Case: 1:07-cv-04737 Document #: 367 Filed: 01/13/20 Page 1 of 159 PageID #:3164 Colbert v. Pritzker Case No. 07-C4737 (N.D. Ill.) Court Monitor FY2019 Compliance Assessment Annual Report to the Court Gail P. Hutchings, MPA Court Monitor January 13, 2020 Case: 1:07-cv-04737 Document #: 367 Filed: 01/13/20 Page 2 of 159 PageID #:3164 Table of Contents Executive Summary………………………………………….…………….…….Page ii Section I: Introduction.……………………………….……………………..……Page 1 Section II: Overview of FY2019 Compliance Assessment Findings………Page 10 Section III: Outreach to Colbert Class Members……………..…….…….…Page 13 Section IV: Evaluation of Colbert Class Members.………….……..…….…Page 24 Section V: Service Planning for Colbert Class Members.…...……….….…Page 39 Section VI: Transition Activities to Support Class Members.…………...….Page 52 Section VII: Community-Based Services and Housing Development…….Page 69 Section VIII: Administrative Requirements.…………..............................…Page 81 Section IX: Implementation Planning…….……….....................................Page 101 Section X: Quality Assurance – Class Member Safety and Mortality……Page 109 Conclusion………………………………….…………..............................…Page 111 Appendix A: Compliance Assessment Ratings for All Colbert Consent Decree, Updated Cost Neutral Plan, and FY2019 Implementation Plan Requirements……. …………………………………………………………………………….......Appendix 1 i Case: 1:07-cv-04737 Document #: 367 Filed: 01/13/20 Page 3 of 159 PageID #:3164 Executive Summary This report is intended to provide Judge Joan Lefkow, Senior United States District Judge, Northern District of Illinois, and the Colbert Consent Decree Parties with the Court Monitor’s thorough assessment of the Defendants’ (and others when relevant) fiscal year 2019 (FY2019) performance under Colbert v. Pritzker (Case No. 07-C737). Specifically the report assesses compliance with the obligations of the Colbert Consent Decree, Updated Cost Neutral Plan, and FY2019 Implementation Plan. Within this report, the Court Monitor endeavors to provide the Court with a fair and neutral assessment of the Defendants’ performance relative to 236 requirements on the Defendants, as well as the Court Monitor’s performance relative to two additional requirements. This is the present Court Monitor’s third report to the Court under Colbert v. Pritzker. While this report is filed under Colbert v. Pritzker, the compliance ratings provided herein apply to two gubernatorial administrations. On November 6, 2018, J.B. Pritzker was elected to serve as the 43rd Governor of Illinois, unseating then-Governor Bruce Rauner. This change in Illinois bifurcated the FY2019 compliance period between two administrations: with the Rauner administration in place until Pritkzer’s inauguration on January 14, 2019 and the Pritzker administration in place after inauguration through the remainder of the fiscal year (and to-date as of the writing of this report). Throughout the full report, the Court Monitor provides detail and analysis related to each administration’s performance relative to specific Consent Decree requirements and an assessment of their overall leadership and execution relative to the Decree. In 2007, a class of Medicaid-eligible adult residents with disabilities in Cook County, Illinois nursing homes, filed suit against the State of Illinois under Colbert v. Blagojevich, alleging that the State of Illinois was in violation of Title II of the American with Disabilities Act and Section 504 of the Rehabilitation Act and contending that adults with psychiatric and physical disabilities were being needlessly segregated in institutional settings and denied the opportunity to receive services in more integrated community-based settings. In 2011, the Colbert Consent Decree was approved, which specified the State’s obligations to afford Class Members the rights to live in the most integrated settings possible, through concerted efforts to transition eligible individuals out of Cook County nursing facilities. The Colbert Consent Decree and Updated Cost Neutral Plan, through 53 unique requirements, lays out the path for the State of Illinois to build a set of approaches to transition individuals out of nursing facilities. These requirements focus on compliance across several interconnected domains, including outreach, evaluation, service planning, transitions, community services and housing development, administration, and implementation planning. Further, there are 183 requirements applicable to FY2019 per their inclusion in the Defendants’ FY2019 Implementation Plan, which is enforceable under the Decree. ii Case: 1:07-cv-04737 Document #: 367 Filed: 01/13/20 Page 4 of 159 PageID #:3164 Figure 1 summarizes the Court Monitor’s compliance determinations relative to all Consent Decree requirements. Of the 236 distinct requirements applicable to Figure 1. Defendants' FY19 Compliance with FY2019 — 53 Consent Colbert Consent Decree Requirements Decree and Updated Cost Total Requirements = 236 Neutral Plan requirements and 183 Implementation Plan requirements — the Defendants are in compliance with 106 requirements (45%), in 87 partial compliance with 43 (37%) 106 requirements (18%), and (45%) out-of-compliance with 87 In Compliance requirements (37%). Partial Compliance 43 For the 53 Consent Decree (18%) Out-of-Compliance requirements applicable to FY2019 alone, the Defendants were found in compliance with 32%, in partial compliance with 15% and out-of-compliance with 40%. Figure 2 compares the distribution of compliance ratings for the previous compliance period — the first half of calendar year 2018 (CY2018) — and FY2019 for Colbert Consent requirements only, demonstrating modest improvement in performance in FY2019 compared to the previous compliance period. There were no Implementation Plan Figure 2. Comparison of Compliance Assessment requirements with which to compare Ratings for Colbert Consent Decree FY2018 and FY2019 compliance Requirements Only: ratings, because of the Defendants’ First-Half CY2018 and FY2019 late filing of their FY2018 Compliance Rating First-Half CY2018 FY2019 Implementation Plan. A closer look at In Compliance 15 (26%) 17 (32%) specific Consent Decree domains Partial Compliance 14 (24%) 15 (28%) shows that when compared to the first Out-of-Compliance 29 (50%) 21 (40%) half of CY2018 there were moderate improvements in FY2019 in the areas of transition and implementation planning, while declining performance in the domains of outreach, service planning, and evaluation. Figure 3 illustrates the Court Monitor’s FY2019 compliance determinations relative to each domain, aggregating to the total number of requirements falling within each compliance category. Within this report, there is a dedicated section for each of the compliance domains listed below, which includes the Court Monitor’s rationale for each compliance assessment rating. iii Case: 1:07-cv-04737 Document #: 367 Filed: 01/13/20 Page 5 of 159 PageID #:3164 Figure 3. Synopsis of FY2019 Compliance Assessments for Colbert Consent Decree, Updated Cost Neutral Plan, and FY2019 Implementation Plan Requirements Outreach Out-of- In Complianceè 17 Partial Complianceè 6 7 Requirements (30) Complianceè Evaluation Out-of- In Complianceè 19 Partial Complianceè 7 13 Requirements (39) Complianceè Service Plan Out-of- In Complianceè 21 Partial Complianceè 1 18 Requirements (40) Complianceè Transition Out-of- In Complianceè 26 Partial Complianceè 6 14 Requirements (46) Complianceè Community-Based Services/Housing Out-of- Capacity In Complianceè 7 Partial Complianceè 3 14 Complianceè Development Requirements (24) Administrative Out-of- In Complianceè 13 Partial Complianceè 15 18 Requirements (46) Complianceè Implementation Plan Out-of- In Complianceè 3 Partial Complianceè 5 3 Requirements (11) Complianceè Total Out-of- Requirements In Complianceè 106 Partial Complianceè 43 87 Complianceè (236) FY2019 Out-of- Performance In Complianceè 45% Partial Complianceè 18% 37% Complianceè Percentage In the Court Monitor’s Compliance Assessment Report to the Court (Compliance Report: January 1, 2018 – June 30, 2018) — the most recent report filed under the Colbert case — major areas of non-compliance centered on four major themes: § A paucity of committed and accountable high-level leadership, § Plummeting performance in numeric transition requirements, § Lack of a data-driven community-based services and housing capacity development strategy, and § Unaddressed and serious process issues, including pipeline impediments that delay or prevent transitions among Class Members. The Rauner administration made commitments in their FY2019 Implementation Plan to remedy many of these long-standing issues. These commitments included the development of a Guiding Coalition for Long-Term Care Reforms comprised of high-level staff from the Governor’s Office and various state agencies that includes executives named as Defendants in the Colbert Consent Decree. The Guiding Coalition was espoused to dedicate the needed attention and energy to overall systems rebalancing and improvements and thus positively impact Consent Decree compliance. iv Case: 1:07-cv-04737 Document #: 367 Filed: 01/13/20 Page 6 of 159 PageID #:3164 Further, Defendants codified several other important commitments in their FY2019 Implementation Plan such as developing a partnership strategy with Cook County Federally Qualified Health Centers and a major local health system to leverage additional service capacity; conducting a gaps analysis to identify needed community-based services