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 fifteenth Ligas Data Report, containing data from January 1, 2020 through June 30, 2020. 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 6/30/2020 |
| 1 |
Living at Home |
15,215 |
15,969 |
| 2 |
ICF/DD after 6/15/11 |
313 |
322 |
| 3 |
ICF/DD on 6/15/11 with an Affirmative Statement to Move (2a) |
1,351 |
1,343 |
| 3a |
DD PAS 10 |
9 |
9 |
| 3b |
DHS 1243/1238 |
952 |
947 |
| 3c |
EFE Form |
168 |
166 |
| 3d |
OSG Request |
202 |
201 |
| 3e |
Other Guardian Request |
20 |
20 |
| 4 |
# At End of Fiscal Year |
16,879 |
17, 634 |
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 |
70 |
15 |
| Individuals in Community Settings |
1,753 |
1,709 |
| Total Additions |
1,823 |
1,724 |
Removals
| Removals |
Removals in FY19 |
Removals In FY20 |
| Individual Moved Out of State |
104 |
75 |
| Determined Clinically Ineligible |
22 |
9 |
| Determined Financially Ineligible |
3 |
2 |
| Withdrew-Reason Not Given |
88 |
91 |
| Individual Deceased |
63 |
50 |
| Objector |
0 |
0 |
| Other |
627 |
518 |
| Incorrect SSN (Duplicate Record) |
4 |
1 |
| Ineligible Setting |
3 |
0 |
| Unable to Locate Individual |
290 |
208 |
| Stay in ICFDD |
13 |
4 |
| Submitted in Error |
0 |
0 |
| Move to ICFDD |
36 |
11 |
| Total Removals |
1,253 |
969 |
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.
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.
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 1 represents the number of ICF/DD Class Members approved for and/or receiving Waiver services:
|
Target Dates from Consent Decree: |
1/1/20 - 6/30/20 |
Cumulative Total as of 6/30/20 |
| 1 |
# of Class Members with Waiver Capacity Award Letters |
2 |
1463 |
| 2 |
*Total Class Members Who Have Moved to Waiver Services (per billing data) |
2 |
1461 |
| 2a |
Subtotal Who Received CILA Services |
2 |
1434 |
| 2b |
Subtotal Who Received HBS Services |
0 |
24 |
| 2c |
Subtotal Who Received CLF Services |
0 |
3 |
Note: 1 The 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 6/30/20 |
| 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 |
4,871 |
| 4 |
Total Class Members Who Have Received Waiver Services (as reported by the PAS agencies and providers) |
4,804 |
| 5 |
Total Class Members Who Have Received Waiver Services (per billing data) |
4,736 |
| 5a |
*Subtotal Who Received CILA Services(per billing data) |
1,125 |
| 5b |
*Subtotal Who Received HBS Services(per billing data) |
3,604 |
| 5c |
*Subtotal Who Received CLF Services(per billing data) |
7 |
Transition Service Plans
An initial version of a standardized format and accompanying instructions was developed with input from the Monitor, Plaintiff's 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 person-centered planning 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 began receiving Personal Plans in lieu of the Ligas Transition Plan (either as initial plans, or annual plans) as of January 1, 2018.
Transitions to CILA by CILA Size of Home
All Persons - Currently in CILA (as of 6/30/2020)
| Type of CILA |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
Total |
| 24 HR |
44 |
55 |
576 |
1,905 |
844 |
1,866 |
780 |
3,869 |
9,939 |
| Family |
412 |
53 |
1 |
14 |
6 |
1 |
0 |
4 |
491 |
| Host Family |
51 |
218 |
31 |
10 |
0 |
0 |
0 |
0 |
310 |
| Intermittent |
263 |
99 |
28 |
51 |
20 |
28 |
7 |
61 |
557 |
| Total |
770 |
425 |
636 |
1,980 |
870 |
1,895 |
787 |
3,934 |
11,297 |
Ligas Placements into CILA (from either an ICF/DD or from the PUNS list) - (as of 6/30/2020)
| Type of CILA |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
Total |
| 24 HR |
8 |
9 |
95 |
499 |
152 |
252 |
81 |
880 |
1,976 |
| Family |
95 |
5 |
0 |
3 |
2 |
0 |
0 |
0 |
105 |
| Host Family |
6 |
23 |
1 |
0 |
0 |
0 |
0 |
0 |
30 |
| Intermittent |
32 |
8 |
0 |
8 |
2 |
2 |
1 |
4 |
57 |
| Total |
141 |
45 |
96 |
510 |
156 |
254 |
82 |
884 |
2,168 |
Crisis Placements (through 6/30/2020)
| Type of CILA |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
Total |
| 24 HR |
6 |
11 |
126 |
264 |
105 |
227 |
102 |
494 |
1,335 |
| Family |
83 |
14 |
0 |
0 |
1 |
0 |
0 |
1 |
99 |
| Host Family |
10 |
37 |
3 |
0 |
0 |
0 |
0 |
0 |
50 |
| Intermittent |
50 |
13 |
0 |
9 |
0 |
4 |
1 |
4 |
81 |
| Total |
149 |
75 |
129 |
273 |
106 |
231 |
103 |
499 |
1,565 |
Note: Information regarding crisis placements (the number of individual as crisis placements receiving home-based support services, currently in state-operated facilities and were in CILA but terminated for various reasons) will be provided when available.
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 |
293 |
3,492 |
| 2 |
Total # of Class Members Approved |
280 |
283 |
3,253 |
| 2a |
# of Class Members Approved for CILA |
194 |
165 |
2,066 |
| 2b |
# of Class Members Approved for HBS |
86 |
118 |
1,187 |
| 3 |
Total # of Class Members Who Received Services |
277 |
283 |
3,237 |
| 3a |
# of Class Members who received CILA Services |
193 |
165 |
2,055 |
| 3b |
# of Class Members Who Received HBS Services |
84 |
118 |
1,182 |
| 4 |
Total # of Class Members Denied Crisis Approvals |
24 |
10 |
239 |
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 as of 6/30/2020 |
| 1 |
# of Agreements Initiated |
9 |
5 |
80 |
| 2 |
Total # Licensed Capacity |
127 |
164 |
1,593 |
| 3 |
Total # of People to Move |
91 |
126 |
1,285 |
| 3a |
*Moved to CILAs |
75 |
19 |
1,107 |
| 3b |
*Moved to HBS |
0 |
1 |
1 |
| 3c |
* Transferred to other ICFs/DD |
11 |
15 |
45 |
| 3d |
*Other |
5 |
3 |
44 |
| 3e |
*Move Pending |
0 |
88 |
88 |
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 |
Cumulative Total as of 6/30/2020 |
| 1 |
Total Class Members Appeals (Rows 2,3,4,5 = Row 1) |
49 |
31 |
436 |
| 1a |
Crisis Appeals |
14 |
3 |
161 |
| 1b |
Eligibility Appeals |
34 |
28 |
275 |
| 2 |
Subtotal Appeals Upheld |
15 |
5 |
136 |
| 3 |
Subtotal Appeals Denied |
27 |
1 |
236 |
| 4 |
Subtotal Appeals Pending |
1 |
17 |
18 |
| 5 |
Subtotal Appeals Withdrawn/Closed |
6 |
8 |
46 |
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 |
1225, as of 06/30/20 |
Total number of individuals who entered services from any PUNS selection
|
FY20 |
| # of Individuals |
602 |
Adults on PUNS Seeking Services as of June 30, 2020
| Time Waiting while Seeking Services as of June 30, 2020 |
Persons |
Est. FY for Services |
| Over 60 months |
693 |
FY22 |
| 59.99 months to 48 months |
1062 |
FY23 |
| 47.99 months to 35 months |
1180 |
FY24 |
| 34.99 months to 24 months |
1247 |
FY25 |
| 23.99 months to 12 months |
1591 |
FY26 |
| 11.99 months and less |
1514 |
Beyond FY26 |
| Total |
*7287 |
|
Note: * Includes 627 persons currently in the DD waiver. Time 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.
Waiver Service 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 2 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 |
1/1/20 - 6/30/20 |
| Adult HBS to Intermittent CILA |
5 |
2 |
0 |
| Adult HBS to Family CILA |
2 |
3 |
1 |
| Adult HBS to Host Family CILA |
0 |
0 |
0 |
| Adult HBS to 24-Hour CILA |
27 |
36 |
20 |
| Adult HBS to CILA Denials |
0 |
0 |
0 |
| Adult HBS to CILA Appeals |
0 |
0 |
0 |
Note : 2 A new process for transitions between Waiver services is in development for FY21. The new process will be in addition to the above process, for the time being.
Ligas Estimated Cost
Note: Projections updated 8/5/2020.
|
FY19 |
FY20 est.3 |
FY21 est.4 |
| PUNS Placements |
$120,979,448 |
$142,148,797 |
$168,032,685 |
| to CILA |
$47,062,776 |
$56,556,088 |
$68,221,181 |
| to HBS |
$73,916,672 |
$85,592,709 |
$99,811,504 |
| Transitions from ICF/DD's |
$93,917,401 |
$101,492,568 |
$112,226,255 |
| to CILA |
$93,239,974 |
$100,812,701 |
$111,534,140 |
| to HBS |
$677,427 |
$679,867 |
$692,115 |
| Ind. Serv. & Supt. Adv. (ISSA) |
$6,232,266 |
$7,207,314 |
$8,610,922 |
| Staffing and Contract Costs |
$8,315,436 |
$8,956,349 |
$9,442,149 |
| Personal Services |
$1,629,774 |
$1,629,774 |
$1,629,774 |
| Court Monitor |
$213,250 |
$243,250 |
$284,850 |
| HBSS Fiscal Agent |
$2,677,000 |
$3,083,800 |
$3,528,000 |
| 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 Advocacy Initiative |
$250,000 |
$250,000 |
$250,000 |
| Trans. Serv. Planning (U of I) |
|
|
|
| Ligas Training |
$21,397 |
$25,000 |
$25,000 |
| Total |
$229,444,551 |
$259,805,028 |
$298,312,011 |
| ICF/DD Liability Change |
($64,572,888) |
($70,784,104) |
($71,768,590) |
| Total Net Costs |
$164,871,663 |
$189,020,924 |
$226,543,421 |
| Change from Prior Year |
|
$24,149,261 |
$37,522,497 |
Notes:
3FY20 expenditures are still estimated due to the State still being in the budgetary lapse process. Actual expenditures for FY20 will be reported separately once final.
4FY21 expenditures are estimated and will continue to be through the fiscal year until the end of the FY21 budgetary lapse process.
| End of year Persons in Service |
FY19 |
FY21 |
FY21 est. |
| PUNS Placements |
|
|
|
| PUNS to CILA |
840 |
945 |
1,072 |
| PUNS to HBSS |
3,140 |
3,662 |
4,166 |
| Subtotal |
3,980 |
4,607 |
5,238 |
| Transitions from ICF/DD's |
|
|
|
| ICFDD to CILA |
1,601 |
1,621 |
1,681 |
| ICFDD to HBSS |
27 |
27 |
27 |
| Subtotal |
1,628 |
1,648 |
1,708 |
| Total (all receive ISSA) |
5,608 |
6,255 |
6,946 |
| ICF/DD Bed Reduction |
FY19 |
FY20 |
FY21 est. |
| Beds Closed in FY |
44 |
16 |
28 |
| Cumulative Beds Closed |
941 |
957 |
985 |
Note: The above budgetary lines do not include the funding for the new FY21 waiver transitions/increased need process because this option is available to all Waiver recipients, not just Ligas Class Members. The cost for the new process in FY21 is $10 million.
Additional Budget Related Information
DD Long Term Care Service System Cost
Overall spending for the DDLTC System is described below:
|
FY19 |
FY20 |
FY21 est. |
| Cost in Millions |
$334.2 |
*$299.5 |
$303.8 |
| $ Change from Prior Yr. |
$334.2 |
* ($34.7) |
$4.3 |
| Average Persons |
3,899 |
3,845 |
3,845 |
| Persons Change from Prior Yr. |
|
-54 |
0 |
Source: Est. Liability per HFS Reports DHS Budget Office.
Note: MC/DD (former SNF/PEDs) were transferred to HFS effective 4/1/2019 (PA100-0646). Both funding and persons have been adjusted for FY20 and FY21.
Adult Waiver Services
Adult Waiver "Accepted Claims" is described below:
|
FY19 |
FY20 |
| Adult Waiver Claims (millions) |
$838.00 |
data not available at time of this report |
| $ Change from Prior Yr. |
$838.00 |
data not available at time of this report |
| Unduplicated Persons |
21,635 |
data not available at time of this report |
| Persons Change from Prior Yr. |
21,635 |
data not available at time of this report |
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 |
FY20 |
| DD CILA Services Billings (millions) |
$689.20 |
$780.20 |
| $ Change from Prior Yr. |
$32.90 |
$91.00 |
| Authorized CILA persons |
11,406 |
11,364 |
| Persons Change from Prior Yr. |
47 |
-42 |
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. DHS has extended the contract through the end of November, is making steady progress toward final recommendations and anticipate the final report, including the rate calculators, in late October/early November.
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. We entered into an agreement with the current providers to expand by two homes each (4 per home). This was delayed due to the COVID-19 pandemic. Planned opening is for end of Q2.
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 updates are posted on the DHS website at: https://www.dhs.state.il.us/page.aspx?item=69861.
Coronavirus 2019
In March of 2020, the Governor of Illinois issued a Stay at Home Order as a result of the Coronavirus (COVID-19). Subsequently, the Department of Human Services temporarily suspended all site-based Community Day Service attendance in effort to prevent the spread of the virus. The Data for Agency-Reported COVID-19 Positive Cases in DDD Community Integrated Living Arrangements (CILAs) is available on the Department's website at https://www.dhs.state.il.us/page.aspx?item=125170. The Department of Public Health tracks statistics for Illinois at large as well as for long-term care facilities; this is available at https://www.dph.illinois.gov/.
