Presentation on theme: "Basics of IRIS and ADRC’s Role Tuesday, April 7, 2015 Noon to 1 p.m. State Capitol, Room 411 South."— Presentation transcript:
Basics of IRIS and ADRC’s Role Tuesday, April 7, 2015 Noon 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 Hagopian Member 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
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 Feldt Director of Kenosha County ADRC
IRIS Consultant Agency (ICA) Overview Shanna Jensen Director of ICA Operations, TMG
CENTERS FOR MEDICARE AND MEDICAID SERVICES IRIS CONSULTANT AGENCY Provider IRIS CONSULTANT 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 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 Points2014 Monthly Average New Participant Plans 240 Plan Updates 1800 New Participant Hired Workers 870 New Vendors53 Participant Hired Workers –checks processed35,000 Vendor Checks processed1900 Background checks870 new; 250 at 4 yr Walk-in visitors5525
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