solve problems, answer questions and provide
  information
• Ensure participants and their families have plans
  that meet standards and are within their
  allocations
• Ensure quality to the State and Feds

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IRIS Independent Consultant

• Good listener
• Navigator
• Person who believes in self-determination

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Participant Orientation

• Provide an overview of the IRIS program
• Discuss the concept of self-direction
• Maximize informal supports and community
  resources
• Discuss individual allocation and budget
• Review the role of the ICA and the FSA
• Begin talking about the persons plan
• Address any questions or concerns

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Building the Support and Service Plan

• Listen to the persons story
• Learn about his or her hopes, dreams and goals
• Brainstorm creative ways to achieve those goals
• Identify the goods, supports and services for the
  plan

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Independent Consultant Training

• Intensive two-day training
• Mandatory monthly meetings and trainings
• Competency based shadowing and mentoring system
• Ongoing support and assistance from the ICA
• Additional training as needed

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Independent Consultant Hiring

• Targeted recruitment
• Where participants are
• Counties in transition
• Employment opportunities open around the state
• Flexible position
• No specific experience or professional background
  required

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Participant 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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Financial Services Agency (FSA) Milwaukee
Center for Independence (MCFI),Milwaukee WI

• 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

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Employer and Employee Set Up

• Caregiver and criminal background checks
• Medicaid Provider Agreement in place
• New employee set up forms, documentation and
  instruction
• Samples of completed invoice documents and
  teaches how to complete forms

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FSA Reporting and Recordkeeping

• 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 required cost and services reports to
  state
• Cost share payment tracking for DHS

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Quality Management

• Quality is everyones responsibility
• Participant
• Providers
• ICA FSA
• State
• Feds

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Our Compliments to IRIS

• 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 so very much
• September 24, 2008

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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_wi.gov

A Program of the Wisconsin Department of Health
Services
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IRIS Independent Consultant Agency

• www.wisconsin-IRIS.com
• 1-888-515-4747
• The Management Group

• Shanna Jensen
• shanna.jensen_at_tmg-wis.com
• Education and Outreach
• [phone]
• [phone] fax

IRIS is a Program of the Wisconsin Department of
Health Services
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IRIS Financial Services Agency

• www.mcfi-fiscalagent.com/iris/default.html
• 1-888-800-5599
• Milwaukee Center for Independence Inc.
• Pat Keefer [phone]
• pkeefer_at_mcfi.net
• IRIS is a Program of the Wisconsin Department of
  Health Services