Presented by: Dean Choate- IRIS Participant, Patty Branton- Support Broker & Sue LeGault- CSP From Family Care to IRIS & Beyond!!!! Self-Directed Support Conference 2011

Long-Term Care Wisconsin’s redesign Dependable Sustainable Responsive to individual outcomes Easily Accessed Quality that is outcome focused

Family Care Family Care is a comprehensive and flexible long-term care service system, which strives to foster people's independence and quality of life, while recognizing the need for interdependence and support. CHOICE – Give people better choices about the services and supports available to meet their needs. ACCESS – Improve people's access to services. QUALITY – Improve the overall quality of the long-term care system by focusing on achieving people's health and social outcomes. COST-EFFECTIVENESS – Create a cost-effective long-term care system for the future.

IRIS Include, Respect, I Self-Direct IRIS, short for Include, Respect, I Self-Direct, is a self- directed long-term support program administered by the Wisconsin Department of Health Services Division of Long Term Care as part of the state and federally funded Medicaid program. Long-term care services are provided to low-income participants who are eligible for Medicaid services. IRIS is an alternative to Wisconsin’s managed long-term care program Family Care, and it allows clients at a nursing home level of care to select and manage the long-term care services they receive.

The IRIS program went into effect in July 2008 and has enrolled more than 4842 participants as of September IRIS is offered in 57 of Wisconsin’s 72 counties, and Wisconsin DHS plans on expanding the program to all counties in the near future. IRIS is administered through regional ADRCs and two statewide contract organizations: the Independent Consultant Agency and the Financial Services Agency. The centers provide enrollment and benefits counseling on all long term-care programs, including IRIS and Family Care. For IRIS, the centers conduct the screening process to determine individual budget allocations IRIS Continued….

Independent Consulting Agency (ICA)- TMG Develop Individual Support Plan The person directs their funding based on this plan Individual Service plan developed. Funding is approved based on RAD ADRC Independent Consultant – Assigned by ICA MCO(s ) Care Manager Current terrain in Wisconsin

Family Care vs IRIS Conceptual Shift

Consumer Directed Supports Medicaid Waivers Manual Chapter IV Allowable Services and Provider Requirements Page IV-59 CONSUMER-DIRECTED SUPPORTS SPC Applies to CIP1A, 1B, BIW (See for similar service) DEFINITION The provision of a flexible array of services provided to participants that include a specified portion of the services covered by the waiver. Services are planned and implemented through processes characterized by: 1. Support for the consumer and those close to the consumer to assist in identifying the consumer’s goals and means of reaching those goals, in a manner that reflects consumer preferences as closely as possible; 2. Planning that occurs within the limits of an individualized budget that is based on typical service costs for Waiver participants with similar needs in similar situations; and 3. An emphasis on identifying and strengthening networks of informal supports and on making use of generic community resources to the maximum extent possible. 4. Processes and supports for person-centered service planning, implementation, operation and monitoring that are established through a locally developed county Consumer-directed Services (CDS) implementation plan that is subject to approval by the department. Based on this plan, a Memorandum of Understanding (MOU) is executed between the county and department. This MOU governs county operation of this service.

Use Self-Directed Supports Self-Determination focuses on helping self- advocates to achieve the following four outcomes: Self-Directed Supports Offers … The Freedom to choose how you want to live The Authority to control your services within a budget The Support to organize services your way The Responsibility to use public dollars wisely and contribute to your community

Common Themes In Self-Determination Expand people’s choices Enable people to control the money spent on their support and services

IRIS Consultant’s (IC’s) Provides IRIS Participants with the assistance necessary to meet their dreams/outcomes and to identify and implement a community-based network of supports, as chosen by the participant. IC's have collaborative relationships with participants, which are based on the level of support the Participant requests of the IC. IC's must be available and must respond to the participant in a timely manner because the Participants rely greatly on the IC to access resources and services. A successful IC shows long-term commitment and responsiveness to the requests and needs of the participants.

IRIS Consultant My IRIS Consultant has been available to assist and support me while I developed my plan to meet my needs and goals within my given budget. They have been able to provide information on the resources available to me through the IRIS Program. They have been available to help me with many aspects of my IRIS participation. but they do not make choices for me. We network together to solve problems when complex situations arise, They know where to find the answers or solution’s to the problem at hand.

Case Management CARE MANAGEMENT/SUPPORT AND SERVICE COORDINATION (Also known as Case Management) SPC 604 Applies to CIP 1A/1B, BIW, CIP II, COP-W, CLTS & COR DEFINITION Care management/support and service coordination is the provision of service to locate, manage, coordinate and monitor all waiver program services, additional services, (regardless of funding source) and informal community supports provided to eligible applicants/participants and to assure that services are provided in accordance with program requirements. This service is intended to insure the waiver program participant’s health and safety by enabling the participant to receive a full range of appropriate services and supports consistent with his/her assessed needs in a planned, coordinated, efficient and cost effective manner. While these general guidelines apply to all care management/support and service coordination provided, the service activities may be target group or age-specific. This service includes assistance with establishing financial, functional and all other aspects of Medicaid waiver eligibility. Service may also include assisting the participant to access waiver, Medicaid state plan, medical, social and natural supports and services. Beyond plan development and service coordination activities, the CM/SSC role includes the primary responsibility to assure participant health and safety.

Sue LeGault – PCHHS CSP Case Manager Dean meets at least monthly with his CSP case manager to discuss issues with such things as housing, finances, relationships, vocational services, medical issues and counseling. As member of his IRIS team I jointly agree on any needed referrals for services, e.g. DVR, CCCW, IRIS. I sit in on his appointments based on availability. Meetings have included other people involved in Dean’s life, at his discretion, to include his roommates, father, friends and support people. I have been involved in Dean's transition from one program to another. I also help make sure services are coordinated properly and accordingly to his plan.

Support Brokers Purpose: To advocate for adults with developmental and other disabilities to lead a self-directed life. We believe people with disabilities deserve the opportunity to direct their own supports while maintaining or improving their quality of life in their homes and in their community. selected by and works for the person receiving support. provides assistance in ways that are flexible, responsive to and controlled by the person. an ally, a partner, a community networker. Each Support Broker develops their own job description.

Patty Branton- Support Broker As Dean’s Support Broker I have been able to assist Dean with Employment, Medicaid, Social Security and Social Services programs. As well as any issue or concerns which have arisen. I have been on Dean’s Team since August 2009.

Dean’s Story From the beginning…..

Dean Choate - Service models PCHHS: Case management – Community Support Program May 2000 to present. Dean met with CSP case manager as needed to discuss issues with housing, finances, relationships, vocational services, medical issues, counseling, etc. Jointly agreed on any referrals, e.g. to DVR, CCCW. Case manager sits in on psychiatric appointments based on availability. Meetings have included other people involved in Dean’s life at his discretion. CCCW: March 2010 to December Dean met with IDT team to formulate plan and services. CSP case manager occasionally sat in on meetings, received copies of plans and authorization for services. Phone/ contact between CSP and CCCW as needed to coordinate services. Case management – CCCW team Fund CSP case management Transportation – Courtesy Cab Fund Counseling – Dan Buss Disposable Medical Supplies – diabetic

Dean Choate - Service models continued…… IRIS: December 2010 to Present. Dean meets with IRIS consultant to develop and monitor plan. Dean meets with vocational consultant. Dean is active in State network for planning and input. Employment consultant Transportation Brokerage services Consumer education/training Supportive Home Care

Dean’s Future……..

Remember……. The Self-Directed Supports option provides an opportunity for YOU to: Make your own decisions about how you want to live & receive the supports necessary to do so. Control your services within a budget. Take responsibility for personal decisions & actions. The Choice is yours!!!!

Resources IRIS Pathways to Independence Family Care Self-Directed Supports SSA DVR Self-employment

Questions????

Thank You! Dean Choate: Patty Branton: Sue LeGault: “When you see a person with a disability, presume competence.” From: Snow, Kathy, Disability is Natural, 2001