Ligas Data Report as of 6-30-19 (issued 8-7-19)

Ligas Data Report as of 6-30-19

August 7, 2019

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 thirteenth Ligas Data Report. 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 is maintaining a centralized, master class 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.

Class Member FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19
1 Living at Home 10,677 10,327 15,106 16,684 13,455 14,140 14,677 15,216
2 ICF/DD after 6/15/11 62 77 170 241 214 240 254 310
3 ICF/DD on 6/15/11 with an Affirmative Statement to Move (2a) 747 981 1,177 1,448 1,318 1,514 1,377 1,355
3a DD PAS 10 12 9 9 10 9 9 9 9
3b DHS 1243/1238 291 585 792 1094 1065 999 964 952
3c EFE Form 407 345 319 288 204 180 175 168
3d OSG Request 23 22 22 21 17 305 209 206
3e Other Guardian Request 14 20 35 35 23 21 20 20
4 # At End of Fiscal Year 11,486 11,385 16,453 18,373 14,987 15,894 16,308 16,881

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

Additions Additions in FY13 Additions in FY14 Additions in FY15 Additions in FY16 Additions in FY17 Additions in FY18 Additions in FY19
Individuals in ICFs/DD on 6/15/11 350 271 329 117 358 3 0
Individuals in ICF/DDs after 6/15/11 17 97 75 36 36 43 68
Individuals in Community Settings 48 5,010 2,179 2,246 2,036 1,773 1,753
Total Additions 415 5,378 2,583 2,399 2,430 1,819 1,821
Removals Removals in FY13 Removals in FY14 Removals in FY15 Removals in FY16 Removals in FY17 Removals in FY18 Removals in FY19
Individual Moved Out of State 35 15 12 311 73 83 104
Determined Clinically Ineligible 18 20 8 56 23 29 22
Determined Financially Ineligible 11 6 3 34 2 2 3
Withdrew-Reason Not Given 132 106 90 450 120 109 88
Individual Deceased 35 14 440 108 54 63 63
Objector 1 1 0 0 0 0 0
Other 4 0 0 3,406 932 712 627
Incorrect SSN (Duplicate Record) 17 0 6 36 20 7 4
Ineligible Setting 26 53 12 7 0 1 2
Unable to Locate Individual 158 68 53 1,260 224 271 290
Stay in ICFDD 78 24 38 47 20 94 9
Submitted in Error 0 0 1 12 0 0 0
Move to ICFDD 1 3 0 58 55 34 36
Total Removals 516 310 663 5,785 1,523 1,405 1,248

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.
  • The relatively large increase in the number of removals reported as deaths during FY15 is due to an enhancement to the DDD's database which now enables the DDD to regularly and automatically identify individuals who have become deceased. This enhancement has captured reports of deaths not previously identified in the prior fiscal years.
  • The reported increase in the number of removals during FY16 is due to an enhancement to the DDD's database which now enables updates to regularly and automatically identify individuals who have been closed on the PUNS waiting list. This enhancement has captured closures not previously identified in the prior fiscal years. The PUNS Integrity Project and the continued automated sweeps of PUNS are both factors in the reported reductions.

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.

Target Dates from Consent Decree: 12/31/13 12/31/15 12/31/17 12/31/19 Cumulative Total to Date
1 # of Class Members with Waiver Capacity Award Letters 610 685 137 22 1454
2 *Total Class Members Who Have Moved to Waiver Services (per billing data) 598 682 149 22 1451
2a Subtotal Who Received CILA Services 583 676 143 22 1424
2b Subtotal Who Received HBS Services 12 6 6 0 24
2c Subtotal Who Received CLF Services 3 0 0 0 3

Please note that the above data includes individuals who are moving due to ICF/DD downsizing and closure agreements.

  • The 12/31/13 Benchmark is 1/3 (297) of the known ICF/DD Class Members as of 6/15/13 (889).
  • The 12/31/15 Benchmark is 2/3 (923) of the known ICF/DD Class Members as of 6/15/15 (1399).
  • The 06/30/17 Benchmark is all of the known ICF/DD Class Members as of 6/15/17.

Services for Class Members from the Waiting List

Eight 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. 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 PUNS Selection Data & Ligas PUNS Selection Data.

# Ligas Benchmarks Total
1 # of Class Members Selected from The Waiting List (PUNS). 6828
2 # of Class Members in ICF/DDs after 6/15/11 who were part of a downsizing 171
3 Total Class Members with Waiver Capacity Award Letters 4226
4 Total Class Members Who Have Received Waiver Services (as reported by the PAS agencies and providers) 4171
5 Total Class Members Who Have Received Waiver Services (per billing data) 4135
5a *Subtotal Who Received CILA Services (per billing data) 1008
5b *Subtotal Who Received HBS Services (per billing data) 3120
5c *Subtotal Who Received CLF Services (per billing data) 7


ICFs/DD Resident Outreach

With input from the Monitor, Class Counsel, and Intervenors, the DDD issued a Request for Proposals (RFP) to secure the services of a contractor or multiple contractors to contact all Potential Class Members residing in ICFs/DD; however, the DDD did not receive any bids in response to the RFP. After consultation with the State's procurement staff to ensure all regulations are appropriately followed, the DDD entered discussions with a potential vendor. The vendor, The Council on Quality and Leadership (CQL), entered into a contract with the DDD to plan and develop outreach activity. CQL assigned/hired a Project Director and Project Manager. The vendor hired individuals to conduct the initial phone contact and face-to-face interviews. With input from the Monitor, Class Counsel, and Intervenors, the vendor developed an overall process description, a set of frequently asked questions with responses, a phone script for initial contacts, and meeting presentation materials. Geographic areas for the phase in of initial contact were selected. These areas were Madison and St. Clair Counties in the southern part of the State and the South and Southwest Suburbs of Cook County in the northern part of the State. CQL conducted training for the interviewers in September, with participation by DDD staff and the Monitor. An additional training session was held in January of 2014 for interviewers who were hired after the initial session. CQL initiated and completed outreach activity in all areas of the State. CQL's contract ended on January 31, 2016.

FY12 FY13 FY14 FY15 FY16
1 Total Potential Class Members pending contact 2620 590 0
2 # with Initial Phone Contact 546 1272 1625
3 # Choosing Not to Meet w/Outreach Contractor 393 941 1281
4 # Choosing not to Meet at this time, but Want Future Contact 29 32 0
5 Total # Choosing to Meet w/Outreach Contractor 124 299 341
5a # Persons Completed Written Request for Community Services Through Outreach 32 83 127
5b # Undecided 18 36 30
5c # Pending 13 46 0
5d # Choosing ICF/DD 61 134 184

Transition Service Plans

An initial version of a standardized format and accompanying instructions was developed with input from the Monitor, Plaintiffs Counsel, ISC agencies, and other advocates throughout the system. Two ISC agencies piloted the draft process and materials with Class Members and providers in their areas. These two ISC agencies participated in a planning/training meeting with the Monitor and DDD staff on August 23, 2012 in order to begin the pilot. DDD staff and the Monitor reviewed the Transition Service Plans that were developed as the pilot was underway. Monthly conference calls were held among the two ISC agencies, Monitor, and DDD staff throughout the pilot. The standardized format and accompanying instructions were modified, based on the experience of the pilot, for Statewide implementation.

Training for all ISC agencies was held on April 16, 2013. This statewide training session was then followed with local training sessions for small groups of ISC agencies throughout the remainder of April and May. The training opportunities were conducted by DDD staff and the Monitor. Statewide implementation occurred on July 1, 2013: as of that date, Transition Service Plans are required for all individuals who move. A modified version of the Transition Service Plan has been provided for the ISC agencies for use with individuals who moved prior to statewide implementation of the Transition Service Plan format.

# Action Total Plans Completed
1 # with Transition Service Plan Completed 1915
2 # of Modified Transition Plans Completed 434
3 Total to Date 2349

Crisis Services

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

# Action FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 Cumulative Total to Date
1 Total # of Crisis Requests Received 343 298 424 486 504 467 373 304 3199
2 Total # of Class Members Approved 290 274 397 461 482 447 339 280 2970
2a # of Class Members Approved for CILA 205 162 217 283 312 263 265 194 1901
2b # of Class Members Approved for HBS 85 112 180 178 170 184 74 86 1069
3 Total # of Class Members Who Received Services 288 269 397 460 479 447 337 277 2954
3a # of Class Members Who Received CILA Services 203 159 217 282 310 263 263 193 1890
3b # of Class Members Who Received HBS Services 85 110 180 178 169 184 74 84 1064
4 Total # of Class Members Denied Crisis Approvals 53 24 27 25 22 20 34 24 229

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 summarizes the agreements underway since the Consent Decree was approved. Please take note of the following issues involving the data in the table below:

  • Included in the FY12 numbers are persons who were part of closure/downsizing agreements that were in process at the time of the approval of the Consent Decree on June 15, 2011. Therefore, some individuals may have moved prior to that date and were not included in the Class as they already had community-based services prior to the approval of the Consent Decree.
  • It is a rare occurrence, but it is possible that 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.
FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 Cumulative Total to Date
1 # of Agreements Initiated 9 16 22 13 2 0 4 9 75
2 Total # Licensed Capacity 144 486 340 238 32 0 62 127 1429
3 Total # of People to Move 117 406 278 202 24 0 41 91 1159
3a *Moved to CILAs 113 381 266 191 22 0 40 66 1079
3b *Moved to HBS 0 0 0 0 0 0 0 0 0
3c *Transferred to other ICFs/DD 4 3 8 4 0 0 0 11 30
3d *Other 0 22 4 7 2 0 1 5 41
3e *Move Pending 0 0 0 0 0 0 0 9 9

 Note: Numbers and outcomes are recorded in the Fiscal Year in which the agreement was initiated.

Eligibility Appeals

The DDD continues to process appeals of eligibility. Below is summary data regarding the appeals processed since the Consent Decree was approved.

FY12 FY13 FY14 FY15 FY16 FY17 FY18
1 Total Class Members Submitting Appeals (Rows 2,3,4,5 = Row 1) 57 56 38 56 51 41 57 46 402
1a Crisis Appeals 23 14 17 23 21 12 34 14 158
1b Eligibility Appeals 34 42 21 33 30 29 23 32 244
2 Subtotal Appeals Upheld 13 30 13 17 21 9 13 13 129
3 Subtotal Appeals Denied 41 19 20 31 25 30 41 25 232
4 Subtotal Appeals Pending 0 0 0 0 0 0 0 4 4
5 Subtotal Appeals Withdrawn 3 7 5 8 5 2 3 4 37

Division of Developmental Disabilities - Ligas Estimated Cost - Projection updated July 2019

FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20
PUNS Placements 16,150,052 49,250,421 69,943,577 80,514,310 93,412,557 111,565,856 125,250,433 145,321,013
Comm. Integrated Living Arrangements 3,350,846 11,930,708 21,908,806 28,448,948 32,964,335 39,690,849 47,900,031 56,394,404
Home Based Support Services 12,799,206 37,319,714 48,034,771 52,065,361 60,448,222 71,875,007 77,350,402 88,926,609
Transitions from ICF/DD's 12,418,220 33,454,591 57,002,579 73,771,181 79,600,288 88,598,392 95,575,635 102,705,592
Comm. Integrated Living Arrangements 12,251,085 33,136,440 56,594,518 73,241,509 78,940,254 87,847,449 94,868,050 101,996,741
Home Based Support Services 167,135 318,151 408,061 529,672 660,034 750,943 707,585 708,851
Net ICF/DD liability change From FY12 (11,864,219) (27,200,082) (50,228,487) (56,412,183) (64,081,848) (38,722,969) (41,560,166) (31,950,582)
Staffing and Contract Costs 329,550 2,039,176 5,462,564 7,142,693 8,214,437 6,259,766 7,051,466 8,280,736 8,749,234
Personal Services 186,932 1,241,559 1,504,825 1,601,574 1,629,774 1,629,774 1,629,774 1,629,774 1,629,774
Court Monitor 142,618 182,367 175,788 189,300 207,544 213,250 213,250 213,250 213,250
HBSS Fiscal Intermediary Costs - 440,250 1,266,450 1,622,200 1,743,500 2,005,700 2,345,800 2,714,900 3,063,600
Independent Service Coordination (ISC) - - 514,336 497,048 497,048 497,048 688,805 1,370,381 1,418,344
Pre-Admission Screening - - 933,665 1,683,247 1,663,994 1,663,994 1,873,837 2,052,431 2,124,266
BIP Services on PUNS database - - - 307,364 1,771,368 - - - -
Outreach - 175,000 700,000 721,000 180,250 - - - -
Family Advocacy Initiative - - 266,700 400,000 400,000 250,000 250,000 250,000 250,000
Transition Service Planning - - 100,800 120,960 120,960 - 50,000 50,000 50,000
Total 329,550 18,743,229 60,967,494 83,860,362 106,087,745 115,190,763 168,492,745 187,546,638 224,825,257

Notes: 
Rates have been adjusted for the DSP hourly increases: FY18 $0.75 (eff 8/1/2017); FY19 $0.50 (eff 7/1/2018). FY20 includes a COLA of 3.5%.
HFS has recently changed the DD LTC (i.e. ICFDD) payment and reporting to a web-based system. This has temporarily interrupted DHS access to traditional production reports, therefore ICFDD liability is subject to further adjustments at a later date.

Additional Budget Related Information

ICF/DD Service System Cost

Overall spending for the ICFDD system is described below:

FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19 FY20
Cost in Millions $382.8 $370.9 $355.6 $332.6 $326.4 $318.7 $344.0 $341.2 $350.8
Change from Prior Year $ (11.9) $ (15.3) $ (23.0) $ (6.2) $ (7.7) $ 25.3 $ (2.8) $9.6
Average Persons 6,244 6,206 5,872 5,424 5,083 5,007 4,963 4,870 4,838
Change from Prior Year -38 -334 -448 -341 -76 -44 -93 -32
Change from FY12 (11.9) $(27.2) $(50.2) $(56.4) $(64.1) $(38.8) $(41.6) $(32.0)

Source: Est. Liability per HFS Reports. DHS Budget Office.

Adult Waiver Services

Adult Waiver "Accepted Claims" is described below:

FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19Est
Adult Waiver Claims (millions) $553.3 $595.3 $658.3 $710.6 $748.6 $763.2 $798.4 $834.5
Change from Prior Year $42.0 $63.0 $52.3 $38.0 $14.6 $35.2 $36.1
Unduplicated Persons 17,607 18,621 19,509 20,512 20,797 21,216 21,371 21,411
Change from Prior Year 1,014 888 1,003 285 419 155 40

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:

Ligas Estimated Cost FY12 FY13 FY14 FY15 FY16 FY17 FY18 FY19
DD CILA Services Billings (millions) $462.1 $498.9 $546.9 $593.5 $619.8 $624.2 $ 655.2 $698.4
Change from Prior Year $36.8 $48.0 $46.6 $26.3 $4.4 $31.0 $43.2
Unduplicated CILA Persons 9,515 10,038 10,441 11,243 11,410 11,430 11,359 11,448
Change from Prior Year 523 403 802 167 20 (71) 89

Source: Billing System & Auth. Report - Client Type C

Transitions from AHBS to CILA

The following data represents individuals who transitioned from the Adult Home-Based Support (AHBS) program to the Community Integrated Living Arrangement (CILA) program for the period specified below. Individual's transitioned to CILA due to an increase in needs and not because of a PUNS selection. This information has been added to the 6-month report based on the Ligas Implementation Plan FY2019 Revisions.

Type of service request January 1 -June 30, 2019
Adult HBS to Intermittent CILA 5
Adult HBS to Family CILA 2
Adult HBS to Host Family CILA 0
Adult HBS to 24-Hour CILA 27
HBS to CILA Denials 0
HBS to CILA Appeals 0

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 update are posted on the DHS website at: Ligas Implementation Plan and Plan Update.