Colbert v. Quinn Case No. 07-C-4737 (N.D. Ill.) Interim Report to the Court

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1 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 1 of 13 PageID #:1665 Colbert v. Quinn Case No. 07-C-4737 (N.D. Ill.) Interim Report to the Court Dennis R. Jones, MSW, MBA Colbert Court Monitor June 3,

2 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 2 of 13 PageID #:1666 I. Scope of Report On December 21, 2011, Judge Lefkow approved the Colbert v. Quinn Consent Decree. 1 The Decree provides both a framework and a timetable for State Defendants to allow willing Class Members the opportunity to receive services in their own homes or in other non-institutional settings. The initial Implementation Plan (I.P.), as developed by the Defendants, was finalized on November 8, The Court Monitor filed the first Annual Report to the Court on November 27, The November 2013 Annual Report detailed the Defendants compliance/non-compliance with the major components of the Consent Decree; in general, the Annual Report found Defendants in compliance with the Decree s requirements regarding Outreach and Education but substantially out of compliance with the provisions regarding Evaluations, Transition Planning and Community Placement. The Court Monitor made seven (7) recommendations as a result of the findings. In conversation with the parties and Judge Lefkow, it was decided that an Interim Report to the Court was in order. This Interim Report details the Defendants efforts since November 8, 2013, current status on key provisions of the Decree, and progress toward a new Implementation Plan (I.P.). II. Assessment of Progress and Compliance with Major Elements of Decree for Past Six (6) Months (November 8, 2013 to May 8, 2014) As noted in the Court Monitor s November 2013 Annual Report, the State Defendants decided in November 2013 to move the lead agency role for Colbert from the Illinois Department of Healthcare and Family Services (HFS) to the Illinois Department on Aging (IDoA); this transition officially occurred on January 21, Hence it should be noted at the onset that IDoA has had approximately 3.5 months to assess all aspects of the current Colbert I.P. and make both immediate changes and evaluate the need for role and structural changes as part of the new I.P. This 1 Capitalized terms used in this Report have the same meaning as set forth in the Consent Decree. 2

3 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 3 of 13 PageID #:1667 Interim Report will delineate changes already being implemented and those under active consideration. A. Outreach, Education, and Referrals The State continues to use four (4) primary methods to do outreach and education and then make referrals for evaluations: 1. Outreach and Education via the Integrated Care Programs (ICPs) Two managed care companies (Aetna and Illinicare) continue to have contracts with the State to do evaluations and care coordination for Colbert Class Members. As part of these contracts, the ICPs have reached out to both their own (pre-existing) ICP enrollees and also to other Class Members (non- ICP enrollees) at targeted Nursing Facilities. The ICPs have, as of April 28, 2014, made initial contacts with over 4,000 Class Members altogether. 2. Money Follows the Person (MFP) Program The State continues to target the 166 Class Members who had previously been involved with the MFP program. This federal/state initiative has had similar objectives as Colbert but without dedicated housing resources. 3. Self-Referrals Nursing Facilities are required to support and assist Class Members who express an interest in potential transition to the community. Since November 2013, 622 Class Member have been assisted in the referral process as a direct result of Nursing Facility support. In addition, online referrals also come via community agencies, the Ombudsmen, plaintiffs, families, ADRC/ADRN, etc. Altogether there have been 1,567 contacts/referrals through these various entities since November 8, ADRC/ADRN The State continues to contract with Age Options which is an Aging and Disability 3

4 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 4 of 13 PageID #:1668 Resource Center (ADRC) for suburban Cook County. Age Options expanded its pre-existing role to target Colbert Class Members starting in February The City of Chicago Department of Family and Support Services, in collaboration with the Mayor s Office for People with Disabilities, has developed an Aging and Disability Resource Network (ADRN) which began operating in August 2013 for Class Members in the City of Chicago. Both of these entities employ professionally trained Transition Engagement Specialists with the principal task of educating Class Members, their families, Nursing home staff and others about the services and supports available under the Colbert Decree. Of the 1,567 self-referrals noted in IIB above, 456 of these referrals came due to the work of ADRC/ADRN. Despite the difficulties experienced in the first year of Colbert, the role of the Transition Engagement Specialists has been a very positive one. The IDoA is looking for ways to strengthen and focus these contracts for FY 2015 with a particular eye to improving communication among the different entities (and with Class Members) during the transition process. One of the specific deliverables for FY 2015 must be the full development and implementation of the Peer Registry. This model would identify, train and provide stipends for interested Class Members (peers) who have successfully transitioned to the community. These peers will be uniquely qualified to impact, educate and support other Class Members during transition and beyond. Overall, the Court Monitor continues to find State Defendants in compliance as it relates to Outreach, Education and Referral. The multiple approaches, while still early in development, appear to be 4

5 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 5 of 13 PageID #:1669 working. The role of the ADRC/ADRN is viewed as critical by the Court Monitor for the next I.P. It is imperative that the Peer Registry model be put in place as soon as possible. B. Evaluations by Qualified Professionals The State continues to contract with Aetna and Illinicare to do the Colbert evaluations through the use of full time multidisciplinary teams. These teams have been operating since February The Consent Decree requires that 500 Class Members be evaluated by May 8, 2013 and 2,000 by May 8, The State has documented that 2,444 evaluations were completed by April 30, Of these 2,444, 673 have been referred for transition. Of the remainder, 657 have not been recommended due to medical and/or psychiatric needs and 434 have declined further involvement in the assessment process. There are also 452 who are in the process of being reassessed. The remainder (228 Class Members) are either unable to be located or are on hold due to geographic preferences or other reasons. In the Court Monitor s November 27, 2013 Annual Report to the Court, major deficiencies were noted in the quality and comprehensiveness of the audited evaluations. The State has moved forward to address these findings most notably in developing and implementing an integrated evaluation tool with both Aetna and Illinicare. This new format began in February 2014 with the mandate to utilize this new form not only for all new referrals but also to re-evaluate Class Members previously evaluated (and positively inclined toward community placement) unless they had already been referred to a housing specialist. As noted earlier, 452 Class Members are still in this reassessment process with June 30, 2014 as the target date for completion. In review of the evaluation requirements, the Court Monitor finds that the State Defendants are in partial compliance. The State has moved assertively to improve the underlying concerns about the quality and comprehensiveness of the 5

6 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 6 of 13 PageID #:1670 evaluations performed by Aetna and Illinicare. However, the re-evaluation process for 452 Class Members remains to be completed by June 30, In addition, the Court Monitor intends to conduct another sampled review of the re-evaluations during the late summer/early fall of Hopefully, the State can come into full compliance by the time of the Court Monitor s 2 nd Annual Report in November C. Transition Planning and Community Placement The Colbert Consent Decree calls for the placement of 300 Class Members by November 8, 2013 and an additional 500 (800 total) by November 8, As noted in the Court Monitor s Annual Report, the State had placed 80 Class Members as of November 8, As of April 30, 2014, there were 240 Class Members placed. While this total number still falls far short of the Decree s requirements, 48 Class Members were placed in April This represents a significant increase over any prior month and hopefully represents the beginning of a consistent upward trend. 1. Short-term Goals Since the transition to the Department on Aging (IDoA), there has been an intense dual focus on a) those thing that could and should be done right away and b) issues/changes that need to occur as part of the new I.P. (July 2014 and beyond). The Court Monitor notes three (3) shortterm changes that have improved the timeliness and efficiency of the transition process: a.) Colbert/Williams Initiative as of March 1, 2014, all transitioning Class Members with a Serious Mental Illness (SMI) began to be referred to a community mental health center following their initial evaluation. The model put in place pursuant to the Consent Decree in Williams v. Quinn (No. 05 C 4673) has been relatively successful for this SMI population in providing intensive transition support, needed 6

7 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 7 of 13 PageID #:1671 housing supports and necessary mental health services supports. Eleven (11) Chicago-area community mental health providers are under contract to provide Colbert services. 170 Class Members have currently been referred to mental health centers, with the anticipation that SMI placements will be in full play by July b.) Revised Housing Subsidy Procedures The prior process of housing location and support was tied to the HUD Section 8 process. While the goal is to move Class Members into Federal HUD Section 8 support whenever possible, the reality is that most Class Members move to the community with a State-supported Bridge Subsidy. Hence, IDoA has streamlined the front-end requirements which have expedited the timeliness of housing placements for Class Members and Housing Specialists. c.) Improved Communication and Accountability The IDoA Colbert Project Director and IDoA staff conduct weekly teleconferences with the MCO Care Coordinators and the Housing Specialists. The detailed case-by-case review helps to clarify roles, sharpen understandings and fix accountability for outcomes (including timelines). While some challenges remain, there is now a sharper focus on needed teamwork and shared accountability. 2. Long-term Goals The longer-term goals are to be addressed as part of the new Implementation Plan to be provided to the Court by July 1, There are several key themes that underlie future progress: a.) Housing the availability and mix of community-based housing units is critical to Colbert success. 7

8 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 8 of 13 PageID #:1672 There are multiple challenges to overcome in developing an adequate array of communitybased housing. One of those is to identify existing units that are accessible for persons with physical disabilities; unfortunately these units are in limited supply in Cook County. The second (and related) issue is to provide home modification to existing units. The Decree provides for home modification up to a cap of $5,000; the State has a contract with the University of Illinois Assistive Housing Technology Unit to manage these needed home modifications. The problem is the $5,000 cap. The State will need to explore some combination of pooled resources and/or amendments to the Consent Decree. A third housing challenge relates to Class Members with either criminal background records or poor credit history; many landlords are unwilling to have rental agreements for this group of Class Members. One of the strategies for this issue is to do master leasing a model that allows an overall agency master lease with subleases to Class Members. b.) State Staff There must be adequate State level personnel to perform the needed tasks of leadership, oversight and support. The IDoA, since January 2014, has already filled five (5) Colbert-dedicated positions and is looking to fill two additional positions in the near future. The filled positions include the Colbert Project Director, the Transition and Research Administrator, a Transition Specialist, the Quality and Compliance Liaison position and an Administrative Assistant. The Housing Coordinator and MCO Contract Liaison 8

9 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 9 of 13 PageID #:1673 positions remain to be filled. The Court Monitor is pleased with the diversity and strength of skill sets of persons hired thus far. The Project Director brings both seasoned leadership skills plus the direct experience in implementing the Williams Decree. There are multiple inter-related administrative tasks that are critical to Colbert success. These include: a) role definition and contract amendments and oversight; b) initial and ongoing training for providers and others; c) tracking the timely flow-through of persons in transition; d) planning and coordinating with other State agency partners; e) building accountability and incentive systems with contractors and; f) developing both information and quality oversight systems (discussed in IIC2 (c and d) below. c.) Information System An information system must be developed that provides timely and reliable data for all key stakeholders. The IDoA has engaged a contractor to both design and build a web-based information system that will track all Colbert Class Members. The intent is that all of the contracted providers will have limited security access to provide relevant information. The intent is that this work will be completed and users trained and ready for implementation by July 1, The IDoA has also hired an additional and Colbert-dedicated Information Technology Specialist to support the ongoing needs of the Information System. The Court Monitor is pleased with both of these resource commitments. The availability of timely and trustworthy data is critical to 9

10 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 10 of 13 PageID #:1674 problem-solving analysis and basic compliance tracking. The work of the Cost Neutral Workgroup (discussed in IID) is also dependent on this data set. d.) Quality Oversight There is a need to develop and implement a reasonably comprehensive Quality Oversight system. There are currently some elements of an overall quality oversight system; there are also gaps and questions about the depth of some functions e.g. mortality reviews. The Governor s Office intends to develop crossagency quality oversight standards, policies, training and processes for all community agency initiatives. The Court Monitor supports this approach provided that it is adequately resourced and done in a timely way. e.) Budget It is imperative that the Illinois legislature appropriate sufficient funds to support the Colbert mandates for FY The IDoA requested $32.5 million as part of the Governor s introduced FY 2015 budget to support the full costs of Colbert services, contracts and related expenses planned for the next fiscal year. The Illinois House and Senate passed the FY 2015 Budget on May 31, 2014 and have sent the bill to the Governor for signature. As relates to Colbert, the budget bill fully funds the $32 million request. However, the sunset of tax surcharge in December 2014 will result in $1.8 billion in lost revenue for the second half of FY There remains great uncertainty as to how the legislature and Governor will ultimately manage the State simpending fiscal crisis and what the 10

11 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 11 of 13 PageID #:1675 impact will be on Colbert and other Consent Decrees. f.) Class Member Feedback It is critical that the State continue to elicit input and feedback from Class Members, families and other key stakeholders. D. Cost Neutral Plan Progress The IDoA has participated in three (3) different forums/focus groups that were specifically intended to elicit thoughts and experiences of Class Members and others who have been involved in the first year and a half of Colbert placement. The Court Monitor participated in two (2) of the three (3) and was impressed with the level of candor and openness by both Class Members and State staff. One of the specific recommendations that is being formally developed is to create a standing Colbert Advisory Committee made up of Class Members and other end users. The Court Monitor believes this could be an excellent means by which to elicit recommendations on an ongoing basis and would strongly encourage Defendants to help bring this Advisory Committee into reality. The Cost Neutral Workgroup has continued to meet on a regular basis. The workgroup continues to include representatives of the key State agencies, Plaintiff s counsel, the Berkeley Research Group (via Plaintiff s counsel) and the Court Monitor. The initial recommendations and cost analysis (prior to the agency move) now need to be reevaluated in light of the move to IDoA. It is anticipated that the Cost Neutral Workgroup will meet on a monthly basis until these changes are fully understood and incorporated into any needed changes in the cost funding design. The cross-agency participation continues to be strong and the 11

12 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 12 of 13 PageID #:1676 support of the pro bono Berkeley Research Group invaluable. The delayed placement of the first 800 Class Members continues to raise questions as to the timely ability of the Court Monitor and parties to make informed judgments on cost neutrality by June 8, The Court Monitor will continue to keep the Court informed as to progress. E. Overall Compliance The Court Monitor continues to find the State in noncompliance at the 18-month mark. It appears that the State will achieve the goal of 300 persons placed sometime in June 2014 fully 7 to 8 months behind the Decree s requirement of 300 placed by November 8, Given all of the delays in Year One, it also raises serious concerns as to the Defendant s ability to achieve the 800 placements benchmark by November 8, However, in stark contrast to the findings in the Court Monitor s first Annual Report of November 27, 2013, there are now multiple hopeful signs. As noted throughout this Interim Report, many of the road blocks to placements have already been addressed and those that remain are clearly targeted for improvement. The recent count of 48 placements in April 2014 is nearly double the previous month s total. The Court Monitor made seven (7) specific recommendations in the November 2013 Annual Report. The following table provides a summarized re-statement of those recommendations and progress to date: Recommendations A. Visible Governor s Office Role B. Lead Agency to IDoA Cross-Agency Involvement C. Necessary State Staff to Support Results A. Visible and hands on involvement. B. IDoA lead as of January 21, Increased crossagency participation. C. Five (5) staff hired with 2 others in process. 12

13 Case: 1:07-cv Document #: 240 Filed: 06/03/14 Page 13 of 13 PageID #:1677 D. Revised Implementation D. On track for now. I.P. by Plan by July 1, 2014 July 1, E. Interim Transition Plan E. Multiple concrete issues addressed to reduce road blocks to placement. F. Temporarily Suspend New Evaluations G. Utilize Williams Service Model for Persons with Serious Mental Illness F. Evaluations temporarily stopped. Restarted once evaluation issues addressed. G. Accomplished as of March 1, 2014 It is evident from these specific outcomes that the State Defendants, while still seriously behind targets, are now positioned to make substantial progress in the next six (6) months. The Court Monitor anticipates progress in not only placements but also the development of infrastructure supports (e.g., IT and Quality Oversight) that are critical for sustained success. 13