Ligas Data Report (for the period ending 12/31/19)

February 25, 2020

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 fourteenth Ligas Data Report, containing data from July 1, 2019 through December 31, 2019. 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.

Class Member List

The DDD maintains a centralized, master Class Member 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.

 FY19 FY20 as of 12/31/19
1 Living at Home 15,216 15,732
2 ICF/DD after 6/15/11 310 322
3 ICF/DD on 6/15/11 with an Affirmative Statement to Move (2a) 1,355 1,346
3a DD PAS 10 9 9
3b DHS 1242/1248 952 948
3c EFE Form 168 168
3d OSG Request 206 201
3e Other Guardian Request 20 20
4 #At End of Fiscal Year 16,881 17,400


Individuals were added to or removed from the Class Member List as follows:

Additions Additions in FY19 Additions in FY20
Individuals in ICFs/DD on 6/15/11 0 0
Individuals in ICF/DDs after 6/15/11 68 12
Individuals in Community Settings 1,753 1,100
Total Additions 1,821 1,112

Removals Removals in FY19 Removals

Removals Removals in FY19 Removals in FY20
Individual Moved Out of State 104 37
Determined Clinically Ineligible 22 7
Determined Financially Ineligible  3 0
Withdrew-Reason Not Given  88 48
Individual Deceased  63 24
Objector 0 0
Other 627 344
Incorrect SSN (Duplicate Record) 4 0
Ineligible Setting 2 0
Unable to Locate Individual 290 122
Stay in ICFDD 9 3
Submitted in Error 0 0
Moved to ICFDD 36 7
Total Removals 1,248 592

Notes:

  • Prior Fiscal Year numbers may change from previous reports due to updates made in class member types and effective dates. The total number of removals and additions will not reconcile to the net increase or decrease in class members due to some individuals changing class status from year to year.
  • "Other" in the above chart represents a variety of situations to include, but not limited to: individuals or family was unresponsive, signed PUNS form was not returned.

Services for Class Members in ICFs/DD

The DDD informed 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. ISC agencies report to the DDD on a monthly basis progress made in assisting the individuals with their options. All previous transition benchmarks for transitions from ICF/DS were met, with the limited exception of the final benchmark of June 30, 2017, just prior to which 310 OSG wards were added to the Class. This benchmark was not fully achieved, but the DDD, OSG and the ISC Agencies worked to evaluate and transition those individuals in a timely manner.

The following chart represents the number of ICF/DD Class Members approved for and/or receiving Waiver services:

Target Dates from Consent Decree: 7/1/19 - 12/31/19 Cumulative Total to Date
1 # of Class Members with Waiver Capacity Award Letters 29 1,461
2 *Total Class Members Who Have Moved to Waiver Services (per billing data) 30 1,459
2a Subtotal Who Received CILA Services 30 1,432
2b Subtotal Who Received HBS Services 0 24
2c Subtotal Who Received CLF Services 0 3

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

Services for Class Members from the Waiting List

Nine 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. Upon selection, Class Members are notified and the ISC agencies complete eligibility determinations and facilitate the choice and provider selection process utilizing Person Centered Planning. A set of tables is maintained that provides summary information regarding the results of the selections. These tables are available on the Division's website at https://www.dhs.state.il.us/page.aspx?item=41142.

Ligas Benchmarks Total as of 12/31/19
1 # of Class Members Selected from the Waiting List (PUNS) 8,079
2 # of Class Members in ICF/DDs after 6/15/11 who were part of a downsizing 176
3 Total Class Members with Waiver Capacity Award Letters 4,576
4 Total Class Members who have received Waiver services (as reported by the ISC agencies and providers) 4,491
5 Total Class Members who have received Waiver services (per billing data) 4,416
5a *Subtotal who received CILA services (per billing data) 1,075
5b *Subtotal who received HBS services (per billing data) 3,334
5c *Subtotal who received CLF services (per billing data) 7

ICFs/DD Resident Outreach

Outreach to all individuals residing in ICF/DDs was required under the Decree. This was completed via a contract with CQL, which conducted Outreach during FY14, FY15 and FY16. CQL's contract ended on January 31, 2016, and no other Outreach activities were required during this reporting period.

Transition Service Plans

An initial version of a standardized format and accompanying instructions was developed with input from the Monitor, Plaintiffs Counsel, ISC agencies, and other advocates throughout the system and implemented during FY13. In 2018, the DDD began transitioning to a more person-centered process for Ligas Class Members. The initial phase of the process involves development of a Discovery Tool, which identifies what is important to and for the Class Member. The second step is the creation of the Personal Plan, which focuses on the individual's strengths, preferences, needs and desires. Finally, an Implementation Strategy is created based on the content of the Personal Plan, which identifies the services and supports needed and which the provider will implement to achieve the outcomes identified in the Personal Plan. This new process began January 1, 2018 for Ligas Class Members. All Ligas Class Members, as of January 2018, have received a Personal Plan.

Transitions to CILA by CILA Size of Home

All Persons - Currently in CILA (as of 1/14/2020)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 44 58 574 1,931 861 1878 801 3,942 10,089
Family 427 47 1 10 5 1 0 4 495
Host Family 53 225 33 10 0 0 0 0 321
Intermittent 271 115 29 61 18 33 6 69 602
Total 795 445 637 2012 884 1912 807 4015 11,507

Ligas Placements (from either an ICF/DD or from the PUNS list)- Currently in CILA (as of 1/14/2020)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 6 6 97 450 145 234 77 820 1,835
Family 85 4 0 3 2 0 0 0 94
Host Family 8 25 1 0 0 0 0 0 34
Intermittent 30 8 0 8 2 2 1 4 55
Total 129 43 98 461 149 236 78 824 2,018

Crisis Placements (through 12/31/2019)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 6 11 122 255 103 221 102 475 1,295
Family 81 14 0 0 1 0 0 1 97
Host Family 10 37 3 0 0 0 0 0 50
Intermittent 50 13 0 9 0 4 1 4 81
Total 147 75 125 264 104 225 103 480 1,523

Regarding crisis placements, in addition to persons in CILA:

  • 865 crisis placements are receiving home-based support services
  • 24 individuals are currently in state-operated facilities
  • 400 individuals were in CILA but terminated for various reasons (i.e. deceased, moved out of state, moved to a nursing facility, returned to natural home, etc.)

Crisis Services

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

FY19 FY20 Cumulative Total to Date
1 Total # of Crisis Requests Received 304 168 3,367
2 Total # of Class Members Approved 280 163 3,133
2a # of Class Members Approved for CILA 194 107 2,008
2b # of Class Members Approved for HBS 86 56 1,125
3 Total # of Class Members Who Received Services 277 163 3,117
3a # of Class Members Who Received CILA Services 193 107 1,997
3b # of Class Members Who Received HBS Services 84 56 1,120
4 Total # of Class Members Denied Crisis Approvals 24 5 234

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 represents ICF/DD Closures or Downsizing agreements for the current reporting period, as well as a cumulative figure since inception (FY13).

In rare instances, 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.

FY19 FY20 Cumulative Total to Date
1 # of Agreements Initiated 9 2 77
2 Total # Licensed Capacity 127 116 1,545
3 Total # of People to Move 91 85 1,244
3a *Moved to CILAs 66 8 1,096
3b *Moved to HBS 0 0 0
3c *Transferred to other ICFs/DD 11 0 30
3d *Other 5 2 43
3e *Move Pending 9 75 84

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

Appeals

The DDD continues to process appeals of eligibility and crisis denials for services under the Adults with Developmental Disabilities Waiver. Below is summary data regarding such appeals.

FY19 FY20 as of 12/31/19 Cumulative Total to Date
1 Total Class Members Appeals (Rows 2,3,4,5 = Row 1) 48 13 418
1a Crisis Appeals 14 1 159
1b Eligibility Appeals 34 12 259
2 Subtotal Appeals Upheld 15 2 133
3 Subtotal Appeals Denied 27 5 240
4 Subtotal Appeals Pending 1 4 5
5 Subtotal Appeals Withdrawn/Closed 5 2 40

Reasonable Pace

Pursuant to the FY19 Implementation Plan, the DDD agreed to a process by which to ensure individuals on the PUNS waiting list enter services "at a reasonable pace". In addition, the DDD agreed to ensure a minimum of 600 individuals enter services during FY20. This includes individuals selected during FY20 or any prior PUNS selection. For FY20 only, this may include individuals transitioning from one Waiver-funded service to another (i.e. HBCS to CILA). For F21-FY25, a minimum of 630 individuals will be required to enter services each year, excluding transitions from one Waiver service to another (HBCS to CILA).

PUNS Selection Date Number of Selection letters sent Contact Made
8/12/19 1251 1211 (as of 12/31/19)

Total number of individuals who entered services from any PUNS selection

FY20

(7/1/19-12/31/19)

# of Individuals 313


Adults on PUNS Seeking Services as of December 31, 2019

Time Waiting while Seeking Services as of December 31, 2019 Persons Est. FY for Services
175 months to 62 months 1521 FY21
61.99 months to 36 months 1519 FY22
35.99 months to 24 months 1510 FY23
23.99 months to 17 months 1508 FY24
16.99 to 6 months 1496 FY25
5.99 months & less 839 FY26
Total *8393

Note: * Includes 876 persons currently in the DD waiver. Ttime Waiting is based on current PUNS data and may fluctuate to some extent, except for FY25, in which Time Waiting will be no more than 60 months.

Transitions from AHBS to CILA

The following data represents the number of Waiver-funded individuals who transitioned from the Adult Home-Based Support (AHBS) program to the Community Integrated Living Arrangement (CILA) program for the period specified below. These service changes were a result of an individual's increased need for such services, and not the result of a selection from the PUNS list.

Type of service request 1/1/19 - 6/30/19 7/1/19 - 12/31/19
Adult HBS to Intermittent CILA 5 2
Adult HBS to Family CILA 2 3
Adult HBS to Host Family CILA 0 0
Adult HBS to 24-Hour CILA 27 36
HBS to CILA Denials 0 0
HBS to CILA Appeals 0 0

Ligas Estimated Cost 

Projection updated 1/24/20; Client data updated 1/14/20

FY19 FY20 est. FY21 proj.
PUNS Placements $120,926,085 $141,778,821 $166,982,197
to CILA $46,986,404 $56,946,506 $67,157,495
to HBSS $73,939,681 $84,832,314 $99,824,702
Transitions from ICF/DD's $93,917,401 $103,270,612 $109,347,042
to CILA $93,239,974 $102,590,745 $108,654,927
to HBSS $677,427 $679,867 $692,115
Ind. Serv. & Supt. Adv. (ISSA) $6,231,877 $7,272,251  $8,269,471
Staffing and Contract Costs $8,316,536 $8,949,349 $9,421,749
Personal Services $1,629,774 $1,629,774 $1,629,774
Court Monitor $213,250 $213,250 $213,250
HBSS Fiscal Agent $2,678,100 $3,056,800 $3,529,200
Ind. Service Coord. (ISC)  $1,370,381 $1,418,344 $1,418,344
Pre-Adm. Screen. (ISC) $2,052,431 $2,124,266 $2,124,266
PUNS Database  
Outreach
Family Advoc. Initiative  $250,000   $250,000   $250,000 
Trans. Serv. Planning (U of I) $50,000 $50,000
Ligas Compliance Monitoring $101,203 $181,915 $181,915
Ligas Training $21,397 $25,000  $25,000 
Total $229,391,899 $261,271,033 $294,020,459
ICF/DD Liability Change -$64,572,888 -$71,384,583 -$74,896,889
Total Net Costs $164,819,011 $189,886,450 $219,123,570
End of year Persons in Service: FY19 FY20 est. FY21 proj.
PUNS Placements
PUNS to CILA 838 975 1,101
PUNS to HBSS 3,140 3,620 4,124
Subtotal 3,978 4,595 5,225
Transitions from ICF/DD's
ICFDD to CILA 1,601 1,661 1,721
ICFDD to HBSS 27 27 27
Subtotal 1,628 1,688 1,748
Total (all receive ISSA) 5,606 6,283 6,973
ICF/DD Liability Change FY19 FY20 est. FY21 proj.
Beds Closed in FY 44 35 28
Cumulative Beds Closed 941 976 1,004

Note: The estimated amounts are anticipated spending based on approved appropriations for the current fiscal year. The projected amounts are anticipated spending not yet appropriated.


Additional Budget Related Information

DD Long Term Care Service System Cost

Overall spending for the DDLTC System is described below:

FY19 FY20
Cost in Millions $334.2 *$294.5
$ Change from Prior Yr. $334.2 * $ (39.7)
Average Persons 3,899 3,845
Persons Change from Prior Yr. 3,899 -54

 Source: Est. Liability per HFS Reports DHS Budget Office.

* MC/DD (former SNF/Peds) were transferred to HFS effective 4/1/2019 (PA100-0646). Both funding and persons have been adjusted.

Adult Waiver Services

Adult Waiver "Accepted Claims" is described below:

FY19
Adult Waiver Claims (millions) $838.0
$ Change from Prior Yr. $838.0
Unduplicated Persons 21,635
Persons Change from Prior Yr. 21,635

Source: Accepted Claims Reports (Mobius)

DD CILA Waiver Services

A subset of Adult Waiver services, spending for CILA services, including residential, day and ISSA is described below:

FY19
DD CILA Services Billings (millions) $ 689.2
$ Change from Prior Yr. $ 32.9
Authorized CILA persons 11,406
Persons Change from Prior Yr. 47

 Source: Billing System & Authorized Client Report


Rates Oversight Committee/Rate Development

The Rates Oversight Committee was established in August 2018 to address concerns regarding the rate structure for CILA and ICF/DD providers. The Committee oversaw seven sub-committees on various subjects and who provided reports and recommendations to the Committee. The Final Report of the Committee was issued on November 13, 2019, and a contractor was hired to conduct a rate study and make recommendations for a revised rate methodology. This study and recommendations are expected by June 30, 2020.

Expansion of Short-Term Stabilization Homes

The DDD previously utilized four Short-Term Stabilization Homes with a total capacity of 16 beds (4 per home) to provide temporary stabilization services to Class Members experiencing extraordinary behavioral issues preventing their continued stay in their Community-Based Setting. During this reporting period, no additional homes or beds have been added.

Implementation Plan Updates and Amendments

The original Implementation Plan was completed and filed with the Court with input from the Monitor, Plaintiffs, and Intervenors. Subsequent annual updates are completed each year. The original Implementation Plan and the subsequent update are posted on the DHS website at: https://www.dhs.state.il.us/page.aspx?item=69861.