DHA Case No. CWA 221163 (Wis. Div. Hearings and Appeals Mar. 19, 2026) (DHS) ↓ Download PDF Services provided by IRIS must be cost-effective. In this case, the petitioner requested a budget amendment to pay for an increased hourly rate by the supported employment provider, whose rate had increased substantially over the past several years. […] Read more
Tag: 5.05.4 IRIS
DHA Case No. CWA 220532 (Wis. Div. Hearings and Appeals Mar. 6, 2026) (DHS) ↓ Download PDF Personal care services must be provided consistent with a written physician’s order and according to state regulations. In this case, the petitioner’s plan of care, which was signed by a physician, ordered 47.5 hour per week for a […] Read more
CWA 220664 (03/04/2026)
IRIS disenrollment for failure to talk and meet with ICA over several months
DHA Case No. CWA 220664 (Wis. Div. Hearings and Appeals Mar. 4, 2026) (DHS) ↓ Download PDF After a service plan is implemented, IRIS consultant agencies (ICAs) must contact the participant monthly and meet in person at least every 90 days. Participants may be involuntarily disenrolled if the ICA is unable to reach the participant […] Read more
DHA Case No. CWA 221054 (Wis. Div. Hearings and Appeals Mar. 3, 2026) (DHS) ↓ Download PDF The IRIS program may include support broker services. A support broker “supports a participant in directing personal assistance services and services budgets” and “assists the participant in planning, securing, and directing self-supports” (essentially, helping a person maintain public […] Read more
DHA Case No. CWA 220503 (Wis. Div. Hearings and Appeals Mar. 9, 2026) (DHS) ↓ Download PDF Services provided through the IRIS program must generally be cost-effective and necessary to achieve a long-term care outcome. In this case, the petitioner had been receiving daily living skills training since 2019 but still required 24-hour support, and […] Read more
DHA Case No. CWA 220447 (Wis. Div. Hearings and Appeals Mar. 25, 2026) (DHS) ↓ Download PDF IRIS participants are generally entitled to a fair hearing appeal of adverse actions, defined as a denial, reduction, termination or limitation of previously authorized services, a denial of requested services, or a determination of ineligibility. In this case, […] Read more
DHA Case No. CWA 220811 (Wis. Div. Hearings and Appeals Mar. 16, 2026) (DHS) ↓ Download PDF IRIS policy provides that a budget amendment (BA) may only be used for costs that exceed a recipient’s base budget and may not be transferred to a different service or service type. In this case, the agency reduced […] Read more
DHA Case No. CWA 220073 (Wis. Div. Hearings and Appeals Mar. 3, 2026) (DHS) (decision after rehearing) ↓ Download PDF IRIS participants must treat the people who are part of the program with respect, including having a safe space in the participant’s home for meetings. In this case, the agency sought disenrollment after a meeting […] Read more
DHA Case No. CWA 221689 (Wis. Div. Hearings and Appeals Apr. 28, 2026) (DHS) ↓ Download PDF An IRIS participant who receives Daily Living Skills Training services (now called Life Skills Training and Education services) must generally demonstrate skill development within a year, or longer if reasonably needed to acquire the skill. Also, as skills […] Read more
DHA Case No. CWA 221317 (Wis. Div. Hearings and Appeals Feb. 27, 2026) (DHS) ↓ Download PDF Every IRIS participant enrolled in the self-directed personal cares (SDPC) program must have a care plan signed annually by the participant’s SDPC nurse and physician. In this case, the petitioner’s SDPC nurse attempted to visit multiple times to […] Read more
DHA Case No. CWA 220576 (Wis. Div. Hearings and Appeals Feb. 17, 2026) (DHS) ↓ Download PDF DHS has an obligation to ensure the IRIS program meets certain federal standards, such as the requirement that settings where home and community-based services are provided have the qualities listed in 42 C.F.R. §441.301(c)(4). In this case, the […] Read more
DHA Case No. CWA 220708 (Wis. Div. Hearings and Appeals Feb. 2, 2026) (DHS) ↓ Download PDF IRIS participants are assigned budgets based on their Long-Term Care Functional Screens, which they must generally stay within (or request a budget amendment). In this case, petitioner received 10 home-delivered meals per week due, in part, to chronic […] Read more
DHA Case No. CWA 221013 (Wis. Div. Hearings and Appeals Feb. 25, 2026) (DHS) ↓ Download PDF IRIS funds approved through the budget amendment process must be used for the requested service and cannot be transferred to a different service or service type, or a different provider type. In this case, the petitioner was enrolled […] Read more
DHA Case No. CWA 220139 (Wis. Div. Hearings and Appeals Jan. 2, 2026) (DHS) ↓ Download PDF To be functionally eligible for the IRIS program, an individual must belong to one of the following target groups (in addition to needing a nursing home level of care): frail elderly, adult with a physical disability, or adult […] Read more
DHA Case No. CWA 219952 (Wis. Div. Hearings and Appeals Dec. 10, 2025) (DHS) ↓ Download PDF The Department may deny enrollment in the IRIS program for substantiated fraud during a previous enrollment, living in an ineligible residential setting, or inability or unwillingness to develop an Individual Support and Service Plan (ISSP) that ensures the […] Read more