SUPPORTIVE LIVING PROGRAM PREADMISSION PROCCESSES

1. SUPPORTIVE LIVING PROGRAM PREADMISSION PROCCESSES August 15, 2019 Mandatory training

2. INTRODUCTION PURPOSE OF TRAINING • Settlement agreement for O’Connor v. Eden Mgt., et al., 13 CV 7391 (U.S. Dist. Ct., N.D. Ill., Judge Gotschall/Magistrate Gilbert), and three related cases, regarding the Supportive Living Program (SLP) • Review of preadmission screening processes • Overview of settlement tasks for SLP providers • FAQ

3. Presenters • Kara Helton, HFS, Bureau of Long Term Care, Supportive Living Program Coordinator • Patti Llacsa, HFS, Office of General Counsel • Jean Summerfield, HFS, Special Assistant for LTC and Mental Health

4. Litigation summary • This settlement, involving the State of Illinois Department of Healthcare and Family Services, the Department of Human Services and the Department on Aging resolved four individual lawsuits: • O’Connor v. Eden Mgt., et al., 13 CV 7391 (U.S. Dist. Ct., N.D. Ill., Judge Gottschall) • H.O.P.E. v. Alden Gardens of Bloomingdale, et al., 15 C 9715 (U.S. Dist. Ct., N.D. Ill., Judge Gottschall) • H.O.P.E. v. East Gate Manor, et al., 15 C 9717 (U.S. Dist. Ct., N.D. Ill., Judge Gottschall) • H.O.P.E. v. Tabor Hills, et al., 15 C 9719 (U.S. Dist. Ct., N.D. Ill., Judge Gottschall).

5. Litigation Summary • The lawsuits alleged discrimination in the Supportive Living Program, in particular to individuals with a mental health diagnosis. • The Settlement clarifies program standards and takes measures to ensure that individuals are properly screened for the Supportive Living Program so that individuals who are otherwise qualified and appropriate for the SLP will not be improperly rejected because of mental health diagnoses. • The Settlement will be monitored for a period of three years.

6. Proposed administrative Rules • Proposed administrative rules required for the settlement agreement were filed in June 2019. The first notice public comment period ended August 5, 2019. Second notice period is underway. • Proposed rule changes for the settlement included clarifications for preadmission processes, new policies and procedures and staff training for providers. • HFS will provide more information regarding new rule requirements after the rules are adopted.

7. Preadmission processes • SLP providers will not conduct the required standardized interview geared towards a potential resident’s service needs until the Determination of Need (DON) and other required preadmission screening assessments are completed and determinations forwarded to the SLP provider. • SLP provider staff will not ask potential residents any medical or clinical questions prior to receiving the results of the above assessments. This includes diagnoses and medications. Applications for admission that request any clinical or medical information will not be provided to the potential resident for completion until after the above assessments are received. • SLP provider staff may answer questions regarding apartment availability, amenities and services provided.

8. February 20, 2019 provider notice • The notice reviews the required preadmission screens, including the DON. It identifies which agencies complete the DON and when a DON is required. • The notice also identifies which agencies complete the Specialized Supportive Living Program Mental Health Assessment for persons with mental illness. • Right to appeal information and a non-discrimination statement were included. • This notice was distributed to all SLP providers in February 2019 and again in July 2019. It can be accessed at https://www.illinois.gov/hfs/MedicalProviders/notices/Pages/prn190220a.aspx .

9. Specialized Supportive living program Mental Health Assessment Discrimination based on the presence or suspicion of serious mental illness (SMI) diagnosis or disability is clearly prohibited in admissions to the SLP. The presence of SMI does not preclude admission to SLP for individuals who meet criteria for the nursing facility (NF) Level of Care and whose needs can be met by the program. However, SLP is not designed to address the entire range of risks and needs that might be presented by every individual with SMI. Some exceed program capacity. To ensure non-discriminatory and appropriate access to SLP, a Specialized Supportive Living Program Mental Health Assessment is conducted by Mental Health (MH) PASRR assessors for individuals with SMI.

10. SPECIALIZED SLP MENTAL HEALTH ASSESSMENT - ACCESS Community An individual seeking SLP admission from the community should first be directed to the Care Coordination Unit (CCU) or Department of Human Services, Division of Rehabilitation Services (DRS) assessor who is charged with conducting the DON to establish NF LOC eligibility. The CCU or DRS assessor will refer to MH PASRR for a Specialized Supportive Living Program Mental Health Assessment if SMI is present or suspected.

11. SPECIALIZED SLP MENTAL HEALTH ASSESSMENT - ACCESS Hospital Similarly, an individual requesting SLP admission from within a hospital should be referred to the CCU by Discharge Planning staff to establish NF LOC eligibility and then on to MH PASRR for the Specialized Supportive Living Program Mental Health Assessment, if applicable. It is important that the need for a Specialized Supportive Living Program Mental Health Assessment for SLP admission be made clear, since it is separate and additional to the assessment for NF placement conducted by MH PASRR.

12. SPECIALIZED SLP MENTAL HEALTH ASSESSMENT - ACCESS Transfer to SLP from NF Placement Since a new DON is not required and NF LOC eligibility is assumed, identification of need for the Specialized Supportive Living Program Mental Health Assessment could come from the NF, the individual or family, or might come from SLP intake staff. If the SLP makes the identification, it is important that further exploration of the diagnosis and the decision on admission be deferred until after the Specialized Supportive Living Program Mental Health Assessment is completed.

13. Specialized SLP Mental Health Assessment – FOCUS and RESULTS The purpose of the Specialized Supportive Living Program Mental Health Assessment is to determine if there are serious and persistent needs and risks associated with the individual’s SMI that are beyond the scope of the SLP to address and manage effectively. Serious and Persistent Needs and Risks - examples • Persistent high risk for suicide attempts or self-injury • History and persistent risk of aggressive or assaultive behavior • Persistent behavioral risks which are highly disruptive or create dangerous situations • History of repeated antisocial behavior (e.g. sexually inappropriate behavior) The Assessment results in a determination of the appropriateness of the SLP setting to meet the individual’s needs. Results are communicated in a brief letter from the MH PASRR assessor indicating whether SLP admission is or is not appropriate. Results are conveyed to the individual as well as the SLP provider. Individuals have the right to appeal decisions. The contact information for appeal to DHS Division of Mental Health is included in the letter.

14. Provider settlement tasks • Mandatory annual training provided by HFS. • Identification and notification of previous denials based solely on a mental health diagnosis and not a person’s assessed risks and needs. Invitation to reapply extended in writing. • Supportive Living Program Potential Resident Inquiry Tracking Log. • Review of new policies and procedures by HFS. • Review of resident contracts by HFS. • Staff orientation and training requirements. • Mailer distributed to SLP providers with this information on July 23, 2019.

15. Frequently asked questions—preadmission Screening process Question: What counts as mental illness? Clearly a history of severe and persistent mental illness requires a SLP Specialized Screening, but where is the threshold? Does major depression count? Anxiety? Insomnia? Does the diagnosis have to be current? Response: In the proposed administrative rules, Serious Mental Illness is defined as: Diagnosis of a major mental illness, such as schizophrenia, schizoaffective disorder, bipolar disorder, major depression, panic disorders, obsessive compulsive disorder and any other disorder which could lead to a chronic disability which is not a primary diagnosis of dementia. If the person has both a dementia diagnosis and another psychiatric condition, the symptoms of dementia must be significantly more progressed than symptoms of the co-occurring psychiatric condition; and for which Duration is significant life disruption or major treatment episodes within the past two years and due to the disorder. This does not necessarily mean that the individual was hospitalized; and that the Disability or Level of Impairment is characterized by active behavioral health symptoms within the preceding six month period which significantly interfere with the individual’s ability to interact interpersonally, concentrate, follow through with goals or needs, and/or adapt effectively to change.

16. Frequently asked questions—preadmission Screening process Question: If the SLP provider cannot ‘consider admission’ until after the DON or SLP Mental Health Screen has had the “opportunity” to receive the screening… does this mean that the  provider cannot conduct their own assessment until after the screenings have taken place?  Response: The DON and any required Specialized Supportive Living Program Mental Health Assessment must first be completed and received by the SLP provider. Question: Is the language purposeful – meaning the prospect has had the “opportunity to receive the screening?  Does that mean that they have had their screening or that they have been asked?  Response: The potential resident must first have received the DON and Specialized Supportive Living Program Mental Health Assessment and the results forwarded to the SLP provider.

17. Frequently asked questions—preadmission Screening process Question: What do we do when a prescreen does not identify mental illness that is then identified later in the application process? What should the SLP do when, following the completion of a screen we learn that the person does in fact have a history of mental illness?   Response: SLP provider staff can contact the PASRR agent and request a Specialized Supportive Living Program Mental Health Assessment. Persons with mental illness can participate in the Supportive Living Program. The Specialized Supportive Living Program Mental Health Assessment will help determine if the individual’s risks and needs can be met in the Program’s setting.

18. Frequently asked questions—preadmission Screening process Question: What should be done in the case of a healthcare provider (hospital) making a referral via fax that includes the prospect’s medical information?  Response: The SLP provider staff should not request this information, but the hospital or potential resident may happen to supply. The SLP provider should keep this information for the file. No determination regarding the potential resident’s admission can be made prior to the DON and if applicable, Specialized Supportive Living Program Mental Health Assessment being completed and received. Question: How do we respond when screeners want health-related information? Response: Provide the screener with the contact information for the potential resident or their designated representative so that the screener may obtain this information from him/her.

19. Frequently asked questions—preadmission Screening process Question: How do we refer for Specialized Screens?   Response: SLP provider staff may request  a Specialized Supportive Living Program Mental Health Assessment from the PASRR agency. If SLP provider staff does not know which agency to contact, email Kara Helton kara.helton@illinois.gov or Jean Summerfield jean.summerfield@illinois.gov or HFS.SLF@Illinois.gov . Question: Does an expired Prescreen require a new Specialized Screen? Since the Prescreen must be done first, and then a Specialized Screen, and then the SLP assessment, it is likely that frequently an apartment will not be available for the applicant to be available within 90 days and the Prescreen will need to be repeated. If the Prescreen expires will a Specialized Screen also be required to be repeated or is the first one still valid? Response: The Specialized Supportive Living Program Assessment is valid for 90 days. SLP providers may consider delaying screening requests until closer to the time an apartment may be available.

20. Frequently asked questions—preadmission Screening process Question: Can we deny an applicant who has been found eligible by the Specialized Screener? What do we do if we feel that the applicant’s needs or behaviors are in excess of what can be provided by the SLP? Does the SLP have the ability to deny the applicant, and if so, how?  Response: SLP providers have always been able to deny admission to potential residents, however, this denial must be based on the individual’s risks and needs, not a particular disability or diagnosis, for example. Question: Have the agencies that conduct the screenings for potential Supportive Living Program residents been notified of the new requirements?  Response: Yes. 

21. Frequently asked questions—SLP POTENTIAL RESIDENT INQUIRY TRACKING LOG Question: Do we log ALL inquiries regardless of whether they identify themselves as having mental illness or a developmental disability?  Response: Yes.  Question: Should the instructions in the SLP Potential Resident Inquiry Tracking Log (paragraph #3) be interpreted that no discussion can occur about the prospect’s health/diagnosis/medications until after the DON results are provided?  Response: The DON and any required Specialized Supportive Living Program Mental Health Assessment must be completed and received prior to the SLP provider staff asking medical/clinical questions or assessing a potential resident.

22. Frequently asked questions—NOTIFICATION OF PREVIOUS DENIALS Question: When it is stated “New requirements effective immediately for SLP providers include notification of persons previously denied admission based solely on having a mental health diagnosis without the opportunity to have their risks and needs assessed through the Determination of Need  (DON) assessment and Specialized SLP Mental Health screening (memo with instructions attached).” – how far back is the community to go back to determine if this was the case? Response: The dates used for this task are: January 1, 2015—July 23, 2019

23. QUESTIONS??? Please send all questions to the Department of Healthcare & Family Services at: HFS.SLF@Illinois.gov HFS will develop and distribute a FAQ document.