IRIS Waiver Renewal: Defining Self-Direction
The IRIS (Include, Respect, I Self-Direct) waiver renewal is a chance to make the program better for participants. One improvement is adding a definition for “self-direction.”
What to know
DHS got valuable feedback from the waiver renewal survey and input sessions. One topic we heard about consistently was self-direction. More education was requested to support participants in making decisions about their services and supports. Our first step is to clearly define self-direction. We intend to:
Explain what self-direction means in IRIS. Participants need to know they are in charge of their own services, workers, and budget.
Help participants better understand self-direction so it’s easier to get the most out of the IRIS program.
Help those having trouble self-directing. DHS wants participants to choose their IRIS services and manage their IRIS budget.
IRIS is a self-directed program
Self-direction means IRIS participants or their legal decision makers are responsible for choosing what services they get within their budget, sticking to their budget, and following program rules.
Participants make all their own decisions. Their IRIS consultant provides support along the way. Being in IRIS comes with freedom and responsibility.
Key parts of self-direction
- Participants who are enrolled in IRIS or their legal decision makers are responsible for making decisions and taking action.
- IRIS consultants support participants and their legal decision makers in understanding self-direction by:
- Giving an IRIS orientation and skills training about self-direction, support and service plan development, and managing a budget.
- Providing information and training about being an employer.
- IRIS consultants complete the Long-Term Care Functional Screen with participants to identify their long-term care needs.
- Participants can get a copy of the screen results from their IRIS consultant.
- Participants are given an IRIS budget based on the Long-Term Care Functional Screen results.
- Participants must manage their own spending choices.
- Participants must work with their IRIS consultant to make changes to their services.
- Participants must not spend more than their budget
- IRIS consultants help participants create their service plan. The services on the plan must fit within their budget. IRIS consultants create the authorizations needed to get services.
- Participants are responsible for planning and spending their IRIS budget. Choosing services should be based on long-term care needs and outcomes.
- Participants are responsible for choosing their service providers.
- Participants agree to follow all program rules.
- Participants can choose to work with an agency who will hire their paid workers. Or, participants can choose to hire, train, schedule, and manage their paid workers.
- Participants who hire their own workers must:
- Find and hire their workers.
- Make sure their workers don’t work more than their service plan allows.
- Review and approve worker timesheets and make sure they log their time correctly.
- Participants are responsible for managing their workers. IRIS consultants can give advice to participants about hiring, managing, and firing workers.
If a participant has a legal decision maker, the legal decision maker must follow all program rules. They take on all required roles and responsibilities on the participant’s behalf.
Read more about the self-direction definition in the waiver application (PDF)
Self-direction in action
Meet Rose, an IRIS participant. Tatiana is her legal decision maker. They’re working with José, an IRIS consultant. Rose is new to IRIS. This is how each part of self-direction may look in IRIS:
- Introduction and responsibility: Rose just joined IRIS and is self-directing. She needs to figure out what services she can get. She meets with José. A Long-Term Care Functional Screen is completed with Rose. It identifies her long-term care needs. Rose asks José for a copy of her screen results.
- Budget authority: José tells Rose she’ll get $1,200 per month for the services she needs. That budget is based on the functional screen results. Rose and Tatiana make sure they stay within their budget each month. Rose can get a copy of her budget by asking her fiscal employment agency (FEA).
- Choice and responsibility: Rose and Tatiana work with José to figure out which services she can get within her budget. They make a service plan that includes an emergency backup plan that Rose and Tatiana would follow if services are unavailable for some reason. José works with Rose’s providers to get authorizations for her services. Rose and Tatiana schedule appointments and work with her IRIS providers to get the care Rose needs.
- Employer authority: Rose and Tatiana select and manage the IRIS providers in her plan. They also hire workers for some of her services. They train the workers, approve their time sheets, and make sure they enter their time correctly.
- Legal decision maker: Tatiana reviews the IRIS program rules and tracks Rose’s budget to make sure they are following the rules. Tatiana knows that doing this will help maintain a strong IRIS program for years to come.
Why is defining self-direction important?
DHS got valuable feedback from the waiver renewal survey and input sessions. One topic we heard about consistently was self-direction. More education was requested to support participants in making decisions about their services and supports.
Our first step is to clearly define self-direction. The definition of self-direction includes helpful information about the required roles, responsibilities, and expectations for IRIS participants and their legal decision makers. Providing a definition of the self-direction service delivery model can help IRIS participants successfully meet their long-term care needs and achieve their long-term care outcomes.