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ICA/FEA/IRIS SDPC Administrators

This area is intended for certified IRIS (Include, Respect, I Self-Direct) consultant agencies (ICAs), fiscal employer agents (FEAs), and/or the IRIS Self-Directed Personal Care (SDPC) Oversite Agency.

For information specific to participants, visit the Wisconsin Department of Health Services(DHS) site.

ICAs and FEAs must be certified prior to providing services on behalf of DHS. All contractors are held to the standards set forth in the IRIS Provider Agreement. Current contractors are required to successfully complete an annual recertification process, which will be implemented and published in 2022. Currently, the IRIS Certification Application materials for new agencies are under revision and will be published upon completion.

Current Certified Contractor Documents

IRIS Certification Acknowledgement
This form is required to be provided to all new IRIS consultants and long-term care functional screeners when an ICA is onboarding new staff. The ICA is required to retain a signed copy of this document for each employee.

Business Associate Agreement
This agreement documents DHS Health Insurance Portability and Accountability Act of 1996 privacy and security obligations, as well as reporting, risk assessment, and resolution of potential and confirmed breaches.

Financial Reporting Template
This form is designated to capture contractually obligated quarterly financial reporting data for ICAs and FEAs.

Applicants for Certification Documents

Financial Projections Template
This financial spreadsheet is designed to capture projections for IRIS lines of business for initial certification as an ICA or FEA.

IRIS Certification Designation of Confidential and Proprietary Information
This form is required by applicant agencies seeking certification as an ICA or FEA, designating what materials, if any, in their submission are confidential or proprietary.

IRIS Provider Agreement and Amendments
This agreement documents the contractual obligations for ICAs and FEAs certified to support IRIS participants.

Conflict of Interest Disclosure – Provider
This form is required to capture conflict of interest attestations and disclosures for providers of and recipients of funds for Medicaid supports and services.

IRIS Certified Public Accountant (CPA) Checklist
This form is designated to be completed and submitted by the responsible CPA alongside the quarterly financial report on behalf of ICAs and FEAs.

Content Regarding SDPC Referrals
This information is regarding referrals for existing participants interested in IRIS self-directed personal care.

IRIS Waiver
This waiver is a federal application that specifies obligations for DHS in implementation of the IRIS program with programmatic, quality, and stakeholder responsibilities.

Service Definition Manual
This manual details definitions of IRIS-allowable goods, services, and supports, and service codes.

Policy Manual
This manual provides IRIS program policies for all contractors (ICAs, FEAs, IRIS SDPC) as determined by DHS.

Work Instructions
These instructions detail IRIS program policies and procedures, including business rules, system requirements, required forms, and designation of responsible party for each task.

Addenda to Policy Manual and Work Instructions

Participant Handbook
This is an introductory handbook for newly enrolled participants and those considering enrollment to understand the IRIS program, the program’s approach to self-direction, and the key role to be played by an enrolled participant.

Participant Education Manual
This manual provides information to IRIS participants about program policies, procedures, and their responsibilities in self-directing their goods, supports, and services.

Participant Education Acknowledgement
This form is designed to capture participant demographics, initials, and signature(s) for initial and annual review of the IRIS Participant Education Manual.

Budget Amendments Participant Education
This educational form is required for IRIS participants pursuing an amendment to their IRIS budget.

One-Time Expense Participant Education
This educational form is required for IRIS participants pursuing a one-time expense request.

This educational form is required for participants pursuing enrollment in IRIS SDPC.

FEA Transfer Schedule
This is a schedule of quarterly FEA transfer deadlines, effective dates, and impacted timesheet or pay dates.

Payroll and Vendor Schedule
This is an annual detailed schedule of payroll and vendor processing weeks for funding files received by FEAs to pay for goods, supports, or services rendered to IRIS participants.

Naming Conventions Document
This document is a reference for IRIS contractors in the naming and retention of participant, provider, worker, or agency-specific documents in WISITS.

ICA Scorecard
This scorecard is a tool to help consumers choose an ICA. Each ICA is represented in the scorecard by star ratings evaluating how well the ICA performs across a variety of factors, including consumer satisfaction and compliance with state standards.
IRIS Participant by County Map
This is a current map of enrolled IRIS participant populations by county and geographic service region.
ICA Scorecard Guide
This resource guide can be utilized at enrollment counseling at Aging and Disability Resource Centers (ADRC)/Disability Resource Center (DRC) when discussing the ICA scorecard.
IRIS SDPC Enrollment by County Map
This is a current map of IRIS participants enrolled in IRIS SDPC services by county and geographic service region.
FEA Scorecard
This scorecard is a tool to help consumers choose an FEA. Each FEA is represented in the scorecard by star ratings evaluating customer satisfaction, in addition to more information to help consumers learn more about each FEA.
ICAs and FEAs by Geographic Service Region
This is a current map of ICA and FEA availability by geographic service region/county.
FEA Scorecard Guide
This resource guide can be utilized at enrollment counseling at ADRC/DRC when discussing the FEA scorecard.
IRIS Enrollment Snapshot Reports
The following library of enrollment reports are broken down by month, ICA, target group, and county:

Transition of Care Between Medicaid Programs or Medicaid Agencies
This is the DHS guide to the transfer and transition of participants or members between adult long-term care (LTC) programs.

Enrollment and Disenrollment Process Desk Aid for Publicly Funded LTC Programs
This DHS desk aid documents the steps taken in the enrollment, disenrollment, and transfer between publicly funded LTC programs.

Adult LTC Programs: Enrollment and Disenrollment Resource Guide
This DHS resource guide describes the roles of the different agencies responsible for providing accurate, efficient, and timely eligibility determinations and enrollments into Wisconsin’s publicly funded LTC programs.

Incontinence Supplies Guide
This guide is a resource that provides information regarding incontinence supplies.

Accessibility Assessment Guide
This guide is a resource that provides information regarding accessibility assessments.

Employment Contact Information for the Division of Vocational Rehabilitation (DVR)
This provides contact information at the Department of Workforce Development, DVR for employment.

Elder Abuse/Adults at Risk/Adult Protective Services Guide for IRIS Consultants
This resource is for IRIS consultants regarding collaboration and information sharing with elder abuse (EA)/adults at risk(AAR)/adult protective services(APS) agencies, as well as understanding EA, AAR, and APS.

Restrictive Measures Guidelines and Standards
These are DHS guidelines and standards for the use, identification, implementation, reporting, and tracking of restrictive measures.

Standards for Certified 1-2 Bed Adult Family Homes
These are DHS guidelines and standards for the establishment and certification of 1-2 bed adult family homes.

Statewide Transition Plan for Compliance with Medicaid HCBS Setting Requirements
This provides Wisconsin's plan for reaching and maintaining compliance with the Medicaid Home and Community-Based Services (HCBS) settings rule’s requirements.

Implementation of Federal HCBS Setting Rule in Wisconsin
This describes Wisconsin’s process for compliance reviews and ongoing compliance checks of assisted living setting within the Medicaid HCBS settings rule requirements.

IRIS Forms List
This list contains all IRIS forms.

ICAs and FEAs by Geographic Service Region
This is a current map of ICA and FEA availability by geographic service region/county.

ICAs Phone Email
Advocates4U 877-739-2203 info@irisadvocates4u.org
Connections 844-520-1712 connections@lsswis.org
Consumer Direct of Wisconsin 877-785-9991 infoIRIS@consumerdirectcare.com
First Person Care Consultants 414-336-2448 info@firstpersoncare.com
Midstate Independent Living Choices, Inc. 800-382-8484 milc@milc-inc.org
Progressive Community Services, Inc. 608-848-8305 Information@pcsdane.org
TMG 844-864-8987 info@tmgwisconsin.com

FEAs Phone Email
GT Independence 877-659-4500 customerservice@gtindependence.com
iLife 888-800-5599 Info@iLIFEfms.com
Outreach Health Services 877-901-5826 outreach.wi@outreachfiscalagent.com
Premier Financial Management Services 855-224-5810 IRIS@premier-fms.com

Oversight Agency Phone Email
IRIS Self-Directed Personal Care Oversight Agency 844-747-7372 ClinicalServices@wisconsin-iris.com

Ombudsmen Phone
Disability Rights Wisconsin – Madison
(ages 18-59)
Toll-free: 800-928-8778
TTY: 888-758-6049
Disability Rights Wisconsin – Milwaukee
(ages 18-59)
Toll-free: 800-708-3034
TTY: 888-758-6049
Disability Rights Wisconsin – Rice Lake
(ages 18-59)
Toll-free: 877-338-3724
TTY: 888-758-6049
Board on Aging and Long-Term Care
(ages 60 and above)

IRIS Phone Email
IRIS Complaints and Grievances Hotline 888-203-8338 DHSIRISGrievances@wisconsin.gov
IRIS Call Center 888-515-4747

Other Contacts Phone Email
DHS IRIS General DHSIRIS@dhs.wisconsin.gov
1-2 Bed Adult Family Homes Certification DHSIRISAFH@dhs.wisconsin.gov
Electronic Visit Verification Customer Care 833-931-2035 vdxc.ContactEVV@wisconsin.gov

Other Resources Web Address
Aging and Disability Resource Center Contact Information www.dhs.wisconsin.gov/adrc/consumer/index.htm
Income Maintenance and Tribal Agency Contact Information www.dhs.wisconsin.gov/forwardhealth/imagency/index.htm

What's New?
A summary of what is new for adult long-term care organizations:

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