Filed Williams Consent Decree amended final FY22 Implementation Plan 08.18.20211.pdf

WILLIAMS CONSENT DECREE

AMENDED FINAL

IMPLEMENTATION PLAN

FY2022

AUGUST 18, 2021

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 1 of 22 PageID #:8876

Table of Contents

I. Introduction

A. Key Priorities for FY22

B. Targeted Action to Analyze Class Member Characteristics and Evaluate

Comprehensive Program Strategies and Outcomes

II. Domain by Domain FY22 Implementation Plan Requirements

A. Front Door Diversion

B. Outreach

C. Assessment

D. Service Planning

E. Transitions

F. Capacity and Housing Development

G. Administration

H. Implementation Planning

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I. Introduction

Pursuant to the requirements in the Williams Consent Decree, the following represents the

Implementation Plan Amendment (Implementation Plan) for Fiscal Year 2022 (FY22). The

Implementation Plan contains the requirements and associated processes for Defendants that are expected to improve toward compliance with the Decree.

With the continuation and improvement in options for the virtual delivery of some services, Defendants will work to ensure that there will not be a significant slowdown of activities, should

COVID-19 cases increase among Consent Decree populations and those who serve them.

Updates on any COVID-19 related issues will be provided by the Defendants in monthly meetings with the Parties and Court Monitor. Should new and significant COVID-19 related issues arise, Defendants will promptly consult with Class Counsel and the Court Monitor to provide updates, identify impacts, and work toward solutions with the intention of ensuring minimal negative impact on Class Members, including the safe and timely transition to the community for those who so choose and are approved to transition through already designated processes.

A. Key Priorities for FY22

A number of key priorities have been identified for FY22. These are based both on prior input from the Court Monitor (see Court Monitor Status Report, 1/22/20) and more recent input from both the Court Monitor and Plaintiffs’ counsel. These key priorities, described more fully below, include the following:

1. Transition Class Members: Defendants will transition 150 Class Members by 12/31/21.

Defendants will transition during the entirety of FY22, a total of 400 Class Members by

6/30/22.

2. Implement Front Door Diversion Program: A revised Front Door Diversion Program will be fully implemented by July 1, 2021. Defendants will provide meaningful, written offers for

Community-Based Services/Settings (Housing) to eligible individuals prior to admission to a

Specialized Mental Health Rehabilitation Facility (SMHRF). A meaningful offer includes the written offer of housing options in Community-Based Settings and specific Community-

Based Services and supports consistent with the individuals’ preferences and clinical needs.

3. Apply rigorous project management to the Comprehensive Program: Ensure that Prime

(service and housing provider) Agencies (and their subcontractors) provide timely and effective services to Class Members in furtherance of their participation in Consent Decree-required services (e.g., Outreach, Assessment, Transition, post-Transition), and in

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 3 of 22 PageID #:8878 compliance with grant requirements. Defendants will measure, report, and hold grantees accountable for all aspects of Transition-related performance. Poor performance will be addressed via issuance of Corrective Action Plans and Performance Improvement Plans for those Prime Agencies not in compliance with the terms of their Comprehensive Program grant requirements and related policies/procedures.

While Defendants maintain overall responsibility for Consent Decree compliance and performance, oversight of the Comprehensive Program will be enhanced beginning in FY22, via involvement of the University of Illinois Chicago – College of Nursing (UIC-CON).

Defendants will continuously review performance and monitor quality and spending by

Prime Agencies, provide quarterly budget reporting to the Parties and Court Monitor, and rigorously identify projected budget lapses earlier in the Fiscal Year to allow for appropriate redirection of funds. Specifically, projected spending lapses will be addressed on a quarterly basis, with modifications and adjustments (as permitted) to address additional needs made in each following quarter, to improve performance and compliance. The Defendants will significantly increase their efforts to better achieve Consent Decree compliance by appropriately spending the funds allocated for such to increase performance, including achieving the required number of transitions.

4. Procure and implement new, statewide Preadmission Screening and Resident Review

(PASRR): The Department of Healthcare and Family Services (HFS) will implement a redesigned, statewide PASRR system in FY22. Because the redesign will feature some limited elements that are outside the scope of federal PASRR requirements for Skilled

Nursing Facility (SNF) admissions yet are relevant to the Consent Decree, moving forward the new system will be referred to as PASRR Plus. The State’s current legacy PASRR policies and processes will remain in place until the launch of PASRR Plus. The Parties and the Court Monitor anticipate that the new PASRR Plus will incorporate both the federally required PASRR screenings for SNFs and upon agreement with the Parties and the Court

Monitor, a revised process for accomplishing screenings for potential admission to

Specialized Mental Health Rehabilitation Facilities (SMHRFs).

As required in the Williams Consent Decree, the current PASRR system is used to screen individuals under consideration for SMHRF admission. Under the redesigned system, it is the intention of the Parties and the Court Monitor that all individuals applying for potential

SMHRF placement will receive a mental health assessment to ascertain whether the individuals can be served in the community. HFS anticipates using the Illinois Medicaid

Comprehensive Assessment of Needs and Strengths as the basis for the SMHRF diversion or admission assessment, pending consultation with the new PASRR Plus vendor, the Court

Monitor, and Plaintiffs’ Counsel.

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As long as the assessment indicates that Community-Based service, supports and housing are appropriate, individuals considering SMHRF admission will first be referred to the Front

Door Diversion Program for services and housing. For those who decline an offer of

Community-Based Services and are deemed appropriate for SMHRF admission, the PASRR

Plus system will be able to authorize and manage short-term admissions approvals to ensure that individuals requiring only brief periods of stabilization or rehabilitation do not remain in institutions longer than necessary.

When agreement is reached on the processes and other key aspects of the PASRR Plus system’s approach to screening for SMHRF diversion or admission, the Parties and the Court

Monitor will work together to petition the Court for a change in the Williams Consent

Decree’s language currently requiring PASRR as the screening tool for SMHRF admission.

Should the Parties or the Court Monitor not reach agreement on a mutually acceptable document, each can separately petition the Court and the Court will make a final determination.

5. Improve the Data Enterprise System and Data Dashboards: The CASPIO data system will be completed and operational by July 1, 2021. The new system allows for real-time data entry, which will provide more accurate, timely, and reliable data for the Comprehensive Program, and will inform further program development and compliance matters. Monthly data dashboards will have improved reliability to accurately reflect ongoing activities, performance and trends.

6. Identify and resolve necessary SMHRF regulatory and policy changes (IDPH): IDPH will consider feedback from Plaintiffs’ counsel and Court Monitor, in conjunction with soliciting recommendations from Prime Agencies, IDHS, and HFS for input before filing. All parties will have an opportunity to review rule drafts prior to formal filing. Revised rules will reflect increased alignment with enforcement tools to comply with Consent Decree obligations.

7. Organize and enhance Consent Decree staffing: In response to the annual requirement for a staffing plan, Defendant agencies will each identify key Consent Decree and other related current or needed staff by position. By December 30, 2021, Defendants will submit a consolidated written report to Parties and the Court Monitor that identifies the positions, staff name(s) who occupy the position(s), or for vacant positions, if applicable, a target date by which the position will be filled (subject to the hiring process and identification of qualified candidates).

8. Expand Provider Capacity: In order to expand the ability of the Comprehensive Program to serve additional Class Members, Defendants will be seeking additional providers for participation in the Program. Initial meetings with potential new providers (mainly providers who specialize in Care Management, who may be able to better serve Class Members with

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 5 of 22 PageID #:8880 complex medical and psychiatric needs), will be completed by July 31, 2021. Depending on the outcome of those discussions, additional grant agreements for new providers will be negotiated. If the initial meetings with potential new providers do not result in expanded provider capacity, Defendants will continue seeking new providers. Updates to the parties and Court Monitor will be provided at the monthly Parties’ Meetings on progress of potential new agreements. Once any new grant agreements are in place, further discussions will be held to modify the Transition requirements for FY22 as applicable. See Capacity

Development Section, Section II.F., Infra., CD5.

B. Targeted Action to Analyze Class Member Characteristics and Evaluate

Comprehensive Program Strategies and Outcomes

To better understand the demographic, clinical, and other key characteristics of Class Members and their impacts on the transition processes overall, and Class Member Transitions specifically, IDHS has engaged the UIC-College of Nursing (UIC-CON) to conduct an analysis of Williams

Class Members residing in SMHRFs. Additionally, IDHS will continue to engage with UIC-Jane

Addams College of Social Work (UIC-JACSW) to evaluate the progress and outcomes of the

Comprehensive Class Member Transition Program pilot.

The work of UIC-CON and UIC-JACSW will continue in FY22 with in-progress reports to inform policy and programmatic changes delivered to the Parties and the Court Monitor. Initial programmatic core components, benchmark studies on the Comprehensive program, and the primary analysis of Class size and demographics will be provided to the Parties and the Monitor by July 15, 2021. Defendants will provide reports on the nature and progress with current and future work under these contracts to the Parties and Court Monitor on a quarterly basis throughout FY 22.

By September 30, 2021, HFS will establish and document salient data points from Medicaid data systems that can be shared with DHS for the purpose of UIC-CON conducting a clinical characteristics analysis, which will also draw from DHS data sets.

II. Domain by Domain FY22 Implementation Plan Requirements

The remainder of this Implementation Plan addresses additional performance requirements aligned with major Consent Decree domains of Front Door Diversion, Outreach, Assessment, Service Planning, Transitions, Community-Based Housing and Services development, Administration, and Implementation Plan development.

The Defendants are obligated to comply with Consent Decree requirements. However, while the standards for Consent Decree-level compliance are not changed, the FY22 Implementation Plan incorporates a process improvement strategy, that in several instances, identifies interim

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 6 of 22 PageID #:8881 benchmarks for Defendants’ satisfactory improvement toward Decree compliance in FY22. This is reflected in several activities throughout the Implementation Plan.1 Defendants acknowledge that for a number of Performance Outcomes, the compliance percentages will increase in future

Fiscal Years.

A. Front Door Diversion

Pursuant to the Williams Decree, no individual “whose Service Plan provides for placement in

Community-Based Settings shall be housed or offered placement in an IMD at public expense, unless, after being fully informed, he or she declines the opportunity to receive services in a

Community-Based Setting.” In FY22, the focus for the Front Door Diversion Program (FDDP) will be on system changes resulting from the FY21 Notice of Funding Opportunity for FDDP providers, resulting in a process in which FDDP referrals allow individuals to receive meaningful offers of community diversion (e.g., the written, pre-admission offer of Community-Based

Services and Settings (housing) and supports, consistent with the indivdiuals’ preferences and needs).

IP # Decree # Description Implementation Plan Strategy Metric Expected

Improvement/Outcome

FD #1 1 (Out of

Compliance)

All individuals will receive an appropriate screening and have a service plan developed prior to SMHRF admission.

Implement redesign of PASRR Plus system including pre-admission screening specifically for SMHRF admissions and referral to Front Door as appropriate.

Within one month after contract start date, schedule and hold planning, policy, and decision-making meetings:

· Within 2 months after contract start date, consult with Court

Monitor and

Plaintiffs on

SMHRF

prescreening process and tools and FDDP referral process, and provide meaningful opportunity for comment before the tool is finalized or implemented.

· Within 3 months after contract

Compliance with federal

PASRR requirements as established by Centers for

Medicare and Medicaid

Services.

Coordination between

SMHRF pre-screening activities and Front Door

Diversion program referrals.

90% of PASRR Plus screens result in clinically accurate and appropriate determinations.

1 The instances of improvement benchmarks during FY22 appear infra in the Implementation Activity tables at O1, O2, O5, A1, A2, SP2, SP3, T1, T2, T6-T9, CD4 and FD1-FD3.

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(QA)

presentation to

Court Monitor and Plaintiffs, including plans to monitor and report on clinical accuracy and appropriateness of SMHRF pre-admission screenings and referrals.

Within 4 months after contract start date, establish intergovernmental agreement with sister agencies specifying responsibilities for

PASRR and SMHRF prescreening process and parameters for information sharing.

Within 6 months after contract start date, finalize workflows for SMHRF admission and SLP admission and notifications to SNFs, etc.

Within 9 months after contract start date, go live with new PASRR and SMHRF prescreening system and processes, including QA mechanism(s).

FD #2 2 (Out of

Compliance)

No individual shall be admitted to a SMHRF who is appropriate for

Community-Based

Services without first being offered such services.

With input and advice from Court

Monitor and Plaintiffs’ Counsel, design and implement new SMHRF pre-admission screening process that coordinates with FDDP.

Establishment of a process with demonstrated linkages between the two programs.

New SMHRF preadmission screening process established within 4 months of PASRR

Plus contract start date.

Complete FY21 plan by revisiting policy on FDDP eligibility requirements, including reviewing data from FY21 regarding Medicaid

By 1/1/22, clarify

FDDP eligibility requirements related to Medicaid.

DHS will provide data and convene Parties and Court

Monitor for discussion by

12/31/21.

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Implement new Front Door Diversion

Program on 7/1/2021; ensure individuals with recommended community options are offered FDD.

# of individuals offered community-based options /# of individuals meeting

SMHRF admissions criteria via the

SMHRF pre-screening process who are appropriate for Community-Based services

# of FDDP individuals offered community setting/# of FDDP referred individuals who engage in program

85% of individuals determined to have met

SMHRF admission standards who are appropriate for

Community-Based Services are provided with a meaningful offer of

Community-Based

Services/Housing prior to

SMHRF admission.

85% of those who accept offer of Community-Based

Services/Housing receive

Community-Based

Services/Housing.

FD3 Implement and monitor effectiveness of new FDD data management system and quality review, and report to Parties and

Court Monitor on an ongoing basis

(including through Data Dashboards and Semi-Annual Reports).

# of FDD offers meeting minimum quality standards/# of

FDD offers

QA results to be reported to the Court

Monitor and the

Parties via data dashboards.

90% of FDDP Community-

Based offers include identification of specific services and housing options

(as needed) and

Consent Decree-related data is tracked.

IDHS will track and report to the

Parties and Court Monitor the outcomes of individuals screened and referred to

FDDP, but who do not enter into FDDP services.

# of engaged participants after referrals/ # of referrals

IDHS will address any identified barriers that may impact entry into FDDP services. IDHS will conduct ongoing analysis of reasons why individuals reject the

FDDP offer.

#of FDDP offers accepted/ # of FDDP offers made

B. Outreach

Outreach services required under the Decree in FY22 will be delivered through the

Comprehensive Program. Prime Agencies are responsible for all Williams activities in their assigned SMHRFs, from Outreach through post-Transition services. All Outreach efforts will continue to be funded through the Comprehensive Program grants.

For FY22, the Defendants will continue to address prior compliance findings related to the provision of information to Class Members about Community-Based Services and Settings

(housing) available under Williams programs. Defendants will also strengthen the processes by which they notify Class Members of their rights to non-retaliation from SMHRFs arising from

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Class Members’ interest in transitioning to the community, including participation (or non-participation) in the Comprehensive Program, and how allegations of retaliation are reported, investigated, and acted upon.

Initial Outreach is to be conducted within 60-70 days of admission to a SMHRF. Further

Outreach for Class Members who either refuse initial Outreach or decline to participate in the

Comprehensive Program is to be conducted quarterly, or within 14 days of a Class Member’s request for Outreach services. These timeframes are requirements of Prime Agencies per the

Comprehensive Program and will be enforced via UIC-CON and IDHS/DMH through the

PIP/CAP processes.

Improvement/Outcome

O1 4 (Partial

Inform CMs about

Settings, including

Permanent Supportive

Housing, and services and financial supports available.

Use new data management system for tracking new and existing CMs to ensure and enforce provider contractual requirements regarding timely access to

Outreach for 100% of CMs.

# of CMs who receive

Outreach/# of CMs requiring Outreach in reporting period

85% of CMs both newly admitted and currently residing in facilities receive

Outreach, including information on their rights to live in community, community-based settings, housing, and services, and financial support Class

Members may receive in these settings, within 60-70 days of admission (“initial

Outreach”) and with appropriate frequency

(“follow-up Outreach” for those not proceeding in

Transition process), defined as one Outreach per quarter for those who are not proceeding to Transition.

O O2 Continue expansion of Peer Support

Ambassador program and In-Home

Recovery Support program, increasing implementation of Peer Bridger-like model using NAMI’s In-Home

Recovery Support program and existing peer staff through Prime Agencies.

# of CMs who are hesitant/decline programming offered

Peer Support/# of

CMs who decline programming (will be tracked for future comparison as well to identify rate of decline)

85% of Class Members hesitant about transitioning to the community (CM who do not accept Outreach or decline to participate in the program) are offered additional Outreach and education by Peer Support.

O3 5 (Out of

CMs will not be subject to retaliation in response to any option selected, nor shall they be pressured to refrain from exploring appropriate

Continue to enforce posting of retaliation poster in facilities and IDPH track CM reports of retaliation using

Complaints processes as outlined in

Rules/Regs.

IDPH will develop a method to track

# of facilities with non-retaliation poster publicly displayed /# of facilities

# of CMs with claims

100% of facilities will have non-retaliation poster prominently displayed by

9/30/21.

100% of reports by or on

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and report data on CM retaliation by

SMHRF/SNF or staff and enforce and track/report on recourse imposed by

IDPH on facilities. Each month, IDPH will review complaint allegations entered into the central complaint registry and ASPEN system to review whether there are retaliation-related allegations. These allegations, whether they are substantiated or non-substantiated, will be entered into a monthly report with descriptions and final enforcement outcomes, if finalized by that time. This system will be developed and be operational by

7/31/21.

of retaliation investigated/# of CMs reporting retaliation behalf of CMs alleging facility retaliation will have their claims investigated through the regulatory process, provided those claims are reported to IDPH directly or through any other

3rd party or entity. All such investigations and outcomes will be reported in semi-annual compliance reports.

All CMs will have access to information regarding their rights to non-retaliation through prominently displayed posters and through continued engagement with provider staff).

O4 4 (Partial

Inform CM about

Settings, including

Permanent Supportive

Housing, and services and financial supports available.

During the first or second mandated quarterly site visit in FY22 all

SMHRFs, Regional Ombudsmen will inquire with Resident Council President to encourage them to allow a presentation on the Long-Term Care

Ombudsman Program at a future meeting. If the President agrees, a presentation will be made at the next regularly scheduled meeting. All agreed-upon presentations will occur by

6/30/22.

# of Ombudsman presentation offers /# of SMHRFs

# of Ombudsman presentations/# of

SMHRFs

Ombudsman invitations

100% SMHRFs in State are provided with an invitation for presentation.

Before the end of FY 2022, the Ombudsman will make a facility presentation to all facilities that allow it.

The Ombudsman will provide residents with contact cards and informational materials summarizing residents’ rights, the role of

Ombudsman, and how to contact their Ombudsman for assistance.

O5 49 (Partial

The Implementation

Plan shall describe methods for engaging residents, including where appropriate, providing reasonable opportunities for residents to visit and observe community-based settings

Develop capacity and programming to introduce and facilitate Class Member observation/visits to community-based settings, for those CM appropriate for such a visit by 10/2/21.

# CM offered community visit/# of

Class Members receiving Outreach

# of CM participating in a community visit/# of Class

Members accepting offer/requesting community visit

70% of CM hesitant to participate, who are appropriate for a community visit are offered such a visit

(including housing options)

85% of Class Members who accept an offer of a community-visit, visit a community-based setting

(including housing options).

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C. Assessment

All Prime Agencies funded under the Comprehensive Program must have Assessors (formerly referred to as Evaluators) with appropriate qualifications. In addition, training will continue to be required of all Prime Agency Assessment staff to ensure use of best- and evidence-based practices in engagement and clinical skills, Consent Decree adherence, and reduced subjectivity in Assessments, basing determinations on services and supports both needed by the Class

Member and available under one of the State service arrays (Waiver services, Comprehensive

Program, etc.).

Beginning on July 1, 2021, a new Rapid Assessment will be utilized by Prime Agency staff responsible for Assessments via the new CASPIO data system. The Rapid Assessment will streamline and shorten the Assessment process thus more quickly determining CMs who are or are not recommended for Transition. For those who are recommended for Transition, the new

Rapid Assessment will allow them to more quickly proceed to the Service Planning part of the transition process. The Rapid Assessment includes all clinical, medical, and behavioral determination factors included in the legacy assessment tool, but removes certain areas that are more appropriately included in the Service Planning tool for Class Members recommended to

Transition (e.g., Class Member interests, housing preferences).

An Initial Assessment is to be initiated by the assigned Prime Agency for each consenting Class

Member within 14 days after the Class Member agrees to participate in the Comprehensive

Program (determined through a positive Outreach outcome). Assessments shall be sufficiently completed before proceeding to the Service Planning phase. Assessments must then be updated annually at a minimum for Class Members not transitioned within one calendar year of the initial

Assessment. Class Members may also request an Assessment at any time. Prime Agencies are responsible for achieving these timeframes and performance will be enforced via UIC-CON monitoring and IDHS/DMH PIP/CAP process.

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Improvement/Outcome

A1 9, 10, 11, 12, 13, 14

(Partial, Out of

Compliance and In

Assessments must be completed by Qualified

Professionals and CMs approached with appropriate frequency;

any CM who declines an Assessment or who has declined to move after a recommended

Assessment, may request another

Assessment at any time; Assessments shall be completed annually; reasons for a

CM opposition to leaving must be explored and addressed.

Enforce Assessment performance metrics with Prime Agencies, in line with policy and procedures, including minimum standards for Qualified

Professionals, with an emphasis on positive outcomes, engagement of CM, timeliness of Assessments.

# of CMs with a completed

Assessment by QP/# of CMs who require

Assessment

# of CMs who receive

Assessment per

Comprehensive

Program timeliness requirements (Initial, requested, annual)/#CM requiring Assessment

(Initial, requested, annual)

100% of Assessments are facilitated by Qualified

Professionals per

Comprehensive Program requirements.

85% of Class Members receive Assessments in compliance with

Comprehensive Program timeliness requirements

(initial assessments initiated within 14 days after positive outreach outcome, annual assessments within one year of prior assessment).

A2 (IP Only)

Assessments shall be sufficient to meet transition benchmarks.

During FY22, require Prime Agencies to conduct enough Assessments to allow for a sufficient flow of

Recommended CM to meet Transition requirements.

N/A 85% of Class Members receive Assessment in compliance with timeliness requirements.

D. Service Planning

In FY22, the Defendants will continue to address prior compliance deficiency findings and improve performance and compliance related to Service Plan development, use, and timeliness.

Monitoring and quality review of Service Plans submitted under the Comprehensive Program will continue to occur and be reported via the monthly data dashboards reported to the Parties and the Court Monitor. Defendants and their grantees/contractors will review Service Plans to ensure each is person-centered and includes documented input from the Class Member, facility staff, family, and/or guardians, as well as others, as requested by the Class Member. Reviewers will also check that Service Plans include specific service, support, education, housing and employment services needed by the Class Member and document his/her functional status, psychosocial status, risk assessments and mitigation strategies, medication status, healthcare utilization, and community engagement. Service Plans must also document Class Members’ strengths, needs, and desires and consider these in developing the Plans. Finally, Service Plans must contain goals and timelines to transition Class Members, both those recommended and not recommended as a result of the Assessment process.

A Class Member’s initial Service Plan must be completed by the Prime Agency within 45 days after the Class Member is Assessed, both for those recommended and not recommended to

Transition. While the Assessment need not be completed within 14 days, sufficient progress

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14 days prior to Transition. These timeframes will be monitored via UIC-CON and enforced by

IDHS/DMH through the PIP/CAP process.

Improvement/Outcome

SP1 15, 16, 17,

20, 21, 22, 23

(Out of

Service Plans must be person-centered, include

CM and others, be promptly developed, and contain services, supports, objectives, and goals.

Issue and enforce performance improvement plans/corrective action plans, in accordance with established

IDHS policy, with Prime agencies whose SP submissions do not meet

Comprehensive Program requirements, either in terms of timeliness or quality, as identified by DMH/UIC-CON.

# of providers who fall below SP timeliness & issued

PIP/CAP /# of providers who fall below SP standards

# of providers who fall below quality standards & issued

PIP/CAP /# of providers who fall below SP quality standards

100% of providers who are significantly below timeliness performance requirements for more than one consecutive monthly reporting period, or 3 months in 2 consecutive quarters, are issued

PIP/CAP.

100% of providers who are significantly below the quality standards performance requirements for more than one consecutive monthly reporting period, or 3 months in 2 consecutive quarters, are issued PIP/CAP.

SP2 By 7/1/21, use new data management system for tracking transitioning CMs to ensure and enforce provider contractual requirements regarding SPs for all CMs.

# of CMs with completed SPs before transition date/# of

CMs who transition

90% CMs transitioning to the community have a

Transition SP completed before the date of Transition.

SP3 Enforce Service Plan performance metrics with Prime Agencies, consistent with program policies and procedures, with an emphasis on quality.

# of SP completed timely /# of SP required

# of SP that meet quality standards/# of

SP required

85% of Service Plans are completed per timeliness requirements.

85% providers meet quality standards in Service

Planning to CMs.

85% of Class Members who complete Outreach will have their Service Plans completed within 59 days of a positive outreach outcome.

SP4 Enforce referrals to Employment

Services where included in Service

Plan.

# of CM referrals to

Employment

Services/# of CM

Service Plans recommending

100% of CM whose Service

Plan includes Employment

Services are referred to

Employment Services.

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Employment Services

E. Transitions

Defendants will transition at least 150 Class Members by 12/31/21. Defendants will transition a total of 400 Class Members during FY22 (by 6/30/22).

Improvement/Outcome

T1 25, 28, 24, 27

(In

Compliance/

Partial/Out of

CM shall be offered the opportunity for placement in

Community-Based

Services within 120 days of the date of their Service Plan; CM shall be transitioned into Permanent

Supportive Housing

(PSH) unless they meet one of the three exclusionary criteria;

CM concentration in buildings shall not exceed 25% (for over 4 units) or 50% (for 4 units or less); housing will remain available post-transition in the event if inpatient treatment.

Transition required number of Class

Members.

Enforce transition performance metrics with providers, in line with

Comprehensive Program contractual obligations, with an emphasis on outcomes and quality.

# of CM transitioned/# of required transitions

# of Prime providers who met contractual transition target/# of

Prime providers

# of CMs transitioned within 120 days of service plan/# of CMs recommended to transition with SP created within 120 days of service plan/# of CMs transitioned

At least 150 Williams CM transitioned by 12/31/21;

400 total Williams CM transitioned by 6/30/22.

100% of Prime providers meet their contractual obligation of transitions per quarterly reporting period.

65% of transitioned Class

Members transitioned within

120 days of their service plan.

T2 By 7/1/21, use new data management system to track Assessment/SP recommendations for CMs recommended to Transition to settings other than PSH or not recommended to transition, to determine compliance with exclusionary criteria protocol.

to PSH/#of CMs transitioned

# of CM assessments/SPs recommended for non-PSH setting/# of

CMs recommended for transition to any setting

# of CM assessments/SPs recommended for non-PSH setting meeting exclusionary criteria or CM choice/# of CM assessments/SPs recommended for

85% of CM recommended to transition to a non-PSH setting meet exclusionary criteria or are documented as based on CM choice.

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T3 Investigate and remedy pipeline issues through dedicated resource development to meet the timeliness requirement for moving from Initial

Service Plan to transition (120 days).

Specifically, receive quarterly reports from Prime agency, with analysis by

UIC-CON on pipeline barriers to inform any necessary systems changes.

N/A Major pipeline issues impacting providers’ ability to achieve transition benchmarks are identified on a quarterly basis to allow for timely resolution or identification of alternative approaches. Updates on identified pipeline issues, strategies for resolution and outcomes will be included in parties’ meetings on a quarterly basis.

T4 IDoA Homecare Ombudsman Program staff (serving individuals receiving HFS

Waiver services such as IDoA CCP-

Elderly, IDHS- HSP, HIV/AIDS, TBI, as well as advocacy services to MMAI recipients) will conduct a recorded webinar to all Prime Agencies in collaboration with IDHS w/in 30 days of the start of FY22. The Home Care

Ombudsman WebEx will provide an overview of the Home Program including the goal and purpose of the

HCO Program, the populations served, the role of the Home Care Ombudsman, services available through the program, and other applicable resources for the waiver population.

This training/webinar will be required for Prime Agencies and included in the

Comprehensive Program training modules.

IDoA Homecare

Ombudsman staff will send the link for the recorded webinar to the Prime agencies by

8/13/2021. Prime

Agencies will be required to report on completion of staff training.

Upon transition, Primes will ensure that the IDoA

Homecare Ombudsmen brochure is included in the

CM’s transition packet.

T5 Continue to promote and support the implementation of HFS’s Community

Transition Initiative with HealthChoice

Illinois health plans:

-Amend master HealthChoice Illinois

Contracts to specify the required minimum transition elements of the

Williams/Colbert Decrees and to require monthly reporting on those elements by

12/15/21;

-Monitor and resolve operational issues using existing management and communications platforms (including

CEO meetings, weekly operational calls, quarterly business reviews, etc.).

monthly updates to Court Monitor;

-Prepare a written report assessing the

# of CMs transitioned by the Community

Transition Initiative

(CTI) in FY22.

# of HealthChoice

Illinois contracts amended/# of

HealthChoice Illinois contracts

Increase number of CTI transitions in FY22.

100% of HealthChoice

Illinois contracts amended by 12/15/2021.

Prompt resolution of identified operational issues.

Monthly updates to Court

Monitor regarding operational issues resolved.

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 16 of 22 PageID #:8891 impact of the CTI by analyzing available CTI data from HealthChoice

Illinois health plans. The report will include information about how the plans operationalized CTI efforts, as well as metrics showing transitions achieved under the CTI in FY21 compared to FY22 (with a commitment to increasing the number of transitions year over year), and benchmark comparisons as data comparability and availability permits, such as: between

Williams and Colbert Class Members and non-Class Members; between CTI and Comprehensive Program; between individuals with mental illness, substance use disorder, physical disability, or a combination of these conditions; and geography.

-Continue to require online Olmstead training for all Care Coordinators newly hired by HealthChoice Illinois Plans.

Ongoing, with annual confirmation of

HealthPlan attestation.

-Using data from the first three quarters of FY22, consider and discuss with the Court Monitor and the Parties creating numeric transition requirement for CTI for FY23 by April 30, 2022 and report to Parties and Court Monitor.

A report outline will be developed by

November 15, 2021, and shared and discussed with the

Court Monitor. The report will be produced at the end of the fiscal year and submitted to Parties by June 30, 2022.

# of newly hired care coordinators trained/# of newly hired care coordinators

Report submitted on time and in accordance with agreed upon outline.

85% of newly hired care coordinators trained by

6/30/2022.

T6 26 (Out of

In the event a SMHRF seeks to discharge a

CM prior to housing being obtained, the

CM will not be left without appropriate housing options.

Continue to use IDPH’s Involuntary

Transfers/Discharges (ITD) process for reviewing and approving involuntary discharges to ensure involuntary discharges are in accordance with the rules.

IDPH’s Hearings Unit will be provided a list of approved contacts for alternative housing and community-based settings. This approved list will be provided by IDPH to the CM at the

ITD hearing so that residents subject to involuntary transfer and discharge has been apprised of their options for community-based assessments and placement opportunities. Hearings Unit staff will discuss the available options with the CM if the CM is willing.

# of involuntary discharges of CM handled via ITD process and given information about

Community-Based

Services in

Community-Based

Settings in that process/# of CM involuntary discharges

90 % of CMs subject to involuntary discharge are provided resources for

Community-Based services and supports.

T7 IDoA Regional Ombudsmen to identify and contact CMs who receive involuntary discharge notices. If the

CM is interested in Ombudsman assistance, the Ombudsman will coordinate with IDPH and the CM

# of involuntary discharge notices sent to CMs quarterly/#

Class Members with involuntary discharges

90% of CMs who receive involuntary discharge notices are offered

Ombudsman assistance.

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 17 of 22 PageID #:8892

Primes on behalf of the CM/resident.

Tracking will be required by the

Ombudsman on a quarterly basis, and final reports will be reported bi-annually (semi-annual compliance reporting)

# CMs requesting

Ombudsman assistance/#CM receiving

Ombudsman assistance

T8 For all Class Members appropriately approved for discharge, continue to use and enforce Prime/MCO offering of supports pre-/upon discharge.

# of recommended

CMs discharged prior to transition offered

Community-Based

Services/Housing w/in 60 days of discharge /# of recommended CMs unexpectedly discharged

85% of recommended CMs unexpectedly discharged prior to transition are offered

Community-Based Services and Housing within 60 days of discharge.

T9 For any CM who transitioned to a non-

PSH setting, the Prime Agency will evaluate CM interest and appropriateness to move to PSH. If evaluation reveals the Class Member desires PSH but is not ready or appropriate, a plan with goals to prepare

Class Member for PSH will be developed within 30 days.

85% of CMs in non-PSH settings are offered the option to move to PSH in the future.

85% of CMs wanting to move to PSH but not ready, receive plan with goals within 30 days of PSH evaluation.

85% of CMs who engage in a secondary transition plan to move to PSH and who are deemed appropriate, receive an offer to move to PSH within 60 days.

F. Capacity and Housing Development

The Defendants are responsible for ensuring the adequacy and appropriateness of treatment, services, supports, and housing necessary to offer Community-Based Services and supports to individuals prior to admission to a SMHRF, as well as for transitioning Class Members currently residing in SMHRFs/SNFs, subject to the State-Plan and Medicaid service array. In FY22, the

Defendants will conduct a capacity and gaps assessment for a number of service areas, including but not limited to: Assertive Community Treatment/Community Support Teams, Substance Use

Disorder services, Peer Supports, Employment Supports, In-Home Waiver Services, and

Housing (including both overall capacity/need by type of housing and geographic preferences of

Class Members).

The analysis will include comparison of the current capacity for these services to the existing

Service Plans of Class Members both in SMHRFs/SNFs, as well as in the community. The

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 18 of 22 PageID #:8893 analysis will also utilize other data sources (e.g., demographic data, HFS data as appropriate and available, Prime agency reports) and also include a projection of needed services and housing for

FDDP participants and Class Members transitioned in FY22. The written capacity assessment report will be submitted to the Parties and Court Monitor by January 1, 2022. A written plan outlining strategies to close identified gaps by developing capacity will be submitted by March 1, 2022.

Improvement/Outcome CD1 36, 37 (Out of

Ensure availability of services and supports of sufficient quantity and quality to meet

Decree requirements;

Provide sufficient measures, consistent with the preferences, strengths, and needs of

CM to provide

Community-Based

Services and Settings.

By 1/1/22, develop Bridge Subsidy to

Permanent Housing Choice Voucher strategic plan to transition CMs from

Bridge Subsidies to other permanent housing options and includes plan for ongoing maintenance.

N/A Strategic plan delivered by

1/1/22, identifying a process for assisting CMs to transition from Bridge

Subsidies to other permanent housing options.

CD2 By January 1, 2022, complete comprehensive Housing & Services

Capacity Development gaps and capacity analysis with continued use of data related to CM geographic locations and housing preferences.

By March 1, 2022, complete a capacity development report based on identified gaps, to inform utilization of current housing and services capacity, and future planning and development.

N/A Deliver gaps analysis by

January 1, 2022.

Deliver capacity development plan by March

1, 2022.

CD3 Following the delivery of the plan, provide to Parties and Court Monitor ongoing updates on capacity expansion.

Updates provided in May and June 2022.

CD4 Make bridge subsidies available to

Class Members recommended for transition but unable to do so due to lack of income, who agree to participate in SOAR and/or employment supports, or who have other means of potential income identified. The data dashboards will report acceptance and refusal rates, the number of Class Members who cannot proceed due to refusal of SOAR and/or employment supports, and the number of successful transitions due to this effort.2

# of qualifying Class

Members with lack of income transitioned with bridge subsidies/# of Class

Members with lack of income and recommended to transition with identified potential income source

(SOAR, employment or other)

75% of Class Members on financial holds who agree to participate in SOAR, employment supports or who have a potential income source identified, transition with bridge subsidies.

CD 5 Identify and initiate discussions with additional providers to enter into grant agreements under for the

Comprehensive Program, focusing on

By 7/15/21, research, seek referrals to, and initiate discussions with potential

Dependent on outcome of discussions, add providers to serve Class Members with medical/psychiatric

2 The Plaintiff Class reserves the right to object to Defendants’ bridge subsidy program in the event that a Class

Member is denied a bridge subsidy because they refused to participate or agree to participate in SOAR or employment supports.

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 19 of 22 PageID #:8894 those with a Care Management focus, to better serve Class Members with complex medical and psychiatric needs.

providers;

By 7/31/21, hold discussions with potential providers about establishing

Comprehensive

Program grant agreements.

If the initial meetings with potential new providers do not result in expanded provider capacity, Defendants will continue seeking new providers.

complexities under the

Comprehensive Program.

G. Administration

As in prior years, the administrative activities associated with implementation of the Williams Consent

Decree remain Defendants’ responsibility and will include the following for FY22 (much of the activity described below will be done in conjunction with the Colbert Decree, i.e., meetings, etc.):

Preparing and submitting semi-annual compliance reports, which will include updates on

SMHRF accreditation status and critical incident reporting;

Holding regular meetings with the Parties and Court Monitor (including Small Parties meetings on targeted issues), on an agreed-upon schedule. One such meeting per quarter will include attendance of UIC-CON for discussion regarding Primes performance and

PIP/CAP actions undertaken to address underperformance. Reports regarding Prime performance and PIP/CAP activities will be provided in advance of the meeting;

Holding biannual meetings with individually named Defendants (not including the

Governor) at two points during FY22: 1) In July 2021 at or around initiation of the FY22

Implementation Plan and 2) at the required meeting (Winter 2021) to discuss Defendants’ plans to come into compliance with Court Monitor rated partial- and out-of-compliance findings from FY21 implementation;

Providing monthly Data Dashboards with reliable performance and trend data that

Defendants confirm and represent as reliable, with the dashboard content as agreed upon with the Court Monitor and the Parties;

Providing information and/or documentation based on reasonable requests of the

Plaintiffs or Court Monitor;

Supplying quarterly budget briefings, including updates on expenditure of funds and potential lapses as set forth below;

Convening internal IDHS and State-Only meetings to discuss issues, strategies, and policies related to implementation and compliance;

Case: 1:05-cv-04673 Document #: 572 Filed: 08/18/21 Page 20 of 22 PageID #:8895

Participating in regular communications between the Olmstead Compliance Officer

(and/or her staff or designee) and Plaintiffs’ Counsel and Court Monitor; and

Addressing Defendants’ staffing needs and modifications. Subject to State personnel requirements, collective bargaining agreements, and any other legal requirements, these will be identified via reassignment/revision of duties, or new staff hiring. Updates to the

Parties and Court Monitor will be provided on staffing determinations, vacancies, and hiring efforts as part of the Large Parties meeting agendas.

IP# Decree # Description Implementation Plan Strategy Metric

Improvement/Outcome

A1 IP Only N/A Monitor and report on Consent

Decrees’ budgeted funds spending on a quarterly basis. Include plans to reallocate potential lapsed appropriations to achieve compliance

(as permitted). (Reporting schedule limited to fiscal reporting requirements/timeframes. Reports made available: 11/30/21; 2/28/22; 5/31/22;

8/31/22).

N/A Regular monitoring and reporting of quarterly spending.

Quarterly plan to address potential lapses delivered.

A2 IP Only N/A Monitor and report on FDDP and

Comprehensive Program services delivered to individuals/CM, and service outcomes on a monthly basis via

Data Dashboards. Monthly reporting generated by CASPIO will include:

Issues reported by providers

(facility/CM access problems, resource needs, etc. and proposed resolutions with outcomes), Corrective Action

Plans issued/penalties imposed for providers who do not meet performance standards, data on rapid Medicaid application process, SMHRF/SNF barriers, employment data, and SOAR activities.

N/A Regular monitoring and monthly dashboards delivered.

A4 IP Only N/A In FY22, continue to assess Consent

Decree staffing needs across all agencies.

N/A By December 30, 2021, Defendants will submit a consolidated report to Parties and the Court Monitor that identifies the positions, staff name(s) who occupy the position(s), or for…