ࡱ>  TbjbjBrBr 7  K+ff8y 4f " .z4|4|4|4|4|4|4$a69\46  66448886dz486z488.j0m`p.f4404._9 ._94j0j0_9~06686666644866646666_9666666666f o:  Quality Improvement Strategy (QIS) Action Plan for Waiver IL.350.R04.00 Illinois Adult Waiver Developmental Disabilities Health and Welfare Enhancements QUALITY IMPROVEMENT STRATEGY ACTION PLANOverall Action: Currently, the State requires the reporting of allegations of abuse, neglect, financial exploitation, and deaths. In order to further enhance oversight related to the health and welfare of waiver participants, the State is submitting this Action Plan to CMS with the waiver renewal application. The Action Plan describes enhancements being planned to address concerns and includes expansion of the reporting requirements for critical incidents (referred to as CI), establishing new tools for the monitoring of CILA providers (referred to below as CILA) as a result of Public Act 097-0441 (formerly House Bill 653), goals for improvements resulting from Executive Order 12-2 regarding DHS Office of Inspector General investigations (referred to as OIG), and other Quality Assurance efforts (referred to as QA) identified during the waiver renewal process. Assurances/Sub-Assurances/Performance Measure: New Critical Incident Performance Measure: The number and percent of critical incidents involving participants receiving residential habilitation services that followed procedures as specified in the approved waiver. Numerator: The number of critical incidents reported that followed procedures. Denominator: The total number of critical instances reported. Major TasksResponsible EntityAnticipated Completion DateStatusCILA The OA (the Department) shall make available to individuals and guardians upon enrollment a document listing telephone numbers and other contact information to report suspected cases of abuse, neglect, or exploitation. The information provided shall include a delineation of the individuals rights.Operating AgencyStatutory date: October 1, 2011 Target date: Quarter ending 6/30/11Task completed June 24, 2011, prior to implementation of the legislation. This information is located at. HYPERLINK "http://www.dhs.state.il.us/OneNetLibrary/27897/documents/Forms/IL462-1201.pdf"http://www.dhs.state.il.us/OneNetLibrary/27897/documents/Forms/IL462-1201.pdf The OA annually conducts on-site reviews of each ISSA agency, based on a statistically valid sample of participants, and ensures through interviews, observations, and documentation reviews, that the ISSAs are complying with this provision. Corrective action plans are required to be submitted to and approved by the OA for any identified findings.CI - Revise provider contracts to require additional critical incident reporting.Operating AgencyQuarter ending 6/30/12Task completed. SFY2013 contracts were revised to include the following language: Critical Incident Reporting. Using electronic reporting mechanisms specified by the Division, the provider shall report critical incidents as defined by the Division within the time frames required by the Division. The reports will include complete and accurate information such as the type of incident, description of the incident, date and time of the incident, participants involved, staff involved, and actions taken by the provider.CI - Develop a draft list of the types of critical incidents to be reported. This list will include definitions of each type and time lines for reporting each type.Operating AgencyQuarter ending 6/30/12Task completed. With the help of the National Quality Enterprise consultant, the OA has obtained information from other States regarding incident reporting policies and procedures. In addition, both the OA and MA staff participated in Quality Forum on Critical Incident Systems.CI - Share the draft list of the types of critical incidents with stakeholders and obtain input from them.Operating AgencyQuarter ending 6/30/12Draft list has been shared. Discussions with providers and advocates throughout the system are ongoing. Input is still being received. The OA met with its advisory quality committee on 3/15/12 and informed it of the plans to enhance critical incident reporting and the work that lies ahead.CILA The OA (the Department) shall require all of its community developmental services agencies to conduct required registry checks on employees at the time of hire and annually thereafter during employment. The required registries to be checked are the Health Care Worker Registry, the Department of Children and Family Services State Central Register, and the Illinois Sex Offender Registry. A person may not be employed if he or she is found to have disqualifying convictions or substantiated cases of abuse or neglect. At the time of the annual registry checks, if a current employees name has been placed on a registry with disqualifying convictions or disqualifying substantiated case of abuse or neglect, then the employee must be terminated.Operating Agency Statutory date: October 18, 2011 Target date: Quarter ending 6/30/12Task completed. The OA adopted language for its SFY2013 contracts that incorporates this requirement. The draft language was shared with the work group for discussion at its meeting on April 25, 2012. The draft language was revised based on comments received through the work group. The SFY2013 contracts include the revised language. The contracts have been issued. The OA annually conducts on-site reviews based on a statistically valid sample of participants, and ensures through interviews, observations, and documentation reviews, that the waiver providers are complying with this provision. Corrective action plans are required to be submitted to and approved by the OA for any identified findings. CILA The OA (the Department) shall make available through its website information on each agency regarding licensure and quality assurance survey results; licensure and contract status; and substantiated findings of abuse, egregious neglect, and exploitation. The Department shall adopt rules regarding the posting of this information and shall inform individuals and guardians of its availability during the initial provider selection process.Operating AgencyStatutory date: July 1, 2012 Target date: quarter ending 6/30/12Task completed. On June 25, 2012 the first reports were posted on the OAs website at: HYPERLINK "http://www.dhs.state.il.us/page.aspx?item=56772"http://www.dhs.state.il.us/page.aspx?item=56772 Prior to posting, the OA shared data from the report with selected providers to check the accuracy of the summary information. The OA also developed reports of licensure surveys and quality assurance review outcomes for posting as well. The OA determined that a rule was not required in order to post this information. The OA has posted on its website an explanation of each of the columns in the reports to increase the ability of consumers to understand the information in the reports. This was completed on September 27, 2012. The information is at HYPERLINK "http://www.dhs.state.il.us/page.aspx?item=60781"http://www.dhs.state.il.us/page.aspx?item=60781. There are two types of onsite reviews referenced on the website. The materials for each of these reviews are available on the OAs website at HYPERLINK "http://www.dhs.state.il.us/OneNetLibrary/4/documents/QualityReview/CILAReviewPacket020111.pdf"http://www.dhs.state.il.us/OneNetLibrary/4/documents/QualityReview/CILAReviewPacket020111.pdf for the DDD reviews and HYPERLINK "http://www.ilga.gov/commission/jcar/admincode/059/05900115sections.html"http://www.ilga.gov/commission/jcar/admincode/059/05900115sections.html for BALC surveys. The DDD reviews are designed to enhance quality throughout the service system and are based on an annual statistically valid sample of Waiver participants. The BALC reviews are designed to survey minimum qualifications for licensure and are completed at least every three years but may be conducted more frequently as detailed in rule based on the score level of the survey. CI - Finalize the draft list of critical incidents. The final list will include deaths of participants that receive services while living in their own or their familys home. (Deaths of participants residing in residential settings are currently reported to the OIG.) Operating and Medicaid AgenciesQuarter ending 9/30/12Task completed on September 13, 2012.CI - Identify, with stakeholder input, the data elements to be reported for each critical incident. These will include the type of incident, description of the incident, participants involved, staff involved, and actions taken by the provider.Operating AgencyQuarter ending 9/30/12Task completed on September 13, 2012.CILA As determined by the OA (the Department), a disproportionate number or percentage of licensure complaints; a disproportionate number or percentage of substantiated cases of abuse, neglect, or exploitation involving an agency; an apparent unnatural death of an individual served by an agency; any egregious or life-threatening abuse or neglect within an agency; or any other significant event as determined by the Department shall initiate a review of the agencys license by the Department, as well as a review of its service agreement for funding. The Department shall adopt rules to establish the process by which the determination to initiate a review shall be made and the timeframe to initiate a review upon the making of such determination.Operating AgencyStatutory date: none Target date: Quarter ending 9/30/12The OA established a work group comprised of internal and external stakeholders, in order to obtain input from consumers, family members, providers and other advocates. The MA is a participant on the work group. The OA prepared draft rule language for review and discussion by the work group. The work group met Dec. 8, 2011 and discussed the proposed rule language. Comments have been received by stakeholders through the workgroup. The OA submitted language for the amendment to the Bureau of Administrative Rules on September 27, 2012, for administrative review and publication for public comment. The public comment period is required by Illinois law. The State will provide to CMS the draft rule once it is available. The administrative review and publication for public comment are all part of one process. CILA The OA (the Department) shall adopt rules under the Illinois Administrative Procedure Act that govern the assignment and operations of monitors and receiverships for community-integrated living arrangements wherein the Department has identified systemic risks to individuals served. The rules shall specify the criteria for determining the need for independent monitors and receivers, their conduct once established, and their reporting requirements to the Department. These monitors and receivers shall be independent entities appointed by the Department and not staff from State agencies. This paragraph does not limit, however, the Departments authority to take necessary action through its own or other State staff.Operating AgencyStatutory date: December 31, 2011 Target date for filing of publication of rule amendment: Quarter ending 9/30/12Initial consideration of this task began by the work group December 8, 2011. Proposed rule language, similar to rule language of the Illinois Department of Public Health (IDPH) for monitors and receivers in Intermediate Care Facilities, was developed by the OA and shared with the work group for review prior to its meeting on April 25, 2012. Link to IDPH rule: HYPERLINK "http://www.ilga.gov/commission/jcar/admincode/077/077003500A02700R.html"http://www.ilga.gov/commission/jcar/admincode/077/077003500A02700R.html Although the statute specifies a date of 12/31/11 for adopting this rule, this date would not have been possible since the bill did not become law until 8/19/11. Illinois rule promulgation process requires publication, two public comment periods, and a public hearing. The Administration will work as quickly as possible with the Legislature to adopt the rule, while ensuring it obtains input from advocates throughout the system. Comments have been received from stakeholders through the workgroup. The OA submitted language for the amendment to the Bureau of Administrative Rules on September 27, 2012, for administrative review and publication for public comment. The public comment period is required by Illinois law. The rule will specify criteria for who can function as the independent monitor. This rule change will be an amendment to Rule 115, along with the change described in #9 above, with the language for each being in separate sections of that Rule.CI - Determine the entities that must receive reports of individual critical incidents and those that must receive summary data.Operating and Medicaid AgenciesQuarter ending 12/31/12CI - Develop protocol for review, analysis and trending of critical incidents.Operating and Medicaid AgenciesQuarter ending 12/31/12OIG Conduct a review of all deaths of waiver participants that occurred during SFY2012 (including those in domestic situations) to ensure that any concerns were appropriately reported, investigated and addressed.Operating and Medicaid AgenciesQuarter ending 12/31/12QA Post corrective actions to the OAs website. Corrective actions are defined as sanctions taken by the State such as prohibiting new admissions, limiting contractual periods, cancelling contracts, increased monitoring, implementation of monitor/receivership, holding payments and\or closing a site. This information will be posted in such a manner that it is understandable and assists the consumer in making an informed choice of residential providers.Operating AgencyQuarter ending 12/31/12QA - Provide consumers with information at the time of selecting a residential provider on grievances and quality of care issues at the site level. To accomplish this, the OA will provide ISSAs with an analytical report by sites, instruct them to share information with participants at the time of site selection, and amend the Rights of Individuals Form to inform participants the information is available.Operating AgencyQuarter ending 12/31/12CI - Work with Information Technology section to develop a web-based critical incident reporting mechanism.Operating AgencyQuarter ending 3/31/13CI - Develop process and time frames for conducting individual reviews of reported incidents.Operating AgencyQuarter ending 3/31/13CI Develop a process for coordinating reportable incidents with the Office of Inspector GeneralOperating AgencyQuarter ending 3/31/13CILA In collaboration with the Department of Children and Family Services and the Department of Public Health, the Department of Human Services shall establish a waiver process from the prohibition of employment or termination of employment requirements in subsection (a) of this Section for any applicant or employee listed under the Department of Children and Family Services State Central Register seeking to be hired or maintain his or her employment with a community developmental services agency under this Act. The waiver process for applicants and employees outlined under Section 40 of the Health Care Worker Background Check Act shall remain in effect for individuals listed on the Health Care Worker Registry.Operating AgencyStatutory date: none Target date: Quarter ending 3/31/13The OA prepared a work chart for this waiver discussion. The work chart included a listing of all the types of findings documented on this register. The work group met December 8, 2011 and discussed the proposed work chart. Members of the work group were asked to consider whether some of the types of findings should be categorically excluded from the waiver process. They were also asked to provide comments in general regarding the waiver process to be developed. Comments were due to the OA by close of business January 10, 2012. Discussion of this issue, including comments received, continued during the work groups meeting on April 25, 2012. Final agreement of all aspects of the waiver process has not yet been achieved. Discussions continue with the work group toward finalizing the waiver process. The waiver process It is a statutory requirement included in Pauls Law. The waiver process is explained in C-2-a and C-2-b. CI - Work with Information Technology section to develop summary and analytical report formats on critical incident reports and outcomes of reviews.Operating AgencyQuarter ending 6/30/13CI - Modify Waiver Manual to reflect the new reporting requirements for critical incidents and post the Manual revisions on the website.Operating AgencyQuarter ending 6/30/13CI - Train providers on the critical incident reporting requirements, procedures, and web-based system.Operating AgencyQuarter ending 6/30/13CI Develop with stakeholder input a process for educating consumers and families about the various reporting mechanisms and the results and information they should expect after a report is made.Operating AgencyQuarter ending 6/30/13CI - Begin receiving and processing incident reports via web portal.Operating AgencyQuarter ending 9/30/13 (The system will be operational to receive the first reports by 7/1/13.)CI - Produce quarterly summary reports on critical incidents for posting on the OA website.Operating AgencyQuarter ending 12/31/13 (The first summary reports produced during the quarter ending 12/31/13 will reflect data for the quarter ending 9/30/13.)The State maintains a separate database for abuse/neglect reports. At this time there are no plans to merge the two databases.CI - Review quarterly summary reports at Waiver Quality Management Committee meetings for identification of trends and system improvements.Operating and Medicaid AgenciesQuarter ending 12/31/13 (The meeting will occur in November of 2013.)CI/CILA/OIG - Inform CMS of progress in the annual 372 report and provide quarterly status reports to the RO until final implementation occurs.Operating and Medicaid AgenciesOngoingQuarterly status report submitted to RO on July 5, 2012 for CILA enhancements (HB653).QA Inform CMS of progress on implementation of the Ligas Consent Decree approximately every six months as reports are available.Operating and Medicaid AgenciesOngoingThe reports being shared are reports required by the Consent Decree. The report issued in August of 2012 is available on the OAs website at: HYPERLINK "http://www.dhs.state.il.us/OneNetLibrary/4/documents/Ligas/LIGASDataReportforending063012.pdf"http://www.dhs.state.il.us/OneNetLibrary/4/documents/Ligas/LIGASDataReportforending063012.pdf. OIG Continue to monitor direction from Administration and General Assembly for additional activities.Operating and Medicaid AgenciesUndetermined Proposed legislation to codify Executive Order 12-2 may be considered during fall veto session or 2013 Spring legislative session. OA and MA will await the results of these legislative discussions. 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