LIGAS DATA REPORT - February 15, 2022

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 sixteenth Ligas Data Report, containing data from July 1, 2021 through December 31, 2021. 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 FY21 FY22 as of 1/22/22
1 Living at Home 15,215 15,969 16,360 15,963
2 ICF/DD after 6/15/11 313 322 323 328
3 ICF/DD on 6/15/11 with an Affirmative Statement to Move (2a) 1,351 1,343 1,335 1,335
3a DD PAS 10 9 9 9 9
3b DHS 1243/1238 952 947 941 941
3c EFE Form 168 166 165 165
3d OSG Request 202 201 200 200
3e Other Guardian Request 20 20 20 20
4 # At End of Fiscal Year 16,879 17,634 18,018 17,626

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

Additions Additions in FY19 Additions in FY20 Additions in FY21 Additions in FY22 as of 12/31/21
Individuals in ICFs/DD on 6/15/11 - - - -
Individuals in ICF/DDs after 6/15/11 70 15 17 8
Individuals in Community Settings 1,753 1,709 1,574 422
Total Additions 1,823 1,724 1,591 430
Removals

Removals

in FY19

Removals

in FY20

Removals

in FY21

Removals in FY22 as of 12/31/21
Individual Moved Out of State 104 75 97 58
Determined Clinically Ineligible 22 9 26 7
Determined Financially Ineligible  3 2 2 0
Withdrew-Reason Not Given 88 91 116 55
Individual Deceased 63 50 47 26
Objector 0 0 0 0
Other 627 518 662 564
Incorrect SSN (Duplicate Record) 4 1 6 9
Ineligible Setting 3 0 0 0
Unable to Locate Individual 290 208 239 94
Stay in ICFDD 13 4 2 2
Submitted in Error 0 0 0 0
Move to ICFDD 36 11 10 7
Total Removals 1,253 969 1207 822
  • 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 including, but not limited to, individual or family was unresponsive or 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 The Council on Quality and Leadership (CQL), which conducted Outreach during FY14, FY15 and FY16. CQL's contract ended on January 31, 2016. No other Outreach activities were required or conducted during this reporting period.

Services for Class Members in ICFs/DD

The DDD informed Independent Service Coordination (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 reported progress made in assisting the individuals with their options to the DDD on a monthly basis. 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: FY20 FY21 FY22 as of 12/31/2021 Cumulative Total to Date
1 # of Class Members with Waiver Capacity Award Letters 31 0 0 1,467
2 *Total Class Members Who Have Moved to Waiver Services (per billing data) 32 0 0 1,467
2a Subtotal Who Received CILA Services 32 0 0 1,440
2b Subtotal Who Received HBS Services 0 0 0 24
2c Subtotal Who Received CLF Services 0 0 0 3

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

Services for Class Members from the Waiting List

Eleven 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 and subsequent amendments. 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. The PUNS Selection Data tables are available on the Division's website.

Ligas Benchmarks Total
1 # of Class Members Selected from the Waiting List (PUNS). 11,236
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 6,074
4 Total Class Members Who Have Received Waiver Services (as reported by the PAS agencies and providers) 5,968
5 Total Class Members Who Have Received Waiver Services (per billing data) 5,848
5a *Subtotal Who Received CILA Services (per billing data) 1,288
5b *Subtotal Who Received HBS Services (per billing data) 4,551
5c *Subtotal Who Received CLF Services (per billing data) 9

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 transitioned 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. Note: The person-centered planning process is used, not just for Ligas Class Members, but all waiver participants within the Adults with Developmental Disabilities Waiver.

Transitions to CILA by CILA Size of Home

All Persons - Currently in CILA as of 12/31/21 (per the CILA Log - agrees with Authorized total per Mobius)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 40 52 585 1,955 899 1,840 781 3,753 9,905
Family 443 47 3 13 5 1 0 4 516
Host Family 54 205 32 7 0 0 0 0 298
Intermittent 265 93 31 46 18 23 6 52 534
Total 802 397 651 2,021 922 1,864 787 3,809 11,253

Ligas Placements into CILA as of 12/31/21 (known placements compared to CILA Log)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 40 52 585 1,955 899 1,840 781 3,753 9,905
Family 443 47 3 13 5 1 0 4 516
Host Family 54 205 32 7 0 0 0 0 298
Intermittent 265 93 31 46 18 23 6 52 534
Total 802 397 651 2,021 922 1,864 787 3,809 11,253

Crisis Placements into CILA as of 12/31/21 (Crisis placements compared to CILA log)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 6 11 140 301 110 248 115 546 1,477
Family 91 14 0 0 0 0 0 1 107
Host Family 11 39 3 0 0 0 0 0 53
Intermittent 57 14 0 9 0 4 1 4 89
Total 165 78 143 310 111 252 116 551 1,726

Crisis Services

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

FY19 FY20 FY21 FY22 as of 12/31/2021 Cumulative Total to Date
1 Total # of Crisis Requests Received 304 293 251 82 3,825
2 Total # of Class Members Approved 280 283 249 80 3,582
2a # of Class Members Approved for CILA 194 165 159 49 2,279
2b # of Class Members Approved for HBS 86 118 85 31 1,303
3 Total # of Class Members Who Received Services 277 283 249 78 3,564
3a # of Class Members Who Received CILA Services 193 165 159 49 2,268
3b # of Class Members Who Received HBS Services 84 118 85 29 1,296
4 Total # of Class Members Denied Crisis Approvals 24 10 2 2 243

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 FY21 FY22 as of 12/31/2021  Cumulative Total To date
1 # of Agreements Initiated 9 5 0 0 80
2 Total # Licensed Capacity 127 164 0 0 1,593
3 Total # of People to Move 91 127 0 0 1,286
3a *Moved to CILAs 75 88 0 0 1,176
3b *Moved to HBS 0 2 0 0 2
3c *Transferred to other ICFs/DD 11 29 0 0 59
3d *Other 5 8 0 0 49
3e *Move Pending 0 0 0 0 0

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.

FY20 FY21 FY22 As of 12/31/21 Cumulative Total to date
1 Total Class Members Appeals (Rows 2,3,4,5 = Row 1) 32 25 17 510
1a Crisis Appeals 3 1 1 183
1b Eligibility Appeals 29 24 16 327
2 Subtotal Appeals Upheld 7 6 1 155
3 Subtotal Appeals Denied 18 5 7 280
4 Subtotal Appeals Pending 1 7 9 17
5 Subtotal Appeals Withdrawn/Closed 6 3 7 58

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 FY21-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 1,251 1,225
7/12/20 1,561 1,536
7/12/21 1,596 1,471

Total number of individuals who entered services from any PUNS selection

FY20 FY21 FY22 as of 12/31/21
# of Individuals 602 708 368

Adults on PUNS Seeking Services as of December 31, 2021

Time Waiting while Seeking Services as of December 31, 2021 Persons Est. FY for Services
Over 60 months 9 FY23
59.99 months to 48 months 25 FY23
47.99 months to 36 months 1,148 *FY23/FY24
34.99 months to 24 months 1,433 *FY24/FY25
23.99 months to 12 months 1,362 FY25
11.99 months and less 1,463 Beyond FY25
Total 5,398

*Note: 1148 people will be selected between fiscal years 2023 and 2024; another 1433 will be selected between fiscal years 2024 and 2025. The actual number of people who are selected in a given year is an estimate at the time of this report.

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 for such services, and not the result of a selection from the PUNS list.

Type of service request FY19 (1/1/19 - 6/30/19) FY20 FY21 FY22 as of 12/31/21
Adult HBS to Intermittent CILA 5 2 1 1
Adult HBS to Family CILA 2 4 6 1
Adult HBS to Host Family CILA 0 0 1 1
Adult HBS to 24-Hour CILA 27 56 67 62
HBS to CILA Denials 0 0 0 0
HBS to CILA Appeals 0 0 0 0

Note: A new process for transitions between Waiver services has been developed and was effective April 6, 2021. The DDD released a final Information Bulletin on the new Waiver Service Transition process (and the Crisis process); the new process took the place of the above process.

Ligas Estimated Cost

Projection updated December 2021

FY19 FY20 FY21 FY22 Proj.
PUNS Placements $120,979,448 $142,124,850 $170,156,764 $199,729,247
to CILA $47,062,776 $56,563,866 $69,121,348 $80,702,576
to HBSS $73,916,673 $85,560,984 $101,035,417 $119,026,671
Transitions from ICF/DD's $93,917,401 $101,492,568 $110,679,759 $115,454,309
to CILA $93,239,974 $100,812,701 $109,987,644 $114,744,856
to HBSS $677,427 $679,867 $692,115 $709,452
ISSA $6,232,266 $7,205,895 $8,645,124 $9,696,692
Staffing and Contract Costs $8,315,436 $9,245,330 $9,521,784 $10,025,091
Personal Services $1,629,774 $1,629,774 $1,629,774 $1,629,774
Court Monitor $213,250 $243,135 $284,850 $284,850
HBSS Fiscal Agent $2,677,000 $3,082,700 $3,571,300 $4,100,400
Ind. Service Coord. (ISC) $1,370,381 $1,418,344 $1,418,344 $1,418,344
Pre-Adm. Screen. (ISC) $2,052,431 $2,124,266 $2,124,266 $2,124,266
Family Advoc. Initiative $250,000 $250,000 $250,000 $250,000
Ligas Compliance Monitoring $101,203 $149,941 $0 $0
Ligas Training $21,397 $25,000 $0 $0
DD Scorecards $0 $43,920 $0 $0
Rate Study $0 $278,250 $243,250 $0
Person Centered Planning $0 $0 $0 $217,457
Total $229,444,551 $260,068,643 $299,003,432 $334,905,338
ICF/DD Liability Change ($64,572,888) ($70,784,104) ($71,152,018) ($71,172,540)
Total Net Costs $164,871,663 $189,284,540 $227,851,414 $263,732,799

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 FY21 proj.
Cost in Millions $330.4 *$287.1 $277.8
$ Change from Prior Yr. $(43.3) $(9.3)
Average Persons 3,898 3,836 3,766
Persons Change from Prior Yr. -62 -70

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 were adjusted for FY20 and FY21.

Adult Waiver Services

Adult Waiver "Accepted Claims" is described below:

FY19 FY20 FY21 proj.
Adult Waiver Claims (millions) $849.80 $845.10 $867.52
$ Change from Prior Yr. ($4.70) $22.42
Unduplicated Persons 21,650 21,944 22,244
Persons Change from Prior Yr. 294 300

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 FY21 proj.
DD CILA Services Billings (millions) $689.20 $784.30 $827.40
$ Change from Prior Yr. $32.90 $95.10 $43.10
Authorized CILA persons 11,406 11,352 11,314
Persons Change from Prior Yr. 47 -54 -38

Source: Billing System & Authorized Client Report (Cl Type C)


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 around the following subject areas: ICF/DD, staffing, assistive technology, employment and training, nursing, transportation, and behavioral supports. These subcommittees provided reports and recommendations to the Committee. The Final Report of the Committee was issued on November 13, 2019, at which point a contractor (formerly Guidehouse) was hired to conduct a rate study and make recommendations for a revised rate methodology. The contract was extended through the end of November 2020 to finalize recommendations and produce the final report, including the rate calculators. The Final Rates Report from Guidehouse was released December 8, 2020.

The Governor's proposed FY 23 budget includes a historic increase for DD funded services. Note: The budget must be passed by the Illinois General Assembly and rate increases must be approved by the Federal Centers for Medicare and Medicaid Services (CMS). The 2022 broad overview of the proposed budget includes the Guidehouse Rate Study increases ($140M): $45.0M - Annualized cost (encumbrance) of FY 22 provider rate increases that took effect 1/1/22 and $94.8M (will require an additional $94.8M investment for FY 24) - $1.00 an hour rate increase for DSPs, CILA Rate Calculator, ICF Residential components effective 1/1/23.

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 Envision and Individual Advocacy Group, the current providers, to expand the previously contracted four Short-Term Stabilization Homes by two homes each, creating an increased total capacity of 32 beds (4 per home) to provide temporary stabilization services for the increased need among Class Members experiencing extraordinary behavioral issues, jeopardizing their continued stay in their community-Based Setting.

Each agency opened one of their two new homes in 2021. Envision opened its third home for occupancy, referred to as Miami, located in Forest Park, IL on April 12th, 2021. Individual Advocacy Group opened its third home, The Portuguese Hill, located in Jacksonville, IL on May 27th, 2021. These two additional homes provide short-term stabilization capacity for an additional eight people. Each agency is projected to open their fourth homes in FY22, adding capacity for eight more people, reaching the total of 32.

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. 

Coronavirus (COVID-19)

In March of 2020, the Governor of Illinois issued a Stay at Home Order as a result of the Coronavirus (COVID-19). The DDD worked with Healthcare and Family Services (HFS) to file an Appendix K amendment to the Waiver to support policy and rate changes to stabilize the system. Subsequently, the Department of Human Services temporarily suspended all site-based Community Day Services (CDS) attendance in effort to prevent the spread of the virus. CDS reopened fully on September 1, 2020, under guidance from the DDD, including reduced capacity and infection control measures, consistent with guidance from both the Centers for Disease Control (CDS) and the Illinois Department of Public Health (IDPH). Effective October 1, 2020, the DDD implemented a new waiver service, Virtual Day Services (VDS), to allow individuals to receive day services virtually during the pandemic.

Data for Agency-Reported COVID-19 Positive Cases in DDD Community-Integrated Living Arrangements (CILAs) is available on the Department's website. IDPH tracks COVID statistics for Illinois at large as well as for long-term care facilities.