Basics of IRIS and ADRC’s Role

Tuesday, April 7, 2015Noon to 1 p.m.

State Capitol, Room 411 South

Agenda• Introduction

• Facilitator• Mitch Hagopian, Supervising Attorney, Disability Rights Wisconsin, and Member of the IRIS Advisory Committee

• Enrolling in IRIS Role of the Aging and Disability Resource Center (ADRC)• Carolyn Feldt, Director, Kenosha County ADRC

• The Basics: How IRIS Works

• Role of IRIS Consultant Agency (ICA)• Overview and Role of the IRIS Consultant Agency • Shanna Jensen, Director of ICA Operations, TMG

• 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)

• Participant Authority and Planning in IRIS• Shanna Jensen, Director of ICA Operations, TMG

• Role of the IRIS Consultant – Sharing Plan Examples

• Mary Beth Freckmann, Oconomowoc, TMG IRIS Consultant• Travis Wick, Sheboygan, TMG IRIS Consultant

• Wrap-up and Questions

• Mitch Hagopian, Supervising Attorney, Disability Rights Wisconsin

IRIS - An Introduction

Mitch HagopianMember of the IRIS Advisory Committee

Supervising Attorney, Disability Rights Wisconsin

IRIS is Wisconsin’s Self-Directed Long-Term 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

Physical Disabilities Frail Elders I/DD

39 %I/DD

49% Phys-ical Dis-abilities

12% Frail El-ders

Allowable Services in IRIS Waiver

• 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 FeldtDirector of Kenosha County ADRC

The Basics: How IRIS Works

IRIS Consultant Agency (ICA)Overview

Shanna JensenDirector of ICA Operations, TMG

CENTERS FOR MEDICARE AND MEDICAID SERVICES

IRIS CONSULTANT AGENCYProvider

IRIS CONSULTANT AGENCYProvider

IRIS FISCAL EMPLOYER AGENCY PROVIDER

IRIS FISCAL EMPLOYER AGENCY PROVIDER

AGING & DISABILITY RESOURCE CENTER

WISCONSIN DEPARTMENT OF HEALTH SERVICES

IRIS Consultant Agency Basic Services

IRIS Consultant Agency (TMG) requirements:– 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 RuxDirector of Operations, iLife, LLC

Gerianne PromVice 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; and5. 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 numbersTouch Points 2014 Monthly Average

New Participant Plans 240Plan Updates 1800New Participant Hired Workers 870New Vendors 53

Participant Hired Workers –checks processed 35,000

Vendor Checks processed 1900

Background checks 870 new; 250 at 4 yr

Walk-in visitors 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

• 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

Supportive Home Care41%

Transportation25%

Service Animal6%

Personal Emer-gency

Re-sponse System

3%

Self-directed Personal Care25%

Deborah, 62 year old with physical disabilities in IRIS

Total Monthly Budget $1,565.77 includes SDPCAdditional Plan Services not funded through the IRIS Waiver:• Room & Board (SSI)• Natural Supports - family support & community activities

Natural Supports for family support and com-munity activities.

Supportive Home Care6%

Transportation53%

Daily Living Skills31%

Therapies11%

Joe, 27 year old with developmental disabilities in IRIS

Total Monthly Budget $1221.54Additional Plan Services not funded through the IRIS Waiver:• Room & Board (SSI)• Job Coaching (DVR)

Natural supports for money management, sup-portive home care, transportation and compan-ionship care.

Supportive Home Care45%

Day Services50%

Therapies5%

Norma, an older adult in IRIS

Total Monthly Budget $1,163.65Additional Plan Services not funded through the IRIS Waiver:• Room & Board (SSI)• Medical Transportation (MA)

Natural supports for personal care, supportive home care and mileage.

Questions and Answers

Additional Resources• DHS IRIS

• https://www.dhs.wisconsin.gov/iris/index.htm

• DHS ADRC • https://www.dhs.wisconsin.gov/adrc/consumer/index.htm

• IRIS Consultant Agency Provider – TMG ICA • http://www.tmgwisconsin.com/

• IRIS Fiscal Employer Agent Provider - iLife• http://www.ilifefinancialmanagement.com/iLife.htm

• IRIS Self-Directed Personal Care Oversight Agency - TMG • http://www.tmgwisconsin.com/clinical-services/self-directed-personal-care-sdpc/

• MetaStar• http://metastar.com/web/

• Disability Rights Wisconsin• http://www.disabilityrightswi.org/