Presentation on theme: "Basics of IRIS and ADRC’s Role Tuesday, April 7, 2015 Noon to 1 p. m"— Presentation transcript:
1Basics of IRIS and ADRC’s Role Tuesday, April 7, 2015 Noon to 1 p. m Basics of IRIS and ADRC’s Role Tuesday, April 7, 2015 Noon to 1 p.m. State Capitol, Room 411 South
2Agenda Introduction Facilitator Mitch Hagopian, Supervising Attorney, Disability Rights Wisconsin, and Member of the IRIS Advisory CommitteeEnrolling in IRIS Role of the Aging and Disability Resource Center (ADRC)Carolyn Feldt, Director, Kenosha County ADRCThe Basics: How IRIS WorksRole of IRIS Consultant Agency (ICA)Overview and Role of the IRIS Consultant AgencyShanna Jensen, Director of ICA Operations, TMGRole 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 IRISRole of the IRIS Consultant – Sharing Plan ExamplesMary Beth Freckmann, Oconomowoc, TMG IRIS ConsultantTravis Wick, Sheboygan, TMG IRIS ConsultantWrap-up and QuestionsMitch Hagopian, Supervising Attorney, Disability Rights Wisconsin
3IRIS - An IntroductionMitch Hagopian Member of the IRIS Advisory Committee Supervising Attorney, Disability Rights Wisconsin
4IRIS 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.
5Introduction Wisconsin’s History of Long Term Care Family Care/IRIS/ADRC consolidated previously fragmented programsIRIS began July 1, 2008Currently 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 disabilitiesEveryone in IRIS has a level of care that would qualify them for nursing home admissionPeople work within a pre-determined budget to meet their long term care needs
6Participant Target Group Almost 12,000 participants including 4,700 who self-direct their personal care
7Allowable Services in IRIS Waiver IRIS Consultant Serviceshttps://www.dhs.wisconsin.gov/publications/p0/p00708.pdf
8Non-Allowable Services in IRIS Waiver https://www.dhs.wisconsin.gov/publications/p0/p00708.pdf
9Director of Kenosha County ADRC ADRC Role OverviewCarolyn FeldtDirector of Kenosha County ADRC
14CENTERS FOR MEDICARE AND MEDICAID SERVICES WISCONSIN DEPARTMENT OF HEALTH SERVICESAGING & DISABILITY RESOURCE CENTERIRIS CONSULTANT AGENCYProviderIRIS FISCAL EMPLOYER AGENCY PROVIDERIRIS CONSULTANT AGENCYProviderIRIS FISCAL EMPLOYER AGENCY PROVIDER
15IRIS Consultant Agency Basic Services IRIS Consultant Agency (TMG) requirements:Recruit and train IRIS ConsultantsDevelop individual support and service plansPerform prior authorization of waiver servicesAssure that approved plans and any modifications remain within a person’s individual budgetAssist the participant in ensuring that employee paperwork is completed correctly and submitted to the Fiscal Employer AgentConduct annual and Change In Condition Functional Screens to determine eligibilityDevelop and implement quality assurance/quality improvement plans related to all of these functions
16Role of the IRIS Fiscal Employer Agency Kimberly RuxDirector of Operations, iLife, LLCGerianne PromVice President, Long Term Care,Center for Independence (CFI)
17Centers 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.Understand billing and documentation responsibilities;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);Process payments for approved goods and services;Track and monitor individual budget expenditures; andIdentify expenditures that are over or under the budget.
18FEA FunctionsProcesses 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.
19Criminal Background Checks iLIFE reviews Background Information Disclosure (BID) for completenessRuns Crime Information Bureau (CIB) criminal history and caregiver background checksCompare convictions against Department of Health Services (DHS) conviction bar listNotify Participant of results of criminal and caregiver background checkshttps://www.dhs.wisconsin.gov/publications/p0/p00708.pdf
20IRIS – a few numbers Touch Points 2014 Monthly Average New Participant Plans240Plan Updates1800New Participant Hired Workers870New Vendors53Participant Hired Workers –checks processed35,000Vendor Checks processed1900Background checks870 new; 250 at 4 yrWalk-in visitors5525
23How IRIS Works – Budget Authority and Planning Shanna JensenDirector of ICA Operations, TMG
24Budget AuthorityDecision-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 budgetClaims paid by FEA as expenses are incurredIRIS Participants manage their resources wisely. Data shows that spending for services remains below approved budget.2014 overall spending was 83% of approved budget amount.
25Budget Authority Participant Responsibilities include: Adhere to IRIS program rulesIdentify long-term care goalsWork with qualified service providersWork within an identified budget
26Employer Authority Directly hiring support workers: IRIS Participant is the Employer of RecordWorkers must meet qualifications, conflict of interest, and background check standards
27Employer Authority Participant Responsibilities include: Recruiting, hiring, training, and supervising workers that will help meet long-term care needsAuthorizing time reports
28Planning for A Life Health and Safety Having a place of one’s own EmploymentCommunity membershipRelationships
29Essential 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?
30Role of an IRIS Consultant Mary Beth Freckmann, IRIS Consultant TMG ICATravis Wick, IRIS Consultant TMG ICA
31Role of an IRIS Consultant Work side by side with peopleAssists with plan creation and implementationStrength based discussionsAllowable servicesBudget ReviewNavigate, connect, support, problem solveFlexible assistanceBased on the person’s needs and preferencesRequired minimum contacts (quarterly face to face and monthly phone contact)Educate and support the development of self-direction skills