Ligas Data Report as of June 30, 2021 (issued August 6, 2021)

Ligas Data Report

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 January 1, 2021 through June 30, 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
1 Living at Home 15,216 15,970 16,360
2 ICF/DD after 6/15/11 313 322 323
3 ICF/DD on 6/15/11 with an Affirmative Statement to Move (2a) 1,351 1,343 1,335
3a DD PAS 10 9 9 9
3b DHS 1243/1238 952 947 941
3c EFE Form 168 166 165
3d OSG Request 202 201 200
3e Other Guardian Request 20 20 20
4 # At End of Fiscal Year 16,880 17,635 18,018

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

Additions Additions in FY19 Additions in FY20 Additions in FY2021
Individuals in ICFs/DD on 6/15/11 0 0 0
Individuals in ICF/DDs after 6/15/11 70 15 17
Individuals in Community Settings 1,753 1,709 1,573
Total Additions 1,823 1,724 1,590
Removals Removals in FY19 Removals in FY20  Removals in FY21
Individual Moved Out of State 104 75 97
Determined Clinically Ineligible 22 9 26
Determined Financially Ineligible 3 2 2
Withdrew-Reason Not Given 88 91 116
Individual Deceased 63 50 47
Objector 0 0 0
Other 627 518 662
Incorrect SSN (Duplicate Record) 4 1 6
Ineligible Setting 3 0 0
Unable to Locate Individual 290 208 239
Stay in ICFDD 13 4 2
Submitted in Error 0 0 0
Move to ICFDD 36 11 10
Total Removals 1,253 969 1207

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.
  • "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 Cumulative Total to Date
1 # of Class Members with Waiver Capacity Award Letters 31 0 1,466
2 *Total Class Members Who Have Moved to Waiver Services (per billing data) 32 0 1,466
2a Subtotal Who Received CILA Services 32 0 1,439
2b Subtotal Who Received HBS Services 0 0 24
2c Subtotal Who Received CLF Services 0 0 3

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

Services for Class Members from the Waiting List

Ten 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 & Ligas PUNS Selection Data tables are available on the Division's website.

Ligas Benchmarks Total
1 # of Class Members Selected from the Waiting List (PUNS). 9,640
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 5,628
4 Total Class Members Who Have Received Waiver Services (as reported by the PAS agencies and providers) 5,557
5 Total Class Members Who Have Received Waiver Services (per billing data) 5,455
5a *Subtotal Who Received CILA Services (per billing data) 1,246
5b *Subtotal Who Received HBS Services (per billing data) 4,201
5c *Subtotal Who Received CLF Services (per billing data) 8

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 6/30/2021 (per the CILA Log - agrees with Authorized total per Mobius)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 45 54 578 1,993 840 1,855 755 3,733 9,853
Family 442 49 3 13 5 1 - 4 517
Host Family 58 211 33 8 - - - 310
Intermittent 261 97 27 50 18 24 6 55 538
Total 806 411 641 2,064 863 1,880 761 3,792 11,218

Ligas Placements into CILA as of as of 6/30/2021 (known placements compared to CILA Log)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 9 10 105 516 158 262 81 850 1991
Family 118 5 0 2 1 0 0 0 126
Host Family 9 23 1 1 0 0 0 0 34
Intermittent 34 9 2 9 3 1 1 4 63
Total 170 47 108 528 162 263 82 854 2214

Crisis Placements into CILA as of 6/30/2021 (Crisis placements compared to CILA log)

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 6 11 136 295 108 243 110 529 1,438
Family 91 14 - - 1 - - 1 107
Host Family 11 38 3 - - - - - 52
Intermittent 54 14 - 9 - 4 1 4 86
Total 162 77 139 304 109 247 111 534 1,683

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 Cumulative Total to Date
1 Total # of Crisis Requests Received 304 293 251 3,743
2 Total # of Class Members Approved 280 283 249 3,502
2a # of Class Members Approved for CILA 194 165 164 2,230
2b # of Class Members Approved for HBS 86 118 85 1,272
3 Total # of Class Members Who Received Services 277 283 249 3,486
3a # of Class Members Who Received CILA Services 193 165 164 2,219
3b # of Class Members Who Received HBS Services 84 118 85 1,267
4 Total # of Class Members Denied Crisis Approvals 24 10 2 241

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 Cumulative Total To date
1 # of Agreements Initiated 9 5 0 80
2 Total # Licensed Capacity 127 164 0 1,593
3 Total # of People to Move 91 127 0 1,286
3a *Moved to CILAs 75 88 0 1,176
3b *Moved to HBS 0 2 0 2
3c *Transferred to other ICFs/DD 11 29 0 59
3d *Other 5 8 0 49
3e *Move Pending 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 Cumulative Total to Date
1 Total Class Members Appeals (Rows 2,3,4,5 = Row 1) 32 20 457
1a Crisis Appeals 3 0 161
1b Eligibility Appeals 29 20 296
2 Subtotal Appeals Upheld 7 6 144
3 Subtotal Appeals Denied 18 3 256
4 Subtotal Appeals Pending 1 7 8
5 Subtotal Appeals Withdrawn/Closed 6 4 49

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 1225
7/12/20 1,561 1536

Total number of individuals who entered services from any PUNS selection

FY20 FY21
# of Individuals 602 708

Adults on PUNS Seeking Services as of June 30, 2021

Time Waiting while Seeking Services as of JUNE 30, 2021 Persons Est. FY for Services
Over 60 months 32 FY23
59.99 months to 48 months 999 FY23
47.99 months to 36 months 1063 FY23/FY24
34.99 months to 24 months 1346 FY24/FY25
23.99 months to 12 months 1362 FY25
11.99 months and less 1463 Beyond FY25
Total 6265

Note: * Includes 439 persons currently in the DD waiver. Time Waiting is based on current PUNS data and may fluctuate to some extent, except for FY25, in which Time Waiting will be no more than 60 months.

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 need1 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
Adult HBS to Intermittent CILA 5 2 1
Adult HBS to Family CILA 2 4 6
Adult HBS to Host Family CILA 0 0 1
Adult HBS to 24-Hour CILA 27 56 67
HBS to CILA Denials 0 0 0
HBS to CILA Appeals 0 0 0

1A 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 June 2021

FY2019 FY2020 FY2021 FY2022 proj.
PUNS Placements $120,979,448 $142,124,850 $170,173,151 $200,525,786
to CILA $47,062,776 $56,563,866 $69,090,273 $80,632,007
to HBSS $73,916,672 $85,560,984 $101,082,878 $119,893,779
Transitions from ICF/DD's $93,917,401 $101,492,568 $110,679,759 $117,927,627
to CILA $93,239,974 $100,812,701 $109,987,644 $117,218,175
to HBSS $677,427 $679,867 $692,115 $709,452
Ind. Serv. & Supt. Adv. (ISSA) $6,232,266 $7,205,895 $8,647,001 $9,782,143
Staffing and Contract Costs $8,315,436 $9,245,330 $9,523,384 $10,053,091
Personal Services $1,629,774 $1,629,774 $1,629,774 $1,627,774
Court Monitor $213,250 $243,135 $284,850 $284,850
HBSS Fiscal Agent $2,677,000 $3,082,700 $3,572,900 $4,130,400
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
Total $229,444,551 $260,068,643 $299,023,295 $338,288,647
ICF/DD Liability Change ($64,572,888) ($70,017,677) ($74,463,870) ($76,646,996)
Total Net Costs $164,871,663 $190,050,966 $224,559,425 $261,641,651
End of year Persons in Service: FY2019 FY2020 FY2021 FY2022 proj
PUNS Placements
PUNS to CILA 840 946 1,069 1,195
PUNS to HBSS 3,140 3,628 4,288 4,792
Subtotal 3,980 4,574 5,357 5,987
Transitions from ICF/DD's
ICFDD to CILA 1,601 1,621 1,626 1,686
ICFDD to HBSS 27 27 27 27
Subtotal 1,628 1,648 1,653 1,713
Total (all receive ISSA) 5,608 6,222 7,010 7,700
ICF/DD Bed Reduction FY2019 FY2020 FY2021 FY2022 proj.
Beds Closed in FY 44 16 4 28
Cumulative Beds Closed 941 957 961 989

 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:

FY2019 FY2020 FY2021 proj.
Cost in Millions $849.80 $845.10 $867.52
$ Change from Prior Yr. ($4.70) $22.42
Average Persons 21,650 21,944 22,244
Persons Change from Prior Yr. 294 300

Source: Accepted Claims Reports (Mobius). FY2021 projected data is not available.

DD CILA Waiver Services

A subset of Adult Waiver services, spending for CILA services, including residential, day and ISSA is described below:

FY19 FY20 FY2021 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


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 (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 and is available on the DHS website.

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.

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. The respective fourth homes are expected to be open in FY22.

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 Ligas Implementation Plan and Plan 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-19 Statistics for Illinois at large as well as for long-term care facilities.