Ligas Rates Oversight Committee - Guidehouse CILA Rate Calculator - October 5, 2023
- Developmental Disability Services Rate Study
- Residential Services and Related Supports
- CILA Rate Methodology
CILA Rate Components - Current & Guidehouse Recommended
- Program Costs
- Staffing Costs
- Other Supply Costs
- Miscellaneous Consultant Service Costs
- Nursing Costs
- Room and Board Costs
- Non-Housing Room and Board Costs
- Transportation Costs
- Administration Costs
CILA Rate - Program Components (Current)
- Program component - Staffing Costs
- Prime Time
- Non-Prime Time
- Night Shift
- Substitute Staff
- QIDP
- Supervisor
- Current Staffing Model deducts five (5) hours per day M - F for day program.
- NOTE: Guidehouse has recommended adopting a Zero-Hour Staffing Model which funds staff 24/7. (minimum round-the clock staffing)
- Program component - Other Supplies
- Habilitation and Training services
- NOTE: Guidehouse Program Component costs are consistent with the current/DDD Program Component costs.
CILA Rate - Program Components (Current & GH recommended)
- Program component - Miscellaneous Consultant Services
- Currently based on ICAP Score in three levels:
- Low Need (70 - 100) $540
- Moderate Need (40 - 69) $705
- High Need (1 - 39) $870
Allowance based on Resource Use Level (RUL) to allow for consultant services
- Updated specific cost assumptions (Numbers below are from 2020. Require Update)
- Adapted to assessment framework with consultant costs per RUL:
| RUL 1 (Low Need) |
RUL 2 |
RUL 3 |
RUL 4 (High Need) |
| $462 |
$594 |
$726 |
$858 |
CILA Rate - Room and Board Components (Current)
- Housing Rate Components (24 Hr. CILA Only):
- 1-4 person CILAs: based on 2012 Department of Housing and Urban Development (HUD) Fair Market Rent (FMR) data
- 5-8 person CILAs: based on 1998 HUD FMR data
- Both have received some Cost-of-Living Adjustments (COLAs)
CILA Rate - Non-Housing Room and Board Components (Current)
- Room & Board Rate Components (24Hr. CILA Only):
- Utilities and Telephone
- Property and Building Insurance
- Maintenance and Housekeeping
- Food Supplies
- Non-Food Supplies
CILA Rate - Room and Board Components (GH recommended)
- Room & Board Rate Components (24Hr. CILA Only):
- Update annually based on HUD FMR for each county and CILA home size
- Standardize the data sources for all CILA sizes
- Reimbursement would reflect current housing costs
- Continue to incentivize smaller CILA settings
CILA Rate - Transportation Components (Current)
- Vehicle Purchase:
- Purchase Price of vehicle
- Debt service over five (5) years
- Non-Ambulatory allowance for vehicle purchase
- Vehicle Operation
- Mileage is updated to current IRS mileage allowance
- Operation based on 10,000 miles per year.
- Calculation: Vehicle Purchase + Vehicle Operation / home size
- NOTE: Only applies to 24-hour CILA (Host Family and Intermittent CILA mileage is funded in updated (GH recommended) rate methodologies
CILA Rate - Transportation Components (GH recommended)
- Vehicle Purchase:
- Update based on Kelly Blue Book
- Update based on current interest rates
- Vehicle operation
- Update based on IRS per Mile Mileage Allowance (Currently being done.
CILA Rate - Administration Costs
- Old: Fixed annual per capita amount that does not vary by staffing needs
- 24 Hr. and Host Family ~ $3,500 annually
- Intermittent ~ $1,600 annually
- New: Tie administration costs to individual budget amounts (15%)
- Administration now amounts to ~$120M
CILA Rate - ICAP and HRST
- ICAP Scores
- Range from 1 to 100
- Lower scores equate to greater needs/more supports needed
- Higher scores equate to lower needs/fewer supports needed
- Health Risk Screening Tool (HRST)
- Scores range across 6 Health Care Levels
- Higher HCLs (5-6) equate to greater needs/more supports needed
- Lower HCLs (1-2) equate to lower needs/fewer supports needed
CILA Rate - DDD (Current) Staffing Tables
- Time of day and days of the week are the same
- Prime Time
- Non-Prime Time
- Night Shift
- 24 DSP Hours/Day Saturday, Sunday & Holidays
- 19 DSP Hours/Day Monday - Friday
- 5-hour allowance for Community Day Services Monday through Friday.
- Staffing Table Look-Up Range is 1-100
CILA Rate - GH Staffing Tables
- Time of day, days of the week and hours per day are the same
- Prime Time
- Non-Prime Time
- Night Shift
- 24 Hr. S & S
- 19 Hr. M - F
- Staffing Table Look-Up Range is now 1-250
- Staffing ratios are different based on the Resource Use Levels
- Range of staff hours at highest and lowest ends are similar
- 5-hour allowance for Community Day Services Monday through Friday
CILA Rate - Assessment Level Score (GH)
- An individual's Health Care Level (from the HRST) plus the individual's ICAP score determines the individual's Assessment Level.
- Assessment Levels range from 1 to 6
- 1 - lowest need
- 6 - greatest need
- Different Assessment Levels assign a "weight" to determine the Staffing Table Look-Up score for the GH Staffing Tables
- The Staffing Table Look-Up score is the number used to determine the DSP staff hours via the Guidehouse Staffing Tables.
- There is a weight added to the Assessment Levels 1-4.
- There is no weight added to Assessment Levels 5 and 6.
CILA Rate - GH Staffing Tables
- Resource Use Levels (RULs): Range from RUL 1 - 4.
- ICAP + HCL score leads to Assessment Level which translates to RULs
- Low ICAP scores mean higher need, high ICAP scores mean lower need
- Low HCL score means lower need, high HCL score means higher need
- Very low ICAP Scores - RUL 4 (1-131) - Highest DSP Hours
- Lower Middle ICAP Scores - RUL 3 (132-250)
- Higher Middle ICAP Scores - RUL 2 (198-210)
- Very High ICAP Scores - RUL 1 (211-250) - Lowest DSP Hours
- Range of staff hours at highest and lowest ends of both the current and GH Staffing Tables are similar.
- 5-hour allowance for Community Day Services Monday - Friday
Guidehouse CILA Rate Calculator
Guidehouse ICAP/CILA Resident Review
ICAP Score +
HRST AL/RUL Weight
| Assessment Level |
Weight |
| AL 6 |
0 |
| AL 5 |
0 |
| AL 4 |
100 |
| AL 3 |
100 |
| AL 2 |
150 |
| AL 1 |
150 |
Example 1
ICAP = 14
AL = 6
14 + 0 = 014
RUL 4
Example 2
ICAP = 78
AL = 3
78 + 100 = 178
RUL 3
Example 3
ICAP = 52
AL = 2
52 + 150 = 202
RUL 2
REVIEW: The evolution of Illinois' ICAP reimbursement adjustment
- When the CILA methodology was devised in the late 1990s, the resident population was substantially different than today.
- The residential population was significantly smaller.
- Overall, residents' aggregate ICAP scores were higher, suggesting lower support need.
- Support need appears to have been more evenly distributed among low, moderate, and high need individuals
| 1998 ICAP Need Level* |
Current ICAP Score Range |
Number of CILA Residents |
Percent of Total |
| Low |
70+ |
500 |
19% |
| Moderate |
40-69 |
1,469 |
56% |
| High |
1-39 |
664 |
25% |
| Total |
1-100 |
2,633 |
100% |
*Based on October 23,1998 statistics available in DDD's CILA rate methodology documentation.
By 2020, the number of CILA residents had increased to eleven thousand, the vast majority of whom live in 24-hour CILA settings.
- While roughly half the population is still categorized as "moderate" need, the proportion of high-need individuals has increased significantly over the last two decades, while the percentage of low need individuals has dwindled.
- A substantial number of low need individuals utilize non-24-hour settings, skewing 24-hour CILA even further to high need individuals.
| Current ICAP Need Level |
Number of All CILA Residents* |
Percent of Total (All) |
Number of 24HR CILA Residents |
Percent of Total (24HR) |
| Low |
960 |
9% |
561 |
6% |
| Moderate |
5,945 |
54% |
5,161 |
53% |
| High |
4,136 |
37% |
3,972 |
41% |
| Total |
11,041 |
100% |
9,694 |
100% |
*Includes all CILA types. Guidehouse excluded 4 residents because they had an aggregated CAP score of 0, and 454 residents because they had a HRST Health Care Level or 0 or blank. Results are based on 96% of the total CILA resident population.
The mechanics of the smoothing adjustment mean that most scores represent variations of moderate and high need staffing.
- The ICAP scores of over two-thirds of residents fall within the range defined by high-need staffing assumptions.
- Staffing assumptions defining the low-need group apply only to 3% of the entire population, rendering it a largely empty rate category.
- Staffing ratios were originally designed so that high need individuals would receive roughly twice the staffing resources of low need residents. For 5-8 bed homes, base reimbursement for high need individuals can be 3.5 to 5 times the amount paid for low need individuals, even though these homes are the best positioned to shift staff incrementally to provide for high need residents.
Effective ICAP Ranges After Smoothing
| Tier |
Score Range |
Number of CILA Residents |
Percent of Total (All) |
| Low |
77+ |
357 |
3% |
| Moderate |
56-76 |
3,168 |
29% |
| High |
1-55 |
7,516 |
68% |
Guidehouse analysis of the distribution of support needs in 2020 suggested the need for an assessment "tune up."
- The gradual upward shift in scores may indicate a population with growing resource needs, but it also suggests potential ICAP "creep."
- With only a small percentage of the 24-hour CILA population identified as "low" need, the disproportionate shift to high and moderate tiers undercut the usefulness of the low-need staffing model and its meaning as a reimbursement category.
- The large proportion of residents classified as "high" need underscored the desirability of realigning the assessment system with fresh staffing assumptions to better distinguish individuals with truly intensive needs from the broader majority of the CILA population.
- The lack of a bell-curve or even distribution across the levels of support need further indicated that the assessment system was due for a "re-centering" of the support tiers and their score ranges, in order to capture more adequately the spectrum of the current CILA population.
When meeting with the ICAP Committee in 2020, Guidehouse developed a plan for revising the role of current assessments in adjusting reimbursement.
- We determined that assessment and provider staff cost data was available to develop a new ICAP/HRST-based resource use framework without intensive time studies.
- Since DDD only collects residents' summary ICAP scores, Guidehouse's recommendations would not include changes to the underlying mechanics of how ICAP is currently scored.
- Our recommendations focused on the following considerations:
- How HRST can supplement the current ICAP assessment process to include acuity data on health and medical needs.
- How resource use groups can be tiered to improve reimbursement with high medical need, but low adaptive and behavioral needs.
- How scores can be more finely tuned to varying resource use by different groups.
Guidehouse recommended a new set of tiers that incorporates HRST assessments of medical need and health risk.
- By tiering residents' ICAP scores into quartiles, the approach addresses the need for "re-centering" the system, establishing a more balanced definition and distribution of each support need grouping.
- Adding the HRST component and grouping support need into "assessment levels" is designed to improve the system's ability to identify more intensive medical and behavioral needs.
| Assessment Level |
ICAP |
HRST |
RUL |
| 1 |
< 26th percentile |
Low Risk (HCL 1-2) |
1 |
| 2 |
26th-50th percentile |
Low Risk (HCL 1-2) |
2 |
| 2 |
< 51st percentile |
Moderate Risk (HCL 3-4) |
3 |
| 4 |
51st-75th percentile |
Low or Moderate Risk (HCL 1-4) |
3 |
| 5 |
> 75th percentile |
Low or Moderate Risk (HCL 1-4) |
4 |
| 6 |
Any |
High Risk (5-6) |
4 |
Guidehouse recommended a new set of tiers that incorporates HRST assessments of medical need and health risk.
- By dividing residents' ICAP scores into quartiles, this approach identifies a wider spectrum of support needs, more evenly distributed between low and high extremes.
- Assessment Levels 3 and 6 are designed to capture more intensive behavioral or medical needs that do not correlate with greater adaptive need.
Guidehouse CILA Rate Calculator
Implementation & Comparison Findings
CILA Rate Calculator - ICAP Range
| ICAP Top Percentile |
ICAP Bottom Percentile |
ICAP Top Range |
ICAP Bottom Range |
| 1st |
25th |
100 |
61 |
| 26th |
50th |
60 |
48 |
| 51st |
75th |
47 |
32 |
| 76th |
100th |
31 |
1 |
CILA Rate Calculator - Assessment Level with Resource Use Level
| Assessment Level |
Weight |
ICAP Percentile |
ICAP Bottom Range |
ICAP Top Range |
HCL |
RUL |
| AL1 |
150 |
less than 26th |
61 |
100 |
1 or 2 |
1 |
| AL2 |
150 |
26th to 50th |
48 |
60 |
1 or 2 |
2 |
| AL3 |
100 |
less than 51st |
48 |
100 |
3 or 4 |
3 |
| AL4 |
100 |
51st to 75th |
32 |
47 |
1 to 4 |
4 |
| AL5 |
0 |
greater than 75th |
1 |
31 |
1 to 4 |
5 |
| AL6 |
0 |
Any |
1 |
100 |
5 or 6 |
6 |
CILA Rate Calculator - Assessment Level with Staffing Table Ranges
| Assessment Level |
HCL |
ICAP Range |
RUL |
Weight |
Staffing Table Look-Up |
Count |
| AL1 |
1 or 2 |
100-61 |
1 |
150 |
211 to 250 |
1,407 |
| AL2 |
1 or 2 |
60-48 |
2 |
150 |
198 to 210 |
1,533 |
| AL3 |
3 or 4 |
100-48 |
3 |
100 |
101 to 197 |
1,208 |
| AL4 |
1 to 4 |
47-32 |
3 |
100 |
101 to 197 |
2,266 |
| AL5 |
1 to 4 |
31-1 |
4 |
0 |
1 to 100 |
2,204 |
| AL6 |
5 or 6 |
100-1 |
4 |
0 |
1 to 100 |
1,279 |
CILA Rate Calculator - CILA Population by HCL/ICAP
| Percentile HCL / ICAP |
75th, 1-31 |
50-76, 32-47 |
25-51, 48-60 |
26th, 61-100 |
Total by HCL |
| 0 |
68 |
47 |
45 |
41 |
201 |
| 1 |
215 |
425 |
631 |
705 |
1,976 |
| 2 |
649 |
848 |
857 |
661 |
3,015 |
| 3 |
735 |
619 |
537 |
330 |
2,221 |
| 4 |
537 |
327 |
223 |
118 |
1,205 |
| 5 |
386 |
326 |
126 |
68 |
906 |
| 6 |
196 |
93 |
63 |
21 |
373 |
| Total by ICAP |
2,786 |
2,685 |
2,482 |
1,944 |
9,897 |
CILA Rate Calculator - Current CILA Population Break-Out
| Assessment Level |
RUL |
24Hr. |
Percent |
- |
| AL 1 |
1 |
1,407 |
14% |
ICAP + 150 |
| AL 2 |
2 |
1,533 |
15% |
ICAP + 150 |
| AL 3 |
3 |
1,208 |
12% |
ICAP + 100 |
| AL 4 |
3 |
2,266 |
23% |
ICAP + 100 |
| AL 5 |
4 |
2,204 |
22% |
ICAP + 0 |
| AL 6 |
4 |
1,279 |
13% |
ICAP + 0 |
CILA Rate Calculator - Example (Individual with ICAP of 78)
| - |
ICAP |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
| Current |
78 |
7,457 |
3,729 |
2,486 |
1,864 |
1,570 |
1,392 |
1,263 |
1,171 |
| AL 5-6 |
78 |
7,456 |
4,401 |
3,254 |
2,854 |
2,629 |
2,462 |
2,508 |
2,494 |
| Difference |
- |
(1) |
672 |
768 |
990 |
1,059 |
1,070 |
1,245 |
1,323 |
| AL 3-4 |
178 |
7,456 |
3,991 |
2,809 |
2,420 |
2,352 |
2,142 |
2,168 |
2,053 |
| Difference |
- |
(1) |
262 |
323 |
556 |
782 |
750 |
905 |
882 |
| AL 1-2 |
228 |
7,456 |
3,728 |
2,485 |
1,864 |
1,598 |
1,421 |
1,294 |
1,199 |
| Difference |
- |
(1) |
(1) |
(1) |
- |
28 |
29 |
31 |
28 |
CILA Rate Calculator - Example (Individual with ICAP of 60)
| - |
ICAP |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
| Current |
60 |
7,457 |
3,957 |
2,958 |
2,445 |
2,272 |
2,095 |
2,097 |
1,986 |
| AL 5-6 |
60 |
7,456 |
4,452 |
3,307 |
2,900 |
2,670 |
2,505 |
2,554 |
2,558 |
| Difference |
- |
(1) |
495 |
349 |
455 |
398 |
410 |
457 |
572 |
| AL 3-4 |
160 |
7,456 |
4,053 |
2,885 |
2,509 |
2,375 |
2,181 |
2,207 |
2,092 |
| Difference |
- |
(1) |
95 |
(73) |
64 |
103 |
86 |
110 |
106 |
| AL 1-2 |
210 |
7,456 |
3,728 |
1,485 |
1,966 |
1,972 |
1,739 |
1,699 |
1,593 |
| Difference |
- |
(1) |
(229) |
(473) |
(479) |
(300) |
(356) |
(398) |
(393) |
CILA Rate Calculator - Example (Individual with ICAP of 40)
| - |
ICAP |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
| Current |
40 |
7,457 |
4,333 |
3,266 |
2,826 |
2,610 |
2,443 |
2,488 |
2,469 |
| AL 5-6 |
40 |
7,456 |
4,509 |
3,365 |
2,950 |
2,715 |
2,553 |
2,606 |
2,630 |
| Difference |
- |
(1) |
176 |
99 |
1245 |
105 |
110 |
118 |
161 |
| AL 3-4 |
140 |
7,456 |
4,126 |
2,972 |
2,608 |
2,407 |
2,229 |
2,255 |
2,145 |
| Difference |
- |
(1) |
(207) |
(294) |
(218) |
(203) |
(214) |
(233) |
(324) |
| AL 1-2 |
190 |
7,456 |
3,949 |
2,758 |
2,360 |
2,336 |
2,116 |
2,142 |
2,027 |
| Difference |
- |
(1) |
(384) |
(508) |
(466) |
(274) |
(327) |
(346) |
(442) |
CILA Rate Calculator - Example (Individual with ICAP of 20)
| - |
ICAP |
1 |
2 |
3 |
4 |
5 |
6 |
7 |
8 |
| Current |
20 |
7,457 |
4,751 |
3,546 |
3,140 |
2,866 |
2,713 |
2,780 |
2,873 |
| AL 5-6 |
20 |
7,456 |
4,574 |
3,431 |
3,008 |
2,767 |
2,608 |
2,666 |
2,713 |
| Difference |
- |
(1) |
(177) |
(115) |
(132) |
(99) |
(105) |
(114) |
(160) |
| AL 3-4 |
20 |
7,456 |
4,574 |
3,431 |
3,008 |
2,767 |
2,608 |
2,666 |
2,713 |
| Difference |
- |
(1) |
(177) |
(115) |
(132) |
(99) |
(105) |
(114) |
(160) |
| AL 1-2 |
20 |
7,456 |
4,574 |
3,431 |
3,008 |
2,767 |
2,608 |
2,666 |
2,713 |
| Difference |
- |
(1) |
(177) |
(115) |
(132) |
(99) |
(105) |
(114) |
(160) |
