Purpose
The Illinois Department of Human Services (IDHS)/Division of Developmental Disabilities (DDD) seeks to ensure that all redeterminations of waiver eligibility for individuals being served are done in a timely manner. The Division identified an Independent Service Coordination (ISC) agency that serves an individual that is overdue for a redetermination.
Basis for Review
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 DDD seeks to ensure that all Waiver participants are assessed through the annual redetermination process of Waiver eligibility within 12 months of their local office coordinator evaluation or within 12 months of their last local office coordinator re-evaluation.
Method of Review
The Bureau of Program Development & Medicaid Administration will review the Annual Waiver Redetermination Reports for Adult Waiver, Children's Support Waiver and Children's Residential Waiver. 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
Adult DD Waiver
| PROVIDER NAME |
Redes Done Within 365 Days |
31-45 Days Overdue |
46-60 Days Overdue |
61-90 Days Overdue |
91-120 Days Overdue |
Over 120 Days Overdue |
TOTAL |
Percentage of Cases Overdue |
| UNKNOWN PAS AGENT |
0 |
0 |
0 |
0 |
0 |
3 |
3 |
|
| ACCESS SERVICES OF NORTHERN IL |
1385 |
1 |
3 |
7 |
1 |
0 |
1397 |
0.9% |
| CENTRAL ILL SERVICE ACCESS INC |
1176 |
12 |
5 |
6 |
5 |
1 |
1205 |
2.4% |
| CHAMPAIGN COUNTY |
321 |
4 |
1 |
0 |
0 |
0 |
326 |
1.5% |
| COMMUNITY ALTERNATIVE UNLTD |
3667 |
39 |
20 |
9 |
6 |
3 |
3744 |
2.0% |
| COMMUNITY SERVICE OPTIONS FOR |
230 |
2 |
1 |
2 |
3 |
1 |
239 |
3.7% |
| COMMUNITY SERVICE OPTIONS INC |
1441 |
16 |
12 |
25 |
4 |
6 |
1504 |
4.1% |
| DAYONE PACT |
844 |
12 |
7 |
10 |
5 |
1 |
879 |
3.9% |
| DAYONENETWORK INC |
528 |
11 |
8 |
7 |
19 |
16 |
589 |
8.9% |
| DEVELOPMENTAL DISABILITY SVCS |
688 |
4 |
2 |
1 |
0 |
0 |
695 |
1.0% |
| GREAT RIVER SVC COORDINATION |
275 |
0 |
0 |
0 |
0 |
0 |
275 |
0.0% |
| LIVINGSTON CO M H BOARD |
84 |
7 |
4 |
7 |
2 |
0 |
104 |
21.7% |
| MENTAL HEALTH AUTHORITY |
195 |
0 |
0 |
1 |
1 |
0 |
197 |
1.0% |
| OPTIONS & ADVOCACY FOR |
230 |
6 |
5 |
7 |
1 |
0 |
249 |
1.5% |
| PRAIRIELAND SVCS COORDINATION |
869 |
7 |
1 |
10 |
12 |
5 |
904 |
3.9% |
| SERVICE OF WILL GRUNDY KANKAKE |
1284 |
21 |
19 |
31 |
18 |
17 |
1390 |
7.7% |
| SOUTHERN IL CASE COORDINATION |
1582 |
7 |
2 |
6 |
1 |
2 |
1600 |
1.1% |
| SUBURBAN ACCESS INC |
2555 |
11 |
1 |
2 |
4 |
7 |
2580 |
0.9% |
| WESTERN ILLINOIS SERVICE COORD |
443 |
0 |
0 |
1 |
0 |
1 |
445 |
0.4% |
| TOTALS |
17797 |
160 |
91 |
132 |
82 |
63 |
18325 |
2.8% |
Children's Support Waiver
| PROVIDER NAME |
Redes Done Within 365 Days |
31-45 Days Overdue |
46-60 Days Overdue |
61-90 Days Overdue |
91-120 Days Overdue |
Over 120 Days Overdue |
TOTAL |
Percentage of Cases Overdue |
| ACCESS SERVICES OF NORTHERN IL |
22 |
0 |
0 |
0 |
1 |
0 |
23 |
4.5% |
| CENTRAL ILL SERVICE ACCESS INC |
61 |
1 |
0 |
0 |
1 |
0 |
63 |
3.1% |
| CHAMPAIGN COUNTY |
16 |
0 |
0 |
0 |
0 |
0 |
16 |
0.0% |
| COMMUNITY ALTERNATIVE UNLTD |
384 |
1 |
0 |
1 |
1 |
0 |
387 |
0.8% |
| COMMUNITY SERVICE OPTIONS FOR |
5 |
0 |
0 |
0 |
0 |
0 |
5 |
0.0% |
| COMMUNITY SERVICE OPTIONS INC |
57 |
2 |
1 |
0 |
0 |
0 |
60 |
5.0% |
| DAYONE PACT |
139 |
2 |
1 |
2 |
0 |
0 |
144 |
3.4% |
| DAYONENETWORK INC |
63 |
1 |
0 |
1 |
2 |
2 |
69 |
9.0% |
| DEVELOPMENTAL DISABILITY SVCS |
18 |
0 |
0 |
0 |
0 |
0 |
18 |
0.0% |
| GREAT RIVER SVC COORDINATION |
10 |
0 |
0 |
0 |
0 |
0 |
10 |
0.0% |
| LIVINGSTON CO M H BOARD |
3 |
0 |
0 |
0 |
0 |
0 |
3 |
0.0% |
| MENTAL HEALTH AUTHORITY |
4 |
0 |
0 |
0 |
0 |
0 |
4 |
0.0% |
| OPTIONS & ADVOCACY FOR |
13 |
0 |
0 |
0 |
0 |
0 |
13 |
0.0% |
| PRAIRIELAND SVCS COORDINATION |
23 |
1 |
0 |
0 |
0 |
0 |
24 |
4.2% |
| SERVICE OF WILL GRUNDY KANKAKE |
114 |
1 |
2 |
4 |
1 |
2 |
124 |
8.4% |
| SOUTHERN IL CASE COORDINATION |
28 |
0 |
0 |
0 |
0 |
0 |
28 |
0.0% |
| SUBURBAN ACCESS INC |
138 |
1 |
0 |
1 |
0 |
1 |
141 |
2.0% |
| WESTERN ILLINOIS SERVICE COORD |
6 |
0 |
0 |
0 |
0 |
0 |
6 |
0.0% |
| TOTALS |
1104 |
10 |
4 |
9 |
6 |
5 |
1138 |
2.9% |
Children's Residential Waiver
| PROVIDER NAME |
Redes Done Within 365 Days |
31-45 Days Overdue |
46-60 Days Overdue |
61-90 Days Overdue |
91-120 Days Overdue |
Over 120 Days Overdue |
TOTAL |
Percentage of Cases Overdue |
| ACCESS SERVICES OF NORTHERN IL |
77 |
0 |
0 |
0 |
0 |
0 |
77 |
0.0% |
| CENTRAL ILL SERVICE ACCESS INC |
38 |
1 |
0 |
0 |
0 |
0 |
39 |
2.6% |
| CHAMPAIGN COUNTY |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
0.0% |
| COMMUNITY ALTERNATIVE UNLTD |
36 |
3 |
0 |
0 |
0 |
1 |
40 |
10.8% |
| COMMUNITY SERVICE OPTIONS INC |
2 |
0 |
0 |
0 |
0 |
0 |
2 |
0.0% |
| DAYONE PACT |
15 |
1 |
0 |
0 |
0 |
0 |
16 |
6.3% |
| DAYONENETWORK INC |
3 |
0 |
0 |
0 |
0 |
0 |
3 |
0.0% |
| DEVELOPMENTAL DISABILITY SVCS |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
0.0% |
| MENTAL HEALTH AUTHORITY |
1 |
0 |
0 |
0 |
0 |
0 |
1 |
0.0% |
| OPTIONS & ADVOCACY FOR |
2 |
0 |
0 |
0 |
0 |
0 |
2 |
0.0% |
| PRAIRIELAND SVCS COORDINATION |
6 |
1 |
0 |
0 |
0 |
0 |
7 |
16.7% |
| SERVICE OF WILL GRUNDY KANKAKE |
6 |
0 |
0 |
0 |
0 |
0 |
6 |
0.0% |
| SOUTHERN IL CASE COORDINATION |
2 |
0 |
0 |
0 |
0 |
0 |
2 |
0.0% |
| SUBURBAN ACCESS INC |
11 |
0 |
0 |
0 |
0 |
0 |
11 |
0.0% |
| TOTALS |
201 |
6 |
0 |
0 |
0 |
1 |
208 |
3.4% |
Actions Taken
The Division contacted the ISC agency that had redeterminations 31 days overdue or more. The ISC agency was provided a list of individuals that were 31 days or more overdue and were requested to complete all outstanding redeterminations as soon as possible.
The Division has concluded from the responses from the ISC's that 544 instances of redeterminations being late were due to the Reporting of Community Services(ROCS) billing system not receiving the information on a timely manner and thus causing an entry on the late redetermination report. In an additional 5 instances, the individual left Waiver services and thus did not require a re-determination. A total of 19 individuals had transferred to another ISC which required following up by the DDD to assure the determination had been completed by the new ISC.
The Division has completed follow up on all overdue redeterminations to the point in which resolution of the individuals shown overdue was current on their annual redeterminations. This follow up assured that all individuals on this report were current with the annual Waiver of eligibility.
