Older Adult Services Act

Transcription

1 State of Illinois Illinois Department on Aging Older Adult Services Act (P. A ) 2017 Report To The General Assembly

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3 Message from Acting Director Jean Bohnhoff To The Honorable Members of the Illinois General Assembly: The following report is submitted as mandated by Public Act , the Older Adult Services Act. This Act requires the Illinois Department on Aging to notify the General Assembly of its progress toward compliance with the Act on January 1, 2006, and every January thereafter. This report summarizes the work completed during calendar year 2016 toward fulfillment of the goals and objectives established by the Older Adults Services Advisory Committee, as well as impediments to such progress, and makes recommendations including legislative action if appropriate. The Department on Aging gratefully acknowledges the members of the Older Adult Services Advisory Committee (OASAC) as well as the many visitors and frequent guests who participate in meetings and contribute to the process of restructuring the State of Illinois long term care delivery system for older adults. The overarching goal for these efforts is to assure that older adults across Illinois have accurate information and timely access to high quality services in the community so that they and their families can find the right community-based service at the right time, place and price to continue to live safely in their own homes and neighborhoods. The Department on Aging also acknowledges and thanks the Department of Healthcare and Family Services, Department of Human Services, Department of Public Health, and the Illinois Housing Development Authority for their thoughtful participation and contributions to the Committee. I am pleased to report that these agencies fully support the goals of the Older Adult Services Act and are assuring that State policies and practices promote the long term care transformation as required in the Act. Please do not hesitate to contact me if you have any questions regarding this report. Sincerely, Jean Bohnhoff Director i

4 Contents A Message from the Acting Director i Executive Summary Health and Human Services Transformation Ongoing Rebalancing Initiatives Balancing Incentive Program Uniform Assessment Tool Conflict Free Case Management No Wrong Door Nursing Home Diversion Pilot Choices for Care Study Care Coordination & Managed Care Entities for the LTC Population Institution to Community Transitions Pathways to Community Living/Money Follows the Person Colbert Consent Decree Home and Community Based Services & Aging Housing Initiatives Impediments to Progress Successes & Recommendations Legislation OASAC Membership References ii Older Adult Services Act

5 Executive Summary The Older Adult Services Advisory Committee (OASAC) met four times during 2016: February 27, May 16, August 22 and November 14. The Executive Committee also met four times: January 11, April 18, July 18 and October 17. A list of OASAC Committee members, meeting agendas, minutes, handouts and materials that were presented at each OASAC meeting are posted to the Illinois Department on Aging website at Members are additionally listed beginning on page 31 of this report. Members continued to engage in dialogue about the rebalancing priority areas identified for 2016 through presentations at meetings and by reviewing and discussing program evaluations, research and reports on rebalancing activities from both a national and State perspective. Members discussed revisions to the priority areas for This report provides an update on the State s progress with regard to the ongoing rebalancing and new initiatives that are listed below: 1. Health and Human Services Transformation 2. Balancing Incentive Program 3. Care Coordination & Managed Care Entities for the Long Term Care Population 4. Institutions to Community Transitions 5. Home and Community Based Services & Aging Waiver Renewal 6. Housing Initiatives 1

6 Health and Human Services Transformation HHS Transformation During the 2016 State of the State address, the governor shared the following Transformation Strategy: Our transformations puts a strong new focus on prevention and public health; pays for value and outcomes; makes evidencedbased and data driven decisions; and moves individuals from institutions to community care, to keep them more closely connected with their families and communities. There are four guiding principles: 1. Create a consumer-centric system: All programs, policies, and technologies place individuals and families at the center. 2. Modernize service delivery: Offer the people of Illinois the evidenced-based support they need when they need it and in the communities and settings best suited for them. 3. Pay for Outcomes and Value: Expect evidence-based practices in service delivery that moves from fee-for-service to value based payment. 4. Organize to Deliver: Ensure a strong, streamlined organization, coordinated operations and a workforce skilled to serve the people of Illinois at the right place, at the right time, and with the right care, at the right cost Demonstration Waiver In the fall of 2016, the Department of Healthcare and Family Services submitted an 1115 Demonstration Waiver to federal CMS with a focus on Behavioral Health; including six main goals: 1. Rebalance the behavioral health ecosystem, reducing over-reliance on institutional care and shifting to community-based care. 2. Promote integrated delivery of behavioral and physical health care for behavioral health members with high needs. 3. Promote integration of behavioral health and primary care for behavioral health members with lower needs. 4. Support development of robust and sustainable behavioral health services that provide both core and preventative care to ensure that members receive the full complement of high-quality treatment they need. 5. Invest in support services to address the larger needs of behavioral health members, such as housing and employment services. 6. Create an enabling environment to move behavioral health providers toward outcomes- and value-based payments. 2 Older Adult Services Act

7 Ongoing Rebalancing Initiatives Balancing Incentive Program (BIP) The Balancing Incentive Program (BIP) was authorized under the Affordable Care Act (Section 10202) to assist states with improving access to Medicaidfunded home and community-based (HCBS) long term services and supports (LTSS) and to streamline program eligibility and service delivery to consumers between state agency programs. Participating states received an enhanced federal match to increase access to non-institutional LTSS. Illinois received an enhanced (2%) federal match to participate in the BIP to further rebalance the State's long term care delivery toward increased HCBS. States are required to implement three structural changes: v Implement a Core Standardized Assessment v Provide assurance of the provision of Conflict Free Case Management across LTSS v Establish a No Wrong Door system for LTSS that is coordinated across all disability populations Illinois received $96M in enhanced match over the award period from July 2013 through September As of September 2016 Illinois was at 47.47% of its benchmark of LTSS expenditures directed to the community and continues to work toward the goal of 50%. Uniform Assessment Tool (UAT) BIP required the development of a core standardized assessment tool that assesses consumers across five domains in a uniform manner throughout the State: v Activities of Daily Living (ADLs) v Instrumental Activities of Daily Living (IADLs) v Medical Conditions/Diagnosis v Cognitive Functioning and Memory/Learning v Behavioral Concerns BIP supports a holistic and personcentered approach to the assessment process and service planning including an individual s needs for training, support services, medical care, transportation, and other services. In 2016, Illinois took the final steps in developing a Uniform Assessment Tool (UAT) to satisfy the BIP s core standardized assessment requirement. The UAT creates a streamlined/standardized intake process that will reduce existing fragmentation and duplication while improving statewide coordination and ensuring consumers experience the same process regardless of how they access services. The UAT involves two levels of assessment: The UAT Initial Screen will be designed to identify the State agency most suited to take the lead in assisting interested individuals with the completion of further needs assessments, including the UAT Assessment if applicable. Individuals will be able to access the Initial Screen through any No Wrong Door/Coordinated Entry Point agency. Interested individuals may also contact the expanded Senior HelpLine/BIP Call Center for additional information on completing and submitting the Level I screen. The UAT Comprehensive Assessment has been designed to assess individuals in many areas, including Activities of Daily Living (ADLs), Instrumental Activities of 3

8 Daily Living (IADLs) and the other three of five domains as required by the BIP. This improved assessment process will view individuals more holistically and lead to the development of a comprehensive person-centered plan. The UAT will be piloted in early Conflict Free Case Management (CFCM) BIP regulation defines conflict free as the separation of case management and eligibility determination from direct service provision; as case managers not being able to establish funding levels for the beneficiary; and as case managers not being able to be related to the beneficiary or their caregivers. BIP requires states to establish firewalls and appropriate safeguards where conflict risks exist to assure consumer choice and protect consumer rights. The state of Illinois case management systems are currently unique to each of the disability populations served under each of the Home and Community-Based Services (HCBS) Waivers and the Medicaid Rehabilitation Option. Four of the eight programs/service areas included in Illinois BIP application are conflict free because the entities that provide case management services are separate from the entities that provide direct services. While State oversight of case management functions exists in the remaining four programs/service areas (Supportive Living Program, Adult Developmental Disabilities Waiver and services provided by the Illinois Department of Human Services Division of Mental Health and Division of Alcoholism and Substance Abuse), the State has developed several new crossagency policies as part of its BIP Conflict-Free Case Management (CFCM) protocol to strengthen and standardize existing oversight. In addition, the State is currently looking into additional policies to comply with the conflict of interest provisions in the new federal CMS HCBS regulations. Given the variance in the depth and scope of these activities across programs, the State is strengthening its LTSS oversight and monitoring functions by implementing the six administrative standardization policies across agencies and programs identified below. As described in the State s CFCM protocol, these policies will apply to all five LTSS agencies in Illinois: Department of Healthcare and Family Services, Department on Aging, Department of Human Services Division of Rehabilitation Services, Division of Mental Health, and Division of Developmental Disabilities; and for services paid for under a fee-forservice or a managed care model. To the extent possible, these changes will build on existing processes and State infrastructure. 1. Establish a common method to inform consumers about filing grievances and requesting appeals. 2. Develop and implement a uniform consumer s rights document. The State is in the process of developing this document via an interagency workgroup and with input from an external stakeholder workgroup. 3. Develop and implement a core set of review elements for State record reviews, building on existing review processes. This will allow the State to better assess the performance of its LTSS system, particularly as it relates to case management and quality. 4. Identify standard survey questions about consumer satisfaction for all LTSS populations; and create new surveys or add questions to existing surveys as appropriate. 5. Establish a cross-agency written policy that prohibits a person 4 Older Adult Services Act

9 who (1) is related by blood/marriage to a consumer or his/her caregiver and/or (2) acts as a guardian to a consumer from performing case management or being responsible for evaluating a consumer s need for services. 6. Begin development of a process to collect/analyze data on results of record reviews, complaints/grievances, etc. across agencies so that the State may better understand and address challenges in its LTSS system. No Wrong Door (NWD) BIP required the development of a statewide system to enable consumers to access all long term supports and services (LTSS) through a coordinated network or portal that: 1. Reduces existing fragmentation and duplication, improves coordination and provides a standardized intake process; 2. Provides application assistance; 3. Provides referrals for services and supports available in the community; and 4. Enables functional eligibility assessments. In 2016 Illinois expanded the Senior HelpLine with additional staff to assist individuals accessing the BIP NWD Call Center. It is anticipated that the BIP NWD Call Center will begin taking calls in early The creation of consistent, Statewide NWD branding and an LTSS website continue to be developed. Additional steps for implementing a NWD system that have been completed through September 2016 include: v Developed state level governing body (the NWD System Planning Executive Committee); v Drafted vision and mission statements; v Gathered stakeholder input about strengths and areas for improvement; v Completed statewide capacity assessment; v Drafted plan describing current capacity, 3-year goals, tasks, timelines, funding sources and responsibilities assigned; v Gained approval from leadership of HFS, DHS and IDoA to disseminate Draft Three-Year Plan for one final round of stakeholder comment; v Made edits to plan based on public comments; and v Submitted final plan to ACL with approval from Governor s Office on September 29, Additionally, the NWD Executive Committee met on October 24, 2016 to begin the implementation process and discuss stakeholder involvement. State agencies will continue to seek out and rely on stakeholders to share their experiences, suggestions and ideas as we move forward with implementation of each of the goals outlined in the plan. Nursing Home Deflection Demonstration In 2016, following an extension by federal CMS, the Illinois Department on Aging (IDoA) continued the implementation of the Nursing Home Deflection demonstration with its 14 lead agencies through September In addition to the 14 lead agencies, other partner agencies include Centers for Independent Living, Community Mental Health Centers, Area Agencies on Aging, Care Coordination Units, and housing partners. While The Lewin Group ended its technical assistance and provided a final report on the demonstration, eight lead agencies were funded to continue 5

10 providing Deflection services through March 31, The purpose of the Nursing Home Deflection demonstration is to reduce the number of initial nursing facility placements at the time of hospital discharge, and to reduce the average length of stay in nursing facilities for shortterm placements. The demonstration serves individuals eligible for Medicaid, Medicare, and other publicly funded long term services and support (LTSS) programs as well as those who are ineligible for publicly funded LTSS programs. The core service package includes: 1. A pre-discharge intervention at time of hospital admission that includes the use of a standardized person-centered planning/screening process to identify appropriate candidates and who are interested in receiving assistance. 2. The use of Options/Person- Centered Counseling to work with participants to develop a personcentered plan for connection to services, referrals and follow-up. 3. Mental health assistance is provided to determine eligibility, access, and linkage to community mental health services, rehabilitation services, and to private providers. 4. Rapid response home modifications are available to program participants. 5. Housing coordination supports clients in identifying and accessing available transitional housing options in the person s own community to: 1) secure housing vouchers for their community-based housing needs; and 2) assist with negotiations with landlords and/or facilities to maintain existing community housing during the time that individuals are in short-term rehabilitation. At the November 14, 2016, meeting of the full OASAC, members were provided with a presentation by representatives from The Lewin Group to learn more about the demonstration, findings being prepared for the final report (The Lewin Group, 2016) and to provide feedback. The final report was issued to IDoA on November 30th (The Lewin Group, 2016). The 14 lead agencies and their partners screened 1,325 individuals; enrolled 858 participants; and had 6,609 engagements with participants. An engagement is an encounter, either inperson or via phone, text, or , between the Person Centered Counselor and the participant or the participant s proxy. Participants were expected to experience more than one engagement while part of the pilot program. Eight key findings were noted in the final report: v Home modifications were the most frequently used demonstration service, accounting for half of demonstration paid services (50%). The remaining demonstration funds were used primarily for in-home LTSS (33%) and behavioral health services (17%). Pilot sites also provided housing services, though these were not directly provided through demonstration funds. v Pilot sites across the board report that collaboration and open communication with partnering organizations is the main area of strength and success of the pilot program. Hospital access, through embedded staff, ongoing relationships, and medical records, are also frequently cited best practices for successful nursing home deflections. 6 Older Adult Services Act

11 v The pilot sites reported challenges related to recruitment and enrollment. This is probably associated with the mixed results they report about their efforts to train hospital staff about the program and home and community-based options. They used several different training and outreach strategies to encourage referrals and program enrollment, with more or less success. Some sites reported difficulty getting hospital partners to make referrals at all or in a timely way, and some are still struggling with explaining the difference between this program and others that are available. v Eight of the pilot sites that completed the initial narrative report indicated that they had first contact with most participants between 3-6 days after admission or after discharge. On average, these sites reported equal or higher enrollment and equal or higher number of discharges into the community than the four sites that reported most initial contacts taking place 1-2 days after admission. The samples sizes are too small to reach final conclusions, but this may indicate that making the first contact with potential participants within a week of admission or even after discharge could be as effective as making contact within a day or two. v The pilot sites initial narrative reports included case studies that illustrate the successful use of demonstration funds to secure accessible housing through assistive technology, including stair lifts, life-alert technology, and home-maker services. The final narrative reports included examples of participants that they helped to access home and community-based services that illustrate both the policies and process that worked well and the challenges in accessing services that show how the policies and processes could be improved. v An analysis of DON data shows that program participants have similar functional limitations as non-participants, but with higher unmet needs. These results suggest that the program successfully targets individuals who are no less functional than non-participants, but who may need more support in order to remain in the community. v The vast majority of participants reported the program helped them to meet their individual goals (98%) and helped them live in the setting they desired (97%). Choices for Care Study In the spring of 2016 using BIP funds, IDoA contracted with The Lewin Group to conduct a study on the ways in which Illinois Choices for Care Program (Program) is meeting its goals. The Program s primary objective is to ensure that individuals seeking admission to a long-term care facility are informed of all possible care options, including community-based options. To learn more about how the Program currently operates, Lewin led site visits at four locations across Illinois, representing rural, suburban, and urban areas, with Nursing Home Deflection pilot program participants, Care Coordination Unit (CCU) staff, hospital and nursing facility staff, Pre Admission Screen (PAS) agents, and partners from other acute care providers. Meetings focused on the study participants knowledge of the Program and their organizations current operations related to fulfilling programmatic requirements. Lewin also 7

12 held virtual, Web-based meetings to ensure adequate representation from different organization types and finished its research by conducting meetings with state staff and leadership from various agencies and state Departments and Divisions that interact with the Program. Organizations reported general compliance with the Program s requirements, namely the need for completion of a Choices for Care screening and resulting documentation within the hospital setting prior to a patient s discharge to a nursing facility in the case of hospital-based requests for screenings. However, participants typically lacked awareness of the Program s intentions and its branding as the Choices for Care Program. Instead, with the exception of the CCUs, most participants recognized the Program solely as a requirement with which their organization must comply. Additionally, participants noted ways in which the Program could be streamlined and refined to better serve individuals and those staff members that serve them. In response to these findings, Lewin developed both systemic and operational-focused recommendations. Operationally, Lewin noted seven broad areas on which to focus process optimization efforts: 1. Adequate notice of the need for hospital-based Choices for Care Pre-Admission screenings prior to discharge or admission to nursing facility or the community. 2. Implement a standardized hospital procedure to transmit completed documentation to an individual s designated nursing facility. Note, however, that the passage of Senate Bill 2929 should resolve this issue, as CCUs will now bear responsibility for providing this documentation to the designated nursing facility directly, a change most meeting participants welcomed. In that regard, a standardized procedure should be developed across CCUs for transmitting required documentation to nursing facilities. 3. Develop a standardized method of providing CCU documentation to nursing facilities in different counties and issuing formal notice that CCUs may not backdate Choices for Care screening dates to allow for nursing facility reimbursement for days in which an individual was admitted without the required screening. While backdating is currently not allowed, this emphasis is important. 4. Provide training to all stakeholders within the Choices for Care Program, including hospital discharge planners, PAS agents, CCUs, and nursing facility staff, on the Program s background, its objectives, and individual staff members roles and responsibilities related to the Program. This is particularly important with the passage of Senate Bill 2929 (Public Act ) and resulting revisions to current policies and procedures. 5. Issue formal guidance on Choices for Care screenings for individuals under 60 years old with specific attention focused on different processes for both the under- and over-60 age populations with mental health needs. 6. Consider the benefit and feasibility of developing a searchable database that stores an individual s completed Choices for Care documentation which would be available to nursing facilities, CCUs, and hospitals. 7. Address concerns related to making referrals for OBRA Level 2 screenings to comply with the federally mandated Pre-Admission 8 Older Adult Services Act

13 Screening and Resident Review (PASRR) process to provide care to individuals with mental health and intellectual and development disability (I/DD) needs. This includes increasing the number of individuals who can conduct OBRA Level 2 screenings and providing comprehensive training on the PASRR process and OBRA Level 2. Systemic recommendations related to the Choices for Care Program focus on four primary areas: 1.. Separate the reimbursementrelated requirements of the Choices for Care Program from the provision of options and education about alternatives to nursing facility placement. Currently, nursing facilities must show receipt of documentation of completed Program-related paperwork to receive reimbursement for an individual s stay. Lewin recommends bifurcating this reimbursement process from the process of educating individuals about care options. 2. Focus efforts related to nursing home deflection on individuals that will likely require long-term nursing facility stays as opposed to including individuals that will likely only require short-term stays or short-term rehabilitation. 3. Develop programming that identifies those individuals who currently require short-term rehabilitation and consider ways to prevent conversion of their stay into long-term stays. This includes a vehicle for CCU and other state Departments/Divisions to followup on all short-term rehabilitation stays in nursing facilities rather than conducting Choices for Care screenings in the hospital. 4. Coordinate efforts among the Choices for Care Program, the State s No Wrong Door system and the state s Balancing Incentive Program Initial Screen and Uniform Assessment Tool to ensure all components mutually support one another and streamline efforts and reduce duplicative processes. 9

14 Care Coordination & Managed Care Entities for the Long Term Care Population Public Act ( Medicaid Reform") required that 50% of Illinois Medicaid clients be enrolled in some type of care coordination program by January 1, Illinois met this requirement by enrolling more than 60% of the Medicaid population into a care coordination program. Care Coordination manages the care needs of an individual by providing the client a medical home with a primary care physician, referrals to specialists, diagnostic and treatment services, behavioral health services, inpatient and outpatient hospital services, dental services, and when appropriate, rehabilitation and long term care services. The benefits of care coordination include better health for the member and a better quality of life for the member at a reduced cost. The Department of Healthcare and Family Services (HFS) has implemented four care coordination programs: The Integrated Care Program (ICP), the Medicare Medicaid Alignment Initiative (MMAI), the Family Health Plan Program (FHP), and the Medicaid Managed Long Term Services and Supports (MLTSS) Program. The MLTSS program was introduced July 2016 to the Greater Chicago region. In Illinois, Care Coordination through these Medicaid programs was once offered through various managed care entities. That included Managed Care Organizations (MCOs), Managed Care Community Networks (MCCNs) Coordinated Care Entities (CCEs), and Accountable Care Entities (ACEs). ACEs and CCEs were created to develop and implement a care coordination model and provide case management services to Medicaid clients. ACEs and CCEs were phased out throughout 2015 and ACEs and CCEs have either partnered with existing MCOs, transitioned to become Managed Care Community Networks (MCCNs), or have terminated as an entity. A description of MCOs and MCCNs is provided here. Managed Care Organizations (MCOs) are HMOs licensed by the Illinois Department of Insurance; they utilize a comprehensive network of providers. Individuals that enroll in an MCO receive all of their Medicaid covered services from the providers that are affiliated with the MCO and must receive prior approval from the MCO to see a nonaffiliated provider. MCOs are health delivery systems designed to provide coordinated care that will reduce unnecessary utilization of services, control costs, and increase and maximize quality. Managed Care Community Networks (MCCNs) are provider sponsored organizations that contract to provide Medicaid covered services through a risk based capitation fee. MCCNs must be certified by HFS rather than licensed by the Illinois Department of Insurance. MCCNs must be owned, operated, managed, or governed by providers. They cover the same services as an MCO, and their contract requirements with HFS are very similar to the contract requirements for an MCO. Integrated Care Program (ICP) The Integrated Care Program (ICP) is a mandatory program for older adults and adults with disabilities (age 19 and over) who have full Medicaid benefits but are not enrolled in Medicare. As of October 1, 2016, HFS holds contracts with 11 MCO/MCCNs to serve the ICP population. ICP covers 30 counties in Illinois, including the entire Greater Chicago Region, Rockford Region, Central Illinois Region, Metro East Region and the Quad Cities Region. As of October 1, 2016, enrollment under ICP was 121,918. Enrollment for Elderly Waiver enrollees in ICP totaled 6, Older Adult Services Act

15 Family Health Plan Program (FHP) The Family Health Plan (FHP) Program is for children, their families, and Affordable Care Act Adults who have full Medicaid benefits and are not enrolled in Medicare. FHP is currently operating in 45 counties including the Greater Chicago Region, Rockford Region, Quad Cities Region, Central Illinois Region and Metro East Region (15 additional counties outside the mandatory Regions have one MCO operating FHP in that county. Participation is optional in those 15 counties for enrollees). As of October 1, 2016, HFS holds contracts with 10 MCO/MCCNs to serve the FHP population. As of October 1, 2016 current enrollment for FHP is 1,882,686. Enrollment for Elderly Waiver enrollees in FHP was 922. Medicare/Medicaid Alignment Initiative (MMAI) In 2013, Illinois and the federal Centers for Medicare and Medicaid Services (CMS) signed a Memorandum of Understanding that approved the Medicare/Medicaid Alignment Initiative (MMAI). MMAI is an effort to reform the way care is delivered to clients eligible for Medicare and Medicaid services (dual eligible) by providing coordinated care. In 2015 MMAI was operational in 21 counties, including the Greater Chicago Region and the Central Illinois Region. There are 7 MCOs providing services under MMAI. As of October 1, 2016, the enrollment under MMAI was 45,070. Enrollment for Elderly Waiver enrollees in MMAI totaled 5,626. MCOs providing services under MMAI are responsible for covering all Medicare and Medicaid services, including Long Term Services and Supports (LTSS). Enrollees can opt out of MMAI at any time, as well as re-enroll at any time; however, enrollees that receive LTSS in Greater Chicago and request to opt out of MMAI are required to participate in the MLTSS program. Medicaid Managed Long Term Services and Supports (MLTSS) Program The Medicaid Managed Long Term Services and Supports Program (MLTSS) is one of Illinois' mandatory managed care programs. This program is for seniors and persons with disabilities who have full Medicaid and Medicare benefits (dual eligibles) and opt-out of MMAI. This program only covers dual eligibles in the Greater Chicago Region that have opted out of the MMAI. As of October 1, 2016, enrollment under the MLTSS program totaled 21,138. Enrollment for Elderly Waiver enrollees in MLTSS was 9,899. Enrollment for this program will continue into November and December

16 Institution to Community Transitions Pathways to Community Living/Money Follows the Person Illinois was approved for a Money Follows the Person rebalancing demonstration award from the federal Centers for Medicare and Medicaid Services (CMS) in May Following development on an Operational Protocol, policies and forms, the first transition began in It was re-branded as the Pathways to Community Living/Money Follows the Person (Pathways/MFP) in The program is designed to help older adults and persons within all disability groups and ages move out of nursing facilities and back into the community with the necessary supports. The program goals are to increase the use of home and community-based services (HCBS); to eliminate barriers that prevent or restrict flexible use of Medicaid funds for necessary long term supports and services (LTSS) in the settings reflecting individual choice; to increase ability to assure continued HCBS LTSS to eligible individuals after transition; and to ensure quality assurance and improvement continuously occurs for HCBS LTSS. Sustainability: When the Affordable Care Act was signed into law, Section 2403 extended MFP through September 30, In April 2015 the Department of Healthcare and Family Services (HFS) submitted to CMS a Sustainability Plan that will authorize MFP-funded transitions through December 31, Illinois plan outlines a key role of MCOs in assisting the State in rebalancing its LTSS system. All transitions completed prior to or on December 31, 2017 must have completed their MFP post-transition eligibility by December 31, The Department on Aging will be working with HFS on possible additional Waiver services to continue MFP-type activities beyond the Sustainability Plan timeframe. Outcomes: As of December 31, 2016, the total number of Pathways/MFP transitions across all State Departments/Divisions since the beginning of the program was 2,764 individuals. For CY 2016, transitions by Aging/Disability population were as follows: Elderly (40), Physically Disabled (30), Serious Mental Illness (17), Intellectually Disabled (19), Colbert Class [MFP eligible] (301); total of 407 individuals. Outside of the Elderly waiver transitions, which were four short of the 2016 projections and Colbert transitions, all other transitions were down significantly from This was attributed to the budget impasse which significantly impacted the contracted providers ability to provide statewide coverage, one-time assistance and housing assistance. The Department on Aging and the Care Coordination Unit Transition Coordinators did pass a new threshold for transitions for a total of 403 since the beginning of the program in Colbert Consent Decree The Colbert v. Quinn lawsuit alleged that individuals are being unnecessarily segregated and institutionalized in nursing facilities in Cook County in violation of the Americans with Disabilities Act (ADA) and Rehabilitation Act. Through the Colbert Consent Decree, the State of Illinois agreed to provide the necessary supports and services to enable a definitive number of consenting Class Members to live in the most integrated community settings appropriate to their needs. The State also agreed to gather data that would reflect the costs of maintaining Colbert Class Members in community-based settings relative to the costs of maintaining those same individuals in nursing facilities. The results would be used to develop a Cost Neutral Plan to be used to guide the State in future community reintegration efforts. Implementation started under the leadership of Illinois Healthcare and Family Services (HFS) in January 2013 and was transferred to the Illinois Department on Aging (IDoA) in January Older Adult Services Act

17 The State has made notable accomplishments in the implementation of the Colbert Consent Decree. In the four years since implementation began the State has built sufficient infrastructure to facilitate significant transition activity for those individuals that expressed interest from the Colbert Class of approximately 18,500 members. As of October 31, 2016, accomplishments include: v 1,424 Colbert Class Members transitioned from Nursing Facilities to community-based settings. v 9,700 Class Members outreached and educated regarding the Colbert Consent Decree. v 5,441 Class Members evaluated for transition to a community-based setting. v 2,727 (50%) Class Members recommended for transition. v Two social service agencies provide dedicated Outreach for Colbert Class Members. v Two Managed Care Organizations provide Evaluation and Care Coordination services for Colbert Class Members. v Three Social Service agencies provide housing locator services. v Nine Community Mental Health Centers provide transition services for Class Members diagnosed with a serious mental illness. v Four Community Mental Health Centers provide Outreach services for Colbert Class Members diagnosed with a serious mental illness. v Five Community Mental Health Centers conduct Evaluations for Class Members diagnosed with a serious mental illness. v Providers enter data regarding Colbert Class Member transition activities into a webbased data system that generates critical management reports. v Three Care Coordination Units provide comprehensive transition services for selected Colbert Class Members age 60 and over. v Quality systems developed with the University of Illinois College of Nursing (UIC-CON) to monitor the quality of Service Plans and assessments, and to conduct incident and mortality reviews. v Assistive Technology and Home Modification assessments for transitioning Colbert Class Members conducted by the University of Illinois Assistive Technology Unit (UIC- ATU). Through these efforts, the State exceeded the transition requirements of the Consent Decree by transitioning 1,114 Colbert Class Members to community-based settings by January 8, The initial phase of the Colbert Consent Decree implementation culminated in calendar year 2016 with the completion of the comparison/analysis of costs of maintaining a designated group of class members in the community to the costs of maintaining those same class members in the nursing facilities. For that group of class members, it was determined by Berkley Research Group that expenditures for maintaining class members in the community were 37.5% less than expenditures for maintaining them in the nursing facilities. Once it was determined that expenditures for maintaining class members in the community were less than maintaining them in the nursing facilities, the Parties (Court Monitor, State representatives and Plaintiff s Counsel) were required to reach an agreement regarding a Cost Neutral Plan to guide further community integration efforts for the Colbert Class. After considerable negotiation, the Parties determined that they were unable to agree on all of the elements of the Cost Neutral Plan and, on September 29, 2016, the Court ruled on the matters on which the Parties differed. The Cost Neutral Plan was finalized and an order filed with the Court on November 16,

18 This amendment stipulates that: v On November 10, 2016, the State will create a list of all Class Members living in Nursing Facilities in Cook County as of September 30, v The State will create and perform outreach activities required to comply with the requirements of the updated Implementation Plan and the Consent Decree. v The State shall create a Transition Activities Schedule by December 30, 2016 that will include at least 150 Class Members that are not opposed to moving to a communitybased setting (excluding Class Members not yet transitioned but who are in the housing queue on December 30, 2016). v The State shall update the Transition Activities Schedule with an additional 1,000 Class Members by June 30, v The State will complete at least 1,000 Evaluations by June 30, v The State will ensure that Service Plans are provided within three (3) months of the evaluations for those Class Members that are approved for transition to a communitybased setting. v The State will transition 250 Class Members to the least restrictive community-based settings by June 30, 2017 and an additional 300 Class Members by December 31, v The Court Monitor, at the State s expense, with the input of the State and the Class Counsel, will retain an appropriate independent consultant to advise the Court Monitor on how the State can develop community capacity to transition increased numbers of Class Members in calendar year 2018 and subsequent calendar years. v During the second quarter of calendar year 2017 the Parties and the Court Monitor shall discuss the proposals made by the consultant described above and transition benchmarks determined for 2018 and 2019 at that time. v Prior to December 31, 2018, the Parties and the Court Monitor shall agree upon a reasonable pace for moving all Class Members determined appropriate for transition to community-based settings. v The State continues to be responsible to develop and increase community capacity necessary and appropriate to comply with the Consent Decree and the updated Implementation Plan. v By November 16, 2016, the State shall send to Class Counsel and the Court Monitor a proposed, updated Implementation Plan that will include detailed plans and programs to achieve compliance with the Cost Neutral Plan and the Consent Decree. v The Parties, either jointly or separately, may request termination of the monitoring process at any time after December 31, 2019, if the Court Monitor agrees that the State has substantially complied with the terms of the Consent Decree, the Implementation Plan and the Cost Neutral Plan. v IDoA staff is working in the last months of calendar year 2016 to meet the initial requirements of the Cost Neutral Plan amendment and anticipates meeting calendar year 2017 transition activity requirements. Other calendar year 2016 activities of note include: v The use of Minimum Data Set Section Q responses to identify Colbert class members who are interested in transitioning to a community-based setting. 14 Older Adult Services Act

19 Nursing Facilities are federally mandated to use the Minimum Data Set for quarterly assessments to include Section Q which queries nursing home residents regarding their interest in moving to a community-based setting. With the assistance of the Illinois Department of Healthcare and Family Services, Colbert transition coordinators are provided the names of individuals who answered affirmatively for outreach and, potentially, evaluation. v The monitoring and revision of newly implemented service delivery systems; Service delivery systems piloted in 2015 to expedite the identification, evaluation and transition of targeted Colbert class members to include those diagnosed with serious mental illness and over 60 years of age were monitored and processes revised as necessary. v The standardization and implementation of a uniform assessment tool; Effective January 2016, Qualified Professionals are required to use a uniform Colbert Consent Decree assessment tool that was developed by UIC-CON in consultation with IDoA. The design and data elements of the tool are comprehensive in scope, grounded in best practices and provide detailed information about the class members. v Partnership with the Department of Human Services, Division of Mental Health to create training opportunities for the community integration workforce utilized to implement the Williams and Colbert Consent Decrees; Initiated in the third quarter of calendar year 2016, the Training Institute provides a series of interactive educational sessions that are designed and facilitated by UIC-CON, in consultation with DHS-DMH and IDoA staff. The sessions, which are intended to promote adherence to process and procedures, and improve outcomes, will cover a wide range of subjects that are grounded in best practices for community integration. Development of Supported Employment resources for Colbert class members interested in employment; DHS/DMH developed the Illinois Individual Placement and Supported Action Plan to help engage Colbert class members diagnosed with SMI around employment. IPS is an evidence-based, fast track, no denial employment program for people recovering from mental illness and will support class members with community integration. DHS/DRS offers Colbert class members with physical disabilities Vocational Rehabilitation services with the support of the Care Coordinator. DHS/DRS s Vocational Rehabilitation program offers training, job placement, and physical/mental restorative services that can assist a Colbert class member to achieve a positive employment outcome. 15

20 Home and Community Based Services & Aging Waiver Renewal Home and Community-Based Services (HCBS) Waivers provide Medicaid recipients with the opportunity to remain in the community through the provision of HCBS services and supports. Individuals must meet specific eligibility criteria to be eligible for an HCBS Waiver which includes that the individual must require an institution level of care (specified by each Waiver) and service needs must be cost effective. The Department on Aging currently offers the following services under the HCBS Aging Waiver: v Adult Day Service v Adult Day Service Transportation v In Home Services v Emergency Home Response Service v *Automated Medication Dispenser n This service has been approved in the Waiver and the Department on Aging has drafted revised language to its Community Care Program Administrative Rule to revise the qualifications for providing Automated Medication Dispenser services. The Department anticipates filing the proposed rule changes in the very near future. On November 20, 2015, the Department of Healthcare and Family Services (HFS) submitted a renewal of the Aging Waiver to federal CMS. Significant changes included: 1) adding language to comply with federal HCBS regulations specific to person-centered planning, 2) ensuring the provision of services in integrated settings, and 3) an increase in the number of individuals served under the Waiver. Federal CMS approved of the renewal of the Aging HCBS Waiver on November 1, As a part of the renewal process, the Department committed to CMS the following; completion of a rate study for each of the Waiver services over the next three years beginning with a study for the Emergency Home Response Service rates in FY 17; distribution of a brochure to all CCP participants that outlines how to report abuse, neglect and exploitation and participant documentation that the brochure was distributed; and the finalization of the automation of the critical event reporting system and training tracking databases. As outlined under the Statewide Transition Plan, the Department on Aging completed the site validation process for its Adult Day Service providers in the spring of 2016 to determine if the sites are integrated into the community as required by the HCBS Waiver regulations. Based on the site validation process, the Department collaborated with the Department of Healthcare and Family Services regarding the submission of six Adult Day Services sites for approval under the federal heightened scrutiny category. The Department conducted training on personcentered planning in the fall of 2016 and plans to file updates to its CCP rules to comply with the HCBS Waiver requirements specific to person-centered planning and integrated settings in the fall of 2017 and the spring of Older Adult Services Act

21 Housing Initiatives The Low-Income Housing Tax Credit Program (LIHTC) Illinois Housing Development Authority (IHDA) administers Low Income Housing Tax Credits (LIHTC), which are a primary source for affordable housing production. IHDA makes LIHTC awards based on the applications it receives from developers, with both mandatory requirements and a point system outlined in its Qualified Allocation Plan (QAP). During the last four years, IHDA has made several amendments to its QAP to grant specific points for tax credit proposals that house persons with disabilities in a community-integrated setting. Developers that agree to set aside between 10% and 20% of their LIHTC units for persons with disabilities, or who are experiencing or are at risk of homelessness and have incomes below 30% of Area Medium Income (AMI) receive substantial points for making this voluntary election. As of December, 2016, IHDA has financed a total of 17,565 age-restricted units with these tax credits. IllinoisHousingSearch.Org ILHousingSearch.org (ILHS) is a free housing locator website for use by the citizens of Illinois to find rental housing in their community. ILHS also helps property managers, owners, and landlords advertise rental properties throughout the state of Illinois. Some unit characteristics detailed on the site include indoor and outdoor amenities, special features, and application requirements. The website also contains a Caseworker Portal for case managers, transition coordinators and housing locators to access three tools: Special Search, Saved Search and Waiting Lists. The Special Search function allows a social service provider to set up specific search criteria for the type of housing and amenities needed by a client. The Saved Search function allows the service provider to save a Special Search that turned up no results so that anytime a new unit is entered onto the site that meets the Saved Search criteria, an alert is sent to the service provider. This public website allows anyone in Illinois to search for rental housing in specific communities and allows property owners to list any rental units that they might have available. Class Members, Community Mental Health Centers (CMHCs) and Housing Specialists can access this site, which lists housing by location, features, vacancy, and other criteria. The PAIR Module Embedded within the website is a caseworker portal that requires a username and password in order to login to the Online Housing Waiting Lists or Prescreening, Assessment, Intake and Referral (PAIR) Module. Statewide Referral Network Units and Section 811 Project Based Rental Assistance Units are accessed from the Online Housing Waiting Lists. Housing Specialists and CMHCs have secure access to the internal Online Housing Waiting Lists or PAIR module that enables them to place Class Members and other eligible supportive housing populations on both of the Online Housing Waiting Lists in order to access housing options that are exclusively available to targeted populations. This option connects eligible households with available, affordable housing. More than 5,000 people around the state have been trained on using the online waiting list. The Statewide Referral Network The Statewide Referral Network (SRN) links vulnerable populations (already connected to services) to affordable, available, supportive housing. The SRN includes units made affordable through Low Income Housing Tax Credits and other funding. Eligible supportive housing populations include persons with disabilities OR persons experiencing homelessness OR at-risk of homelessness with very low incomes at or below 30% of Area Median Income (AMI). 17

22 The Statewide Housing Coordinator, responsible for the PAIR module that manages access to Statewide Referral Network (SRN) units, continues to disseminate the Heads Up on Housing newsletter that contains information on available SRN units with no active referrals. It also provides encouragement and tips on using the online waiting lists. The newsletter is distributed to more than 800 transition coordinators, case managers and housing locators around the state. For more information about SRN unit capacity and projected growth, see H.1a1. As of December 2016, there are 55 Colbert class members on the SRN Waiting List, 34 of which have an open offer to properties and nine class members have been housed in SRN units. Section 811 Program The State was awarded $11.9 million by HUD for the Section 811 program in 2013, to provide up to 732 project-based vouchers to persons with disabilities who are coming out of nursing homes and other institutional facilities to help them transition back into the community. Since the award, IHDA and HUD have agreed to reduce the number of units, not the amount of funding, in order to be able to pay up to a full Fair Market Rent for Section 811 units. The new unit goal is approximately 370 units. In 2015, IHDA was awarded an additional $6.42 million, which it projects will assist approximately 200 households. This money is to help assist Illinois in its efforts to meet obligations set into place by the three court-ordered consent decrees (Williams, Colbert, and Ligas), as well as the Money Follows the Person (MFP) Program and persons wishing to move from State Operated Developmental Centers (SODCs). Illinois Housing Development Authority (IHDA) continues to sign Rental Agreement Contracts with new affordable housing projects that are coming online. When a project is at 65% construction complete, the Section 811 Rental Assistance Contract (RAC) process begins if the units are in communities of preference for class members. As of September 2016, 105 units have been Board approved. The first Section 811 units were made available to class members starting in December The Section 811 waiting list is also managed in the PAIR module by the Statewide Housing Coordinator. As of December 2016, the Section 811 Waiting List includes 36 Colbert class members, 13 of which have an open offer to properties and one class member has been housed in a Section 811 unit. New Funding for the Permanent Supportive Housing Program and Long-Term Operating Support IHDA released a request for application (RFA) for the Permanent Supportive Housing Development Program (PSH). The program will fund developments serving extremely low-income persons with disabilities, persons experiencing homelessness and other vulnerable populations. Eligible developments may contain no more than 25 units and are required to set aside a minimum of 10 percent of units for referrals through the Statewide Referral Network. Funding will be awarded to the highest scoring applications. PSH applications are due February 27, A new Long Term Operating Support Program (LTOS) request for application is also an available resource. LTOS is through the Rental Housing Support Program administered by IHDA. Under this new request for application (RFA), rental subsidies will be provided over 15 years to eligible landlords serving households referred through the Statewide Referral Network. LTOS grants will be awarded to the highest scoring applications to bridge the gap between the contract rent and what extremely low-income households can afford to pay. Eligible developments must be located outside the City of Chicago, meet the accessibility requirements listed in the Request for Application, and commit to accepting tenants referred through the Statewide Referral Network in order to be considered. Applications for LTOS are now being accepted on a rolling basis until further notice. 18 Older Adult Services Act

23 Other Housing Initiatives for Colbert Class Members 811 Match with Public Housing Authorities In early 2013, HUD's Office of General Counsel approved a statewide Coordinated Remedial Plan for the State of Illinois which allows local public housing authorities (PHAs) to establish preferences on their Public Housing and/or Housing Choice Voucher waiting lists for Olmstead populations. They are allowed to adopt a remedial preference which specifically allows them to provide preference to persons with disabilities who are leaving one of the State-licensed facilities that are subject to one of the three court consent decrees previously discussed (Colbert, Williams, and Ligas) or are participating in the Money Follows the Person Program (MFP), and those who are seeking to move out of a State-Operated Developmental Center (SODC). The strategy is to further expand affordable housing choices for persons with disabilities and consent decree class members. PHAs must still revise their Public Housing Plans to reflect the requested preference and request a waiver. These requests are submitted directly to the Chicago Regional Office instead of HUD Headquarters in Washington D.C. In 2014, IHDA worked with the Governor's Office of Health Innovation and Transportation (GOHIT) and Illinois-based PHAs to promote participation in this program and provide any needed training. The Statewide Housing Coordinator (SHC) from DHS is a key participant in this effort. The SHC has worked with several PHAs in the past four years to establish agreements for voucher and public housing unit set-asides. These set-asides are specifically for the populations described above, which are also eligible for the Section 811 program. The Defendants for all three consent decrees have worked with IHDA and the Statewide Housing Coordinator (SHC) to connect Class Members to Statewide Referral Network units, including Section 811 units. They have also worked with the SHC to secure housing vouchers and public housing units through local public housing authorities including Cook County, the City of Chicago, Rockford, Decatur, and Lake County. All of these public housing authorities committed housing choice vouchers and/or public housing units as match to the State s/ihdas two approved Section 811 applications to HUD. These match resources are replacing some bridge rental subsidies that many Class Members are currently using to make community based housing affordable. The bridge subsidies are State rental housing subsidies (funded through the General Revenue Fund) which helps them pay a portion of their rent and provide household necessities (e.g., furniture, appliances) when needed. Bridge rental subsidy was designed to be short-term assistance. Currently, the SHC is working with bridge subsidy recipients from Williams and Colbert to place people in set-aside PHA vouchers. Colbert Bridge Subsidies Many Colbert Class Members have income limited to entitlements such as SSI/SSDI, and require assistance with rental payments. The Colbert Bridge Subsidy is designed to bridge the gap between when an individual transitions into his or her own community housing unit and the time that they can secure a more permanent rental subsidy (e.g. Section 8 Housing Choice Voucher, IHDA s Rental Housing Support Program, any other comparable permanent rental subsidy), or can otherwise achieve an increase in their income. The Colbert Bridge Subsidy provides essential, interim support to individuals transitioning into Permanent Supportive Housing and can also be project-based for specific units. As of November 30, 2015, approximately 65% of the 999 Colbert Class Members living in a community-based setting were supported by a Colbert Bridge Subsidy. 19

24 Assistive Technology/Home Modification Assistive Technology has the potential to help make possible the transition to living in the community, and to enable individuals to maximize their independence and safety once in the community. The University of Illinois-Chicago Assistive Technology Unit (UIC-ATU) is a multi-disciplinary, community-based clinic within the UIC Department of Disability and Human Development. The UIC-ATU Colbert team is staffed with Assistive Technology Specialists from five (5) disciplines: occupational therapists, physical therapists, speech-language pathologists, rehabilitation engineers, and architects. Additionally, the UIC-ATU Colbert team support staff includes a fabrication specialist, office manager, case management staff, and a graduate student from the UIC School of Architecture. UIC-ATU services are available in the Assistive Technology areas of activities of daily living (ADLs), adaptive equipment, augmentative communication, computer access, electronic aids to daily living, environmental control, home modification, seating/wheeled mobility, and worksite modification. Thus far in UIC-ATU s involvement in Colbert, services have been provided in the areas of ADLs, adaptive equipment, augmentative communication, home modification, and seating/wheeled mobility. UIC-ATU involvement in the Colbert initiative began on February 2015, and a total of 494 referrals have been made. During fiscal year 2017, an increased referral rate has been experienced, and is on a pace now for 393 referrals for the fiscal year. In the Colbert initiative, UIC-ATU services span the entire timeline from Nursing Facility to community living. 20 Older Adult Services Act

25 Impediments to Progress During 2016 Illinois continued to work through the existing challenges in rebalancing Long Term Supports and Services (LTSS) that were identified in 2015 in addition to new challenges. Primary challenges include: v The settlement of three Olmstead lawsuits (Ligas, Williams, Colbert) within two years of each other continues to create a huge demand on the community infrastructure. The capacity of the community infrastructure needs to be strengthened to respond to the increased demand for services and gaps in the current delivery model need to be addressed. v The Aging and Disability community infrastructure continues to adapt to massive change simultaneously. Many of these changes are positive and address some of the shortfalls of the current structure. However, the provider community is adjusting to how they fit into the new system; specifically, the expansion of managed care models for LTSS, the rebalancing initiatives that are underway, and the expansion of Medicaid resulting from the implementation of the Affordable Care Act (ACA). Changes at the federal level will have an impact on the future of the ACA and how states will need to adapt to any changes beginning in v The FY budget impasse continues to impact many community-based Human Services agencies in maintaining their ability to fully operate and provide their full level of services. Numerous agencies have ceased providing services, reduced services, and/or hours of operation and have furloughed or laid-off staff. 21

26 Successes & Recommendations Successes: Increased Investment in the Community Long Term Services and Supports (LTSS) System: Over the past several years, Illinois has made significant progress toward increasing its spending on community-based services and supports. As of September 2016, Illinois was at 47.47% of its benchmark of LTSS expenditures directed to the community (an almost 2 percentage point increase from September 2015) and continues to works toward the goal of 50%. Progress on Transitions: While the budget impasse did negatively impact transition activity, Illinois continues to make strides in transitioning individuals from institutional settings to the community. Statewide transitions (excluding Cook County) reached a total of 1,531. Transitions under the Colbert Consent Decree impacting individuals residing in Cook County nursing facilities increased its total to 1,233 individuals. Since the beginning of MFP in 2009 there have been 2,764 transitions of participants from institutional to community-based settings. Deflection Activities: The State is focusing its efforts on deflection of care in institutional settings through the continued focus on the Bridge Model Program, the extended funding for the Nursing Home Deflection demonstration, the completion of the Lewin Group study on the Choices for Care policy, and the recent changes to the Choices for Care policy. The Department anticipates collecting valuable data as a result of the strengthening of the Choices for Care policy and plans to use the data to modify policy based on what is learned. Implementation of the UAT: The State has finalized a number of contracts with vendors over the last several months resulting in significant progress towards implementation of the Uniform Assessment Tool (UAT). Development of the No Wrong Door Three Year Plan: A plan was drafted with approval from leadership of HFS, DHS and IDoA describing the State s current capacity, 3-year goals were identified including tasks, timelines, and funding sources. Additional roll-out responsibilities were assigned to State agency leadership. A final plan was submitted to ACL with approval from the Governor s Office on September 29, Recommendations: Expand Deflection Efforts: In 2016 OASAC briefly convened a workgroup to study the Nursing Home Deflection Demonstration and consider expansion of the Bridge Program Model to increase hospital deflections from nursing facilities. This included working with AARP on implementation of the CARE Act. This workgroup will be reconvened to continue to address best practices and expansion of deflection efforts. Managed Care, Person-Centered Planning & Customer Satisfaction: With the requirement by federal CMS of adding Person-Centered Planning (PCP) to its Community Care Program administrative rule and policies as required by December 2017, OASAC recommends that PCP be a consideration with managed care organizations providing community-based services in the State. Additionally, OASAC recommends that customer satisfaction be included as a measure of success for MCOs providing community-based services in the State. 22 Older Adult Services Act

27 Future of CRM Dashboard Post-MFP: The Money Follows the Person program (MFP) will be sun-setting with the last day MFP referrals may be sent to HFS by June 30, 2017 and the last day to transition under MFP by December 31, OASAC recommends that HFS and its MFP partner Departments continue operating the centralized CRM Dashboard for making webbased referrals for entities interested in having someone talk with them about moving from an institutional setting back in to the community as required by MDS 3.0, Section Q. Community Reinvestment Program: OASAC requests ongoing updates on the final development of the Community Reinvestment Program (CRP) including how it will be measured for its impact upon implementation and how it will be evaluated on an ongoing basis. Understanding Changes at the Federal Level: With the election of a new President and changes in Congress, OASAC seeks to be informed of changes that may directly impact the State s rebalancing efforts. This may include changes to the ACA, Medicaid block grants, and housing subsidies. 23

28 Legislation Following are several pieces of enrolled legislation from the 99th General Assembly that effect Illinois senior population: Public Act (Senate Bill 2929) PA will require Care Coordination Units (CCU), hospitals, and nursing facilities to perform the Pre-Admission Screening (PAS) process as it was executed prior to a 2014 law change. This will require CCUs to provide required assessment documentation directly to a nursing facility prior to a patient s discharge rather than providing it to a hospital discharge planner to send to a nursing facility. If a CCU is unable to complete a PAS prior to a patient's discharge, they are to report this to IDoA. IDoA and HFS will also be required to promulgate rules to address these incidents. As written, all involved parties will still be required to follow state and federal laws and regulations regarding the PAS assessment process. This includes the requirement that a hospital provide notification to the CCU 24 hours prior to a patient s discharge and that the CCU perform the PAS prior to a patient leaving the hospital. Effective Jan. 1, Public Act (House Bill 4552) This is a Department on Aging initiative that comes from Adult Protective Services (APS). PA adds the State s Attorney Office to entities which are entitled to request Adult Protective Services records, which will enable APS to better serve its vulnerable population by expediting investigations of abuse, neglect and financial exploitation. Public Act (House Bill 5009) Currently, the Long-Term Care Ombudsman Program (LTCOP) serves residents of Institutes for Mental Diseases. As these facilities become Specialized Mental Health Rehabilitation Facilities (SMHRF), the LTCOP should continue to serve those residents. PA extends the LTCOP's jurisdiction to include those residing in SMHRFs. This bill also adds a 3-year limit on provisional licenses for SMHRFs. Public Act (House Bill 5603) PA makes necessary changes to improve Public Act , the Electronic Monitoring in Long-Term Care Facilities Act. This bill adds references to facilities licensed under the MC/DD Act. It also requires the nursing facility to shut off recording if a new roommate does not consent to recording (changes MAY to SHALL). The Department of Public Health s electronic monitoring assistance fund will be subject to appropriation. It includes a provision prohibiting intentional discrimination and retaliation against a resident for consenting to electronic monitoring. It also includes necessary references in other statutes, corrected an erroneous Life Safety Code reference (2012 instead of 2000), and states that provisions in the bill shall not be delayed due to rulemaking Older Adult Services Act

29 Public Act (House Bill 5805) As described in 720 ILCS 5/17-56, all financial exploitation crimes against the elderly or those with disabilities are felony offenses. The previous statute of limitation for these cases, 720 ILCS 5/3-5(b), only allows prosecution to be held after three (3) years. PA allows prosecution within seven (7) years of the last act committed for the crimes described in the Act. These include financial exploitation of an elderly person or person with a disability. By adding four (4) years to the statute of limitation for cases of financial exploitation, victims who may not have known they had been exploited will have more time to pursue justice. Public Act (House Bill 5924) Under PA , guardians of a ward shall make reasonable attempts to contact the ward s adult children, if they have requested notification, in the event that the ward is admitted to a hospital, hospice, passes away, and of their funeral arrangements. The court may also order the guardian to allow visitation between a ward and their adult children if it is substantiated that the children were unreasonably prevented from doing so. The Public Guardian and the Office of State Guardian are excluded from the new requirements of this bill. 25

30 Older Adult Services Advisory Committee Members The Department on Aging, Department of Healthcare and Family Services, Department of Human Serves, Department of Public Health and Illinois Housing and Development Authority gratefully acknowledge the service of the Older Adult Services Advisory Committee (OASAC). The State of Illinois benefits from the broad representation of the OASAC membership and their commitment to advise the Departments on all matters pertinent to the Older Adults Services Act and the delivery of services to older adults. OASAC has been instrumental in the support of a transformation of Illinois comprehensive system of older adult services from funding a primarily facility-based service delivery system to primarily a home-based and community-based system. The following individuals served as the current OASAC members effective December 31, (**Denotes members of the Executive Committee). ** Carol Aronson Case Management Sherry Barter Hamlin Nursing Home or Assisted Living Establishments Jennifer Belkov Alzheimer s disease and Related Disorders June Benedick Parish Nurse Amy Brown Nutrition Andy Chusid Nursing Home or Assisted Living Establishments Theresa Collins Community Care Program Homemaker Thomas Cornwell, M.D. MD specializing in Gerontology Cindy Cunningham Adult Day Services Carla D. Fiessinger Legal Kelly Fischer Hospice Care Robyn Golden Health care facilities licensed under the Hospital Licensing Act Jan Grimes Home Health Agency ** Terri Harkin Trade or union member Lori Hendren Statewide organization in advocacy or legal representation on behalf of the senior population Susan L. Hughes, Ph.D. Gerontology Health Policy Analyst Kaye Kibler Nursing Home or Assisted Living establishments Michael Koronkowski Pharmacist Jonathan Lavin Illinois Area Agencies on Aging Dave Lowitzki Trade or union member ** Phyllis B. Mitzen Citizen Member over the age of 60 Patricia O Dea-Evans Family Caregivers Samantha Olds Frey Primary Care Service Provider 26 Older Adult Services Act

31 ** Susan Real Family Caregiver Karen Schainker Statewide senior centers associations Jason Speaks Nursing Home or Assisted Living Establishments ** Cathy Weightman-Moore Illinois Long Term Care Ombudsman Louise Starmann Citizen Member over the age of 60 Ancy Zacharia Advanced Practice Nurse with experience in Gerontological nursing OASAC State Department Members (Ex-officio) (Denotes **Executive Committee) ** Jean Bohnhoff, Director, Department on Aging ** Kelly Cunningham, Department of Healthcare and Family Services ** Debra D. Bryars, Department of Public Health ** Lyle VanDeventer, Department of Human Services ** Megan Spitz, Illinois Housing Development Authority Jamie Freschi, Department on Aging Gwen Diehl, Department of Veterans Affairs 27

32 OASAC Workgroup Members CARE Act/Bridge Model/NH Deflection Workgroup Carol Aronson Shawnee Alliance for Seniors Amy Brown CRIS Healthy Aging Center Robyn Golden Rush University Medical Center Jan Grimes Illinois Homecare and Hospice Council Sherry Barter Hamlin River to River Residential Corporation Lori Hendren AARP Kay Kibler Willowbrook Memory Support Houses Michael Koronkowski UIC College of Pharmacy Jon Lavin AgeOptions Dave Lowitzki SEIU Healthcare Illinois and Indiana Phyllis Mitzen Health and Medicine Policy Research Group Susan Real East Central Illinois Area Agency on Aging Louis Starmann Cathy Weightman-Moore Catholic Charities LTC Ombudsman Program Renae Alvarez Health and Medicine Policy Research Group Amanda Gronin Marsha Nelson Shawnee Alliance for Seniors Sharon Post Health and Medicine Policy Research Group Walter Rosenberg Rush University Medical Center 28 Older Adult Services Act

33 References The Lewin Group, Inc. (November 14, 2016). Updates about Illinois No Wrong Door System Plan, Choices for Care Study, and NH Deflection Demonstration. (Prepared for the Older Adults Services Advisory Committee). PowerPoint. The Lewin Group, Inc. (November 30, 2016). Illinois Nursing Home Deflection Demonstration Final Report. (Prepared for the Illinois Department on Aging). The Lewin Group, Inc. (October 25, 2016) Illinois Choices for Care Program Report: Findings and Recommendations. (Prepared for the Illinois Department on Aging). (This report was prepared for OASAC by the Illinois Department on Aging, Division of Planning, Research and Development). 29

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36 2017 Report to the General Assembly State of Illinois Department on Aging One Natural Resources Way, Suite 100 Springfield, Illinois Senior HelpLine: , (TTY) 8:30 a.m. to 5:00 p.m. Monday through Friday 24-Hour Adult Protective Services Hotline: , (TTY) The Illinois Department on Aging does not discriminate in admission to programs or treatment of employment in compliance with appropriate State and Federal statutes. If you feel you have been discriminated against, call the Senior HelpLine at , (TTY). Printed by Authority State of Illinois IOCI copies 5/17