Ligas Data Report - August 15, 2022

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 seventeenth Ligas Data Report, containing data from January 1, 2022, through June 30, 2022. 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.

Class Members FY19 FY20 FY21 FY22
1 Living at Home 15,216 15,970 16,360 16,812
2 ICF/DD after 6/15/11 313 322 323 339
3 ICF/DD on 6/15/11 with an Affirmative Statement to Move (2a) 1,351 1,343 1,335 1,334
3a DD PAS 10 9 9 9 9
3b DHS 1243/1238 952 947 941 940
3c EFE Form 168 166 165 165
3d OSG Request 202 201 200 200
3e Other Guardian Request 20 20 20 20
4 # At End of Fiscal Year 16,880 17,635 18,018 18,485

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

Additions Additions in FY19 Additions in FY20 Additions in FY21 Additions in FY22
Individuals in ICFs/DD on 6/15/11 0 0 0 0
Individuals in ICF/DDs after 6/15/11 70 15 17 22
Individuals in Community Settings 1,753 1,709 1,573 1,662
Total Additions 1,823 1,724 1,590 1,684
Removals Removals in FY19 Removals in FY20 Removals in FY21 Removals in FY22
Individual Moved Out of State 104 75 97 100
Determined Clinically Ineligible 22 9 26 22
Determined Financially Ineligible 3 2 2 0
Withdrew-Reason Not Given 88 91 116 121
Individual Deceased 63 50 47 45
Objector 0 0 0 0
Other 627 518 662 725
Incorrect SSN (Duplicate Record) 4 1 6 15
Ineligible Setting 3 0 0 0
Unable to Locate Individual 290 208 239 175
Stay in ICFDD 13 4 2 3
Submitted in Error 0 0 0 0
Move to ICFDD 36 11 10 11
Total Removals 1,253 969 1207 822

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 FY22 Cumulative Total to Date
1 # of Class Members with Waiver Capacity Award Letters 31 0 1 1468
2 *Total Class Members Who Have Moved to Waiver Services (per billing data) 32 0 0 1467
2a Subtotal Who Received CILA Services 32 0 0 1440
2b Subtotal Who Received HBS Services 0 0 0 4
2c Subtotal Who Received CLF Services 0 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 on the Division's website that provides PUNs Selection Summary Information regarding the results of the selections.

Ligas Benchmarks Total
1 # of Class Members Selected from the Waiting List (PUNS). 11,236
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 6,482
4 Total Class Members Who Have Received Waiver Services (as reported by the PAS agencies and providers) 6,354
5 Total Class Members Who Have Received Waiver Services (per billing data) 6,276
5a *Subtotal Who Received CILA Services (per billing data) 1,335
5b *Subtotal Who Received HBS Services (per billing data) 4,932
5c *Subtotal Who Received CLF Services (per billing data) 9

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 (per CILA Log) as of 6/30/2022. Most recent CILA log, all persons currently in CILA. 

Type of CILA 1 2 3 4 5 6 7 8 Total
24HR 42 53 565 1,953 932 1,861 777 3,643 9,826
Host Family 50 202 32 7 - - - 91
Intermittent* 670 138 45 60 18 24 5 57 1,017
Total 76 393 642 2,020 950 1,885 78 3,700 11,134

Ligas Placements into CILA (from either an ICF/DD or from the PUNS list) as of 6/30/2022.  Compares all Ligas placements over time to the most recent CILA log.

Type of CILA  1 2 3 4 5 6 7 8 Total
24HR 6 11 111 217 173 276 87 855 2,036
Host Family 3 22 1 - - - - - 26
Intermittent * 148 11 6 7 3 1 1 4 181
Total 6 44 118 254 176 277 88 859 2,243

Crisis Placements into CILA as of 6/30/2022. Updates the last 6-month report with Crisis approvals from 1/1/2022 to 6/30/2022.

Type of CILA /Size of Home 1 2 3 4 5 6 7 8 Total
24HR 6 11 143 312 119 257 119 563 1,530
Host Family 11 39 3 - - - - - 53
Intermittent * 151 28 - 9 1 4 1 5 199
Total 168 78 146 321 120 261 120 568 1,782

Note: As of January 1, 2022, Family CILA (displayed on previous reports) has been rolled into Intermittent CILA.

Crisis Services

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

Service Request for Individuals in Crisis FY19 FY20 FY21 FY22 Cumulative Total To Date
1 Total # of Crisis Requests Received 304 293 360 108 3,709
2 Total # of Class Members Approved 280 283 358 108 3,470
2a # of Class Members Approved for CILA 194 165 159 83 2,212
2b # of Class Members Approved for HBS 86 118 85 25 1,253
3 Total # of Class Members Who Received Services 277 283 249 108 3,454
3a # of Class Members Who Received CILA Services 193 165 159 83 2,201
3b # of Class Members Who Received HBS Services 84 118 85 25 1,248
4 Total # of Class Members Denied Crisis Approvals 24 10 2 0 239

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.

ICF/DD Closures or Downsizing agreements FY19 FY20 FY21 FY22 Cumulative Total To Date
1 # of Agreements Initiated 9 5 0 2 80
2 Total # Licensed Capacity 127 164 0 115 1,593
3 Total # of People to Move 91 127 0 83 1,286
3a *Moved to CILAs 75 88 0 1 1,176
3b *Moved to HBS 0 2 0 0 2
3c *Transferred to other ICFs/DD 11 29 0 13 59
3d *Other 5 8 0 3 49
3e *Move Pending 0 0 0 24 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.

Appeals of eligibility and Crisis Denials FY20 FY21 FY22 Cumulative Total to Date
1 Total Class Members Appeals (Rows 2,3,4,5 = Row 1) 32 25 31 524
1a Crisis Appeals 3 1 2 184
1b Eligibility Appeals 29 24 29 340
2 Subtotal Appeals Upheld 7 7 4 159
3 Subtotal Appeals Denied 18 9 20 298
4 Subtotal Appeals Pending 1 2 7 9
5 Subtotal Appeals Withdrawn/Closed 6 3 7 58

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 1,234
7/12/20 1,561 1,540
7/12/21 1596 1,557

Total number of individuals who entered services from any PUNS selection

Individuals who entered services from any PUNS selection FY20 FY21 FY22
# of Individuals 602 708 764

Adults on PUNS Seeking Services as of June 30, 2022

Time Waiting while Seeking Services as of JUNE 30, 2022 Persons Est. FY for Services
Over 60 months 37 FY23
59.99 months to 48 months 549 FY23/FY4
47.99 months to 36 months 1268 FY24
35.99 months to 24 months 1283 FY24/FY25
23.99 months to 12 months 1362 FY25
11.99 months and less 1453 Beyond FY25
Total 6119

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. Initially, these service changes were a result of an individual's increased need for such services, and not the result of a selection from the PUNS list. A new process for transitions between Waiver services was 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 increased need process.

Type of Transition

FY19 

(1/1/19 - 6/30/19)

FY20 FY21 FY22
Adult HBS to Intermittent CILA 5 2 1 2
Adult HBS to Family CILA 2 4 6 0
Adult HBS to Host Family CILA 0 0 1 0
Adult HBS to 24-Hour CILA 27 56 67 55
HBS to CILA Denials 0 0 0 0
HBS to CILA Appeals 0 0 0 0

Ligas Estimated Cost

Projection updated June 2022

Ligas Activities FY2019 FY2020 FY2021 FY2022 FY2023 Est.
PUNS Placements $120,979,448 $142,169,132 $170,266,255 $199,946,201 $249,509,523
to CILA $47,062,776 $56,563,866 $69,140,993 $88,414,039 $113,950,192
to HBSS $73,916,673 $85,605,266 $101,125,262 $111,532,162 $135,559,331
Transitions from ICF/DD's $93,917,401 $101,492,568 $110,749,919 $129,070,490 $153,891,587
to CILA $93,239,974 $100,812,701 $110,057,804 $128,422,862 $153,195,756
to HBSS $677,427 $679,867 $692,115 $647,628 $695,831
ISSA $6,232,266 $7,208,020 $8,592,405 $9,688,319 $10,605,392
Other Costs $3,262,850 $4,074,546 $4,326,775 $4,963,785 $5,289,250
Court Monitor $213,250 $243,135 $256,500 $284,850 $284,850
HBSS Fiscal Agent $2,677,000 $3,084,300 $3,574,100 $4,205,400 $4,754,400
Family Advocate Initiative $250,000 $250,000 $250,000 $250,000 $250,000
Ligas Compliance Monitoring $101,203 $149,941 $0 $0 $0
Ligas Training $21,397 $25,000 $0 $0 $0
DD Scorecards $0 $43,920 $0 $0 $0
Rate Study $0 $278,250 $246,175 $6,078 $0
Person Centered Planning $0 $0 $0 $217,457 $0
Total $224,391,965 $254,944,266 $293,935,354 $343,668,795 $419,295,752
End of year Persons in Service:   FY2019    FY2020      FY2021    FY2022  FY2023 Est. 
PUNS Placements
PUNS to CILA 840 946 1,071 1,155 1,250
PUNS to HBSS 3,140 3,631 4,260 4,964 5,500
Subtotal 3,980 4,577 5,331 6,119 6,750
Transitions from ICF/DD's
ICFDD to CILA 1,601 1,621 1,627 1,628 1,628
ICFDD to HBSS 27 27 27 27 27
Subtotal 1,628 1,648 1,654 1,655 1,655
Total (all receive ISSA) 5,608 6,225 6,985 7,774 8,405
ICF/DD Bed Reduction FY2019 FY2020 FY2021 FY2022 FY2023 Est.
Beds Closed in FY 44 16 5 - -
Cumulative Beds Closed 1,015 1,031 1,036 1,036 1,036

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 FY2020 FY2021 FY2022 Est. FY2023 Proj.
Cost in Millions *$287.2 $278.60 $285.70 $310.40
$ Change from Prior Yr. ($8.60) $7.10 $24.70
Average Persons 3,837 3,586 3,382 3,341
Persons Change from Prior Yr. -251 -204 -41

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

Note: 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" FY2020 FY2021 FY2022 Est. FY2023 Proj.
Adult Waiver Claims (millions) $852.30 $920.48 $1,021.74 $1,205.65
$ Change from Prior Yr. $68.18 $101.25 $183.91
Unduplicated Persons 21,974 22,674 23,305 23,936
Persons Change from Prior Yr. 700 631 631

FY2020 Source: Accepted Claims Reports (Mobius). FY2021 thru FY2023 are estimates based on growth in adult waiver services.

DD CILA Waiver Services

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

Spending for CILA Services FY2020 FY2021 FY2022 Est. FY2023 Proj.
DD CILA Services Billings (millions) $784.30 $843.60 $932.80 $1,119.36
$ Change from Prior Yr. $59.30 $89.20 $186.56
Authorized CILA persons 11,352 11,492 11,618 11,744
Persons Change from Prior Yr. 140 126 126

Source: Billing System & Authorized Client Report (Cl Type C)


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 initially 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.

Each agency opened one of their two new homes in 2021. 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. These two additional homes provide short-term stabilization capacity for an additional 8 people. Each agency is projected to open their fourth homes in FY23, adding capacity for eight more people, reaching the total of 32.

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 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 statistics for Illinois at large as well as for long-term care facilities; this COVID-19 Data is available on the IDPH website.