IRIS Policy Manual: Work Instructions

1 Department of Health Services Division of Medicaid Services P-00708A (10/2021) IRIS Policy Manual: Work Instructions State of Wisconsin Page 1 of 133 IRIS Policy Manual: Work Instructions Table of Contents Chapter 2: Eligibility .. 9 Medicaid Cost Share Payments .. 9 Business Rules .. 9 Cost Share Payments .. 9 Monitoring .. 10 Supplemental Security Income Exceptional (SSI-E) .. 11 Business Rules .. 11 Supplemental Security Income Exceptional (SSI-E) .. 12 Monitoring .. 13 Chapter 3: Referral, Welcome, Orientation and Enrollment.

2 14 IRIS Consultant Biography Page .. 14 Business Rules .. 14 Education .. 15 Completion of IRIS Consultant Biography (F-01486) .. 15 Data Collection, Reporting, and Monitoring .. 15 Transfers between IRIS Consultant Agency Providers .. 16 Business Rules .. 16 Transferring IRIS Consultant Agency (ICA) Providers .. 18 Monitoring .. 19 Youth in Transition Referral Special Considerations .. 20 Business Rules .. 20 Youth in Transition Referral .. 20 Department of Health Services Division of Medicaid Services P-00708A (10/2021) IRIS Policy Manual: Work Instructions State of Wisconsin Return to TOC Page 2 of 133 Denial of Enrollment.

3 22 Business Rules .. 22 Denial of Enrollment Process .. 23 Data Collection, Reporting, and Monitoring .. 24 Withdrawal from Referral Process .. 25 Business Rules .. 25 Agency-Initiated Referral Withdrawal Process .. 25 Participant-Initiated Referral Withdrawal Process .. 26 Monitoring .. 26 Participant Handbook and Participant Education Manual .. 27 Business Rules .. 27 Requesting Printed Copies of Handbook and Manual .. 27 Initial Enrollment and Review of Participant Education Manual .. 27 Annual Review of Participant Education Manual.

4 28 Record Review Remediation of Participant Education Manual Chapter(s) .. 29 Chapter 4: Health and Welfare .. 30 40-Hour Health and Safety Assurance .. 30 Business Rules .. 30 Plan Development .. 30 Payments .. 31 Exceptions .. 32 Self-Directed Personal Care (SDPC) and Exceptions .. 33 Continuous and Ongoing Exception Criteria .. 34 Short-Term Planned or Unplanned Exception Criteria .. 34 Education .. 36 Incorporating the 40-hour Health and Safety Assurance into the Planning Process .. 36 Submitting Timesheets .. 36 How FEAs will apply the 40-hour Health and Safety Assurance to Timesheets Exceeding the 40-Hour Limit.

5 36 Requesting Additional Hours .. 37 Data Collection, Reporting, and Monitoring .. 37 Assessing Risk .. 38 Department of Health Services Division of Medicaid Services P-00708A (10/2021) IRIS Policy Manual: Work Instructions State of Wisconsin Return to TOC Page 3 of 133 Business Rules .. 38 Identifying Risk .. 39 Addressing Risk in the ISSP .. 40 Allowing for Informed Decision-Making about Risk .. 40 Monitoring .. 41 Restrictive Measures .. 42 Business Rules .. 42 Development of Restrictive Measures Application .. 44 Restrictive Measures Application Approval Process.

6 45 Communication of Review Panel s Decision and Implementation of Restrictive Measures .. 45 ICA Monitoring of Restrictive Measures .. 46 DHS Monitoring of Restrictive Measures Processes .. 46 Critical Incident Reporting .. 48 Business Rules .. 48 Incident Reporting and Follow-Up Process: .. 49 Referrals to Adult Protective Services (APS) .. 50 Referrals to Division of Quality Assurance (DQA) .. 51 Referrals to 1-2 Bed AFH Certifying Unit at LSS .. 52 CIR SharePoint Review Process .. 52 Remediation Assurance (RAP) Process .. 53 Data Analysis and Reporting.

7 54 Monitoring .. 54 Emergency Backup Plan .. 56 Business Rules .. 56 Education .. 57 Completing the Emergency Backup Plan .. 57 Changing the Emergency Backup Plan .. 57 Completing the Annual Emergency Backup Plan Review .. 58 Data Collection, Reporting, and Monitoring .. 58 Chapter 5: Person-Centered Planning .. 59 Meaningful Individual Support and Service Plan Development .. 59 Department of Health Services Division of Medicaid Services P-00708A (10/2021) IRIS Policy Manual: Work Instructions State of Wisconsin Return to TOC Page 4 of 133 Business Rules.

8 59 Identifying Long-Term Care Outcomes .. 60 Support/Services/Goods Prioritization .. 61 WISITS .. 61 Monitoring .. 62 Budget Amendment Process .. 62 Business Rules .. 62 Identifying the Need for a Budget Amendment .. 67 Budget Amendment Submission 67 Pre-Review 68 DHS Review .. 68 Budget Amendment Annual Verification .. 69 Independent Review Process (Does not apply to BAAVs) .. 69 Appeals Process .. 70 Monitoring Process .. 71 Data and Quality Management Process .. 71 One-Time Expense Requests .. 71 Business Rules .. 71 Identifying Needs for One-Time Expense.

9 74 One-Time Expense Submission Process .. 74 Pre-Review 75 DHS Review .. 76 Independent Review Process .. 77 Appeals Process .. 78 Monitoring Process .. 78 Data and Quality Management Process .. 78 Project SEARCH .. 80 Business Rules .. 80 Identification, Outreach & Assessment .. 80 Applying for Project SEARCH .. 81 Paying for Project SEARCH .. 82 Department of Health Services Division of Medicaid Services P-00708A (10/2021) IRIS Policy Manual: Work Instructions State of Wisconsin Return to TOC Page 5 of 133 After Completion of Project SEARCH Program.

10 83 Chapter 6: Participant Choice of Qualified Providers .. 84 Participant Employer and Participant-Hired Worker Setup Packets .. 84 Business Rules .. 84 FEA Set-up of Participant Employer and PHWs .. 85 Monitoring .. 86 Participant-Hired Worker Background Checks .. 87 Business Rules .. 87 Identification of Applicant and Completion of Paperwork .. 89 Completion of Background Checks for New Hires .. 89 Completion of Scheduled Background Checks for Ongoing Participant-Hired Workers .. 90 Completion of Ad-Hoc Background Checks for Ongoing Participant-Hired Workers.