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.
IRIS SDPC 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.
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.
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