HR0057 98TH GENERAL ASSEMBLY

HR0057 LRB098 07984 GRL 38074 r

HOUSE RESOLUTION

WHEREAS, The Illinois Department of Corrections (Department) has approximately 47,000 inmates at its 27 correctional centers; and

WHEREAS, In 2011, the Department of Healthcare and Family Services awarded a 10-year, $1.36 billion contract to Wexford Health Sources, Inc. (Vendor) to "provide comprehensive medical and mental health services to offenders [in the custody of the Department]... in order to maintain their health status, establish innovative and cost effective medical and administrative programs, improve the quality of care, provide acceptable, cost effective levels of staffing, [and] positively impact purchasing of pharmaceutical and/or medical supplies"; and

WHEREAS, Pursuant to the solicitation for the contract awarded to the Vendor, the Vendor is required to provide services at targeted performance levels (including compliance with staffing schedules, administrative directives, and treatment protocols) with any failure to meet the target levels of performance subjecting the Vendor to payment adjustments; and

WHEREAS, Also pursuant to the solicitation, the Department is required to "[c]onduct audits to confirm the validity of the performance guarantee results reported and enforce penalties as appropriate"; and

WHEREAS, The Department has indicated that it would "contract with a vendor outside the comprehensive medical contract to audit activities of the comprehensive medical provider"; and

WHEREAS, The Vendor is required to submit monthly utilization reports detailing inpatient hospitalization referrals, outpatient referrals, emergency services referrals, primary healthcare services utilization data, and pharmaceutical usage; and

WHEREAS, At the time the solicitation was issued, the Department was pursuing accreditation from the American Correctional Association for its facilities and projected that the accreditation would occur within 3 years; and

WHEREAS, At the time the solicitation was issued, the Department identified approximately 250 pending inmate healthcare lawsuits in which the State, its employees, or agents were named parties; and

WHEREAS, A Department administrative directive requires each correctional center to "develop a comprehensive Quality Improvement Program that provides for the systematic, on-going, objective monitoring and evaluation of the quality and appropriateness of offender care", including an internal audit of the directive to be conducted at least semi-annually; therefore, be it

RESOLVED, BY THE HOUSE OF REPRESENTATIVES OF THE NINETY-EIGHTH GENERAL ASSEMBLY OF THE STATE OF ILLINOIS, that the Auditor General is directed to conduct a management audit of the Department of Corrections' implementation of a comprehensive medical and mental health services program for adult offenders; and be it further

RESOLVED, That the audit include, but not be limited to, the following determinations:

(1) whether the Department adequately monitors the Vendor's performance and compliance with contractual requirements, including the timeliness of services, scope of services, recordkeeping, periodic reporting, staff qualifications, and staffing levels;

(2) whether the Department takes appropriate action in response to instances where the Vendor is noncompliant or where Vendor performance issues are identified;

(3) whether the Department has in place an audit program to confirm the validity of performance guarantee results and to audit the activities of the comprehensive medical provider;

(4) whether the Vendor's and the Department's processes for tracking, reviewing and recording inmate complaints, grievances, and requests pertaining to medical and mental health services are adequate;

(5) whether the billings submitted by the Vendor are adequately reviewed by the Department, and are supported and allowable under the terms of the contract;

(6) whether each correctional center has in place a Quality Improvement Program as required by Department administrative directives and whether required internal audits are being performed; and

(7) the status of the Department's pursuit of accreditation from the American Correctional Association; and be it further

RESOLVED, That any State agencies, the Vendor, and any other entity having information relevant to this audit cooperate fully and promptly with the Auditor General's Office in the conducting of this audit; and be it further

RESOLVED, That the Auditor General commence this audit as soon as possible and report any findings and recommendations upon completion in accordance with the provisions of Section 3-14 of the Illinois State Auditing Act.