September 11, 2013 - Quality Care Board Meeting


Open to the Public


Wednesday, September 11, 2013


2:00 pm



Phone #: 888-494-4032 Access Code: 1469835118


Speaker: Lois McCarthy - New Legislation Discussion HB 0948 (Adult Protective Services Bill)

  1. Policy and Procedure Committee Review of INV directives 1 - 30 recommendations - Lois McCarthy
  2. Quality Care Board's Role - "Oversight" reference update
    1. Letter to Governor's Office
    2. Letter modifying/clarifying language in the statute
  3. Reorganization of OIG Update
  4. Approval of April 30, 2013's meeting minutes
  5. Miscellaneous Issues/Questions
  6. Next meeting is November 14, 2013 at 1:00 p.m.
  7. Schedule new meeting dates
    1. January
    2. April
    3. August
    4. November


Present: Susan Keegan, Chairperson; Ginny Conlee; Thane Dykstra; Untress Quinn; Inspector General Michael McCotter; Deputy Inspector General Robert Furniss; and Chris Milbrandt

1. Speaker: Lois McCarthy - New Legislation Discussion - HB 948 (Adult Protective Services Bill)

Since Lois had previously discussed this Bill with the Board at the end of April, she went through and compared the two versions to see what had changed. Lois prepared an outline for everyone to review prior to this meeting. The outline focused on the changes and problems she saw as far as the statutory language.

In the definition section, there are no specific definitions for physical abuse or sexual abuse. They are only generally defined as an injury. Lois is not sure the definitions are going to be real workable if they are intending on putting people on the registry.

Another problem in the definition section is they define an ineligible adult as age 18 - 59 or a person age 60 or older living in a domestic living situation. However, in Section 7.5 of the statute it references eligible adults as over 18 and 60 or older. Although the 60 or older is the same language, it does change it if it says over 18 when the other definition says 18 - 59.

Proof for substantiating these allegations remains reason to believe. Question: What is the age for the DCFS hotline? Response: DCFS goes up to 18, the day before their 18th birthday. ADAP started at age 18. I think their intent is to say up to age 18 - 59, not over 18. When you try to call something in and they are a day shy of 18, it is going to be a problem in regard to intake. They can always do some clean up in the veto session. Lois has not heard of any emergency rules that are going on, but again since it isn't OIG anymore she may not see information regarding that.

On page 2 of Lois' outline, Section 3.5 under Other Responsibilities, there is a major change from the Bill in April. In the first sentence, "contingent upon adequate funding within three months" has been deleted from the law that passed. It now states that the following activities are contingent upon adequate funding and the first and second dot points are to be undertaken as soon as practicable which includes access and use of the registry. Rather than three months, we are now as soon as practicable. This has been delayed and probably for a good reason.

Nothing has changed in reports of abuse or neglect or procedures. Much of it is identical to what the Bill was.

There was a change with previous report requirements. In April, they only had to write reports if the case was substantiated. This requirement was changed to all cases of reported abuse, neglect, financial exploitation, or self-neglect must result in a case report regardless of the finding. This is very important for audit and monitoring purposes.

They deleted that within six months they had to get the registry up and running, but that is no longer the case. Now they are requiring Aging to convene and lead a committee with DHS and IDPH to study the use and how they can access the registry. They are supposed to issue a report to the Governor and legislature within 12 months which would mean July 1st of next year. It is unclear when it will be implemented.

Reporting to the registry - They have very different standards - One for paid caregivers and one for privately paid caregivers. Lois doesn't quite understand what they mean by these standards. They are going to have to tighten some of these standards up.

Access to and use of the registry - Access is limited to licensed, certified or regulated providers by IDPH , HFS, DHS and DOA. IDPH's registry - OIG uses their registry. It is a public registry and anybody can check that registry to see if an employee is on it. Lois doesn't know why they would send people to the registry and not allow "lay" people, so to speak, to access the registry to see if a person they want to hire has any kind of finding against them. It would be an important part of prevention. It may be because they are proposing to put volunteers on the registry. Lois sees this as very problematic.

Sections for registry placement - They don't really set forth the standards. It would likely be preponderance of the evidence. Lois can't imagine any administrative law judge substantiating with less than that. The problem is the standard for substantiating these cases is reason to believe and then they are going to crank it up to preponderance to put them on the registry and also to get off the registry. We have case law in this state that says that is not constitutional. They are going to have to work on that.

The rest, nothing has changed. Lois is curious to see what rules promulgate from this statute.

Questions/comments: Thane asked Lois if she be involved in the process to develop the rules. Response: No. I do it for OIG. This isn't my business any more. If they want to talk to me about it, I would be more than happy to, with Mike's approval.

Question: Does this cut the work of the IG? What is the role of the IG now? Response: We have nothing with regard to this statute. This is Aging's statute. It does say they are supposed to work with DHS, IDPH and HFS to work on the registry component. Other than that we don't really have a role. We put our investigators back in Rule 50. We never got any funding for that program. Mike responded that it was an unfunded mandate.

Susan state that correspondingly it would mean our over sight would be cut down. Response: Sure. We don't have that program any more. Question: Have they changed the name of Aging? Response: This statute changes the title to Adult Protective Services (APS). It also changes it to the APS Act. They are still called the Department on Aging. I haven't heard of that happening yet.

Susan stated we need to circumscribe what our duties on over sight should be with respect to the remaining piece of what we are supposed to be looking at. We need to go through the remaining duties and determine what sort of reports we are going to need and how often we should get them; should they be samples, and in what sort of compilation so we can meet our mandate.

Susan asked Mike if he would be available to meet and he said any time. We have Rule 50 cases now. I don't know if you were able to send a letter to the Governor's Office. Susan stated she had talked to the Governor's Office in July and was told to wait for the dust to settle. Maybe we could meet in October to develop a format for the Board's over sight. We could look at some things and circumscribe what our over sight will be. Mike suggested reserving a day that he and Bob can meet with her. Susan reiterated that this will not be an official meeting. They will just be determining what information the Board can over sight.

2. Policy and Procedure Committee Review of INV directives 1 - 30 recommendations - Lois McCarthy

 Susan suggested that the Board discuss the policies and procedures after it is determined what is going to be reported. Lois asked Susan you mean after you talk to Mike and Bob in October? Response: Yes. Lois stated that if you do that then I need to be involved. I am in the process of revising them. Question: Do you want our suggestions as to revisions? Lois - Yes. Susan asked everyone if they had had a chance to look at these. Thane responded that he has looked at the first 30. Question: Do you have any suggestions? Thane - I don't have as much as far as revisions. I thought they were pretty comprehensive. I had questions what exactly the investigators are trained for in terms of community settings and things like that. I think our time would be better served if we hashed what our over sight is going to be and go through them one at a time. My issues were more like questions or things I wasn't aware of. Lois reminded everyone that if you have any questions, feel free to ask.

 Thane stated he read about the past practice groups. I was interested in learning more about the groups we have. Lois stated we haven't had those groups for a long time (2001?). I am rescinding that one for the time being. We don't have the time or money any more. It is a great idea though.

 Mike informed everyone that the closest we have come to that is when I came on board I visited each bureau and sat down with each investigator, without their supervisors, and asked how we could help them. I plan on continuing that. Now that I have been here a while and people are more familiar with me, I am going to go back out and do that again. I want their input. I get a lot of e-mails with a number of good suggestions. Everything is cost-related too. We can only do so much.

 Thane is interested in the training that the investigators receive, especially in terms of the changing landscape in the community in managed care. Who is educating the investigators about changes that are occurring? For instance, even the limiting of the formulary to four medications, and with the managed care companies in this state, all of the prior authorizations that are required. That has an impact on things like the medications that aren't available in some of the housing and how is that viewed by OIG. Do the investigators know what is happening out there?

 At this time, Bob Furniss joined the meeting by teleconference. Mike asked Bob if he had any answers for that. Response: We would find out most of those things from the division I would imagine.

 Thane asked if the division realizes that it is harder to be on top of medications because of these prior authorizations and the limitations since we are going down to four medications. The SMART Act put a limit on the maximum of four meds for people on Medicaid. People on a fifth medication have to go through a process to appeal it. The last couple of years really have had a lot of changes that impact the community providers.

 Mike stated that we will have to look into that a little closer. Thane will make a shortlist of what he thinks people should be made aware of. Even things like the current process for getting additional behavioral support in community settings. A lot of times OIG will make recommendations for people with real challenging behaviors that maybe you should request a behavioral add-on from the state. But even that process is pretty arduous and very time limited. The previous packet was 20 some pages of forms you had to complete. It may be a valid recommendation, but I don't think some people understand what that really entails. An OIG investigator commented that we should get additional nursing support, but we are funded for a ratio of 1:100 - that is how the rate methodology works out. Investigators are used to institutional settings. Question: How many clients do you serve? Thane responded 500 residentially. Thane will jot some things down that are going on and that he is aware of. Mike indicated he would appreciate seeing it.

 Lois left the meeting at this time.

3. Quality Care Board's Role - "Oversight" reference update

 This agenda item has already been covered.

4. Reorganization of OIG Update

 Susan stated that we will look at this topic in the over sight meeting. Information from the meeting will be sent out to the members in advance of the November Quality Care Board meeting for approval. Who else would like to work on this? Thane volunteered. Susan stated that she would like to have it in a format we can look at quarterly, but doesn't want it to be cumbersome. Thane reminded everyone that we will still have a lot of cases and that the cases require a lot of different resources. Susan asked if we wanted samples or numbers, how many people seen, outcomes, or categories for example. The meeting will be held Tuesday, October 8th, 10:00 am, Mike's office in Chicago, 401 South Clinton, 7th floor. They will reserve a conference room. Bob, Mike, Susan, and Thane are the committee. Susan asked they have reports ready for the meeting.

5. Approval of April 30, 2013's meeting minutes

 Motion to approve the minutes - Ginny

 Motion seconded - Thane

 All in favor - Minutes approved as written

6. Miscellaneous issues/questions

Next Quality Care Board meeting is November 14, 2013 at 1:00 p.m. by teleconference

 Quality Care Board Meeting dates for 2014:

 Thursday, January 9 at 2:00 pm (teleconference)

 Thursday, April 10 at 2:00 pm (Springfield, McFarland MHC)

 Thursday, July 10 at 2:00 pm (teleconference)

 Thursday, November 13 at 2:00 pm (teleconference)

 Susan asked Mike if we will we be getting another member. Mike stated he mentioned it to Bob Morgan in the Governor's Office. We were short members before Ed Baker's vacancy.

Susan asked if it would be of some value to have a face-to-face meeting. Mike stated it would be advisable at least once a year. Let's do our April meeting in Springfield (McFarland MHC) at 2:00 pm.

Susan will call Bob Morgan to see if we can get someone else on the Board. Thane asked if there are certain requirements the Board members have to meet. Chris read from the By-Laws the qualifications the Board must be made up of. Susan asked Chris to fax the Board make up to her.

 Motion to adjourn meeting - Thane

 Motion seconded - Untress

 Motion Moved - 2:50 pm