Overview of the Colbert Consent Decree Implementation

Paul H. Bennett – Project Director for the Implementation of the Colbert Consent Decree

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Colbert Consent Decree Background • The Colbert Consent Decree sought declaratory and injunctive

relief to remedy alleged violations of Title II of the Americans with Disabilities Act (ADA), 42. U.S.C. 12131-32, Section 504 of the Rehabilitation act, 29, US.C 794(a) and the Social Security Act, 42, U.S.C. 1396-1396v (SSA). Plaintiffs alleged that they are inappropriately segregated and institutionalized in Nursing Facilities and forced to live with numerous other people with disabilities in violation of the ADA and the Rehabilitation Act.

• The Colbert Consent Decree is an actualization of the 1999 U.S. Supreme Court Decision in L.C. v. Olmstead and advances the claim that persons have been improperly denied the opportunity to received community services in the most integrated setting.

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Colbert Consent Decree (Background)

• Colbert v. Quinn was filed in August 22, 2007 & settled December 20, 2011; a time clock started; Implementation Plan agreed to November 8, 2012

• Court monitor was appointed to oversee the process of plan development and implementation

• Class Members are Medicaid recipients

residing in nursing homes in Cook County, Illinois

• Benchmarks – Move 300 by November 8, 2013 – Move 800 by November 8, 2014 – Move 1100 May 8, 2015

• Defendants – Illinois Department of Healthcare and

Family Services – Office of the Governor – Illinois Department on Aging – Illinois Department of Human

Services – Illinois Department of Public Health

• Counsel for the Plaintiffs

– SNR Denton US LLP – Equip for Equality – The Roger Baldwin Foundation of the

ACLU, Inc. – Law Offices of Stephen F. Gold

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Overriding Philosophy

• Principles

– Self-Determination

– Informed Choice

– Person-Centered Planning

– Care Coordination

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Cost Neutrality

• Colbert Consent Decree defines a requirement of the development of a Cost Neutral Plan

• To determine cost neutrality, transitions of Class Members cost the same or less to the state in the aggregate as if those Class Members instead had remained in the Nursing Facilities

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Dissemination & Community Education • Outreach & Education

– Aging and Disabilities Resource Center under AgeOptions, the Suburban Cook County Area Agency on Aging

– An Aging and Disabilities Resource Network under the Chicago Department of Family and Support Services, the Area Agency on Aging in Chicago and the Mayor’s Office for Persons with Disabilities

• Representatives of the ADRC and ADRN will speak with Class Members in individual and small group meetings – Establish a peer registry of former nursing home residents to help

disseminate, educate and provide personal testimony – Peers can be most effective at helping to engage Class Members and

discourage “transition trauma”

• Through community education, Class Members have the opportunity to self-identify, supporting a principle that “no Class Member will be left behind.”

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Informational Materials & Methods for Self-Identification

• Fact Sheet

• Illinois Pathways to Community Transition/Money Follows the Person (MFP) and On-Line Referral Form

• Section Q of the Minimum Data Set (MDS)

• Signage

• Ombudsmen (Supported under MFP)

• Letters to Guardians

• Video

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Integrated Care Coordination Implementation Strategy

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Target Date Methodology Strategy

FEBRUARY 2013 Integrated Care Program in Suburban Cook County -- Seniors and Persons with Disabilities (SPD) Medicaid clients only

Up to 31 NHs * ** Will serve their own members

Year 1 Transition Plan: Care Coordination services contracted with ICP vendors, for persons who self-identify (not already in ICP Plans -- Duals in Suburban Cook; any SPD in Chicago)

Year 1 Transition Plan: Care Coordination services contracted with ICP vendors to cover residents who are Duals in Suburban Cook or any SPD in NHs in Chicago

Up to 30 additional NHs for a total of 61 NHs * ** Each vendor to be assigned 1/2 half of NHs

Integrated Care Coordination Implementation Strategy

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Target Date Methodology Strategy

Choice of full complement of MCEs providing all needs

Up to an additional 72 NHs for a total of 133 NHs ***

In year leading up to 2015 Choice of full complement of MCEs providing all needs

All 185 NHs in Cook Co.

* More nursing homes will be targeted if necessary to reach required benchmark by end of year. ** Demographics of Class Members may be found in separate charts. *** Additional nursing homes to be determined.

Benchmarks

• Evaluate 500 Class Members by May 2013

• Transition 300 Class Members by November 2013

• Transition a total of 800 Class Members by November 2014

• Transition a total of 1100 Class Members by May 2015

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Class Member Selection Process

• Primarily through self-identification

– Managed Care Entities (MCEs)

– Class Members who self-identify through the on-line referral & Section Q mechanisms

• Secondary strategies

– MCEs will be provided with data from MDS 3.0 and RUG groupings; analysis of persons who have successfully transitioned under the Pathways to Community Living/MFP initiative

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Relationship of Colbert to MFP

• Colbert Class Members who meet MFP enrollment definitions will be counted in Colbert & benchmark transition numbers for both programs

• MFP Operational Protocol is in process of being amended for Colbert Class Members

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Colbert Implementation & Relationship to MFP • It is anticipated that 95% of the Class Members

transitioning under the Colbert Implementation Plan will qualify for MFP – In large measure, those that will NOT qualify are

persons that choose a non-qualified setting – Persons that no longer meet nursing home/HCBS level

of care – The Colbert Implementation Plan & its processes of

care transition & planning has replaced the providers under MFP that had been performing in Cook County. • The current MFP processes remain the same outside of Cook

County

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Class Member Evaluation by MCE

• Using a person-centered and cross-discipline integrative approach, the MCE will utilized qualified professionals in the role Care Coordinators to conduct assessments beginning with a chart review through transition to community residency – Strength of this approach is the coordination of medical and non-

medical services and assessing the person from a holistic perspective – Cross-discipline team will consist of a nurse, Behavioral health social

worker and Bachelor level Care Coordinator – all positions to require prior experience

• No one tool for assessment has been identified at this time – Current tools will be utilized – Process incorporates a social history, cost neutrality elements and the

use of MFP processes to assure that needs are addressed in care planning and monitoring of post transition follow-up

• Care Coordinators will utilize the array of state plan and waiver services in addition to other services that are part of the enrollee’s MCE network 14

Housing

• Identification – Housing Resource Specialists

• State Housing Coordinators • Use of the state funded Internet On-Line Housing Locator

• Benefits – Assessment for Home Modification and Adaptation ($5,000);

Services to be provided by the University of Illinois at Chicago Assistive Technology Unit

– Assistance for Costs Associated with moving and the establishment of the household ($4,000); Managed by fiscal agent

• Housing Assistance – Bridge subsidy using HUD Section 8 guidelines (Difference

between FMR and income) ; Managed by fiscal agent; provided by the Housing Authority of Cook County

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Working with Guardians

• Meet individual to discuss each Class Member

• If there is a willingness to proceed, Guardian, Care Coordinator and Class Member meet to discuss options, needs in the community

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What are our goals?

• Inform & educate the resident of his/her options – There are home and community-based options in addition to the continued nursing home residency – Many nursing home residents, particularly amongst older adults

have families that need to be included in this conversation

– Families & residents may not know options – need to provide an informed choice

– Come with brochures should the conversation lead in that direction

• Engage the person in a conversation

• Transition interested motivated Class Members

Why did the state change the MFP model under Colbert?

• Money Follows the Person (MFP) is a demonstration project

• As a demonstration project, much has been learned over the last three years

• Data from the demonstration project indicates the need for a multi-disciplinary approach

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“Typical” MFP Participant

• 57 year old male who lived in his current nursing facility (NF) for approximately 2½ years

• Almost half (42%) have 5 or more major medical and mental co-morbidities

• Major health conditions include diabetes, heart disease, and COPD, and serious mental illnesses (SMI)

• Almost half (47%) experienced an Emergency Department (ED) visit in the previous year

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Lessons Learned under MFP

• MFP participants that have transitioned represent a very complex population; Nearly half of participants have a co-occurring mental illness diagnosis in addition to other disabilities and chronic health related conditions.

• Services provided to participants are not coordinated across systems. Each DHS Division and IDoA have their own transition coordination service providers. Current TC’s do not have the capacity to assess a participant’s multiple chronic physical and mental health conditions in addition to other disabilities. Current approach doesn’t view participants holistically and service plans do not necessarily address primary health and disability service needs.

• Service packages provided by the HCBS Waivers - DRS, IDoA, and DD Waivers do not respond well to participants with complex needs, as individuals cannot be enrolled in more than one HCBS Waiver at a time.

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Lessons Learned (Continued)

• No uniform assessment tool that addresses participants with complex needs. Assessment tools focus on specific disability, but do not take into account all of participants health & disability needs.

• Expertise of professionals conducting assessments is not uniform across agencies.

• Evaluation of outcomes under MFP recommends the creation of an integrated care management model that focuses on the complex co-morbid population.

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Lessons Learned - Risk Factors

• A majority (at least 50%) of “typical” MFP participants who transitioned were assessed with the following risk factors:

– needs assistance taking or monitoring medications (82%)

– taking 9 or more medications (59%)

– requires regular laboratory tests (56%)

– needs assistance with finances (54%)

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Lessons Learned - Critical Incidents

• About half of MFP participants (49%) experienced a Critical Incident (CI) after transition;

– 29% had 1 or 2 CIs, 20% had 3 or more

– Most of these CIs were either ED visits or hospital admissions

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