Ligas Implementation Plan FY23

Case: 1:05-cv-04331 Document #: 775 Filed: 02/03/22, Page ID #:14078

State of Illinois
Department of Human Services, Division of Developmental Disabilities
July 13, 2022

FY23 Ligas Implementation Plan


Table of Contents

Section I: Introduction

Section II: Development and Maintenance of the Class Member List

Section III: Outreach

Section IV: Development of Community Capacity

Section V: Community-Based Services/Placement for Individuals Residing in ICFs/DD

Section VI: Transition Planning

Section VII: Waiting List for Community Services and Placement

Section VIII: Community Crises

Section IX: Appeal Process

Section X: Resources Necessary for Implementation

Section XI: Interagency Agreement

Section XII: Process for Plan Reporting and Modification

Section XIII: Compliance Survey Results

Section XIV: Acronyms


Section I. Introduction

This document sets forth the State's plans to implement the provisions of the Consent Decree for Fiscal Year 2023 (FY23). It was developed in accordance with Paragraph 26 of the Consent Decree and has incorporated input received from the Plaintiffs, Intervenors, and the Court Monitor. References to paragraph numbers in each of the sections below refer to paragraphs within the Consent Decree from which language is excerpted. For full context, readers should refer to the Consent Decree. Should any language in the Implementation Plan unintentionally conflict with that of the Consent Decree, the Consent Decree governs. Each Section of the decree is discussed separately below.

Section II. Development and Maintenance of the Class Member List

Paragraph 6. Within thirty (30) days after Approval of the Decree, Defendants shall compile an initial list of Class Members by taking the list of Individuals to whom notice of Preliminary Approval of this Decree was sent, adding those Individuals from whom any of the Parties received a written, affirmative request to receive Community-Based Services or placement in a Community-Based Setting after notice of Preliminary Approval of this Decree was sent, but excluding (i) those individuals who filed objections to the Proposed Consent Decree that was the subject of the July 1, 2009 Fairness Hearing as described in Paragraph 3(i) above, and (ii) those Individuals from whom Defendants receive written requests that the Individuals do not wish to receive Community-Based Services or placement in a Community-Based Setting.

Paragraph 8. Defendants shall maintain a statewide database in which all Class Members are enrolled.

Consistent with Paragraph 6 of the Consent Decree, a Class Member list was created and has been maintained since the initial list was provided to the Monitor and Plaintiffs on July 15, 2011. The list does not include those excluded from the Class in accordance with the provisions of Paragraph 6 of the Decree. For the first six years of the Decree (through June 11, 2017), the ICF/DD Class Member List was finalized, and per the Decree, new ICF/DD Class Members will only be added if they enroll on PUNS and go through the process identified in the Reasonable Pace section (see Section VII - Waiting List for Community Services and Placement). The Class List may continue to be modified under limited and specific circumstances where an individual's rights under the Ligas Decree were not properly exercised. However, individuals from the PUNS waiting list continue to be added as Class Members (including individuals who may be residing in an ICF/DD and enroll on PUNS).

Section III. Outreach

Paragraph 25. Defendants shall maintain a fair and accessible process by which Individuals with Developmental Disabilities, or their legal guardians can affirmatively request in writing to receive Community-Based Services and/or placement in a Community-Based Setting or to receive ICF-MR services in an ICF-DD, and Defendants shall maintain up-to-date records of those requests.

Outreach required by the Decree to potential Class Members in ICF/DD settings has concluded. DDD will continue to identify those Medicaid-eligible individuals in need of services through continuation of the PUNS database and work with the Independent Service Coordination (ISC) Agencies. DDD will continue to maintain the ISC office locator function and toll-free number, in addition to numerous web-based resources, to enable families and guardians to learn about and apply for services.

General Information Sharing

DDD continues to maintain and update the Ligas page1 on its website. The DDD will post a schedule on its website of all events in which it will present information about the Consent Decree.

Ligas Class Member/Family Advisory Committee

The Defendants, in conjunction with the Monitor and with input from the Parties, established a Ligas Class Member/Family Advisory Committee (CMAC). For FY23, DDD will hold three Ligas Family Advisory Committee meetings and one Ligas Town Hall subject to COVID restrictions and precautions. The Town Hall and CMAC meetings may be held via webinar, in person, or through a hybrid model. These meetings will allow Class Members, families, guardians, and other interested parties to hear updates directly from DDD staff and to speak from their perspective. DDD staff will consult and coordinate with the Monitor and Class Counsel when planning these meetings. The Town Hall will be open to the public. Meeting dates and summaries will be posted on the DDD's website, including a link on the Ligas webpage by June 30, 2022.

ISC Visits

Beginning in FY23, ISC case managers will be visiting with Waiver recipients four times a year in order to further build relationships and an understanding of people's needs and desires as well as identify any changes in needs that must be addressed.

Section IV. Development of Community Capacity

Paragraph 4. The choices of Individuals with Developmental Disabilities, including Class Members, to receive Community-Based Services or placement in a Community-Based Setting or to receive ICF/MR services in an ICF-DD will be honored; provided, however, that this commitment to honoring choice does not alter Defendants' current obligations under existing law regarding licensed ICF-DD capacity system-wide or at any specific ICF-DD, and provided that, under current applicable law, this commitment does not entitle an Individual with Developmental Disabilities to receive ICF/MR services in a specific ICF-DD. Defendants shall implement sufficient measures to ensure the availability of services, supports and other resources of sufficient quality, scope and variety to meet their obligations to such individuals under the Decree and the Implementation Plan consistent with such choices. While the Decree remains in effect, any amendment to the State Plan submitted by the State pursuant to 42 U.S.C.§ 1396, et seq. will continue to include ICF-DD services as an alternative for long-term care services for eligible Individuals with Developmental Disabilities. Nothing in this Decree shall impair Defendants' ability to make changes in their provision of supports and services to Individuals with Developmental Disabilities, including Class Members, regardless of setting, provided that Defendants continue to honor Individuals' choices and fulfill Defendants' obligations under the Decree and Implementation Plan. Resources necessary to meet the needs of Individuals with Developmental Disabilities who choose to receive services in ICFs-DD shall be made available and such resources will not be affected by Defendants' fulfillment of their obligations under the Decree, including the obligations under Paragraphs 17 through 19 and 21 through 23. Funding for services for each Individual with Developmental Disabilities will be based on the Individual's needs using federally approved objective criteria regardless of whether the Individual chooses to receive services in an ICF-DD or in a Community-Based Setting; provided, however, nothing in this Decree shall require Defendants to change their current method for establishing funding or from adopting new methods based upon federally approved objective criteria.

Paragraph 5. Annual budgets submitted by Defendants on behalf of their agencies shall request sufficient funds necessary to develop and maintain the services, supports and structures described in the Decree, consistent with the choices of Individuals with Developmental Disabilities, including Class Members. Defendants shall take steps sufficient to implement funding mechanisms that facilitate transition among service settings.

1- IDHS Ligas Page

During the first six years of the Decree, the benchmark of serving 3,000 individuals currently living at home through either Community Integrated Living Arrangements (CILAs) or Home-Based Support Service (HBS) was achieved. In addition, Class Members residing in ICF/DDs also moved to CILA or HBS settings. Class Members continue to move into CILA or HBS settings under the Reasonable Pace provisions of the Decree. Individuals selected to receive services under this Consent Decree may choose from any qualified and willing provider as defined in the Waiver.

Illinois has a substantial base of qualified HBS, CILA, and day program providers. Based on billing information, as of May 1, 2022, there are 230 CILA providers, 113 Self-Directed Assistance providers,2 142 Community Day Services (CDS) providers, and 51 supported employment providers actively billing for services. Additionally, there are providers of therapies, assistive technology, and other support services under the Waiver.

Provider Capacity for Specific Populations

Although the community-based service system supports thousands of people with I/DD to have lives in the community, the State engaged the University of Illinois at Chicago (UIC) in FY22 to produce a report to look at current provider capacity to serve people with specific support needs, including high behavioral supports, medical supports, deaf/hard of hearing, blind/visually impaired, mobility impaired, among others. In FY23, DDD will complete its review of the report and will establish policies, procedures, and other modifications to the current operational system to address and work to resolve the issues identified, as it determines appropriate in consultation with the Parties and Monitor. A plan will be developed and a timeline for implementation will be created in consultation with the Parties and Monitor. DDD will report regularly at Parties' meetings regarding progress of implementation of these new policies, procedures, and other modifications, and the impact of those changes on system capacity.

2- Service Facilitation is no longer a requirement under the Home-Based Services Program, but such services, now called "Self-Directed Assistance" are available, if desired. 

Data Reporting, Focused Selection, and the PUNS Selection List

DDD reports on all active Class Members seeking and/or in need of services on the Ligas Services List, which has been compiled into a database allowing inquiries and searches of particular groups and individual Class Members.

DDD has continued to participate in monthly calls with Defendants, Class Counsel, and the Monitor to discuss specific Ligas Class Members who have funding sources and who continue to seek community-based services.

DDD includes in the monthly reports a summary of all Class Members who have either been removed from the Ligas selection list or placed on "hold."3 In addition, a separate submission is provided only to the Plaintiffs and Monitor, to identify the factual basis for the determination. DDD will also continue to provide to Plaintiffs and the Monitor PUNS data (including those actively seeking services and planning) and a list of all individuals who have been selected from PUNS but who have not initiated services within 18 months of their selection for further analysis and discussion.

Ligas Six Month Data Reports will continue to be completed semi-annually, and will be distributed to the Parties and Monitor, and posted to the DDD Ligas webpage.

Provider Qualifications and Training

New Providers

New provider information continues to be available on the DDD website,4 including information on qualifications, regulations, compliance issues, staff training, DDD contacts, etc., as well as information on mandatory orientation sessions required for all new providers. DDD continues to explore ways to identify potential provider agencies, including working with national organizations to identify strategies to bring in new providers, educating providers that they cannot discriminate against people with disabilities (including physical, sensory, behavioral, and medical) and encourage/incentivize existing providers to serve individuals with physical accessibility needs, high behavioral needs, and high medical needs. In FY23, DDD will implement changes based on the review of UIC's Capacity Study to assist in development and recruitment of new providers.

3 - "Hold" is for Ligas Class Members who have been selected from PUNS to receive services but do not wish to actively pursue community-based services at the time of selection; additional information on "hold" is provided below.

4 - IDHS New Provider

Conversion of ICF/DD Capacity

DDD may enter into voluntary closure agreements with providers of ICFs/DD, during which DDD ensures that ICF/DD residents transitioning to a new residential setting are provided with an assessment and service plan that meets the requirements of the Decree, informed of their right to explore options among any qualified provider and are given a choice of qualified residential providers if they choose to explore those options. For ICFs/DD with the capacity to serve 16 or more individuals, closure agreements provide for rates during the closure period that recognize the need for coverage of fixed costs while individuals are transitioning to new residential settings of their choice, whether operated by the same or a different provider.

To provide more detail about the downsizing/closure process, a sample agreement is available for reference on the DDD's website.5

Employment

Competitive Integrated Employment (CIE) will continue to have an increased focus during FY23 through the Division of Developmental Disabilities' (DDD) sustained efforts to improve access to quality employment services and supports for individuals with disabilities, including but not limited to Class Members. Thus, many of these activities below do not fall under the consent decree but will positively impact Class Members.

DDD continues to work in collaboration with the Division of Rehabilitation Services (DRS) on multiple projects, as outlined below, to 1) improve alignment within the employment service delivery system, 2) ensure consistent and positive employment experiences and outcomes 3) expand provider knowledge, capacity, and quality & 4) utilize data to drive decisions on future employment initiatives.

DDD/DRS Collaboration includes:

  • DRS Subminimum Wage to Competitive Integrated Employment (SWTCIE) Grant
    • The SWTCIE Grant, offered by the RSA to State Vocational Rehabilitation agencies, is designed to increase the self-determination and self-advocacy among SWTCIE participants that will result in competitive integrated employment (CIE). SWTCIE is a 5 year project with an estimation of between 12 and 18 awards. This effort will enhance those already underway, such as the CIEC Grant, to engage more individuals with disabilities in obtaining and sustaining competitive integrated employment.
  • Disability Innovation Fund - Subminimum Wage to Competitive Integrated Employment (SWTCIE)State Learning Collaborative (SLC)
    • In conjunction with the Institute for Community Inclusion (ICI) and State Employment Leadership Network, the SLC will offer I/DD specific training for personnel from DRS Vocational Rehabilitation, ISCs and DDD Regions
  • Competitive Integrated Employment Capacity Grant
    • 11 Agencies, representing statewide coverage, funded to expand capacity and build sustainability in employment programs
  • Memorandum of Understanding (MOU)
  • Revision to Career Counseling, mandated under Section 511 of the Rehabilitation Services Act, as Amended by WIOA
  • Continued support for the DRS Customized Employment Pilot, initially launched in FY21
    • DRS CE contracts for FY23 were issued to 8 providers with capacity to serve 40 individuals
    • DRS CE constitutes a very small percentage of services - it is important to note that individuals with I/DD, including Class Members, remain

5 - Intermediate Care Facility for the Developmentally Disabled - 16 Beds and More - Downsizing Agreement
5 - Intermediate Care Facility for the Developmentally Disabled - 16 Beds and Less - Downsizing Agreement

Other areas of focus:

  • DDD has implemented, and will continue to directly monitor, an efficient and clear process for Medicaid Waiver funded individuals, including Class Members, to request and revalidate DDD Supported Employment Program funding. This process is directly reviewed by the DDD Supported Employment Administrator and
    • Allows individuals to obtain and sustain long term employment supports once DRS funding has been exhausted or is not available.
    • Ensures alignment with the Medicaid Waiver and HCBS Settings
    • Maximizes likelihood of appropriate implementation of supports to all eligible individuals
  • DDD has, in 2021 and 2022, provided annual training and technical assistance to over 300 Independent Service Coordination personnel per year. Similar efforts will continue in future years.

FY23 Priorities

  • Increase and systemize data collection and sharing, on jointly served individuals, between DDD & DRS
  • Increase alignment and consistency within individual plans for employment and implementation strategies developed by DRS, ISCs and the provider network
  • Continue collaborative training, technical assistance, and grant projects
  • Develop (or revise existing) and expand, strategy, policy and capacity/competency building activities which support improved employment outcomes for individuals working towards CIE.
  • Continue efforts to fulfill the DRS / DDD MOU

Defendants will keep the Monitor and Class Counsel regularly updated on its progress with its efforts to continue to expand employment opportunities for Class Members including reporting on activities in the 6-month data reports.

PUNS/ICF/DD Class Members-Ligas Services List "Hold" and Removal

Removal

Class Members in ICF/DDs and individuals selected from the PUNS list for services are still subject to removal from the Ligas Services List for several reasons. Removal of a Class Member from the Ligas Services List does not necessarily result in removal from the PUNS list, nor does it prevent the individual from seeking other Waiver-based services or expressing an interest to become a Class Member in the future. Removal is warranted under the following circumstances:

ICF/DD Class Members:

  • Individuals who are ineligible for services will be removed from the Active/Confirmed list. Reasons for ineligibility include death, relocation out of state, clinical ineligibility, and inability to financially qualify for Medicaid. For those who are deemed ineligible, they will be given timely written notice on how to appeal that determination and if the eligibility is overturned, they will be returned to the Active/Confirmed list.
  • Individuals who do not meet Ligas Class Member requirements will be removed from the Ligas Services List but will remain on the PUNS waiting list.
  • Declined Community-Based services, demonstrated by completion of a written document stating their and their guardian's preference to remain in the ICF/DD. Individuals and their guardians are free to change their minds and make a Current Record of their interest to receive Community-Based Services or placement in a Community-Based Setting.

PUNS Class Members:

  • Ineligible for services. Reasons for ineligibility include but are not limited to death, relocation out of state, clinical ineligibility, and inability to financially qualify for Medicaid.6 Ineligibility will also result in removal from the PUNS list, but removal in certain of these circumstances is subject to the appeal rights of the individual.
  • Failure to meet Ligas Class Member requirements (but may remain on the PUNS waiting list).
  • Decline of services, in which the individual/guardian may affirmatively request to be placed in the "Planning" category of need on PUNS.
  • Decline of services (although Ligas services may be re-initiated during the 3 months after the date services were declined). Failure to re-initiate services within 3 months of the decline of services will void the PUNS selection and the individual will remain in the "Planning for Services" (formerly "Planning") PUNS category.
  • Decline of services and request to be removed from PUNS will result in the removal of the individual from the Ligas Selection List and the PUNS database. This is also subject to the 3-month limit to re-initiate services, after which the PUNS selection will no longer be valid and re-enrollment in PUNS will be required.
  • Refusal to complete or failure to cooperate in the assessment process. This includes, but is not limited to, any of the following:
    • Failure to either make contact with or respond to inquiries (telephonic, written, or other) from the assigned ISC Agency within the initial 6-month period following the mailing of the selection letter.
    • Failure to engage in and begin the assessment process within the initial 6-month period.
    • After obtaining an extension on the initial 6-month application deadline, failure to complete the assessment and obtain an eligibility determination within 9 months from the date of mailing of the PUNS selection letter. Extensions will be granted upon a showing of continued engagement with the ISC Agency and for extraordinary circumstances.

6 - Individuals and their guardians will be afforded a full 9-month time period (with extensions as needed for good cause) to become eligible for Medicaid.

Hold List

DDD continues to monitor Class Members who are on the "Hold" list, in which certain individuals selected from ICF/DDs or the PUNS list, who are not yet ready to initiate services or who are unable to complete the process, are given a temporary "Hold" period during which they may still exercise the benefits arising from their selection. A Class Member may remain on "Hold" for a maximum of two years, during which time the ISC Agency will contact the individual once every six months. During the two-year period, the individual/guardian may, at any time, choose to continue with the Waiver process to obtain services. However, if the individual fails to take any action in furtherance of service initiation, at the end of the two-year Hold period, the individual's PUNS selection will be invalidated.7 At that point, the individual will be able to enroll on PUNS as a new enrollment. Any future PUNS selection will be based on the new enrollment date.

Individuals may be placed in the "hold" category for the following reasons:

  • Seeking services from particular provider(s);
  • Awaiting opportunity to move with particular peers;
  • Undecided on a provider;
  • Deciding between home-based and CILA services;
  • Determining whether to proceed with Waiver services;
  • To allow time to address medical or personal matters (including, but not limited to, rehabilitation, medical procedures, family emergencies, or other matters that may delay decisions as to services);
  • Other reasons with approval from DDD.

Individuals on Hold are not counted toward ICF/DD transitions or Reasonable Pace benchmarks.

Capacity Development

In response to the compliance findings regarding capacity Development, as of the date of this

7 - Individuals on the Hold list will be notified at the 18-month point that absent further action, they will be removed from Hold in six months (at the two-year mark) and be removed from PUNS. ISCs will contact individuals prior to removal. However, if the delay in taking action within the two-year period is through no fault of the individual or their guardian, the Hold period may be extended on a case-by-case basis.

Implementation Plan, a number of actions have been taken to bring the Defendants into compliance. This includes, but it not limited to, the following:

  • Guidehouse Rate Study Implementation: In December 2020, Guidehouse (formerly Navigant Consulting) issued its final report, Developmental Disability Services Rate Study, which provided rates and rate methodology recommendations for Waiver funded and ICF services and supports. The report includes phased-in recommendations, recommending implementation in Fiscal Years 2022 through 2026. As set out in the report, the cost for implementation in FY23 would be $329 million with each year thereafter costing an additional roughly $100 million, with the total cost of implementation being approximately $745 million. The State is proposing a robust, but longer, phase-in timeline for implementation due to the cost of the recommendations and other State budget demands and pressures, as set forth below8.
  • FY23 Budget and Guidehouse Rate Study Implementation: During the FY22 legislative session, the Illinois General Assembly passed, and Governor Pritzker signed, a budget for FY23 that provides $209 million in new funding for services for people with intellectual and developmental disabilities (I/DD), following a $170 million investment in FY 2022. With this funding, the Division of Developmental Disabilities (DDD) will be able to invest additional resources into the service system, including implementing DDD's promised deliverables for FY 2023 from the Guidehouse Study Implementation Plan. Highlights include:
    • Increasing the average Waiver Direct Support Professional (DSP) wage reimbursement from $16.00/hour to $17.00/hour across the State of Illinois. This includes CDS DSPs and ICFDD aides. This change will be effective January 1, 2023, pending Federal Centers for Medicare and Medicaid (CMS) approval.
    • Increasing the average CILA DSP wage reimbursement from $16.00/hour to $19.55/hour in Chicago, Cook County, and the collar counties, effective January 1, 2023, pending Federal CMS approval by implementing the regionality component of the Guidehouse Rate Study for CILA residential. Please note that the regional differences in ICF reimbursement remain in effect such that DSP wage reimbursement for ICFs in the Chicago area will also be $19.55.
    • DDD will select 700 new adults from the PUNS list. In addition, DDD will select 100 children from the PUNS list for children's Home-Based Support services for the first time in 12 years.
    • Increasing visits by Independent Service Coordination (ISC) agencies to 4 visits per year (from 2). This reinstates the quarterly visit schedule that ended in FY 2018 and will ensure Waiver-funded residents have independent support and monitoring.
    • Funding parity with DCFS for Children's Group Homes.
    • A 2% COLA for all DDD grant lines as well as services including ISCs and Community Living Facilities, effective January 1, 2023, pending Federal CMS approval.
    • Funding to cover the increase in the HCBS self-directed program, Home-Based Services (HBS). The HBS budgets are increasing due to a cost of living increase in Supplemental Security Income, which determines HBS funding
    • Funding to maintain the FY 2022 increases recommended by the Guidehouse Rate Study. Note: without this additional funding DDD would not be able to continue the current FY 2022 Guidehouse recommended rate increases.
    • Implementation of the Guidehouse recommended CILA Rate Calculator, effective January 1, 2023 (pending Federal CMS approval), which will provide a new methodology and updated rates to determine an individual's rate for services including:
      • Using the Health Risk Screening Tool to refine rate setting
      • Adjusting base nursing and medication administration hours by the individual Waiver recipient's needs
      • Implementing a regionalization factor that will provide an additional 15% on CILA residential wage rates for Chicago, Cook, and the collar counties (as noted above)
      • Updating rates and/or percentages for room and board, transportation, employee-related expenses, program, and administration. Also included in the budget is funding for ISCs to provide outreach

8 - The Monitor, Class Counsel, and Intervenors all recommend that the State fully implement the Guidehouse Rate Study in the time frame set forth in the report, believing that comprehensive and timely implementation is necessary for the State to come into compliance with the Consent Decree.

Also included in the budget is funding for ISCs to provide outreach to Intermediate Care Facilities for the Developmental Disabilities (ICF/DDs) and State Operated Developmental Centers (SODCs) about community services and Waiver service options as well as funding for a 2 year Housing Navigator pilot project to support people to access alternative housing options.

Previous Rate Increases: The proposed rate increases are in addition to rate increases already enacted over the past several years, which are summarized in the chart below:

Fiscal Year Funding Increase - HCBS Funding Increase - LTC Implementation Effective Date
2018 $0,75/hour wage increase $0,75/hour wage increase Pass-through to front-line staff (HCBS); pass- through to staff through program & support components of rate (ICF) 08/01/2017 (Both)
2019 $0,50/hour wage increase $0.04 for Chicago $0,50/hour wage increase Pass-through to front-line staff (HCBS); pass- through to staff through program & support components of rate (ICF) 10/01/2018 (Both)
2020 3.5% rate increase 3.5% rate increase Rate increase/COLA 07/01/2019; 08/01/19 for LTC
2020 (mid-year, non- legislative) $0.58 & $0.62/hour wage increase $0.24/hour wage increase Wage increase (not required to be pass-through) 01/01/20; est. 06/01/20 for LTC
2021

$1.00/hour wage increase

$0.50/hour wage increase

$1.00/hour wage increase

$0.50/hour wage increase

$0.80/hour and $0.40/hour, respectively, required to be pass-through to non-exec staff 07/01/20 and 01/01/21
2022 $170 million total $170 million total 50% pass through, 50% rates 07/01/2021 (ICF/DD) and 01/01/2022 (CMS required approval)
2023 $207 million total (see above for detail) $207 million total (see above for detail) $0.50/hour and required to be pass-through to frontline staff 07/01/22 and 01/01/23

Additionally, as stated above, in FY23, DDD will identify strategies in response to the UIC capacity report, develop a timeline and implement recommendations, as appropriate, to expand capacity among service providers to address specific support needs including high behavioral supports, high medical supports, deaf/hard of hearing, blind/visually impaired among others. DDD will share the strategies and timeline as well as provide updates to and get input from the Monitor and Parties.

Per the request of the Monitor and Parties, the following represents additional activities currently underway within the DDD. These activities, while related to certain of the Monitor's concerns, are not specific to the Ligas Decree, as they are much broader and impact all individuals who receive services under the Adults with Developmental Disabilities Waiver. As such, the State does not consider them to be a part of, nor governed by either the Ligas Consent Decree or the Implementation Plan but does agree that these activities provide a benefit to Class Members. The State makes no representations as to the end result from these activities, but will continue to update the Parties and Monitor on progress and developments in these areas as they occur, especially as they impact Ligas Class Members. Plaintiffs and the Court Monitor disagree with the State as to the applicability that the Ligas Decree and Implementation Plan have on these activities, but as the parties do not disagree on the nature of these activities, the issue need not be resolved at this time.

Short-Term Stabilization Homes: In FY20, the DDD funded an expansion of Short-term Stabilization Homes (SSH) under the adult Medicaid Waiver increasing from the initial four homes to eight homes, utilizing the two providers under contract with the DDD on the original four homes. In FY21, the providers opened 2 of these additional homes. The third and fourth home have not yet opened due to COVID and staffing concerns. DDD plans to open the last two homes in FY23. DDD will explore the impact of the SSH homes and will evaluate in first quarter of FY23 whether there should be further SSH expansion. Each home can serve four individuals; the expansion increases capacity from sixteen (16) to thirty- two (32) individuals. SSH homes provide temporary stabilization services due to extraordinary behavioral issues. The homes are equipped with high staffing and oversight ratios, as well as the necessary staff or consultants to address individual behavior and medication needs. Transition planning for post-stabilization placement is ongoing throughout an individuals' tenure at an SSH, with the primary goal, if feasible, that the individual return to their own/prior home. However, these transition plans are fluid and depend on the progress that the individual makes toward stabilization.

Rules: The DDD is in the process of updating rules that govern the I/DD system. The rules and their current status are as follows:

  • 59 IAC 115 (CILA): To be re-posted for JCAR First Notice in FY23.
  • 59 IAC 119 (CDS): Through DDD Regulatory Advisory Board; currently with IDHS internal review.
  • 59 IAC 120 (Waiver): Through DDD Regulatory Advisory Board; currently with JCAR for pre-approval.
  • 59 IAC 117 (Home-Based Services): Completed JCAR pre-approval and with IDHS for internal review.
  • 59 IAC 116 (Medication Management): Currently with a DDD work group for review.

Assistive Technology: The DDD continues to educate stakeholders through trainings on assistive technology and has included additional questions on assistive technology in the Discovery and Personal Plan tools that have been released in FY22 and will be utilized starting in July 2022 starting with using the updated Discovery Tool, Personal Plan and Implementation Strategies. By the end of FY23, all people should be engaged in a discussion of assistive technology needs through this process.

Support Stabilization Services: The DDD has expanded the availability of support stabilization services to provide bridge support for individuals transitioning out of SODCs. In addition, 4 ISCs covering the 7 SODCs are helping to support people who have indicated that they want to transition to the community, including Ligas class members who have entered the SODC for short term stays.

Behavior Services and Supports: The DDD continues to provide increased Behavior Therapy hours of up to 104 annually to individuals under the adult Waiver. In FY22, saw an increase in funding for the Guidehouse recommendation of increasing the Behavioral Services and Supports rate, which went into effect in January 2022.

Quality Management: The quality improvement system for the Waiver is described in Appendix H of the Waiver. Performance measures are outlined throughout the Waiver itself. The Bureau of Quality Management (BQM) regularly completes on-site reviews of service delivery for individuals served in the Adult DD Waiver. While the Waiver quality reviews are not specific to Ligas Class Members, many Ligas Class Members go through the review process each year by virtue of being in the Waiver program. BQM cites any deficiencies noted, requires corrective action plans to address those deficiencies, and follows-up on the plans to ensure they were appropriately implemented. Defendants will share Ligas Class Member reviews with the Court Monitor and Class Counsel within 60 days of completion of the FY21 reviews. The DDD revised the BQM tool during FY22, with plans for ongoing future revisions and improvements.

Housing Options for Class Members

IDHS believes that persons with disabilities can live fully integrated within their community of choice with appropriate services and supports within affordable supportive housing options, whether scattered site or within small single site supportive housing buildings. This not only complies with federal CMS Home and Community-Based Services regulations defining home and Community-Based as well as the Olmstead integration mandate but is also cost effective and meets the desires of persons with disabilities.

As such, in addition to the typical community settings of HBS and CILA, DDD has been collaborating with the IDHS Statewide Housing Coordinator and the Illinois Housing Development Authority (IHDA) to make supportive housing options available to eligible Ligas Class Members. Class Members are eligible for Statewide Referral Network (SRN) and Section 811 Project-Based Rental Assistance (PBRA) units (depending on income), which are affordable studio, one-, and two-bedroom units available across the state. These units are individually controlled, with the tenant or their guardian having an individually controlled lease and rights of tenancy. In FY22, the DDD provided training on supportive housing for stakeholders.

In FY23, the DDD, in partnership with the Illinois Council on Developmental Disabilities (ICDD), is increasing the support for people with I/DD to access affordable, supportive housing in Illinois. DDD is funding seven ISCs to hire dedicated Housing Navigators in eleven regions, and ICDD is funding technical assistance, training, evaluation models, and support to the Housing Navigators. DDD anticipates helpful data, the building of relationships with landlords and housing developers, and more education and support for people to understand their options

including alternatives to 24 hour CILA. In FY23, DDD will review the ICILA information bulletins and update communications with stakeholders to ensure understanding of the ICILA process. DDD will discuss the ICILA process with ISCs to determine if there are any additional process improvements needed.

The DDD will work with IDHS housing staff and IHDA to include people with I/DD in statewide housing strategic discussions. In addition, the DDD will continue to work with ICDD to identify ways to expand access to a diverse set of housing options. ICDD has added the DDD Deputy Director of the Ligas Consent Decree to their housing funding committee.

Defendants will keep the Monitor and Class Counsel regularly updated on their progress in developing housing for Class Members including in the 6-month report. As stated above, the DDD is looking to partner with the IDHS Statewide Housing Coordinator on training and to ensure that people with I/DD are fully included in the statewide housing strategy.

Section V. Community-Based Services/Placement for Individuals Residing in ICFs/DD

Paragraph 17. …within six (6) years after Approval of the Decree, all Class Members residing in ICFs-DD as of the date of Approval of the Decree (regardless of when in this timeframe the Class Member affirmatively requested placement in a Community-Based Setting) will transition to Community-Based Settings consistent with their Transition Service Plan, if, at the time of transition, the Class Member requests placement in a Community-Based Setting…

As of June 30, 2017, all known ICF/DD Class Members who indicated a desire to move, were to have been moved to a Community-Based Setting. As of April 1, 2021, there were 1558 Class Members residing in ICF/DDs on or prior to June 15, 2011. Of these, 1465 Class Members residing in ICF/DDs have received award letters for Waiver services provided by specific providers, and 1464 have moved to their community-based Waiver setting.

In addition to the 1465 Class Members who determined the services they wanted and received award letters to get those services, as of May 1, 2022, there were 56 Class Members in ICF/DDs who have not yet received award letters because they have not accepted a specific service package. Of those remaining 56 Class Members actively seeking services, 42 are individuals under the guardianship of the Office of State Guardian. DDD will review the data on all 56 Class Members and report their current status in the 6-month report. The Monitor will review the data on the OSG wards who are on Hold and share her findings with DDD and Class Counsel. The previous process of the DDD monitoring ICF/DD transitions through monthly contact and an internal database ceased in 2017. The DDD now monitors all Class Members (ICF, PUNS, etc.) including individuals transitioning from ICFs to community-based settings or services, through an internal database. Updates are provided to the DDD staff monthly through the ISC agencies. DDD will work with Guardianship and Advocacy/OSG to identify any additional tools, training, and supports that their guardians might need in understanding community options in FY23, including resharing the presentation and recording from this year.

In addition to the activities by State staff, the Pre-Admissions Screening (PAS)/Individual Service and Support Advocacy (ISSA) monitor the individual's successful adjustment to the new

services by completing four weekly visits with the Class Member during the first month and quarterly visits thereafter. In the event the ISSA identifies problems, it shall take steps to resolve issues locally and refer matters as needed to the DDD per the Problem Resolution Protocol within the ISSA Guidelines. It may also request more hours for additional visits per the Guidelines.

DDD also has engaged the ISCs to provide institutional outreach yearly to people living in SODCs and ICF/DDs, which will include a yearly outreach letter and follow up as well as visits to ICF/DDs to be available for questions. While not under the Ligas Consent Decree, this outreach will allow people who would like to consider Waiver services to learn more and potentially sign up for PUNs.

Individuals who Decline Community-Based Services to Remain in ICF/DD

Any individual residing in an ICF/DD as of June 15, 2011, who did not join the class by June 15, 2017, is no longer automatically eligible for Ligas-based services but may choose to seek Community-Based Services through enrollment on the PUNS database.

Section VI. Transition Planning

Paragraph 11. The Transition Service Plan shall describe the services the Class Member requires in a Community-Based Setting or through Community-Based Services; where and how such services can be developed and obtained; the supports and services the Class Member will need during his or her transition to a Community-Based Setting; and a timetable for completing that transition.

Paragraph 12. The Transition Service Plan shall be developed by a Qualified Professional in conjunction with the Class Member and, where one has been appointed, the Class Member's legal guardian, and, where appropriate, the Class Member's family members, friends and support staff who are familiar with the Class Member.

Paragraph 13. The process for developing a Transition Service Plan shall focus on the Class member's personal vision, preferences, strengths and needs in home, community and work environments and shall reflect the value of supporting the Class Member with relationships, productive work, participation in community life, and personal decision- making.

Paragraph 14. All services and supports in the Transition Service Plan must be integrated into the community to the maximum extent possible, consistent with the choices of the Class Member and the Class Member's legal guardian.

Paragraph 15. The Transition Service Plan shall not be limited by the current availability of services, provided, however, that nothing in this paragraph obligates Defendants to provide the types of services beyond those included in the Waiver and/or the State Plan.

The Person-Centered Planning process implemented in January 2018 continues to be used for all Ligas Class Members, as well as other Waiver recipients. In FY22, IDHS engaged UIC to  conduct a review with a focus on specific areas in response to the Monitor's reports. These areas are as follows: (i) the entire Person-Centered Planning process and (ii) identification of gaps in community service capacity, which is discussed above. UIC submitted the Person-Centered Planning Report and updated templates in May 2022. Statewide stakeholder training was done on the report, processes have been updated and new discovery process, personal plan, and implementation strategy templates have been created and distributed to providers/ISCs and posted on the website. DDD plans to continue quarterly office hours as training and technical assistance for ISCs and providers as they implement the changes.

UIC will also help to support continued DDD and provider trainings in FY23, and in providing additional materials to the DDD website. UIC will implement the recommendations that are identified in the PCP project, report on accessible housing opportunities, and continue provider training. DDD will provide regular updates to the Monitor and Class Counsel on the progress and deliverables of this initiative.

Section VII. Waiting List for Community Services and Placement

Paragraph 22(d). Within two (2) years after Approval of the Decree, Defendants shall provide, in accordance with the Class Members' Transition Service Plans, appropriate Community-Based Services and/or placement in Community-Based Settings for at least 1,000 Waiting List Class Members who are selected from the Waiting List…with these Class Members served in order of priority. In each of the third, fourth, fifth and sixth years following Approval of the Decree, Defendants shall serve at least 500 additional Waiting List Class Members who are selected from the Waiting List, again in order of priority.

Paragraph 23. All Class Members who are on the Waiting List after the end of the sixth year following Approval of the Decree shall receive appropriate Community-Based Services and/or placement in a Community-Based Setting, such that they move off the Waiting List at a reasonable pace…

Over the first six years of the Decree, the DDD was to serve 3,000 individuals under the Medicaid Waiver from the waiting list. DDD met and exceeded the requirement to serve 3,000 waiting list Class Members within this first six years.

Reasonable Pace

As part of the FY20 Implementation Plan, the parties agreed on a schedule for individuals to receive services from the PUNS list at a "reasonable pace." This multi-year plan has an end goal such that by FY2025, the maximum wait time for the PUNS list will be 60 months (5 years) (measured as of the date of enrollment or the individual's 18th birthday if they were enrolled prior to age 18).

PUNS selections will be conducted annually. Approximately six months prior to the beginning of each fiscal year, individuals and/or guardians who are anticipated to be in the selected group will be provided notification of their likely upcoming selection to encourage early planning. In addition to the annual PUNS selection, if, six-months post selection, the responses to the

selection letters are below the anticipated targets, the DDD will conduct a second PUNS selection to fill the unused targeted capacity.

In Fiscal Years 21 through 25, the DDD agrees to serve a minimum of 630 individuals from the PUNS list each year. However, for this period, individuals selected from the PUNS list who were receiving Home-Based services at the time of selection and who move to CILA services will not be counted toward the 630 minimum. In addition, the DDD agreed to serve an average minimum of 630 individuals from the PUNS list for the years FY20-FY22, such that no fewer than 1,890 individuals will be served for that time period. DDD will update the Monitor and Class Counsel on this via the 6-month data reports.

FY21: Initial Yearly Selection will be based on a maximum wait of 70 months; FY22: Initial Yearly Selection will be based on a maximum wait of 64 months; FY23: Initial Yearly Selection will be based on a maximum wait of 63 months; FY24: Initial Yearly Selection will be based on a maximum wait of 61 months; FY25: Initial Yearly Selection will be based on a maximum wait of 60 months.

The DDD has already reached the minimum wait time of 60 months, but will continue to select individuals per the processes identified above to serve a minimum of 630 individuals in FY23.

Movement Between Waiver Services

During FY21, the DDD worked with the Parties and Court Monitor on a draft policy to govern requests for a change in Waiver services. After the policy was finalized, the DDD issued an Information Bulletin to the field that explained not just the process for transitioning between Waiver services, but also the crisis process. As individuals no longer need to enroll on PUNS in order to change services, the next step in this process will be to remove individuals currently receiving Waiver services from the PUNS list. During bi-weekly ISC/DDD meetings, DDD will remind ISCs of the waiver transition process and re-share the 2021 information bulletin on the subject.9 The DDD is in the process of reaching out to these individuals to notify them of their removal from the PUNS list, as well as to provide them with guidance regarding how to navigate the Waiver service transition process.

The DDD will include updates regarding the Waiver service transition process in the 6-month data reports, including the number of people who request movement between Waiver services and the number of people who receive those services per month. If any issues arise with the Waiver service transition process, the Defendants also will notify the Parties and Court Monitor.

9 - Waiver Transitions information bulletin:

Section VIII. Community Crises

Paragraph 21(c). Defendants shall ensure that all Class Members who are determined to be in a situation of Crisis, and who request to receive Community-Based Services and/or placement in a Community-Based Setting, receive such services and/or placement in such setting expeditiously.

The ISC agencies continue to submit requests for services from individuals in crisis situations,

and the DDD will continue to process these requests, using existing criteria available on the DDD website.11 These requests are separate from and not included in service totals for Reasonable Pace or Movement Between Waiver Services. The DDD continues to work to ensure that individuals determined to be in crisis situations are served per the Consent Decree.

In FY21, the DDD completed a review of the safety plans process and submitted the review to the Parties. The DDD also issued an Information Bulletin to explain the crisis process as well as the Waiver service transitions process10. In FY23, the DDD will continue to review the crisis process and provide updates to the Monitor and Class Counsel via the 6-month data reports. In addition, DDD will be meeting with the Monitor and Class Counsel to continue to clarify the crisis definition and cases requiring 24-72 hour placement to assure that such crisis obligations are being met.

In FY 23, the Parties/Monitor will continue to evaluate the status and transition process for Class Members who have been placed in temporary placements due to a crisis, including in SODCs.

Section IX. Appeal Process

Paragraph 24. Any Class Member who disputes a decision by Defendants or a Community Service Provider regarding eligibility for, or delivery of, Community-Based Services or placement in a Community-Based Setting shall, pursuant to governing law, have the right to appeal or seek administrative or judicial review of such decisions through Defendants' existing Fair Hearings process (as set forth in 89 Ill.Adm.Code Part 120) or as otherwise provided by law. Class Members also may avail themselves of any informal appeal process that currently exists.

Individuals may appeal any denial, suspension, termination, or reduction of Home and Community-Based Waiver Services. The appeal process, including time frames, is described in 59 Ill. Admin. Code 120.11 Individuals are informed of this right to appeal through the use of Form IL462-1202, Notice of Individual's Right to Appeal, available on DDD's website.12

Individuals are also informed of their right to appeal a determination of ineligibility via the DDPAS-10 Form, available on the DDD website.13

10 - Adult Crisis Criteria for Funding(PDF)

11 - Rule 120 MEDICAID HOME AND COMMUNITY-BASED SERVICES WAIVER PROGRAM FOR INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES

12 - Form IL462-1202, Notice of Individual's Right to Appeal(PDF)

13 - DDPAS-10 Form(PDF)

Section X. Resources Necessary for Implementation

Paragraph 5. Annual budgets submitted by Defendants on behalf of their agencies shall request sufficient funds necessary to develop and maintain the services, supports and structures described in the Decree, consistent with the choices of Individuals with Developmental Disabilities, including Class Members.

Each year of the Consent Decree, the DDD and the IDHS Budget Office will prepare annual proposals for inclusion in the Governor's Introduced Budget for the funds necessary to carry out the provisions of the Decree. These proposals will include items that are currently funded and must be maintained as well as items that require new funding, including additional funding identified in the new rate methodology currently under development and any other funding implicated by policies identified in the Rates Oversight Committee not addressed by the new rates.

Appropriations

The DDD's budgets since FY12 combined the major appropriation line for community-based services and ICF/DD services into one line. This enables the DDD to redirect resources, if appropriate, as individuals and providers make future choices regarding service provision.

However, DDD maintains sufficient records to enable the Monitor to determine whether the State is fulfilling its obligations under Paragraph 4 of the Decree, including its obligation to provide funding sufficient to meet the needs of those who choose to live in ICFs/DD and to ensure that such resources are not affected by the State's fulfillment of its obligation to provide Community-Based Services or Settings to those who choose those service options.

Annually, per the deadline established by the Governor's Office of Management and Budget, the DDD will calculate and submit details of needed resources for consideration for inclusion in the Governor's Introduced Budget for the following fiscal year. Each year the needed resources for implementation of the Consent Decree, separate and apart from the maintenance items specified above, will include, at a minimum, funding for:

  • Community-Based Services and Community-Based Settings, both new funds for those beginning services and annualized funds for those who began services in the prior year;
  • Assessments;
  • Special rates for ICFs/DD voluntary closure agreements; and
  • Contractual consultants and staff.

The proposed budget for Ligas implementation will be annually presented to the Court Monitor, Plaintiffs, and Intervenors, along with final budget numbers after the conclusion of the legislative session. Budget information is also included in the data reports. The DDD will include an update on FY23 spending towards the FY23 budget for Ligas Consent Decree activities in the 6-month data report. Starting in FY23, DDD agrees to provide the estimated spend versus budgeted of Ligas community funding, annually, to the Monitor and the Parties. It is anticipated that DDD will be able to provide this information within 30 days of expiration of the State's lapse period.

The annual budgets for FY18, FY19, FY20, FY21, and FY22 all included increases, either to wages or to rates/Cost of Living Adjustments. That wage and rate increase information can be found above, in Section IV, Development of Community Capacity.

Federal Approval of Waiver Capacity

Each year, as new enrollment opportunities are made available for individuals, the DDD works with HFS to submit an amendment increasing the capacity of the adult Waiver,14 as needed.

The current adult Waiver capacity is 24,500.

Section XI. Interagency Agreements

Interagency agreements, necessary to carry out the provisions of the Decree, are in place among the Departments. Specifically, there remain interagency agreements among the Departments of Children and Family Services, Healthcare and Family Services, Human Services, and Public Health that address the interactions involving developmental disabilities Medicaid programs. These agreements are available upon request from the DDD.

Additionally, The DDD and DRS leadership continue to meet regularly with Supported Employment Leadership Network (SELN) towards goals of creating a seamless experience for people with I/DD receiving employment support from either or both agencies, under the FY21 Memorandum of Understanding. Specifically, by the end of FY23, DRS, with DDD support, will address the following: (i) written policies that will positively impact people with I/DD, (ii) supports for and expansion of Community Rehabilitation Providers (CRPs), and (iii) increased data collection and reporting on individuals with I/DD who are receiving employment supports.

The DDD does not anticipate the need for any other new interagency agreements to implement the Decree.

Section XII. Process for Plan Reporting and Modification

Paragraph 28. The Implementation Plan shall be updated and amended annually, or at such earlier intervals as Defendants deem necessary or appropriate…

Paragraph 33. …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. Prior to the first report, the Parties and the Monitor will agree on the data and information that must be included in such reports…

Pursuant to Paragraph 28 of the Decree, the DDD will review the Implementation Plan on an annual basis. This Implementation Plan contains the recent, agreed-upon revisions for FY23.

Per Paragraph 33 of the Decree, the DDD will report data and information regarding its progress toward compliance with the provisions of the Decree, including data regarding Reasonable Pace and Movement Between Waiver Services. The Parties, Intervenors, and Monitor agreed to a standard format for these data reports, which are now being produced twice per year by February 15th and August 15th. These reports are being posted on the DDD's website.15 The reports will include COVID-19-related data.

14 - Adults with Developmental Disabilities Waiver9PDF)

15 - Ligas Data Reports

Section XIII. Compliance Survey Results

In FY20, a Compliance Survey was conducted and overseen by the Monitor on a statistically significant (n=225) number of Class Members who had transitioned into CILA settings. This survey measured compliance in seventeen (17) separate domains. The results of this survey were included in the Monitor's Seventh Annual Report.

The seventeen (17) categories from the Ligas Compliance Tool are as follows:

  1. Person-Centered Planning/Measuring Outcomes
  2. Independent Service Coordination
  3. Safety
  4. Staff Presence, Conduct, Competence
  5. Employment/Day Activities/Community Integration
  6. Leisure, Recreation, Social Relationship
  7. Personal Funds Management
  8. Transportation
  9. Health Care
  10. Vision, Hearing, Sensory Supports and Services
  11. PT/OT/SLP/Communication Supports and Services
  12. Adaptive Equipment and Assistive Technology
  13. Dining and Dietary Supports and Services
  14. Behavioral Supports and Services
  15. Mental Health Supports and Services
  16. Protection from Harm
  17. Rights and Autonomy

In FY 21, DDD took many steps to address the report and findings. In FY22, DDD worked on the following:

  • Person-Centered Planning/Measuring Outcomes (Category #1)
    • Develop a DDD-approved Implementation Strategy template for providers that includes guidance for documentation expectations- Completed
    • Survey ISC agencies and provider agencies on their needs and wants as well as gaps within the PCP process. (Related to Section IV, Development of Community Capacity action steps above) - Completed
  • Develop PCP process trainings - Completed
  • Independent Service Coordination (Category #2)
    • Develop ISC agency training specific to the PCP process- Expected completion by 7/30/2022
  • Safety (Category #3)
    • Review safety and environmental concerns focusing on the processes for addressing and resolving health, safety, and environmental concerns between the ISC and provider or reported by the family, guardian, or individual - Completed
  • Employment (Category #5)
    • In FY21, DDD hired a full time Employment Administrator who made significant steps in validating the current SEP process.
    • FY22 activities have been outlined above and will continue into FY23
  • Transportation (Category #8)
    • UIC developed Transportation Report highlighting challenges and best practices- Expected completion by 7/30/2022
  • Vision, Hearing, Sensory Supports & Services (Category #10)
    • Development of training on the use of adaptive devices, mobility training, and sign language - Completed
  • Adaptive Equipment and Assistive Technology (Category #12)
    • Review the existing Discovery Tool's Assistive Technology assessment to determine if more questions/information should be gathered - Completed
  • Rights and Autonomy (Category #17)
    • Review the Rights Statement within the ISSA form for any updates or changes - Expected completion by 7/30/2022
    • Creation of a portal/receptacle for rights/autonomy resources - Expected completion by 7/30/2022

Continued Compliance Monitoring:

Individual Scorecard Process:

The Ligas Compliance Measures for People Living in CILAs was a review process which concluded with follow-up reviews to verify plans of corrective actions (POCAs) from agencies which received individual scorecards with identified scores of less than 85%. A sample of 30 class members from the original review of 225 were selected for follow up reviews based upon POCAs that were rated Provisional or Not Accepted, including five individuals for whom no POCAs were received as required. One individual whose POCA received an Accepted rating was also included to verify the corrective actions.

Discussions including the Monitor, program analyst, and DDD were held with BQM to define the follow-up process. BQM served in the role of communicating expectations of the process to the identified agencies as well as gathering requested documents for the reviews and providing these documents to the Monitor, program analyst and reviewers. These follow-up reviews, conducted by a reviewer from the Monitor's team and two staff from BQM, began in April of 2022 and were completed in late June of 2022. All of the reviewers participated in cross-team

training and interrater reliability feedback sessions. A full analysis of the completed reviews is currently in process and will be shared by mid-July, 2022.

In FY23, DDD will work with the Monitor and parties on modification to the 2019 Compliance Measurement tool and score card. DDD will engage an external contract to support the FY23 Person-Centered Planning Review Process including the review of 225 people's person-centered plan and implementation strategies, as were completed in FY20. Continuing Ligas compliance reviews will be completed utilizing both BQM and independent groups, such as a team selected by the Monitor within FY23.

DDD Compliance Review

In FY22, BQM updated its tool and engaged the Monitor for feedback. Due to the longer than anticipated process of updating the administrative rule that directs the Bureau of Accreditation Licensure and Certification (BALC) work and tool, it is anticipated that their tool will be updated and utilized by June 30, 2023, contingent on the adoption of administrative rule changes.

Consent Decree Exit Plan Discussion

Following discussions, the State submitted a proposed Consent Decree exit plan to the Court in May 2022. Class Counsel, the Intervenors, and the Monitor are expected to respond to that proposal to the Court by the August 31 status hearing. The State, Parties, and Monitor will continue Consent Decree exit plan discussions in FY23.

Section XIV. Acronyms

The following, for reference, is a list of acronyms used throughout this document:

BALC - Bureau of Accreditation, Licensure, and Certification
BQM - Bureau of Quality Management
CILA - Community Integrated Living Arrangement
DDD - Division of Developmental Disabilities
HFS - Illinois Department of Healthcare and Family Services
ICF/DD - Intermediate Care Facility for Persons with Developmental Disabilities
IDHS - Illinois Department of Human Services
HBS - Home-Based Support Services
ISC - Independent Service Coordination
ISSA - Individual Service and Support Advocacy
JCAR - Joint Committee on Administrative Rules
PCP - Person-Centered Planning
PUNS - Prioritization of Urgency of Need for Services
RFP - Request for Proposals
SODC - State-Operated Developmental Center