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 fifth Ligas Data Report. Per the Ligas Consent Decree, the Division of Developmental Disabilities (DDD) will produce reports of data and information regarding implementation of the provisions of the Ligas Consent Decree every six months. The due dates for these reports will typically be February 15th and August 15th of each year. Unless otherwise specified in the body of this report, the data collected for FY 2014 represents a time frame of July 1, 2013 through December 31, 2013.
Class Member List
The DDD is maintaining a centralized, master class list as described in the Ligas Implementation Plan. Individual records are categorized into three separate areas: individuals living at home in the community, individuals living in an ICF/DD who were admitted after June 15, 2011, and individuals living in an ICF/DD who were there on June 15, 2011 (the date of the Court's approval of the Consent Decree). Written statements documenting a desire to be a part of the class are obtained for each individual in the latter category. Individuals are added to or removed from the class list as appropriate. The table below provides a summary of the class list as of December 31, 2013.
|
|
FY12 |
FY13 |
FY14 |
FY15 |
FY16 |
FY17 |
Cumulative Total to Date |
| 1 |
Living at Home |
10,697 |
10,311 |
14,121 |
|
|
|
|
| 2 |
ICF/DD after 6/15/11 |
22 |
36 |
105 |
|
|
|
|
| 3 |
ICF/DD on 6/15/11 with an Affirmative Statement To Move (2a) |
686 |
906 |
951 |
|
|
|
|
| 3a |
DD PAS 10 |
12 |
9 |
9 |
|
|
|
|
| 3b |
DHS 1243/1238 |
209 |
495 |
576 |
|
|
|
|
| 3c |
EFE Form |
437 |
364 |
338 |
|
|
|
|
| 3d |
OSG Request |
7 |
6 |
6 |
|
|
|
|
| 3e |
Other Guardian Request |
14 |
20 |
22 |
|
|
|
|
| 4 |
# At End of Fiscal Year |
11,406 |
11,253 |
15,177 |
|
|
|
|
Individuals were added to or removed from the Class Member List as follows during FY13 and FY14:
|
Additions in FY13 |
Additions in FY14 |
| Individuals in ICFs/DD on 6/15/11 |
350 |
89 |
| Individuals in ICF/DDs after 6/15/11 |
16 |
69 |
| Individuals in Community Settings |
47 |
3943 |
| Total Additions |
413 |
4101 |
| Removals |
Removals in FY13 |
Removals in FY14 |
| Individual Moved Out of State |
35 |
6 |
| Determined Clinically Ineligible |
18 |
10 |
| Determined Financially Ineligible |
11 |
5 |
| Withdrew-Reason Not Given |
156 |
51 |
| Individual Deceased |
35 |
10 |
| Objector |
1 |
1 |
| Other |
5 |
0 |
| Incorrect SSN (Duplicate Record) |
17 |
10 |
| Ineligible Setting |
26 |
3 |
| Unable to Locate Individual |
169 |
59 |
| Stay in ICFDD |
92 |
32 |
| Total Removals |
565 |
177 |
Note: The relatively large increase during FY14 in additions of Class Members living at home is due in part to an enhancement to the DDD's database which now enables the DDD to regularly and automatically identify new enrollments in its waiting list and document the individuals as Class Members.
Services for Class Members in ICFs/DD
The DDD informed PAS/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. PAS/ISC agencies are now reporting to the DDD on a monthly basis progress made in assisting the individuals with their options. The DDD continues to inform the PAS/ISC agencies of new class members as they are identified.
|
Target Dates from Consent Decree: |
12/31/13 |
12/31/15 |
6/30/17 |
Cumulative Total to Date |
| 1 |
# of Class Members With Waiver Capacity Award Letters |
620 |
|
|
|
| 2 |
Total Class Members Who Have Moved to Waiver Services (per billing data) |
578 |
|
|
|
| 2a |
Subtotal Who Received CILA Services |
565 |
|
|
|
| 2b |
Subtotal Who Received HBS Services |
10 |
|
|
|
| 2c |
Subtotal Who Received CLF Services |
3 |
|
|
|
Note:The above data includes individuals who are moving due to ICF/DD downsizing and closure agreements.
Services for Class Members from the Waiting List
Four 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. The Class Members selected have been notified and the PAS/ISC agencies have been instructed to complete eligibility determinations and facilitate the choice and provider selection process. A set of tables is maintained that provides summary information regarding the results of the selections. These tables are available on the Division's web site at https://www.dhs.state.il.us/page.aspx?item=41142. Outcomes for the individuals selected are reported below under the time frame in which the selection occurred.
|
Ligas Benchmarks |
1,000 6/30/13 |
500 6/30/14 |
500 6/30/15 |
500 6/30/16 |
500
6/30/17 |
Cumulative Total to Date |
| 1 |
# of Class Members Selected From The Waiting List (PUNS). |
3112 |
500 |
|
|
|
3612 |
| 2 |
# of Class Members in ICF/DDs after 6/15/11 who were part of a downsizing |
17 |
2 |
|
|
|
19 |
| 3 |
Total Class Members With Waiver Capacity Award Letters |
1594 |
74 |
|
|
|
1668 |
| 4 |
Total Class Members Who Have Received Waiver Services (as reported by the PAS agencies and providers) |
1512 |
48 |
|
|
|
1560 |
| 5 |
Total Class Members Who Have Received Waiver Services (per billing data) |
1491 |
29 |
|
|
|
1520 |
| 5a |
Subtotal Who Received CILA Services (per billing data) |
211 |
3 |
|
|
|
214 |
| 5b |
Subtotal Who Received HBS Services(per billing data) |
1279 |
26 |
|
|
|
1305 |
| 5c |
Subtotal Who Received CLF Services(per billing data) |
1 |
0 |
|
|
|
1 |
ICFs/DD Resident Outreach
With input from the Monitor, Class Counsel, and Intervenors, the DDD issued a Request for Proposals (RFP) to secure the services of a contractor or multiple contractors to contact all Potential Class Members residing in ICFs/DD; however, the DDD did not receive any bids in response to the RFP. After consultation with the State's procurement staff to ensure all regulations are appropriately followed, the DDD entered into discussions with a potential vendor. The vendor, The Council on Quality and Leadership (CQL), is now under contract with the DDD. CQL assigned/hired a Project Director and Project Manager. The vendor also hired individuals to conduct the initial phone contact and face-to-face interviews. With input from the Monitor, Class Counsel, and Intervenors, the vendor has developed an overall process description, a set of frequently asked questions with responses, a phone script for initial contacts, and meeting presentation materials. Geographic areas for the phase in of initial contact were selected. These areas are Madison and St. Clair Counties in the southern part of the State and the South and Southwest Suburbs of Cook County in the northern part of the State. CQL conducted training for the interviewers in September, with participation by DDD staff and the Monitor. An additional training session was held in January of 2014 for interviewers who were hired after the initial session.
|
|
FY12 |
FY13 |
FY14 |
FY15 |
FY16 |
FY17 |
Cumulative Total to Date |
| 1 |
Total Potential Class Members |
|
|
2777 |
|
|
|
|
| 2 |
# with Initial Phone Contact |
|
|
122 |
|
|
|
|
| 3 |
# Choosing Not to Meet w/Outreach Contractor |
|
|
82 |
|
|
|
|
| 4 |
# Choosing not to Meet at this time, but Want Future Contact |
|
|
38 |
|
|
|
|
| 5 |
Total # Choosing to Meet w/Outreach Contractor |
|
|
2 |
|
|
|
|
| 5a |
# Persons Completed Written Request for Community Services Through Outreach |
|
|
1 |
|
|
|
|
| 5b |
# Undecided |
|
|
0 |
|
|
|
|
| 5c |
# Pending |
|
|
1 |
|
|
|
|
| 5d |
# Choosing ICF/DD |
|
|
0 |
|
|
|
|
Transition Service Plans
An initial version of a standardized format and accompanying instructions was developed with input from the Monitor, Plaintiffs Counsel, PAS/ISC agencies, and other advocates throughout the system. Two PAS/ISC agencies piloted the draft process and materials with Class Members and providers in their areas. These two PAS/ISC agencies participated in a planning/training meeting with the Monitor and DDD staff on August 23, 2012 in order to begin the pilot. DDD staff and the Monitor reviewed the Transition Service Plans that were developed as the pilot was underway. Monthly conference calls were held among the two PAS/ISC agencies, Monitor, and DDD staff throughout the pilot. The standardized format and accompanying instructions were modified, based on the experience of the pilot, for Statewide implementation.
Training for all PAS/ISC agencies was held on April 16, 2013. This statewide training session was then followed with local training sessions for small groups of PAS/ISC agencies throughout the remainder of April and May. The training opportunities were conducted by DDD staff and the Monitor. Statewide implementation occurred on July 1, 2013: as of that date, Transition Service Plans are required for all individuals who move. A modified version of the Transition Service Plan has been provided for the PAS/ISC agencies for use with individuals who moved prior to statewide implementation of the Transition Service Plan format.
|
|
FY12 |
FY13 |
FY14 |
FY15 |
FY16 |
FY17 |
Cumulative Total to Date |
| 1 |
# with Transition Service Plan Completed |
0 |
116 |
382 |
|
|
|
498 |
| 2 |
# of Modified Transition Plans Completed |
0 |
22 |
405 |
|
|
|
427 |
| 3 |
Total to Date |
0 |
138 |
787 |
|
|
|
925 |
Crisis Services
The DDD continues to process service requests for individuals in crisis situations. Below is summary data regarding the requests processed.
|
|
FY12 |
FY13 |
FY14 |
FY15 |
FY16 |
FY17 |
Cumulative Total to Date |
| 1 |
Total # of Crisis Requests Received |
343 |
298 |
210 |
|
|
|
851 |
| 2 |
Total # of Class Members Approved |
290 |
274 |
199 |
|
|
|
763 |
| 2a |
# of Class Members Approved for CILA |
205 |
162 |
102 |
|
|
|
469 |
| 2b |
# of Class Members Approved for HBS |
85 |
112 |
97 |
|
|
|
294 |
| 3 |
Total # of Class Members Who Received Services |
288 |
269 |
196 |
|
|
|
753 |
| 3a |
# of Class Members Who Received CILA Services |
203 |
159 |
100 |
|
|
|
462 |
| 3b |
# of Class Members Who Received HBS Services |
85 |
110 |
96 |
|
|
|
291 |
| 4 |
Total # of Class Members Denied Crisis Approvals |
53 |
24 |
11 |
|
|
|
88 |
Voluntary ICFs/DD Closure/Downsizing Agreements
The DDD continues to work with ICF/DD providers that wish to downsize or close their facilities on a voluntary basis. The information below summarizes the agreements underway since the Consent Decree was approved. Please take note of the following issues involving the data in the table below:
- Included in the FY12 numbers are persons who were part of closure/downsizing agreements that were in process at the time of the approval of the Consent Decree on June 15, 2011. Therefore some individuals may have moved prior to that date and were not included in the Class as they already had community-based services prior to the approval of the Consent Decree.
- It is a rare occurrence, but it is possible that some individuals who are part of closure/downsizing agreements are determined to be ineligible for the Adult Developmental Disabilities Medicaid Waiver. In such instances, the individuals are funded in community-based services with only State funding and are not eligible for membership in the Ligas Class.
- In comparing this data with that in the section entitled "Services for Class Members in ICFs/DD", note that the data source for whether an individual has moved is different between the two sections. This section uses self-reported information from the ICF/DD providers regarding the status of their closure/downsizing agreements; the section entitled "Services for Class Members in ICFs/DD" uses billing data. Typically, there is a greater lag time in the billing data.
|
|
FY12 |
FY13 |
FY14 |
FY15 |
FY16 |
FY17 |
Cumulative Total to Date |
| 1 |
# of Agreements Initiated |
9 |
16 |
12 |
|
|
|
37 |
| 2 |
Total # Licensed Capacity |
144 |
486 |
183 |
|
|
|
813 |
| 3 |
Total # of People to Move |
117 |
403 |
154 |
|
|
|
674 |
| 3a |
Moved to CILAs |
113 |
237 |
0 |
|
|
|
350 |
| 3b |
Moved to HBS |
0 |
0 |
0 |
|
|
|
|
| 3c |
Transferred to Other ICFs/DD |
4 |
0 |
0 |
|
|
|
|
| 3d |
Other |
0 |
17 |
0 |
|
|
|
|
| 3e |
Move Pending |
0 |
149 |
154 |
|
|
|
|
Note:Numbers and outcomes are recorded in the Fiscal Year in which the agreement was initiated.
Eligibility Appeals
The DDD continues to process appeals of eligibility. Below is summary data regarding the appeals processed since the Consent Decree was approved.
|
|
FY12 |
FY13 |
FY14 |
FY15 |
FY16 |
FY17 |
Cumulative Total to Date |
| 1 |
Total Class Members Submitting Appeals
(Rows 2,3,4,5 = Row 1) |
57 |
57 |
20 |
|
|
|
134 |
| 1a |
Crisis Appeals |
N/A |
16 |
9 |
|
|
|
25 |
| 1b |
Eligibility Appeals |
N/A |
41 |
11 |
|
|
|
52 |
| 2 |
Subtotal Appeals Upheld |
9 |
22 |
4 |
|
|
|
35 |
| 3 |
Subtotal Appeals Denied |
29 |
18 |
7 |
|
|
|
54 |
| 4 |
Subtotal Appeals Pending |
17 |
11 |
5 |
|
|
|
33 |
| 5 |
Subtotal Appeals Withdrawn |
2 |
6 |
4 |
|
|
|
12 |
Budget for Ligas
The Budget for FY14 included $32.5 million in increased funding to the Division of Developmental Disabilities for items related to Ligas Consent Decree implementation for an FY14 total of $68.1 million. This $68.1 million includes:
| Budget Category - Description of Expense |
FY14 Proposed Amount |
Comments |
| Contractual Agreements |
|
|
| RFP ICF/DD Outreach |
$700,000 |
|
| Eligibility Determinations and TSPs |
$500,000 |
|
| Increased PUNS Enrollment Processing |
$500,000 |
|
| New ISSA Services |
$592,000 |
|
| Training, Consultation, & Family Support |
$400,000 |
|
| Total Contractual |
$2,692,000 |
|
| DDD Additional Staffing |
|
|
| Strategic Planning-Ligas Compliance Coordinator |
$108,277 |
|
| Data Support |
$93,408 |
|
| Quality Management-clinical reviews |
$653,856 |
|
| Transition Services-facilitate and monitor |
$373,632 |
|
| Appeals |
$79,004 |
|
| Rate Setting |
$93,408 |
|
| Medicaid Waiver-post payment reviews |
$280,224 |
|
| Total Staffing |
$1,681,809 |
|
| Direct Services |
|
|
| PUNS Selection |
$49,772,300 |
500 additional individuals; 1,000 annualized from FY12 and FY13.
500 phased in during FY14; one-half CILA and one-half HBS;
average annual cost for CILA $49,429, plus $2,500 one-time
start-up; average cost for HBS $25,740 |
| ICF/DD Transitions |
$13,925,100 |
600 individuals; 400 annualized from FY12 and FY13 and
200 phased in during FY14; average annual cost for CILA
$49,429, plus $2,500 one-time start-up |
| Total Direct Services |
$63,697,400 |
|
| Total Estimated Budget |
$68,071,209 |
|
The funding for Ligas Consent Decree Implementation in the State's FY14 budget includes an increase of $32.5 million, for an FY14 total of $68.1 million.
Spending for the ICF/DD program remains constant. In FY11 ICF/DD spending totaled $392.8 million, with 6,427 individuals being served at the end of that fiscal year. In FY12, spending for ICF/DDs in FY12 was $381.1 million, with 6,414 being served at the end of the fiscal year. The FY13 spending is $372.4 million, with 5,986 being served at the end of the fiscal year. ICF/DD spending is projected at $370.1 million for FY14.
Spending for the adult Waiver program was $568.4 million in FY11, $588.0 million in FY12, $634.2 million in FY13, and $362.4 million year-to-date in FY14. Based on accepted claims for the adult Waiver program, 17,456 individuals were served in FY11, 17,593 were served in FY12, 18,512 were served in FY13, and 18,429 have been served year-to-date in FY14. [Note that, with this fifth report, the figures in this paragraph are based on a new data source that provides a more accurate and consistent summary of annual spending and individuals served. Also note, that accepted claims data typically includes a lag of information as the State has two years from the date of service to process Medicaid claims.]
As a subset of the Waiver program, the total DDD funding for the CILA program, including day program services, for FY11 was $422.5 million, with 9,567 persons served throughout the year. In FY12, spending was $448.8 million, with 9,678 being served throughout the year. In FY13, spending was $512.7 million with 10,136 persons served. Spending for FY14 is projected to be $561.4 million with 10,600 persons served year to date.
NOTE: This report reflects the services provided in each fiscal year, regardless of the year from which payment was made.
Implementation Plan Updates and Amendments
The first annual update of the Ligas Implementation Plan was completed with input from the Monitor, Plaintiffs, and Intervenors. The second annual update is being finalized as this data report is being issued.
