PASRR B36696 2021-23-008-3 SEFS 050123.pdf

Sole Source Justification Form

Version 7.01 Page 1 of 7

Bulletin Reference Number 23-478HFS-MEDPR-B-36696

Requesting Agency/University Illinois Department of Healthcare and Family Services

Sole Source Justification Form - Part I Section I - General Information

Department/Bureau/Section: HFS - Division of Medical Services - Bureau of Long Term Care

Need Identified Date: Aug 18, 2021 Supply/Service Need By Date: Jun 1, 2023

Project Title: Pre-admission Screening and Resident Review - Amendment #2

Vendor: Maximus US Services, Inc.

Provide a description of the supplies or services required: SMHRF Continued Stay Reviews and Dementia Assessments

Value: Estimated Value of Initial Term, this Change Order or Amendment: 38,795,455

Will this Sole Source amend a Professional or Artistic Services contract? Yes No

*Sole Source may not be used for amendments for Professional or Artistic Services if the amendment would increase the value by more than 5% of the initial award or extend the term by more than 60 days.

Type: One-Time Amendment or Change Order

Section II - Proposed Term

One-Time Purchase Term Contract

Estimated Contract Begin Date: Nov 4, 2021

Estimated Contract End Date: Nov 3, 2025

Number of Potential Renewals: 2

Length of Each Renewal in Months: 36

Total Value of All Renewals: 24,494,889

If a Term Contract, does the term, including renewals, exceed 12 months? Yes No

If yes, provide a detailed justification including any economic benefit received for agreeing to a multi-year term:

Aligning the amendment to the multi-year term of the existing contract and its renewals is critical for establishing continuity of services.

The Agency's need for continuity stems from the state's fragmented long term care system. The state is under scrutiny to streamline, coordinate, and track services to comply with the Americans with Disabilities Acts and the U.S. Supreme Court Olmstead decision. As such, is imperative to integrate the services under this amendment with the other services provided by the vendor through the full term and renewals of the contract.

Section III - Funding Source Select the type of funding to be used (Check all that apply): State Appropriate Funds Federal Funds Other (Explain):

State funds with federal Medicaid match.

Section IV - Sole Source Justification

This purchase is economically only available from a single source primarily because it is: (If "Other" explain in one sentence)

Critical Changes to the Existing Contract are Necessary and Best Accomplished by the Contract Holder

Are there secondary justification(s) for this sole source? Yes No

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Bulletin Reference Number 23-478HFS-MEDPR-B-36696

Requesting Agency/University Illinois Department of Healthcare and Family Services

Another justification that this purchase is only available from a sole source is because it is:

Compatibility of Equipment, Accessories, Replacement Parts or Service

Another justification that this purchase is only available from a sole source is because it is:

To comply with Colbert and Williams Consent Decrees (attached)

Section V - Purchase History

Has the Agency or University Purchased these supplies or services in the past? Yes No

Section VI - Business Rationale

1. Provide a detailed explanation of the need for the supplies or services:

Please see attached Narrative for Section VI, 1 response.

2. Provide a list and describe in detail the specifications required to satisfy the need:

Please see attached Narrative for Section VI, 2 response.

3. Provide detail explaining the justification selected in Section IV to explain why the requested supplies or services are the only ones available that can satisfy the agency or university requirements?

Maximus is equipped to perform the Continued Stay Reviews and the only vendor that can perform this service without adding delays and/or increasing the risk of vital information not being added to the overall information flow relied upon by everyone providing services to class members. This is a highly customized new service fully rooted in the preadmission assessments and technology which Maximus is already providing in Illinois. Maximus and the technology the state uses through the contract with Maximus are well known to the SMHRF staff. Specifically, Maximus currently receives the referral for the preadmission assessment through AssessmentPro, Maximus then completes the preadmission assessment and creates the outcome in AssessmentPro, the admitting SMHRF uses the Pathtracker function in AssessmentPro to add the individual to the census, and Maximus currently repeats preadmission assessments for individuals nearing the end of a short-term SMHRF stay. Attempting to add a different vendor would, at a minimum, (a) require additional state resources, (b) add additional technology to this process, (c) add more hand-offs where information must be passed to different entities and they need to pick up and provide services in a timely manner, and (d) require additional training of all involved (above and beyond training required to add this service by Maximus). Moreover, as described above, among the critical challenges that the state is seeking to address are to eliminate unnecessary delays in services caused by information failing to be available and efficiently tracked among all involved entities. Using another vendor would do the opposite of addressing that challenge by adding a layer of complexity to a service landscape that is already challenging for the state to oversee and difficult for Class Members to navigate.

The leadership and performance of Maximus in developing and implementing the new SMHRF preadmission assessment under this contract has exceeded expectations of the Agency. They have consistently demonstrated high levels of quality, transparency, and accountability – including in meetings involving the Williams/Colbert Court Monitor. No other vendor has the experience that Maximus has already gained working with Parties to the Williams Consent Decree. Without such experience, other vendors will require longer lead time to develop the service.

Additionally, the agency would incur additional costs if another vendor were to provide this service. A different vendor would have to build redundant infrastructure, which would be costly. Moreover, the agency would need to invest substantial human and financial resources into coordinating the work of two vendors and establishing an interface, either electronic or manual, between their systems.

As with the continued stay reviews, Maximus represents the only acceptable option for providing the dementia assessments. Under the contract, Maximus is currently providing preadmission assessments for individuals seeking to enter Colbert Nursing Facilities and follow up assessments of many residents. As a result, Maximus staff is currently in the Colbert facilities on a regular basis and interacting with facility staff. The technology provided by Maximus – AssessmentPro – is currently providing the critical tool to bring all of the assessment information together. The Court Monitor has noted the strong work of Maximus in performing its current responsibilities.

The addition of this service falls under the contract provision at 1.2.5.4, “Vendor must have a system capable of adding other assessments.” To attempt to conduct a separate procurement for this service would clearly run the risk of doing more of exactly what is creating significant obstacles for the state and class members – adding unnecessary complexity and delay to a system we are required to work hard to simplify.

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Bulletin Reference Number 23-478HFS-MEDPR-B-36696

Requesting Agency/University Illinois Department of Healthcare and Family Services

4. What are the unique features of the supplies or services that are not available in any other product or by any other vendor? Provide specific quantifiable factors/qualifications:

Maximus plays a pivotal role in the Illinois long-term care landscape generally, and the Williams and Colbert compliance work specifically. No other centralized vendor has the experience delivering clinical assessment services to Class Members. No other vendor has the confidence and trust of the federal Court Monitor. And as noted above, their work on Continued Stay Reviews and Dementia Assessments will be integrated into processes already in place and working well, rather than adding a layer of complexity which would be unavoidable with any other vendor and would likely exacerbate ongoing problems involved in working with class members. The compatibility of the system to work as one is of the utmost importance to the user, the Court Monitor, and the Agency.

5. Has the Agency or University considered alternative supplies or services to satisfy their need? Yes No

5a. If no, why weren't alternatives evaluated?

Alternative services would not satisfy the obligations of the state under the Consent Decrees and the Implementation Plans.

6. Are there resellers or distributors?

Yes No N/A

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Bulletin Reference Number 23-478HFS-MEDPR-B-36696

Requesting Agency/University Illinois Department of Healthcare and Family Services

7. What efforts were made to get the best possible price (i.e. did the agency/university negotiate) and how did you determine the price for this purchase is considered fair and reasonable?

The Agency has conducted analyses to determine whether Maximus is offering a good price for these two services. We looked at similar services being provided in Illinois to comparable populations and concluded that the pricing is fair and reasonable.

SMHRF Continued Stay Reviews The Agency compared specifications and pricing for the Continued Stay Reviews of individuals residing in SMHRFs to the specifications and pricing for the Admission Assessments currently covered by the Maximus contract for individuals seeking admission to a SMHRF.

The Admission Assessment involves the face-to-face evaluation of an individual seeking admission to a SMHRF and documentation of the outcome of that evaluation and as such, is significantly less intensive and time consuming than the SMHRF Continued Stay Reviews.

SMHRF Continued Stay Reviews, by contrast, include multiple dimensions, informants, and extensive document review. As described in Section 2, the Continued Stay Reviews include an assessment of the individual residing in a SMHRF. However, the service is far broader and includes: a review of the individual’s experience and treatment history in the SMHRF facility; interviews with SMHRF staff and other sources of collateral information such as the individual’s family members and guardian; and a review of treatment needs and discharge planning to date. In addition to documentation of the individual’s assessment, the documentation will likewise include a report on SMHRF compliance with treatment plans and progress preparing the individual for transition to community settings.

It is reasonable to anticipate that the more detailed, multidimensional, and resource-intensive services of the Continued Stay Review might cost 300-400% more than the narrower, more straightforward Admission Assessment. The unit price for each Continued Stay Reviews is $476.44, 215% higher than the unit price of $220.85 for SMHRF Admission Assessments that was secured through competitive procurement. Considering the scope and intensity of the service (not to mention the behavioral health workforce shortage in Illinois), the Agency believes the price for Continued Stay Reviews is fair and reasonable.

Dementia Assessments The Agency compared Maximus specifications and pricing for Dementia Assessments to a similar dementia confirmation service currently provided by the University of Illinois Chicago Department of Psychiatry (UIC-Psychiatry) on behalf of our sister agency, the Department of Human Services (DHS). Under this arrangement, UIC-Psychiatry provides dementia assessments at a rate of $255.00/ hour, with each assessment being completed in one hour. In contrast, Maximus’ unit price for the comparable service is $179.07 per assessment, 30% less than the UIC-Psychiatry rate. Based on this analysis, the Agency believes the price for Dementia Assessments is fair and reasonable.

INITIAL TERM: 14,300, 566; RENEWAL 1: $13,171,341; RENEWAL 2: $11,323,548

FY23 $2,910,692; FY24 $4,666,835; FY25 $5,088,820; FY26 $4,605,331; FY27 $4,444,168; FY28 $4,444,168; FY29 $3,828,237; FY30

3,774,516; FY 31 3,774,516; FY32 1,258,172

8. Will this purchase obligate the State to this vendor for future purchases such as maintenance, licensing or continuing need?

Yes No

9. What will be the financial or other impact to the State if this sole source is not approved and a competitive bid is required?

To attempt to conduct a separate procurement for this service would clearly run the risk of doing more of exactly what is creating significant obstacles for the state and class members – adding complexity and delay to a system we are mandated to simplify.

More critically, a competitive bid will create delays in implementing critical services for Williams and Colbert Class Members. Delays in implementing continued stay reviews for SMHRF residents risk both unnecessary institutionalizations of Medicaid enrollees as well as non-compliance findings in federal court under the Williams Consent Decree. Delays in implementing Dementia Assessments present the legal risk of non-compliance findings in federal court and put the state in a position of having fewer tools to prevent unnecessary institutionalization of individuals with serious mental illness as required by the ADA, Olmstead and the Consent Decree.

As discussed above, the State seeks to eliminate delays in services caused by information failing to be available and efficiently tracked among all involved entities. Using another vendor would do the opposite of addressing that challenge by adding a layer of complexity to a service landscape that is already challenging for the state to oversee and difficult for Class Members to navigate.

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Bulletin Reference Number 23-478HFS-MEDPR-B-36696

Requesting Agency/University Illinois Department of Healthcare and Family Services

10. Is there any additional information you would like to add to justify this sole source?

No.

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Bulletin Reference Number 23-478HFS-MEDPR-B-36696

Requesting Agency/University Illinois Department of Healthcare and Family Services

Section VII

Requesting Department Representative

Requesting Department Signature Required

I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed.

Date May 1, 2023

Printed Name Gabriela Moroney E-mail Address Gabriela.M.Moroney@illinois.gov

Phone Number 217-843-1415

State Agency Bureau/Division Head or University Purchasing Director Approval and Signature Required

I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed. (All prior form fields will lock once this e-signature is completed)

E-mail Address Devin.McQuillan@illinois.gov

Phone Number 217-558-3059 Date May 10, 2023

Printed Name Devin McQuillan

Agency Bureau/Division Head or University Purchasing Director and Not a Designee

SPO Approval and Signature Required

I have reviewed and understand the contents of this Sole Source Justification and agree with the State Agency or University determination.

I have reviewed and understand the contents of this Sole Source Justification and do not agree with the State Agency or University determination. As a result, the State Agency or University must explore other sourcing methods to satisfy their need.

State Purchasing Officer Signature Phone Number 217-993-1719 Date 5/10/2023

Printed Name Jennifer Klein E-mail Address jennifer.klein@illinois.gov

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Bulletin Reference Number 23-478HFS-MEDPR-B-36696

Requesting Agency/University Illinois Department of Healthcare and Family Services

Sole Source Justification Form - Part II Section I - General Information

Project Title Pre-admission Screening and Resident Review - Amendment #2

Vendor Maximus US Services, Inc.

Initial Date of Procurement Bulletin Posting 5/10/2023

Was a Sole Source hearing held per 30 ILCS 500/20-25?

Yes - Complete Section II and III below (Section II will only be visible when this option is selected)

No - Section II not required, go to Section III below Section III - CPO Approval and Signature Required

Based on my review, I authorize the Agency/University to proceed in accordance with the published Notice referenced above.

Based upon my review, I authorize the Agency/University to proceed with the following Changes.

Based on my review, the Agency/University is not authorized to proceed with this sole source as presented and my recommendation is that it be cancelled.

Other

CPO Signature CPO Phone 217-5586897

Printed Name Ellen H. Daley Date

CPO E-mail ellen.h.daley@illinois.gov

Version 7.01 Page of Sole Source Justification Form - Part I Section I - General Information Will this Sole Source amend a Professional or Artistic Services contract?

If yes, what was the original contract value?

*Sole Source may not be used for amendments for Professional or Artistic Services if the amendment would increase the value by more than 5% of the initial award or extend the term by more than 60 days.

Section II - Proposed Term If a Term Contract, does the term, including renewals, exceed 12 months?

If yes, provide a detailed justification including any economic benefit received for agreeing to a multi-year term:

Section III - Funding Source Select the type of funding to be used (Check all that apply):

Section IV - Sole Source Justification Are there secondary justification(s) for this sole source?

Section V - Purchase History Has the Agency or University Purchased these supplies or services in the past?

Term Term From Term To Value Description Contract Number Type Section VI - Business Rationale

1. Provide a detailed explanation of the need for the supplies or services:

2. Provide a list and describe in detail the specifications required to satisfy the need:

3. Provide detail explaining the justification selected in Section IV to explain why the requested supplies or services are the only ones available that can satisfy the agency or university requirements?

4. What are the unique features of the supplies or services that are not available in any other product or by any other vendor? Provide specific quantifiable factors/qualifications:

5. Has the Agency or University considered alternative supplies or services to satisfy their need?

5a. If yes, name the alternative vendors whose supplies or services were evaluated:

5b. If yes, what were the alternatives for each vendor and why were they unacceptable? Be specific with regard to features, characteristics, requirements, capabilities and compatibility:

5c. Explain how the market evaluation was conducted?

*This evaluation is to determine available options within a market. If the evaluation is to determine quality or best suited option, this is not the appropriate source selection. Under no circumstances shall the evaluation consist of testing alternative options. These activities must be conducted in a competitive transparent environment (i.e. IFB or RFP).

5a. If no, why weren't alternatives evaluated?

6. Are there resellers or distributors?

7. What efforts were made to get the best possible price (i.e. did the agency/university negotiate) and how did you determine the price for this purchase is considered fair and reasonable?

8. Will this purchase obligate the State to this vendor for future purchases such as maintenance, licensing or continuing need?

8a. If yes, please provide details regarding future obligations and/or needs:

9. What will be the financial or other impact to the State if this sole source is not approved and a competitive bid is required?

10. Is there any additional information you would like to add to justify this sole source?

Section VII Requesting Department Signature Required I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed.

State Agency Bureau/Division Head or University Purchasing Director Approval and Signature Required I know and understand the contents of this Sole Source Justification and attest that all statements are true and correct and the fairness and reasonableness of the price was adequately confirmed. (All prior form fields will lock once this e-signature is completed) SPO Approval and Signature Required Sole Source Justification Form - Part II Section I - General Information Was a Sole Source hearing held per 30 ILCS 500/20-25?

Section II - Sole Source Hearing Details The State posted to the Illinois Procurement Bulletin a description of the State's need, the justification for the sole source decision, and information regarding the opportunity to submit comments and testify at a public hearing. Notice of the hearing was also posted outside of the hearing room 48 hours prior to the hearing.

The public hearing was conducted for the purpose of receiving testimony regarding the sole source determination. The Hearing Officer recommends the following:

The following relevant documents are attached:

Section III - CPO Approval and Signature Required 9.0.0.2.20101008.1.734229 ellen.h.daley@illinois.gov

The leadership and performance of Maximus in developing and implementing the new SMHRF preadmission assessment under this contract has exceeded expectations of the Agency. They have consistently demonstrated high levels of quality, transparency, and accountability – including in meetings involving the Williams/Colbert Court Monitor. No other vendor has the experience that Maximus has already gained working with Parties to the Williams Consent Decree. Without such experience, other vendors will require longer lead time to develop the service.

Additionally, the agency would incur additional costs if another vendor were to provide this service. A different vendor would have to build redundant infrastructure, which would be costly. Moreover, the agency would need to invest substantial human and financial resources into coordinating the work of two vendors and establishing an interface, either electronic or manual, between their systems.

As with the continued stay reviews, Maximus represents the only acceptable option for providing the dementia assessments. Under the contract, Maximus is currently providing preadmission assessments for individuals seeking to enter Colbert Nursing Facilities and follow up assessments of many residents. As a result, Maximus staff is currently in the Colbert facilities on a regular basis and interacting with facility staff. The technology provided by Maximus – AssessmentPro – is currently providing the critical tool to bring all of the assessment information together. The Court Monitor has noted the strong work of Maximus in performing its current responsibilities. The addition of this service falls under the contract provision at 1.2.5.4, “Vendor must have a system capable of adding other assessments.” To attempt to conduct a separate procurement for this service would clearly run the risk of doing more of exactly what is creating significant obstacles for the state and class members – adding unnecessary complexity and delay to a system we are required to work hard to simplify.

SMHRF Continued Stay Reviews The Agency compared specifications and pricing for the Continued Stay Reviews of individuals residing in SMHRFs to the specifications and pricing for the Admission Assessments currently covered by the Maximus contract for individuals seeking admission to a SMHRF. The Admission Assessment involves the face-to-face evaluation of an individual seeking admission to a SMHRF and documentation of the outcome of that evaluation and as such, is significantly less intensive and time consuming than the SMHRF Continued Stay Reviews.

SMHRF Continued Stay Reviews, by contrast, include multiple dimensions, informants, and extensive document review. As described in Section 2, the Continued Stay Reviews include an assessment of the individual residing in a SMHRF. However, the service is far broader and includes: a review of the individual’s experience and treatment history in the SMHRF facility; interviews with SMHRF staff and other sources of collateral information such as the individual’s family members and guardian; and a review of treatment needs and discharge planning to date. In addition to documentation of the individual’s assessment, the documentation will likewise include a report on SMHRF compliance with treatment plans and progress preparing the individual for transition to community settings.

It is reasonable to anticipate that the more detailed, multidimensional, and resource-intensive services of the Continued Stay Review might cost 300-400% more than the narrower, more straightforward Admission Assessment. The unit price for each Continued Stay Reviews is $476.44, 215% higher than the unit price of $220.85 for SMHRF Admission Assessments that was secured through competitive procurement. Considering the scope and intensity of the service (not to mention the behavioral health workforce shortage in Illinois), the Agency believes the price for Continued Stay Reviews is fair and reasonable.

Dementia Assessments The Agency compared Maximus specifications and pricing for Dementia Assessments to a similar dementia confirmation service currently provided by the University of Illinois Chicago Department of Psychiatry (UIC-Psychiatry) on behalf of our sister agency, the Department of Human Services (DHS). Under this arrangement, UIC-Psychiatry provides dementia assessments at a rate of $255.00/hour, with each assessment being completed in one hour. In contrast, Maximus’ unit price for the comparable service is $179.07 per assessment, 30% less than the UIC-Psychiatry rate. Based on this analysis, the Agency believes the price for Dementia Assessments is fair and reasonable.

INITIAL TERM: 14,300, 566; RENEWAL 1: $13,171,341; RENEWAL 2: $11,323,548

FY23 $2,910,692; FY24 $4,666,835; FY25 $5,088,820; FY26 $4,605,331; FY27 $4,444,168; FY28 $4,444,168; FY29 $3,828,237; FY30 3,774,516; FY 31 3,774,516; FY32 1,258,172

More critically, a competitive bid will create delays in implementing critical services for Williams and Colbert Class Members. Delays in implementing continued stay reviews for SMHRF residents risk both unnecessary institutionalizations of Medicaid enrollees as well as non-compliance findings in federal court under the Williams Consent Decree. Delays in implementing Dementia Assessments present the legal risk of non-compliance findings in federal court and put the state in a position of having fewer tools to prevent unnecessary institutionalization of individuals with serious mental illness as required by the ADA, Olmstead and the Consent Decree.

As discussed above, the State seeks to eliminate delays in services caused by information failing to be available and efficiently tracked among all involved entities. Using another vendor would do the opposite of addressing that challenge by adding a layer of complexity to a service landscape that is already challenging for the state to oversee and difficult for Class Members to navigate.