Paragraph 33 of the Ligas Consent Decree: …Not less than every six (6) months, Defendants shall provide to the Monitor, Plaintiffs, Class Counsel, Intervenors and Intervenors' Counsel and make publicly available, a detailed report containing data and information sufficient to evaluate Defendants' compliance with the Decree and Defendants progress toward achieving compliance…

This is the fifth Ligas Data Report. Per the Ligas Consent Decree, the Division of Developmental Disabilities (DDD) will produce reports of data and information regarding implementation of the provisions of the Ligas Consent Decree every six months. The due dates for these reports will typically be February 15th and August 15th of each year. Unless otherwise specified in the body of this report, the data collected for FY 2014 represents a time frame of July 1, 2013 through December 31, 2013.

Class Member List

The DDD is maintaining a centralized, master class list as described in the Ligas Implementation Plan. Individual records are categorized into three separate areas: individuals living at home in the community, individuals living in an ICF/DD who were admitted after June 15, 2011, and individuals living in an ICF/DD who were there on June 15, 2011 (the date of the Court's approval of the Consent Decree). Written statements documenting a desire to be a part of the class are obtained for each individual in the latter category. Individuals are added to or removed from the class list as appropriate. The table below provides a summary of the class list as of December 31, 2013.

FY12 FY13 FY14 FY15 FY16 FY17 Cumulative Total to Date
1 Living at Home 10,697 10,311 14,121
2 ICF/DD after 6/15/11 22 36 105
3 ICF/DD on 6/15/11 with an Affirmative Statement To Move (2a) 686 906 951
3a DD PAS 10 12 9 9
3b DHS 1243/1238 209 495 576
3c EFE Form 437 364 338
3d OSG Request 7 6 6
3e Other Guardian Request 14 20 22
4 # At End of Fiscal Year 11,406 11,253 15,177

Individuals were added to or removed from the Class Member List as follows during FY13 and FY14:

Additions in FY13 Additions in FY14
Individuals in ICFs/DD on 6/15/11 350 89
Individuals in ICF/DDs after 6/15/11 16 69
Individuals in Community Settings 47 3943
Total Additions 413 4101
Removals Removals in FY13 Removals in FY14
Individual Moved Out of State 35 6
Determined Clinically Ineligible 18 10
Determined Financially Ineligible 11 5
Withdrew-Reason Not Given 156 51
Individual Deceased 35 10
Objector 1 1
Other 5 0
Incorrect SSN (Duplicate Record) 17 10
Ineligible Setting 26 3
Unable to Locate Individual 169 59
Stay in ICFDD 92 32
Total Removals 565 177

Note: The relatively large increase during FY14 in additions of Class Members living at home is due in part to an enhancement to the DDD's database which now enables the DDD to regularly and automatically identify new enrollments in its waiting list and document the individuals as Class Members.

Services for Class Members in ICFs/DD

The DDD informed PAS/ISC agencies of the confirmed class members residing in ICFs/DD as of June 15, 2011, and instructed the agencies to complete eligibility determinations and facilitate the choice and selection process. PAS/ISC agencies are now reporting to the DDD on a monthly basis progress made in assisting the individuals with their options. The DDD continues to inform the PAS/ISC agencies of new class members as they are identified.

Target Dates from Consent Decree: 12/31/13 12/31/15 6/30/17 Cumulative Total to Date
1 # of Class Members With Waiver Capacity Award Letters 620
2 Total Class Members Who Have Moved to Waiver Services (per billing data) 578
2a Subtotal Who Received CILA Services 565
2b Subtotal Who Received HBS Services 10
2c Subtotal Who Received CLF Services 3

Note:The above data includes individuals who are moving due to ICF/DD downsizing and closure agreements.

Services for Class Members from the Waiting List

Four selections have been completed from the PUNS database (the Division's waiting list) since the approval of the Consent Decree using the criteria specified in the Ligas Implementation Plan. The Class Members selected have been notified and the PAS/ISC agencies have been instructed to complete eligibility determinations and facilitate the choice and provider selection process. A set of tables is maintained that provides summary information regarding the results of the selections. These tables are available on the Division's web site at http://www.dhs.state.il.us/page.aspx?item=41142. Outcomes for the individuals selected are reported below under the time frame in which the selection occurred.

Ligas Benchmarks 1,000 6/30/13 500 6/30/14 500 6/30/15 500 6/30/16 500
6/30/17
Cumulative Total to Date
1 # of Class Members Selected From The Waiting List (PUNS). 3112 500 3612
2 # of Class Members in ICF/DDs after 6/15/11 who were part of a downsizing 17 2 19
3 Total Class Members With Waiver Capacity Award Letters 1594 74 1668
4 Total Class Members Who Have Received Waiver Services (as reported by the PAS agencies and providers) 1512 48 1560
5 Total Class Members Who Have Received Waiver Services (per billing data) 1491 29 1520
5a Subtotal Who Received CILA Services (per billing data) 211 3 214
5b Subtotal Who Received HBS Services(per billing data) 1279 26 1305
5c Subtotal Who Received CLF Services(per billing data) 1 0 1

ICFs/DD Resident Outreach

With input from the Monitor, Class Counsel, and Intervenors, the DDD issued a Request for Proposals (RFP) to secure the services of a contractor or multiple contractors to contact all Potential Class Members residing in ICFs/DD; however, the DDD did not receive any bids in response to the RFP. After consultation with the State's procurement staff to ensure all regulations are appropriately followed, the DDD entered into discussions with a potential vendor. The vendor, The Council on Quality and Leadership (CQL), is now under contract with the DDD. CQL assigned/hired a Project Director and Project Manager. The vendor also hired individuals to conduct the initial phone contact and face-to-face interviews. With input from the Monitor, Class Counsel, and Intervenors, the vendor has developed an overall process description, a set of frequently asked questions with responses, a phone script for initial contacts, and meeting presentation materials. Geographic areas for the phase in of initial contact were selected. These areas are Madison and St. Clair Counties in the southern part of the State and the South and Southwest Suburbs of Cook County in the northern part of the State. CQL conducted training for the interviewers in September, with participation by DDD staff and the Monitor. An additional training session was held in January of 2014 for interviewers who were hired after the initial session.

FY12 FY13 FY14 FY15 FY16 FY17 Cumulative Total to Date
1 Total Potential Class Members 2777
2 # with Initial Phone Contact 122
3 # Choosing Not to Meet w/Outreach Contractor 82
4 # Choosing not to Meet at this time, but Want Future Contact 38
5 Total # Choosing to Meet w/Outreach Contractor 2
5a # Persons Completed Written Request for Community Services Through Outreach 1
5b # Undecided 0
5c # Pending 1
5d # Choosing ICF/DD 0

Transition Service Plans

An initial version of a standardized format and accompanying instructions was developed with input from the Monitor, Plaintiffs Counsel, PAS/ISC agencies, and other advocates throughout the system. Two PAS/ISC agencies piloted the draft process and materials with Class Members and providers in their areas. These two PAS/ISC agencies participated in a planning/training meeting with the Monitor and DDD staff on August 23, 2012 in order to begin the pilot. DDD staff and the Monitor reviewed the Transition Service Plans that were developed as the pilot was underway. Monthly conference calls were held among the two PAS/ISC agencies, Monitor, and DDD staff throughout the pilot. The standardized format and accompanying instructions were modified, based on the experience of the pilot, for Statewide implementation.

Training for all PAS/ISC agencies was held on April 16, 2013. This statewide training session was then followed with local training sessions for small groups of PAS/ISC agencies throughout the remainder of April and May. The training opportunities were conducted by DDD staff and the Monitor. Statewide implementation occurred on July 1, 2013: as of that date, Transition Service Plans are required for all individuals who move. A modified version of the Transition Service Plan has been provided for the PAS/ISC agencies for use with individuals who moved prior to statewide implementation of the Transition Service Plan format.

FY12 FY13 FY14 FY15 FY16 FY17 Cumulative Total to Date
1 # with Transition Service Plan Completed 0 116 382 498
2 # of Modified Transition Plans Completed 0 22 405 427
3 Total to Date 0 138 787 925

Crisis Services

The DDD continues to process service requests for individuals in crisis situations. Below is summary data regarding the requests processed.

FY12 FY13 FY14 FY15 FY16 FY17 Cumulative Total to Date
1 Total # of Crisis Requests Received 343 298 210 851
2 Total # of Class Members Approved 290 274 199 763
2a # of Class Members Approved for CILA 205 162 102 469
2b # of Class Members Approved for HBS 85 112 97 294
3 Total # of Class Members Who Received Services 288 269 196 753
3a # of Class Members Who Received CILA Services 203 159 100 462
3b # of Class Members Who Received HBS Services 85 110 96 291
4 Total # of Class Members Denied Crisis Approvals 53 24 11 88

Voluntary ICFs/DD Closure/Downsizing Agreements

The DDD continues to work with ICF/DD providers that wish to downsize or close their facilities on a voluntary basis. The information below summarizes the agreements underway since the Consent Decree was approved. Please take note of the following issues involving the data in the table below:

  • Included in the FY12 numbers are persons who were part of closure/downsizing agreements that were in process at the time of the approval of the Consent Decree on June 15, 2011. Therefore some individuals may have moved prior to that date and were not included in the Class as they already had community-based services prior to the approval of the Consent Decree.
  • It is a rare occurrence, but it is possible that some individuals who are part of closure/downsizing agreements are determined to be ineligible for the Adult Developmental Disabilities Medicaid Waiver. In such instances, the individuals are funded in community-based services with only State funding and are not eligible for membership in the Ligas Class.
  • In comparing this data with that in the section entitled "Services for Class Members in ICFs/DD", note that the data source for whether an individual has moved is different between the two sections. This section uses self-reported information from the ICF/DD providers regarding the status of their closure/downsizing agreements; the section entitled "Services for Class Members in ICFs/DD" uses billing data. Typically, there is a greater lag time in the billing data.
FY12 FY13 FY14 FY15 FY16 FY17 Cumulative Total to Date
1 # of Agreements Initiated 9 16 12 37
2 Total # Licensed Capacity 144 486 183 813
3 Total # of People to Move 117 403 154 674
3a Moved to CILAs 113 237 0 350
3b Moved to HBS 0 0 0
3c Transferred to Other ICFs/DD 4 0 0
3d Other 0 17 0
3e Move Pending 0 149 154

Note:Numbers and outcomes are recorded in the Fiscal Year in which the agreement was initiated.

Eligibility Appeals

The DDD continues to process appeals of eligibility. Below is summary data regarding the appeals processed since the Consent Decree was approved.

FY12 FY13 FY14 FY15 FY16 FY17 Cumulative Total to Date
1 Total Class Members Submitting Appeals
(Rows 2,3,4,5 = Row 1)
57 57 20 134
1a Crisis Appeals N/A 16 9 25
1b Eligibility Appeals N/A 41 11 52
2 Subtotal Appeals Upheld 9 22 4 35
3 Subtotal Appeals Denied 29 18 7 54
4 Subtotal Appeals Pending 17 11 5 33
5 Subtotal Appeals Withdrawn 2 6 4 12

Budget for Ligas

The Budget for FY14 included $32.5 million in increased funding to the Division of Developmental Disabilities for items related to Ligas Consent Decree implementation for an FY14 total of $68.1 million. This $68.1 million includes:

Budget Category - Description of Expense FY14 Proposed Amount Comments
Contractual Agreements
RFP ICF/DD Outreach $700,000
Eligibility Determinations and TSPs $500,000
Increased PUNS Enrollment Processing $500,000
New ISSA Services $592,000
Training, Consultation, & Family Support $400,000
Total Contractual $2,692,000
DDD Additional Staffing
Strategic Planning-Ligas Compliance Coordinator $108,277
Data Support $93,408
Quality Management-clinical reviews $653,856
Transition Services-facilitate and monitor $373,632
Appeals $79,004
Rate Setting $93,408
Medicaid Waiver-post payment reviews $280,224
Total Staffing $1,681,809
Direct Services
PUNS Selection $49,772,300 500 additional individuals; 1,000 annualized from FY12 and FY13.
500 phased in during FY14; one-half CILA and one-half HBS;
average annual cost for CILA $49,429, plus $2,500 one-time
start-up; average cost for HBS $25,740
ICF/DD Transitions $13,925,100 600 individuals; 400 annualized from FY12 and FY13 and
200 phased in during FY14; average annual cost for CILA
$49,429, plus $2,500 one-time start-up
Total Direct Services $63,697,400
Total Estimated Budget $68,071,209

The funding for Ligas Consent Decree Implementation in the State's FY14 budget includes an increase of $32.5 million, for an FY14 total of $68.1 million.

Spending for the ICF/DD program remains constant. In FY11 ICF/DD spending totaled $392.8 million, with 6,427 individuals being served at the end of that fiscal year. In FY12, spending for ICF/DDs in FY12 was $381.1 million, with 6,414 being served at the end of the fiscal year. The FY13 spending is $372.4 million, with 5,986 being served at the end of the fiscal year. ICF/DD spending is projected at $370.1 million for FY14.

Spending for the adult Waiver program was $568.4 million in FY11, $588.0 million in FY12, $634.2 million in FY13, and $362.4 million year-to-date in FY14. Based on accepted claims for the adult Waiver program, 17,456 individuals were served in FY11, 17,593 were served in FY12, 18,512 were served in FY13, and 18,429 have been served year-to-date in FY14. [Note that, with this fifth report, the figures in this paragraph are based on a new data source that provides a more accurate and consistent summary of annual spending and individuals served. Also note, that accepted claims data typically includes a lag of information as the State has two years from the date of service to process Medicaid claims.]

As a subset of the Waiver program, the total DDD funding for the CILA program, including day program services, for FY11 was $422.5 million, with 9,567 persons served throughout the year. In FY12, spending was $448.8 million, with 9,678 being served throughout the year. In FY13, spending was $512.7 million with 10,136 persons served. Spending for FY14 is projected to be $561.4 million with 10,600 persons served year to date.

NOTE: This report reflects the services provided in each fiscal year, regardless of the year from which payment was made.

Implementation Plan Updates and Amendments

The first annual update of the Ligas Implementation Plan was completed with input from the Monitor, Plaintiffs, and Intervenors. The second annual update is being finalized as this data report is being issued.