Colbert Dementia Reviews are independent, conflict-free, Dementia Reviews to facilitate the Illinois Department of Healthcare and Family Services (HFS) compliance with Colbert Consent Decree requirements. This new service will help to:
Per the Colbert Consent Decree, Cook County NF residents (referred to as Class Members under the Consent Decree) might be excluded from further Prime Agency outreach, assessment, and community transition activities on the basis of a medical determination that the exclusionary conditions are unlikely to improve.
Identifying these individuals allows for limited assessment and service planning resources provided by Prime Agencies to focus on Class Members who are appropriate for transition, rather than those who may be unable to transition due to their cognitive status.
Colbert Dementia Reviews are conducted for Medicaid eligible adults living in a Cook County NF (referred to as Colbert Class Members) who have been identified as someone who may potentially have “severe dementia or other clinically significant and progressive cognitive disorder that is unlikely to improve.”
MMS support for Dementia Reviews began in September 2023. MMS will initiate all individual referrals after receiving an approved list and NF contact information from the State. The exact timing of Reviews will largely depend on where the individual appears on the list, which will be worked chronologically. Timelines are also dependent upon the NF’s timely submission of supporting documentation. NFs will have up to 14 calendar days to respond to MMS’ request for information.
The NF is responsible to submit supporting documentation for the Dementia Review upon their receipt of an electronic request for information from MMS.
MMS recommends that the NF social worker and/or discharge planner respond to such inquiries, and we aim to route them accordingly. However, MMS is dependent upon the contact information first provided by the State which will be confirmed via phone call to the facility and clarified or corrected as needed. Active users of the PathTracker census tracking system in MMS’ AssessmentPro system are also likely candidates to support submission.
Since the Dementia Review aims to verify whether or not a person has a severe dementia unlikely to improve, documents which support this determination are expected to include the following:
*Note: A documented diagnosis alone is not sufficient evidence to justify an exclusionary condition.
Upon completion of a Dementia Review, Maximus will generate and outcome and explanation letters which will be mailed to the NF, the individual, and any applicable legal guardian.
Yes, if the Dementia Review outcome results in excluding a person from transition services and supports, they or someone acting on their behalf, may appeal the decision.
Being excluded from potential community transition supports is considered an adverse decision. Appeal information will be included with all adverse decisions. The process and instructions are detailed in the outcome letter that will be sent anytime a person receives the outcome, “Exclusionary Criteria is Met.”
In 1999, the US Supreme Court held in Olmstead v L.C., that the unjustified segregation of people with disabilities constitutes discrimination in violation of Title II of the with Disabilities Act (ADA). In Illinois, the Colbert v. Pritzker lawsuit claimed that people were living in nursing homes in Cook County when they could live in the community, which violates the ADA, the Rehabilitation Act, and Olmstead. The Colbert Consent Decree is the largest of three Olmstead settlements in Illinois.
Through this settlement and ongoing Consent Decree, the State agreed to provide supports and services to help Class Members move to and live in the community, in the most integrated setting that meets their needs.
Additional information can be found here:
https://www.dhs.state.il.us/page.aspx?item=136629
The UIC College of Nursing also offers free training courses for those that register here:
Referred Class Members will be assessed by a qualified professional in order to determine the presence of a “severe dementia” or other “clinically significant cognitive disorder unlikely to improve. Findings will be based on a document-based review and confirmed by a physician unaffiliated with a NF.
Possible outcomes of the Dementia Review include determinations that:
Exclusionary Criteria is Met which means the information made available during the Dementia Review supports the presence of a dementia/major Neurocognitive Disorder (NCD) diagnosis and the person clinically presents with severe disease which is unlikely to improve. This also means the person will be excluded from any further Prime Agency services related to assessment and potential transition to the community/Permanent Supportive Housing.
or
Exclusionary Criteria is Not Met which means the information made available during the Dementia Review indicated no major NCD only mild NCD, or the information provided was insufficient to allow for a conclusive determination. This also means the person will continue to receive Prime Agency services related to assessment and potential transition to the community/Permanent Supportive Housing.
or
Cancelled, which means the NF did not respond to request for information within the 14 days allotted or the individual has discharged to new facility, a lower level of care or has passed away.
Each facility works with one Colbert/Williams program agency. To be in the Colbert/Williams program, you can contact the agency for your facility. This can be done by Class Members, family, friends, or the general public. To find the right agency, contact IDHS. Call: 1.312.814.3784 or email:
DHS.ColbertDecree@illinois.gov or DHS.WilliamsConsentDecree@illinois.gov
