Wisconsin IRIS

1
Self-Determination in Wisconsin International
Conference on Self-Determination May 4,
2009 Winston-Salem, NC
Wisconsin Department of Health Services
2
Alexis IRIS Story

• One of the first persons to choose IRIS
• 19 years old, values her friends and independence
• Dedicated supportive family
• Creative use of IRIS funds to safely promote her
  independence

3
IRIS is a Simple Equation

• ELIGIBLE PERSONS
• SUPPORT AND ASSISTANCE
• PUBLIC FUNDING

4
IRIS Program Features

• Founded on Self-Determination Principles
• Restores power to participants
• They lead, self-manage and direct as desired
• Staff is employed directly, share employment or
  hire an agency
• Sensible approaches creatively tackle problems
• Connect people, communities and natural supports
• Simplify and make publicly funded long-term care
  transparent
• Quality management incorporated with each aspect
  of program

5
IRIS Beginnings

• WI LTC Reform Goal Save Money Improve
  Quality Right service, right amount, right time
  improved skills, health, and community
  integration
• Blend county, state and federal dollars
• No waiting lists
• Wisconsin DHS, Stakeholders create IRIS as 1915c
  CMS required alternative choice to managed care
• July 1, 2008 IRIS Birthday

6
The Name is Important
7
IRIS is Catching On
8
IRIS Choosers by Age
Total 409 IRIS Participants
8
9
AJs IRIS Story

• 28 years old
• Values his family, his computer and his tub
• AJ and his mother have both found new
  opportunities in IRIS

10
IRIS Design
WISCONSIN DEPARTMENT OF HEALTH SERVICES(DHS)
AGING DISABILITY RESOURCECENTER (ADRC)
COUNTY SUPPORT SERVICE COORDINSATOR/ CARE
MANAGER
IRIS participant
IRIS INDEPENDENT CUNSULTANT AGENCY (ICA)
IRIS FINANCIAL SERVICE AGENCY (FSA)
IRIS INDEPENDENT CONSULTANT (IC)
Long Term Care transition role
11
How to Access IRIS

• Local Aging and Disability Resource Center
  (ADRC)
• Completes Long Term Care Functional Screen
  (LTCFS)
• Verifies correct level of care
• Calculates IRIS monthly budget allocation
• Medicaid eligibility established
• Non-biased enrollment counseling
• Informs of allocation amount
• Offers IRIS to all, choice is between IRIS or
  managed care
• Refers to IRIS Independent Consultant Agency

12
IRIS Eligibility

• Three target groups
• Adults with developmental disabilities
• Adults with physical disabilities
• Elders with frail health

13
PERSONAL EXPERIENCE OUTCOMES
Individual Outcomes Priority
Participant wisely chooses own outcomes and
creates plan to meet their outcomes others
assist as desired
safety
home life
friends
involvement
privacy
fairness
stability
respect
choice
in charge
work
14
Roberts IRIS Story

• 31 years old
• Values being able to live the way he used to with
  his wife and young children
• Goes to school
• Rural area
• Traveling as a family

15
Monthly Budget Allocation

• Individualized for each person
• Predicted ongoing services cost
• Matches MCO spending for similar persons
• Geographic adjustment (urban/rural)
• Medicaid Card Services and infrequent use
  services excluded
• Significant change in condition adjusts
  allocation
• Annual cost of living adjustment
• No reduction due to under-spending

15
16
Monthly Allocations
17
Allocation Adjustment/Extraordinary Expense
Review

• Reviews Types
• Insufficient Allocations
• Infrequent Service Costs (example home
  modification)
• IC helps participant create a plan prior to DHS
  request
• ICA completes request for DHS panel review
• Pre-established criteria govern decision-making
• Prompt and Responsive

17
18
Kens IRIS Story

• 36 years old
• Values his independence and autonomy
• Finally able to move from assisted living to his
  own apartment
• Able to purchase furniture for his new home

19
Customized Goods and Services

• definition
• Help achieve outcome related to living
  arrangement OR relationship OR community
  inclusion OR work, OR medical or functional
  status.
• Listed on plan, allowable per Fed/State rule, no
  other fund obligation, not experimental
• AND also either
• Safety in home or community maintained or
  increased OR
• Reduce Medicaid service dependence or prevents
  increase, OR
• Skill improves or loss prevented, OR
• Community access or involvement increased or
  maintained.

20
Possible Services List

• Adaptive Aids
• Adult Day Care
• Adult Family Home
• Certified Residential Care Apartment Complex
  (RCAC)
• Communication Aids/Interpreter Services
• Community-Based Residential Facility (CBRF)
• Consumer Education and Training
• Counseling and Therapeutic Resources
• Customized Goods and Services
• Daily Living Skills Training
• Day Services

• Home Delivered Meals
• Home Modifications
• Housing Counseling
• Personal Emergency Response Services
• Prevocational services
• Relocation Services
• Respite
• Support broker
• Skilled Nursing Services
• Specialized Medical Equipment and Supplies
• Supported Employment
• Supportive Home Care
• Transportation
• Vocational Futures Planning

21
Independent Consultant Agency (ICA)The
Management Group Inc. (TMG), Madison, WI

• Day-to-day IRIS administration
• Data Management
• Program Development
• Quality Management
• Outreach and Education
• Primary functions
• Operating a comprehensive Service Center
• Overseeing Independent Consultants

22
ICA Service Center

• IRIS ICA hub, 24hrs/day 7days/week
• Field phone calls, e-mails
• Central point for all new referrals and
  eligibility issues
• Information center for independent consultants
• Solve problems, provide information
• Central point for all plan changes and approvals
• Prepare and submit DHS requests for allocation
  adjustments or infrequent expenses

22
23
More Compliments to IRIS
November 20, 2008 Im delighted with IRIS. We
have been in other programs over the years and
have begun to realize what opportunity we have
in IRIS.   Being out from under the control of
case managers is no small feat!  We are now able
to make decisions as a family on what works best
for our son without first having to get
everything approved by a case manager.  Our IRIS
Independent Consultant has been superb.  We know
what works best for our son it is so nice to be
recognized as a respected source of opinion of
what makes sense for him. Thank You
24
ICA Start-Up Process

• ADRC or County refers to ICA.
• ICA Call Center welcomes to IRIS and helps person
  select their IRIS Independent Consultant (IC)
• Consultant provides IRIS orientation and plan
  development begins
• Participant creates plan with help they choose
  (consultant assists if requested)
• Select plan start date, ICA approves plan. Old
  plan continues until new plan begins
• Coordinate with ADRC and County or MCO regarding
  start dates
• DHS/ICA IRIS start letter to participant, cc
  FSA, ADRC, IM

25
IRIS Independent Consultant

• Expectations
• Strong interpersonal communications skills
• Creative problem solving skills flexible
• Ability to work with diverse populations and in
  varied circumstances.
• Ability to develop and monitor the participant
  proposed plan and budget
• Attend 2 day initial training, plus monthly
  computer/teleconference training

26
IRIS Independent Consultant

• Meets participant at home or in community
• Provides IRIS education, explains scope of
  choices and responsibilities of self-direction
• Learns what is important to participant,
  strengths they bring, challenges they face,
  assist in outcome creation
• Assists with plan development within the monthly
  budget amount
• Help identify providers as requested
• Help assure health safety, back up plans

27
IRIS Independent Consultant

• Essential link between ICA, FSA, and participants
• Statewide recruitment
• Independent Consultant geographically close to
  participant
• Part-time and full-time consultants
• Must adhere to DHS timelines

27
28
Gretas IRIS Story

• 92 years old
• Values being with her family and watching her
  shows
• Volume was too loud for the rest of the family
• Able to spend time as a family now

29
Financial Services Agency (FSA) Milwaukee
Center for Independence INC. (MCFI),Milwaukee WI

• Collections, Invoice and Payroll Payments
• Collect required Medicaid cost share and
  spend-down payments
• Process worker time sheets, pay wages and also
  garnishment and levy orders
• Process invoices write provider payments/checks
  twice per month

30
Employer and Employee Set Up

• Caregiver and criminal background checks
• Medicaid Provider Agreement in place
• New employee set up forms, documentation and
  instruction
• Samples of completed invoice documents and
  teaches how to complete forms

31
FSA Reporting and Recordkeeping

• All payroll tasks, withholding and required tax
  reporting such as W-2
• Monthly expense reports to IRIS Participant and
  ICA
• Contacts ICA, and DHS, regarding significant
  variations or suspected fraud
• Completes required cost and services reports to
  state
• Cost share payment tracking for DHS

32
Quality Management Discovery Remediation
Verification

• DHS IRIS Quality Management Plan
• FSA Quality Management Plan
• ICA Quality Management Plan
• CMS required quality areas
• Level of Care, Individual Support and Service
  Plan, Participant Health and Welfare, Qualified
  Providers, Financial Monitoring

33
IRIS Independent Consultant Agency

• www.wisconsin-IRIS.com
• 1-888-515-4747
• The Management Group, Inc.

• Peter Tropman
• peter.tropman_at_tmg-wis.com
• Shanna Jensen
• shanna.jensen_at_tmg-wis.com
• Jan Ham
• jan.ham_at_tmg-wis.com
• [phone]

ICA in partnership with www.self-determination.co
m Annette Downey adowney_at_comlivserv.com
IRIS is a Program of the Wisconsin Department of
Health Services
34
IRIS Financial Services Agency

• www.mcfi-fiscalagent.com/iris/default.html
• 1-888-800-5599
• Milwaukee Center for Independence Inc.
• Pat Keefer [phone]
• pkeefer_at_mcfi.net
• IRIS is a Program of the Wisconsin Department of
  Health Services

35
Wisconsin Department of Health Services

• Bureau of Long Term Support
• www.dhs.wisconsin.gov/bdds/IRIS
• John OKeefe IRIS Manager
• (608)-261-6749
• DHSIRIS_at_wisconsin.gov or
• John.OKeefe_at_wi.gov

A Program of the Wisconsin Department of Health
Services
36
Our Compliments to IRIS
Now that she is in IRIS, our daughter is very
excited to finally be allowed to make decisions
for her life, decisions that affect her every
day. It is truly the best thing that could have
happened to her. It relieves much of the stress
and frustration that comes with never having your
opinions count, having others steer the course of
your life, and having someone else tell you what
is best for you. Thank You all so very
much September 24, 2008