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Basics of IRIS and ADRC’s Role Tuesday, April 7, 2015 Noon to 1 p. m

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Presentation on theme: "Basics of IRIS and ADRC’s Role Tuesday, April 7, 2015 Noon to 1 p. m"— Presentation transcript:

1 Basics 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

2 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 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

3 IRIS - An Introduction Mitch Hagopian Member of the IRIS Advisory Committee Supervising Attorney, Disability Rights Wisconsin

4 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.

5 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

6 Participant Target Group
Almost 12,000 participants including 4,700 who self-direct their personal care

7 Allowable Services in IRIS Waiver
IRIS Consultant Services https://www.dhs.wisconsin.gov/publications/p0/p00708.pdf

8 Non-Allowable Services in IRIS Waiver
https://www.dhs.wisconsin.gov/publications/p0/p00708.pdf

9 Director of Kenosha County ADRC
ADRC Role Overview Carolyn Feldt Director of Kenosha County ADRC

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12 The Basics: How IRIS Works

13 IRIS Consultant Agency (ICA) Overview
Shanna Jensen Director of ICA Operations, TMG

14 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

15 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

16 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)

17 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. 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; and Identify expenditures that are over or under the budget.

18 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.

19 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

20 IRIS – a few numbers Touch Points 2014 Monthly Average
New Participant Plans 240 Plan Updates 1800 New Participant Hired Workers 870 New 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

21 Budget Statement, Section Two

22 Budget Statement, Section One

23 How IRIS Works – Budget Authority and Planning
Shanna Jensen Director of ICA Operations, TMG

24 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.

25 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

26 Employer Authority Directly hiring support workers:
IRIS Participant is the Employer of Record Workers must meet qualifications, conflict of interest, and background check standards

27 Employer Authority Participant Responsibilities include:
Recruiting, hiring, training, and supervising workers that will help meet long-term care needs Authorizing time reports

28 Planning for A Life Health and Safety Having a place of one’s own
Employment Community membership Relationships

29 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?

30 Role of an IRIS Consultant
Mary Beth Freckmann, IRIS Consultant TMG ICA Travis Wick, IRIS Consultant TMG ICA

31 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

32 Examples of IRIS Plans Deborah Joe Norma

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36 Questions and Answers

37 Additional Resources DHS IRIS DHS ADRC
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  IRIS Fiscal Employer Agent Provider - iLife IRIS Self-Directed Personal Care Oversight Agency - TMG   MetaStar  Disability Rights Wisconsin


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