PURPOSE
The IDHS/DDD seeks to ensure that all redeterminations of waiver eligibility for individuals being served are done in a timely manner. The Division can identify an ISC agency that serves an individual that is overdue for a redetermination.
BASIS FOR REVIEW
The ILDHS/DDD conducts ongoing annual reviews of Medicaid Waiver programs per the approved Medicaid Waiver Application. The Waiver stipulates that each individual must be determined eligible for Waiver services on an annual basis.
The IDHS/DDD seeks to ensure that all Waiver participants are assessed through the annual redetermination process of Wavier eligibility within 12 months of their LOC evaluation or within 12 months of their last LOC re-evaluation.
METHOD OF REVIEW
The Bureau of program Development & Medicaid Administration will review the Annual Wavier Redetermination Reports for the Adult Wavier, Children's Support Wavier and Children's Residential Wavier. This data is obtained from Mobius Reports #M044G221 and #M044G222. Report # M044G221 provides a statewide summary of redetermination timeliness, broken out by agency and number of days overdue. Mobius Report #M044G222 is a detail list of individuals that show as overdue for redetermination, and is specific to the ISC agency.
FINDINGS
| ISC Name |
Redes Done Within 365 Days |
31-60 Days Overdue |
61-120 Days Overdue |
120+ Days Overdue |
Total Overdue |
Percentage of Cases Overdue |
| ACCESS SERVICES OF NORTHERN IL |
1492 |
3 |
0 |
0 |
6 |
0.40% |
| CENTRAL ILL SERVICE ACCESS INC |
1277 |
6 |
4 |
0 |
20 |
1.55% |
| CHAMPAIGN COUNTY |
346 |
0 |
0 |
1 |
1 |
0.29% |
| COMMUNITY ALTERNATIVE UNLTD |
4170 |
20 |
5 |
4 |
54 |
1.29% |
| COMMUNITY SERVICE OPTIONS INC |
1523 |
20 |
16 |
5 |
77 |
4.92% |
| CSO |
250 |
0 |
1 |
1 |
3 |
1.19% |
| DAYONE PACT |
1001 |
8 |
1 |
0 |
18 |
1.78% |
| DAYONENETWORK INC |
666 |
10 |
5 |
1 |
31 |
4.55% |
| DEVELOPMENTAL DISABILITY SVCS |
712 |
1 |
0 |
0 |
2 |
0.28% |
| GREAT RIVER SVC COORDINATION |
280 |
3 |
0 |
0 |
6 |
2.12% |
| LIVINGSTON CO M H BOARD |
97 |
3 |
3 |
0 |
12 |
11.65% |
| MENTAL HEALTH AUTHORITY |
197 |
2 |
1 |
0 |
6 |
3.00% |
| OPTIONS & ADVOCACY FOR |
245 |
4 |
1 |
0 |
10 |
4.00% |
| PRAIRIELAND SVCS COORDINATION |
930 |
4 |
0 |
0 |
8 |
0.86% |
| SERVICE OF WILL GRUNDY KANKAKE |
1528 |
8 |
4 |
0 |
24 |
1.56% |
| SOUTHERN IL CASE COORDINATION |
1646 |
5 |
5 |
2 |
22 |
1.33% |
| SUBURBAN ACCESS INC |
2733 |
2 |
3 |
2 |
12 |
0.44% |
| WESTERN ILLINOIS SERVICE COORD |
464 |
2 |
0 |
0 |
4 |
0.86% |
| Totals |
19557 |
101 |
49 |
16 |
316 |
1.60% |
ACTIONS TAKEN
The Division contacted the ISC agencies that had redeterminations 30 days overdue or more. The ISC agency was provided with a list of individuals that were 30 days or more overdue and were requested to complete all outstanding redeterminations as soon as possible.
If the list contained individuals who were no longer served by the agency, or were no longer receiving Wavier services, the ISC would then submit a STAR form to the appropriate DD Region Representative.
In some instances it was found that the individual moved out of the listed ISC agency's area, so Division staff would find the name of new ISC agency and notify them about the need for a redetermination update.
Division staff followed up on all overdue redeterminations until the individuals shown as overdue were current on their annual Waiver eligibility.
