Ligas Implementation Plan FY24

Case: 1:05-cv-04331 Document #: 819 Filed: 10/03/23 Page ID #:14448

State of Illinois
Department of Human Services, Division of Developmental Disabilities
October 3, 2023

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Table of Contents

1. Section I. Introduction
2. Section II. Development and Maintenance of the Class Member List (Paragraph 6)
3. Section III. Outreach
4. Section IV. Development of Community Capacity
5. Section V. Community-Based Services/Placement for Individuals Residing in ICFs/DD
6. Section VI. Transition Planning
7. Section VII. Waiting List for Community Services and Placement
8. Section VIII. Community Crisis
9. Section IX. Appeal Process
10. Section X. Resources Necessary for Implementation
11. Section XI. Interagency Agreements
12. Section XII. Process for Plan Reporting and Modification
13. Section XIII. Compliance Survey Results
14. Section XIV. Acronyms

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Section I. Introduction

This document sets forth the State's plans to make further progress implementing the provisions of the Consent Decree for Fiscal Year 2024 (FY24). It was developed in accordance with Paragraph 26 of the Consent Decree and incorporates input received from the Plaintiffs, Intervenors, and the Court Monitor. Revisions to the FY24 Implementation Plan have been made to reduce the historical information that has been included in prior years, and to focus this document on a forward-looking Implementation Plan, with an emphasis on current requirements and activities to continue and further compliance. Defendants have further noted some of the areas where they believe that substantial compliance has already been achieved. These notes are not exhaustive and do not cover all areas where Defendants believe they are in substantial compliance. Likewise, Defendants recognize that the Court Monitor, Plaintiffs, and Intervenors may not agree with this belief in some or all of the instances.

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)

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. Since 2017, new ICF/DD Class Members are added when 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, and it is the Defendants' position that they are in substantial compliance with the Outreach requirements as defined in the Decree. 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. In FY24, DDD, through the grant agreements with ISC agencies, will continue to conduct outreach to residents in State-Operated Developmental Centers and private ICF/DDs to ensure that individuals residing in these facilities are aware of their options to receive Community-Based Services and to live in Community- Based Settings.

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 FY24, DDD will hold three Ligas Family Advisory Committee meetings and one Ligas Town Hall. 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 agendas will be posted on the DDD's website, including a link on the Ligas webpage by June 30, 2024.

ISC Visits

ISC case managers will visit Waiver recipients at a minimum of four times a year during FY24 in order to further build relationships and an understanding of individual's needs and desires, as well as identify any changes in needs that must be addressed.

1- IDHS Ligas Page

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.

Provider Capacity for Specific Populations

Although the community-based service system supports thousands of individuals with intellectual and developmental disabilities (I/DD) to live in the community, including people with specific support needs such as high behavioral supports, medical supports, deaf/hard of hearing, blind/visually impaired, mobility impaired, among others, the State will continue to expand those opportunities during FY24. For example, in FY24, based on notice of funding opportunities (NOFOs) released in FY23, DDD will expand short term stabilization homes and develop long term stabilization homes for those people who need more intensive behavioral support for either up to 90 days or between 6 months and two years, respectively. DDD will continue with the activities outlined in the DDD response to UIC's Evaluation of Community Capacity Barriers and Opportunities for Expansion in Illinois for Adult DD Waiver Services,

including the completion of an updated statewide Direct Support Professional (DSP) training curriculum, exploring the creation of credentialing or additional levels for DSPs and additional trainings to address topics outlined in the capacity report as well as hold discussions with internal and external stakeholders on recommendations to expand targeted funding and services.

Stakeholder meetings held to date have included providers of SST and SSH services, downstate providers, ISCs, new providers, smaller providers, associations and advocates. DDD also has engaged in discussions with the National Association of State Directors of Developmental Disabilities Services (NASDDDS) to gain perspective on how other states might be addressing some of these concerns.

Below outlines the recent and current activities to grow community capacity:

Strategy	Activities	Estimated Timeframe	Anticipated Outcome
Expand and strengthen Providers	Update and expansion of new provider orientation to increase prepared and successful providers including an intro Q&A meeting, 3 day NPO, practice interview and additional TA before the BALC interview process, follow up TA during the provisional license period. Updated training and presentation material. Increased NPO session to quarterly basis.	Implemented Q2 2023	In the next year, we expect to see an increase of new providers successfully completing the BALC licensing process. In FY23, 1 provider was licensed. We anticipate in FY24, at least 5 new providers will be licensed.
-	Creation and expansion of Technical Assistance Unit, whose goal is to support new providers and struggling providers	Initial staff to be hired by June 1, 2023	The success of the TA unit will be based on support that are offered to providers, and if struggling providers benefit from that support. The goal is for 20-30 providers to receive TA support through the unit during the Fiscal Year. Timelines for measuring success will be dependent on the development and staffing of the TA unit.
Increase Investment in Services	Guidehouse Rate Study Implementation: FY23 Annualization Rate Calc and $1/hr - $98.2 $2.50 DSP effective 1/1/24 - $88.5 CDS Regionalization 1/1/24 - $10.0	FY24 budget, with expected CMS approval by Jan 1, 2024	Staff stabilization with $2.50 increase in wages and CDS regionalization. Total Cost of FY24 Investment - $196.3 GH Investment thru FY24 - $477.60
Expand supports focused on high behavioral support needs	Expansion of short-term stabilization homes from 8 to 10.	FY24 budget, expected CMS approval by Jan 1, 2024. Expected opening by FY25.	Expand capacity from 32 to 40 people at once with an estimate of 128 per year.
-	Creation of 6 long term stabilization homes.	FY24 budget, expected CMS approval by Jan 1, 2024. Expected opening by FY25.	Support 24 people at one time.
-	Expand Support Services Team (SST) supports in new ways to expand to support people transiting from institutions.	Implemented in FY23, but evolving the model to increase effectiveness	In FY23, 855 people were served. In FY23, SST received 533 new referrals; 39% from CILA (251, 7% from ICF (37), 2% from Child Residential (10) and 5% other (26). For FY24, the Division anticipates serving more than 850 individuals via SST. This figure is fluid and may be impacted by individuals transitioning from Choate Developmental Center.
Support Transitions into the community	Creation of 4 transition homes.	FY24 budget, expected CMS approval by Jan 1, 2024. Expected opening by FY25.	Support 16 people at one time.
-	Housing Navigators - helping to support people transiting to affordable supportive housing with waiver services. We have expanded the initial pilot to include all ISC regions as of June 2023	Began April 2022	As of July 2023; 241 people were actively enrolled in the program, 35 people had been housed, 175 people had been enrolled in SRN, and 14 had applied for other housing. Similar numbers of people engaged are anticipated FY24.
-	Money Follow the Person Program - funding for case management and transition supports to move to people out of institutions and into waiver services.	Planning grant will be submitted for approval by CMS July 2023. With CMS approval, DDD can begin the program which helps to support people moving out of institutions into the community.	-
-	1. ADA/Olmstead Outreach - ISCs connect with everyone living in an SODC or ICF/DD to see if they want to learn about waiver services. All people receive info/education.	Began in FY23	At least 47 people in ICFs have been added thus far to PUNs as a result of the outreach, and approximately 112 new people (Not just Ligas Class Members) in SODCs have indicated they want to move.
General Crisis Services	Respite Services - Envision Unlimited provides In-Home Respite services in the Chicagoland area and the central Illinois area. DDD has provided additional monies above their contract amount to provide additional families, mostly targeted in the central Illinois area access to In-Home Respite Services.	FY23- additional $65,000	Families on the PUNS List will be able to access needed services/supports to avoid crisis or as a part of safety plan support.

Class Counsel has serious concerns about the adequacy of the steps DDD is taking in FY24 to address the lack of community capacity. The parties and Monitor agree to meet by the end of calendar year 2023 to discuss these concerns and the steps DDD will take in FY25 to address capacity. DDD will continue to provide updates to Class Counsel and the Court Monitor on continued efforts to build and expand community capacity.

Data Reporting, Focused Selection, and the PUNS Selection List

During FY24, DDD will continue to report 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 will continue 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 will continue to include in the monthly reports a summary of all Class Members who have either been removed from the Ligas selection list or placed on "hold."2 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 will continue to be made available on the DDD website,3 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. New provider orientation has been updated. A two-hour initial question and answer training has been added prior to the two-day training that includes an in depth review of administrative rules, the waivers, the Home and Community Based Services (HCBS) Settings Rule and other key information. Following a submission of an application, an additional third day of training occurs. DDD has created technical assistance office hours and resource materials as well as a quiz for potential providers to prepare for the BALC interview. If a provider passes the interview and proceeds to become a licensed provider, DDD is offering additional technical assistance with the new Technical Assistance Unit in order to offer support and direction.

DDD will continue to identify potential provider agencies, including working with national organizations to identify strategies to bring in new providers, meeting with providers to encourage growth in needed areas, 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 FY24, DDD will continue to implement changes based on the timeline and plan developed in response to UIC's capacity study.

Funding as outlined by the Guidehouse Rate Study continues to be implemented through the budget process and that funding including higher than ever wages for DSPs and ICF-DD aids is working to expand provider staff. Also as outlined in the section above, DDD is working to

2 - "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.

3 - The link to the Becoming A New Developmental Disability Provider or Established Provider Adding Services invest in targeted areas. DDD will share with the Court Monitor and Parties additional proposals by end of October 2023. In addition, DDD commits to host an additional discussion with Parties to discuss concerns about CILA closures and strategies for additional provider supports by the end of calendar 2023.

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.4

Employment

Competitive Integrated Employment (CIE) will continue to have an increased focus during FY24 through DDD's 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 the activities below are not exclusive to the Consent Decree.

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, and (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 Rehabilitation Services Administration (RSA) to State Vocational Rehabilitation agencies, is designed to increase opportunities for Illinois youth and adults with disabilities to transition from Subminimum Wage (SMW) to Competitive Integrated Employment (CIE). SWTCIE's demonstration project focuses on supporting organizations which hold a 14(c) certificate from the U.S. Department of Labor to increase employment personnel capacity/expertise and engage individuals with disabilities in activities intended to achieve CIE. SWTCIE is a 5 year project with an estimation of between

4 - The links to the downsizing agreements are:
Intermediate Care Facility for the Developmentally Disabled - 16 Beds and More - Downsizing Agreement
Intermediate Care Facility for the Developmentally Disabled - 16 Beds and Less - Downsizing Agreement

6 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 CIE.

• Performance under SWTCIE will be based upon review of the following standards:
• Engagement of at least eight (8) youth and adults (combined) with disabilities who are contemplating or currently employed under a 14(c) subminimum wage certificate.
• Completion of individual assessments and develop a case plan for each participant with a focus on CIE.
• Creation of new or modification of existing job descriptions for personnel related to CIE activities.
• At least two agency personnel dedicate 100% of their efforts to SWTCIE Illinois project activities.
• Training
• At least two agency personnel to participate in SWTCIE Illinois required ACRE certification requirements.
• At least two agency personnel to participate in SWTCIE Illinois required trainings in evidence-based CIE practices and professional development activities.
• Engagement of program participants in CIE using evidence-based practices.
• By the end of FY24, participating grantees to become an authorized DRS Community Rehabilitation Provider (CRP) consistent with 89 ILCS 530
• Compliance with SWTCIE Illinois developed data and reporting protocols - including submission of SWTCIE Illinois developed periodic report protocols in a timely and accurate manner.
• Outreach and Collaboration: Development and distribution of marketing and communication materials per FY24
• Facilitation of at least one (1) outreach event per quarter to engage key SWTCIE Illinois stakeholders per FY24 (adults and youth with disabilities, business partners, schools, DRS VR, community members, etc.).

DRS / DDD State Learning Collaborative (SLC)

• In conjunction with the Institute for Community Inclusion (ICI) and State Employment Leadership Network, the SLC has offered I/DD specific training for personnel from DRS Vocational Rehabilitation, ISCs, DDD Regions and Community Providers.
• Following the conclusion of the grant funded training collaboration between DRS & DDD, the Divisions will continue offering at least semi-annual trainings to personnel from each Division, ISCs and CRPs.

Competitive Integrated Employment Capacity Grant

• DDD's CIEC Grant continues to fund 11 Agencies, representing statewide coverage, all of who are working to expand capacity and build sustainability in their respective employment programs.
• CIEC funding is set to expire at the end of FY24 at which point the 11 grantee agencies will have achieved the intended outcomes of the grant and transitioned from CIEC funds to revenue from DRS

• 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 (CE) Pilot, initially launched in FY21
  • CE Contracts by FY:
    • FY22: 8
    • FY23: 13
    • FY24:14
      • FY24 CE Providers are: Avenues to Independence, Centerstone, Challenge Unlimited, Community Choices Inc, EP!C, Human Support Services, IAG, JCFS, Little City, Michelle's Vocational Placement LLC, Streator Unlimited, The Arc of the QC, Total Link2Community & UCP Seguin of Greater Chicago
• DRS CE constitutes a very small percentage of services - it is important to note that individuals with I/DD, including Class Members, remain eligible for other comparable DRS / DDD employment programs

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 does the following:
• 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 the HCBS Settings Rule; and
• Maximizes likelihood of appropriate implementation of supports to all eligible individuals.

Specifically, DDD will ensure that all DDD SEP Requests, which are not approved will result in consultation/resolution with the provider and notification to ISC & Regions.

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 consistent with right to place authority. 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. In addition, ISCs continue to perform ADA/Olmstead outreach to individuals including in this category.

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.5 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.

5 - 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.6 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 community integrated living arrangement (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.

6 - 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.

In FY24 the State will continue its practice regarding removal from PUNS and "holds" as described in the FY23 IP.

Class Counsel is very concerned about the large number of Office of State Guardian (OSG) wards in ICF/DDs who elected to be class members before the 6-year deadline, but still remain in ICF/DDs. The Parties, the State and the Monitor will meet before the end of calendar 2023 to discuss how to resolve this. Representatives from OSG will be invited to this meeting.

Capacity Development

In response to the compliance findings regarding capacity development, as of the date of this 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. As set out in the Rate Study, the cost for implementation in the first year would be $329 million with each year thereafter costing an additional roughly $100 million for 4 years (5 years total), with the total cost of implementation being approximately $745 million. The State has proposed 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 below7.

• FY24 Budget and Guidehouse Rate Study Implementation: During the FY23 legislative session, the Illinois General Assembly passed, and Governor Pritzker signed, a budget for FY24 that provides $196.7 million in new funding for services for individuals with I/DD directly from the Guidehouse Rate Study and its recommendations. This follows Guidehouse Rate Study specific investments of $209 million in FY23 and $170 million in FY22. With the FY24 funding, DDD will be investing in the service system, including an acceleration of DDD's promised deliverables for FY24 from the Guidehouse Study Implementation Plan. Highlights include:
  • $88.5M for $2.50/hour DSP (waiver and ICF) wage increase (effective January 1, 2024, subject to the federal Centers for Medicare and Medicaid Services (CMS) approval).
  • $10M for Community Day Services (CDS) regionalization (also effective January 1, 2024, subject to federal CMS approval).
  • Funding $98.2M to maintain the FY23 increases recommended by the Guidehouse Rate Study and implemented effective January 1, 2023. Notes: without this additional funding, DDD would not be able to continue the current FY23 Guidehouse recommended rate increases. DDD has paused the implementation of the CILA Rate Calculator DSP hours; DDD is bringing a rate consultant on contract to review the Rate Calculator components; the consultant will be working with the Ligas Rates Oversight Committee to determine what, if any, changes need to be made to the Rate Calculator components and calculations.

7 - 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 Governor's proposed budget is:

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; additional $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 $1.50/hour wage increase	$170 million total $1.50/hour wage increase	50% passthrough, 50% flexible for wages	07/01/2021 (ICF/DD) and 01/01/2022 (CMS required approval)
2023	$207 million total $1.00/hour wage increase	$207 million total $1.00/hour wage increase	50% passthrough, 50% flexible for wages	01/01/23 (CMS required approval)
2024	$196.7 million total (see above for detail) $2.50/hour wage increase	$196.7 million total (see above for detail) $2.50/hour wage increase	50% passthrough, 50% flexible for wages	01/01/24 (CMS required approval)

Additionally, as stated above, in FY24, DDD will continue to implement the strategies developed in response to the UIC Capacity Report 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 continue to share 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 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 (Adult 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 and may be resolved by Judge Coleman.

• Short-Term Stabilization Homes: DDD currently has 8 homes, with a capacity for 32 people. DDD will be releasing a NOFO in FY24for an additional 2 homes for up to 4 people each (8 people total).
• Long-Term Stabilization Homes: In FY24, DDD anticipates selecting providers through a NOFO process for up to 10 long-term stabilization homes (LTSH) that will serve up to 4 people each (40 people total). The NOFO is anticipated to be released Q1 of FY24 with implementation by July 1, 2024. The LTSH is meant to offer increased behavioral supports and other services for 6-24 months for people who need additional support and cannot find a permanent placement. This can include people who are homeless, those in hospitals, and those who have been discharged from their previous home and are struggling to find another placement due to behavioral support needs. Six homes will focus generally on people on the waiver or in crisis with the other four homes focusing on transitioning people who need additional support from SODCs to community placement.
• Rules: 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): Rule adopted late FY23.
  • 59 IAC 119 (CDS): Completing final IDHS reviews before posting for first notice.
  • 59 IAC 120 (Waiver): Posted for First Notice in FY23. IDHS is in the process of reviewing and responding to public comment letters.
  • 59 IAC 117 (Home-Based Services): Completing final IDHS reviews before posting for First Notice.59 IAC 116 (Medication Management): Currently being reviewed by Clinical Services. Will go to DDD Regulatory Advisory Board for review next.
• Assistive Technology: DDD continues to educate stakeholders through trainings on assistive technology and has included additional questions on assistive technology in the Discovery Tool and Personal Plan templates that were released in FY22 and were implemented in October 2022.
• Support Stabilization Team (SST) Services: 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 they want to transition to the community, including Ligas Class Members who have entered the SODC for short term stays. DDD is working with SST to re-evaluate the Tier-2 model. Based on this year's efforts and challenges getting SST fully staffed, it has been determined adjustments are needed. DDD will share with Class Counsel and the Monitor any changes made once they have been decided.
• Behavior Services and Supports: DDD continues to provide increased Behavior Therapy hours of up to 104 annually to individuals under the Adult Waiver. In FY22, DDD increased funding for the Guidehouse Rate Study recommendation 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 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. DDD revised the BQM tool during FY22 and anticipates additional revisions and improvements in FY24. BQM leaders are reviewing, editing and focusing the tool to ensure updates including HCBS Settings Rule, and Administrative Rule changes are robustly reflected in the tool. The tool is anticipated to be completed by January 1, 2024.

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 HCBS regulations defining home and community-based and the Olmstead integration mandate, but is also cost effective and meets the desires of individuals with disabilities.

In addition to the typical community settings of Home Based Support Services (HBS) and CILA, DDD has been collaborating - and will continue in FY24 to collaborate -- with the IDHS Statewide Housing Coordinator and the Illinois Housing Development Authority (IHDA) to make supportive housing options available to eligible Ligas Class Members. DDD continues to work with IHDA to review their RFPs and prioritize housing developments that prioritize supporting people with I/DD. IHDA staff participate in Ligas Parties Meetings as well. ICDD and DDD meet regularly with a focus on the Housing Navigator Pilot program, meeting monthly with housing navigators and ISC leadership planning purposes.

In FY24, DDD will fund all seven ISCs to hire/continue to employ dedicated Housing Navigators in all 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. As it relates to people being served in non-24-hour CILA, DDD will review the ICILA information bulletins and update communications with stakeholders to ensure understanding of the ICILA process. DDD will also discuss the ICILA process with ISCs to determine if there are any additional process improvements needed.

The DDD will continue to work with IDHS housing staff, IHDA, and ICDD to include people with I/DD in statewide housing strategic discussions. UIC is leading an evaluation process of the housing navigation pilot, funded by ICDD. DDD has met with them and will work with ICDD and UIC to identify ways to continue to strengthen and expand this work based on the evaluation in FY24. The ICDD funded evaluation is anticipated to be completed May 2025.

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. Before the end of calendar year 2023, the Parties and Monitor will work to reach agreement with respect to what housing information will be included in the 6-month report going forward.

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…

The State has satisfied this requirement and is in compliance with Paragraph 17 of the Decree.

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 services as a Ligas Class Member 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, as updated in FY22, continues to be used for all Ligas Class Members, as well as all other Waiver recipients. BQM staff review the plans and implementation strategies and the services people are receiving during reviews.

DDD has taken the UIC Person-Centered Planning Report and rolled out the Person- Centered Planning templates in July 2022 with a required use by October 2022.

DDD staff offered numerous in-depth trainings on Person-Centered Planning and each of the new templates as well as bi-weekly and now monthly office hours to provide additional time for DDD staff to offer support to ISC staff and provider staff. Office hours are continuing with training quarterly. DDD staff are gathering additional feedback and expect to continue to update templates each year based on stakeholder feedback.

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, 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 and is in compliance with Paragraphs 22 and 23 of the Decree.

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).

The DDD reached the minimum wait time of 60 months in FY2021 but will continue to select individuals per the processes identified above to serve a minimum of 630 individuals in FY24. Defendants are currently in compliance with the Reasonable Pace requirements.

Movement Between Waiver Services

DDD continues to support transitions between waiver services for individuals whose needs and wants change. DDD includes updates regarding the Waiver service transition process in the 6-month data reports, including the number of people who transitioned from AHBS to any type of CILA over the 6-month period and the number of people currently in CILA by size of CILA home. DDD will include the number of people who request movement between Waiver services and the number of people who receive those services per month in the 6-month reports. If any issues arise with the Waiver service transition process, the Defendants also will notify the Parties and Court Monitor.

Section VIII. Community Crisis

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.

DDD will work with the Court Monitor and Class Counsel to address the current dispute regarding the crisis and SODC issues.

In FY24, DDD will continue to process requests for services from individuals in crisis situations, 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. DDD continues to work to ensure that individuals determined to be in crisis situations are served per the Consent Decree.

In FY24, DDD will continue to review the crisis process and provide updates to the Monitor and Class Counsel via the 6-month data reports. DDD has updated the 1238 form that tracks when an individual enters an ICF/DD as an interim placement and is still interested in waiver services. DDD has talked with ISCs to clarify the process and will continue to educate and monitor the process to ensure it is continuing. In FY24, DDD will provide Class Counsel with data on the number of Class Members who entered an ICF/DD in crisis and how long it takes those Class Members to transition to the community. In FY24, the Parties will meet to discuss how DDD will address Class Members who entered ICF/DDs in Crisis before the new 1238 tracking form was implemented and work together to develop a process for timely transition.

DDD has provided the Monitor and Class Counsel with a tracking document on Class Members and those who live at home and go into crisis and enter State Operated Developmental Centers. In addition, DDD has provided the Monitor and Class Counsel with monthly reporting of individuals in crisis and working with ISCs. In FY24, DDD will continue to provide updated tracking monthly and will continue to meet monthly to discuss specific cases. In FY24, DDD will work with the ISCs to ensure the crisis and eligibility processes are the most efficient.

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 120.8 Individuals are informed of this right to appeal through the use of Form IL462-1202, Notice of Individual's Right to Appeal, available on the DDD website.9

8 - Rule 120

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

During FY24, the Parties and the Monitor will meet to discuss Class Counsel's concerns about the appeal process and work to reach consensus.

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.

In FY24, the State will comply with this requirement, including preparing proposed budgets 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 Guidehouse Rate Study and any other funding implicated by policies identified by the Rates Oversight Committee report not addressed in the Rate Study.

DDD will include an update on FY24 spending towards the FY24 budget for Ligas Consent Decree activities in the 6-month data report. In FY24, DDD will provide the estimated spend versus budgeted of Ligas community funding to the Monitor and the Parties.

Federal Approval of Waiver Capacity

Each year, as new enrollment opportunities are made available for individuals, DDD works with HFS to submit a Waiver amendment to increase the capacity of the Adult Waiver,11 as needed.

9 - Form IL462-1202, Notice of Individual's Right to Appeal

10 - DDPAS-10 Form (PDF)

The current Adult Waiver capacity is 25,859.

Section XI. Interagency Agreements

Interagency agreements, necessary to carry out the provisions of the Decree, are in place among the Departments. Specifically, there are 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.

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…

This Implementation Plan contains the agreed-upon revisions for FY24.

Per Paragraph 33 of the Decree, DDD will report data and information regarding its progress toward compliance with the provisions of the Decree, which will be produced twice per year by February 15th and August 15th. These reports are being posted on the DDD's website.12

Section XIII. Compliance Survey Results

11 - Adults with Developmental Disabilities Waiver (PDF)

12 - previous Ligas Data Reports

In FY24, DDD will work with the Monitor and Parties to address findings from the Monitor's report on the FY23 Person-Centered Planning Review Process.

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