IRIS PROGRAM OPERATIONS
Steps on the Path to IRIS
IRIS is a Wisconsin long term care option that began July 1, 2008
and features individuals self managing their chosen publicly funded long
term care supports, goods and services. The steps described below briefly
outline how persons choosing IRIS can participate. Remember no one
uses IRIS alone unless they choose to. Family, friends allies and also
both the State DHS provided IRIS Consultant Agency and the
Financial Services Agency are always there to give you help and support if
you need it. You may also hire others out of your budget to help you be
the best self manager possible! Specific details of IRIS are
described in other documents available at this website.
Contact is made with the local Aging and Disability Resource Center (ADRC).
Eligibility for publicly funded long-term care is established including
long-term care functional eligibility and Medicaid financial eligibility.
Persons that must pay a monthly Medicaid Cost share make their cost share
payment to the Financial Services Agency each month and the payment is
recorded to ensure continued Wisconsin Medicaid eligibility.
Choices are offered including information on the estimated IRIS monthly budget
amount and the
choice to explore using IRIS (Include, Respect, I Self-Direct) is made.
A state-funded IRIS Consultant Agency (ICA) helps the person select
their IRIS consultant from an approved list of trained local
The chosen IRIS Consultant provides orientation and if requested, helps
identify the participant's priorities and the specific goods and services
to be purchased within the individual budget to help meet these
When the providers include paid caregivers, The state-funded Financial Services
Agency (FSA) explains choices around being the direct employer of workers
or using an employment agent and also employment rules including the
requirement to have criminal background checks completed on certain
providers. Time sheets and payroll calendar are provided for
workers to know when they will be paid.
Decisions on selected goods and services such as the provider, fee
agreement and service start date are completed and the IRIS
Consultant documents the
plan for participant signature and subsequent ICA approval.
If the monthly budget is insufficient to fund the cost of necessary and
approved services, the ICA helps participants access the DHS Budget Review
process to have their budget increased. Infrequent expenses such as
housing modifications for example, are also accessed in this manner. The
ICA helps participants get the funding they need to pay for goods and
State Department of Health Services sends a letter acknowledging IRIS
participation and verifies eligibility details such as the start date and
required annual review month.
Goods and services are received as agreed. The IRIS participant receives
the invoice or time sheet, signs to authorize and forwards to Financial
Services Agency for payment.
The Financial Services Agency pays providers as agreed and sends monthly
spending updates to each participant. The FSA contacts the IRIS participant if spending
doesn't match the plan.
IRIS Consultant Agency and Financial Service Agency provide ongoing
support and guidance. As lives change so might the IRIS plan. IRIS maintains a toll
free telephone number for participants to call at any time for answers to
1-888-515 IRIS (4747)
Choice is ongoing and IRIS participation is voluntary. Persons choosing
to use IRIS as the method to self manage their publicly funded long term
care goods and services may choose to discontinue IRIS at any time just
like in other programs. Participants are asked to contact the ICA who will
connect them to their local Aging and Disability Resources Center.
Where to find updated information:
We will continue to update and add to the information about
IRIS and self-directed supports on these web pages, so check back frequently. If you need information that
is not published here, you may contact:
Wisconsin Department of Health Services
Bureau of Long
1 West Wilson Street, Room 418
P.O. Box 7851
Madison WI 53707-7851
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January 30, 2014