Basics of IRIS and ADRC’s Role
Tuesday, April 7, 2015
Noon to 1 p.m.
State Capitol, Room 411 South
Agenda
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Introduction
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Facilitator
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Mitch Hagopian, Supervising Attorney, Disability Rights Wisconsin, and Member of the IRIS Advisory Committee
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Enrolling in IRIS Role of the Aging and Disability Resource Center (ADRC)
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Carolyn Feldt, Director, Kenosha County ADRC
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The Basics: How IRIS Works
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Role of IRIS Consultant Agency (ICA)
• Overview and Role of the IRIS Consultant Agency
• Shanna Jensen, Director of ICA Operations, TMG
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Role of the IRIS Financial Employer Agency (FEA)
• Kimberly Rux, Director of Operations, iLife LLC (former MCFI FSA)
• Gerianne Prom, Vice President, Long Term Care, Center for Independence (CFI)
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Participant Authority and Planning in IRIS
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Shanna Jensen, Director of ICA Operations, TMG
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Role of the IRIS Consultant – Sharing Plan Examples
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Mary Beth Freckmann, Oconomowoc, TMG IRIS Consultant
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Travis Wick, Sheboygan, TMG IRIS Consultant
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Wrap-up and Questions
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Mitch Hagopian, Supervising Attorney, Disability Rights Wisconsin
IRIS - An Introduction
Mitch Hagopian
Member of the IRIS Advisory Committee
Supervising Attorney, Disability Rights Wisconsin
IRIS is Wisconsin’s Self-Directed LongTerm Care Program
Founded upon…
• Freedom to decide how to live life.
• Authority over a specific dollar amount.
• Supports to organize resources in meaningful
ways.
• Responsibility for the wise use of public dollars.
• Confirmation of the importance of self-advocacy.
Introduction
• Wisconsin’s History of Long Term Care
• Family Care/IRIS/ADRC consolidated previously fragmented
programs
• IRIS began July 1, 2008
• Currently available in 57 counties, soon to be 64 (7 in
currently approved Northeast expansion)
• Completely self-directed option for long term care for older
adults, and people with intellectual/developmental and
physical disabilities
• Everyone in IRIS has a level of care that would qualify them
for nursing home admission
• People work within a pre-determined budget to meet their
long term care needs
Participant Target Group
• Almost 12,000 participants including 4,700 who self-direct
their personal care
49%
Physical
Disabilities
39 %
I/DD
12%
Frail
Elders
Physical Disabilities
Frail Elders
I/DD
Allowable Services in IRIS Waiver
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IRIS Consultant Services
https://www.dhs.wisconsin.gov/publications/p0/p00708.pdf
Non-Allowable Services in IRIS Waiver
https://www.dhs.wisconsin.gov/publications/p0/p00708.pdf
ADRC Role Overview
Carolyn Feldt
Director of Kenosha County ADRC
The Basics: How IRIS Works
IRIS Consultant Agency (ICA)
Overview
Shanna Jensen
Director of ICA Operations, TMG
CENTERS FOR MEDICARE AND MEDICAID SERVICES
WISCONSIN DEPARTMENT OF HEALTH SERVICES
AGING & DISABILITY RESOURCE CENTER
IRIS CONSULTANT AGENCY
Provider
IRIS FISCAL EMPLOYER
AGENCY PROVIDER
IRIS CONSULTANT AGENCY
Provider
IRIS FISCAL EMPLOYER
AGENCY PROVIDER
IRIS Consultant Agency
Basic Services
IRIS Consultant Agency (TMG) requirements:
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Recruit and train IRIS Consultants
Develop individual support and service plans
Perform prior authorization of waiver services
Assure that approved plans and any modifications remain
within a person’s individual budget
– Assist the participant in ensuring that employee
paperwork is completed correctly and submitted to the
Fiscal Employer Agent
– Conduct annual and Change In Condition Functional
Screens to determine eligibility
– Develop and implement quality assurance/quality
improvement plans related to all of these functions
Role of the IRIS Fiscal Employer Agency
Kimberly Rux
Director of Operations, iLife, LLC
Gerianne Prom
Vice President, Long Term Care,Center for Independence
(CFI)
Centers for Medicaid and Medicare
and Self-Direction
Financial Management Services (FMS)
Financial Management Services (FMS) must be available to assist
individuals in exercising budget authority.
1. Understand billing and documentation responsibilities;
2. Perform payroll and employer-related duties (e.g.,
withholding and filing federal, state, local and
unemployment taxes; purchasing workers' compensation or
other forms of insurance; collecting and processing worker
timesheets; calculating and processing employee benefits;
and issuing payroll checks);
3. Process payments for approved goods and services;
4. Track and monitor individual budget expenditures; and
5. Identify expenditures that are over or under the budget.
http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Delivery-Systems/Self-Directed-Services.html
FEA Functions
• Processes New Employee Start-Up Packet and issues Participant-hired Worker
start date.
• Notifies IRIS Consultant Agencies of missing and/or incomplete paperwork
submitted by IRIS participants.
• Completes criminal and caregiver background checks as required by DHS and
interacts with participant and IRIS Consultant Agencies (ICA) as needed on results.
• Receives and processes participant authorized employee time reports and issues
payments in accordance to approved Individual Support and Service Plan (ISSP)
and program rules.
• Issues bi-monthly payroll.
• Withholds and deposits applicable employee federal, state and local income taxes
and garnishments, etc.
• Generates W-2 Tax Forms annually and mail to all employees.
• Detects and prevents fraud and abuse.
Criminal Background Checks
• iLIFE reviews Background Information Disclosure
(BID) for completeness
• Runs Crime Information Bureau (CIB) criminal
history and caregiver background checks
• Compare convictions against Department of
Health Services (DHS) conviction bar list
• Notify Participant of results of criminal and
caregiver background checks
https://www.dhs.wisconsin.gov/publications/p0/p00708.pdf
IRIS – a few numbers
Touch Points
New Participant Plans
Plan Updates
New Participant Hired Workers
New Vendors
Participant Hired Workers –checks processed
Vendor Checks processed
Background checks
Walk-in visitors
2014 Monthly Average
240
1800
870
53
35,000
1900
870 new; 250 at 4 yr
5525
Budget Statement, Section Two
Budget Statement, Section One
How IRIS Works –
Budget Authority and Planning
Shanna Jensen
Director of ICA Operations, TMG
Budget Authority
Decision-making authority over all of one’s Medicaid budget
amount. This budget amount is an estimate determined
through the evaluation of needs and goals. Individuals with
budget authority have the freedom to create person centered
supports that meet their needs, are guided by their personal
preferences, and are fiscally responsible.
• People decide how to best achieve their goals within a set
budget
• Claims paid by FEA as expenses are incurred
• IRIS Participants manage their resources wisely. Data shows
that spending for services remains below approved budget.
• 2014 overall spending was 83% of approved budget amount.
Budget Authority
Participant Responsibilities include:
• Adhere to IRIS program rules
• Identify long-term care goals
• Work with qualified service providers
• Work within an identified budget
Employer Authority
Directly hiring support workers:
• IRIS Participant is the Employer of Record
• Workers must meet qualifications, conflict of
interest, and background check standards
Employer Authority
Participant Responsibilities include:
• Recruiting, hiring, training, and supervising
workers that will help meet long-term care
needs
• Authorizing time reports
Planning for A Life
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Health and Safety
Having a place of one’s own
Employment
Community membership
Relationships
Essential Strength Based
Planning Questions
• What can I do for myself?
• What do I need a little help with?
• What goods or services do I need to purchase
or have done for me?
Role of an IRIS Consultant
Mary Beth Freckmann, IRIS Consultant
TMG ICA
Travis Wick, IRIS Consultant TMG ICA
Role of an IRIS Consultant
• Work side by side with people
• Assists with plan creation and implementation
– Strength based discussions
– Allowable services
– Budget Review
• Navigate, connect, support, problem solve
• Flexible assistance
– Based on the person’s needs and preferences
– Required minimum contacts (quarterly face to face and
monthly phone contact)
• Educate and support the development of self-direction
skills
Examples of IRIS Plans
• Deborah
• Joe
• Norma
Deborah, 62 year old with physical disabilities in IRIS
Personal
Emergency
Response System
3%
Self-directed
Personal Care
25%
Service Animal
6%
Transportation
25%
Natural Supports for family support and
community activities.
Supportive Home
Care
41%
Total Monthly Budget $1,565.77 includes SDPC
Additional Plan Services not funded through the IRIS
Waiver:
• Room & Board (SSI)
• Natural Supports - family support & community
Joe, 27 year old with developmental disabilities in IRIS
Supportive Home
Care
6%
Therapies
10%
Daily Living Skills
31%
Natural supports for money management,
supportive home care, transportation and
companionship care.
Transportation
53%
Total Monthly Budget $1221.54
Additional Plan Services not funded through the
IRIS Waiver:
• Room & Board (SSI)
• Job Coaching (DVR)
Norma, an older adult in IRIS
Therapies
5%
Day Services
50%
Natural supports for personal care,
supportive home care and mileage.
Supportive Home
Care
45%
Total Monthly Budget $1,163.65
Additional Plan Services not funded through the IRIS
Waiver:
• Room & Board (SSI)
• Medical Transportation (MA)
Questions and Answers
Additional Resources
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DHS IRIS
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DHS ADRC
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http://www.tmgwisconsin.com/clinical-services/self-directed-personal-care-sdpc/
MetaStar
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http://www.ilifefinancialmanagement.com/iLife.htm
IRIS Self-Directed Personal Care Oversight Agency - TMG
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http://www.tmgwisconsin.com/
IRIS Fiscal Employer Agent Provider - iLife
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https://www.dhs.wisconsin.gov/adrc/consumer/index.htm
IRIS Consultant Agency Provider – TMG ICA
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https://www.dhs.wisconsin.gov/iris/index.htm
http://metastar.com/web/
Disability Rights Wisconsin
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http://www.disabilityrightswi.org/