DHA Case No. CWA 209455 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF An individual is functionally eligible for IRIS if he or she needs a “nursing home” level of care, as determined by the functional screen. In this case, the two most recent functional screens found the petitioner needed […] Read more

DHA Case No. CWA 207243 (Wis. Div. of Hearings and Appeals May 19, 2023) (DHS) ↓ Download PDF The Department must ensure the health and safety of IRIS participants. The IRIS policy manual allows involuntary disenrollment for “health and safety risks that participants are unable or unwilling to resolve.” In this case, the petitioner’s mother […] Read more

DHA Case No. CWA 206737 (Wis. Div. of Hearings and Appeals January 18, 2023) (DHS) ↓ Download PDF The IRIS Policy Manual allows involuntary disenrollment for “mismanagement of employer authority.” In this case, the petitioner’s son and approved personal care worker became incarcerated; then the petitioner’s grandson, who had the same name, took over care […] Read more

DHA Case No. CWA 189840 (Wis. Div. of Hearings and Appeals January 24, 2019) (DHS) ↓ Download PDF IRIS can pay for a participant-hired worker to attend a conference as a “Community Integration Event” if the participant is also attending. In this case, the petitioner’s mother attended a Fragile X conference alone; she apparently was […] Read more

DHA Case No. CWA 189467 (Wis. Div. of Hearings and Appeals January 3, 2019) (DHS) ↓ Download PDF The IRIS program cannot cover nursing services that are already covered by the state Medicaid plan. In this case, the petitioner’s IRIS supportive home care (SHC) hours were reduced from 96 hours per week to 40 hours […] Read more

DHA Case No. CWA 189325 (Wis. Div. of Hearings and Appeals January 8, 2019) (DHS) ↓ Download PDF When a person must use adaptive aids to perform an activity of daily living (ADL), this counts as needing assistance with the ADL for functional eligibility. In this case, the petitioner held onto the bed rail when […] Read more

DHA Case No. CWA 208405 (Wis. Div. of Hearings and Appeals October 16, 2023) (DHS) ↓ Download PDF Community transportation can be covered by IRIS, but the service assumes that someone besides the participant is doing the driving. In this case, the petitioner had a community transportation budget with his wife as the “participant-hired worker” […] Read more

DHA Case No. CWA 208350 (Wis. Div. of Hearings and Appeals September 19, 2023) (DHS) ↓ Download PDF The IRIS program can cover “individual directed goods and services” that are not covered under another service category and not obtainable from another source. In this case, the petitioner somehow had IRIS paying for food from vendors […] Read more

DHA Case No. CWA 208070 (Wis. Div. of Hearings and Appeals June 6, 2023) (DHS) ↓ Download PDF Home and community-based waiver programs may cover “other services … as cost effective and necessary to avoid institutionalization.” In this case, the IRIS program paid the petitioner’s internet under the “other services” authorization since 2019 but stopped […] Read more

DHA Case No. CWA 208193 (Wis. Div. of Hearings and Appeals October 2, 2023) (DHS) ↓ Download PDF When DHS increases a member’s cost share, it has the burden of proof on appeal. In this rather messy case, it was clear that the cost share should have been lower but it was not clear whose […] Read more

DHA Case No. CWA 206353 (Wis. Div. of Hearings and Appeals January 17, 2023) (DHS) ↓ Download PDF Services included in an IRIS member’s budget must be cost effective and at the usual and customary rate for the area. In this case, the petitioner’s medical transportation provider increased its rate for transporting him to his […] Read more

DHA Case No. CWA 206183 (Wis. Div. of Hearings and Appeals January 17, 2023) (DHS) ↓ Download PDF The moving party generally has the burden of proof; when an IRIS participant requests new services, the participant must prove that the requested services meet approval criteria by a preponderance of the evidence. In this case, the […] Read more

DHA Case No. CWA 207516 (Wis. Div. of Hearings and Appeals May 18, 2023) (DHS) ↓ Download PDF An IRIS participant may request a budget amendment to pay for an ongoing need not met within the current budget. In this case, the petitioner asked for a budget increase when her home health agency ended her […] Read more

DHA Case No. CWA 207522 (Wis. Div. of Hearings and Appeals April 18, 2023) (DHS) ↓ Download PDF An IRIS participant may request a budget amendment to pay for an ongoing need not met within the current budget. In this case, the petitioner asked for a budget increase when her home health agency ended her […] Read more