TO: Developmental Disabilities Service Providers, Pre-Admission Screening Providers, Statewide Advisory Council for Developmental Disabilities,
Other Advocacy Organizations

FROM: Lilia Teninty, Director

Division of Developmental Disabilities

DATE: April 16, 2008

RE: Service Requests and Authorizations

This correspondence will provide additional details regarding the new procedures for selection of individuals for services through the Prioritization of Urgency of Need for Services (PUNS) database as announced in a memorandum dated January 4, 2008. We are asking for public comment on the information provided in this memorandum through e-mail address to  no later than April 30, 2008, and at the Statewide Advisory Council meeting in Springfield on April 17, 2008. Once public comments are collected and reviewed, we will issue a revised memorandum reflecting accepted recommendations. Given the importance of this change and the detail put forth in this correspondence, we ask that you review the information carefully and thoroughly.

With over 13,000 individuals currently active in the PUNS database, it is important that the process by which individuals are selected to receive services is transparent and ensures that people in similar situations have an equal opportunity to receive services, regardless of how or where they come into the system. There has been a lack of understanding about the process that has been used to identify people for services in the past. The point system used by the Division to determine how many people would be served has not been publicly disseminated and there has not been a written explanation available of the emergency criteria used in reviewing requests for services. We believe we can do a better job of offering transparency and a level of assurance that people in similar situations will have similar opportunity to receive services.

This fundamental need to put in place a more transparent and uniform system is the reason the division will be moving to identify people for services from the PUNS database. This memorandum provides detail on the process we propose for making the selections. It also includes an explanation of the point system that has been, and will be used to ensure we do not exceed the level of attrition from the waiver programs.

Moving to a system that identifies people for services from the PUNS database is a strong and important step in the direction of making our system more person-focused. As with all changes of this nature, we fully expect there will be a need to monitor and adjust our process as we gain experience and gather input. For example, we are committed to reviewing and revising the point system recognizing there has been significant growth in the Medicaid waiver programs over the past few years. We will also look for ways to account for attrition that are more person focused than the current point system. We will continually work with the service coordination agencies to verify those identified are eligible and meet the specific criteria under which they were identified. We will continue and expand outreach efforts to improve representation in PUNS of under-represented communities. We will adjust categories in PUNS to better reflect needs of those we serve and our process as we make adjustments and modifications. And, although we have put forth a distribution plan for the current points, as you will see below, we will determine how to identify the use of the final number of capacities now being proposed as well as those available through future recalculations based on public comment and input.

We are hopeful this change will go smoothly, with little to no time lost between funding of the last eligible packets submitted before January 31, 2008, and the initiation of services for the first group we identify from PUNS. We appreciate your cooperation and willingness to work in partnership with us as we make this important improvement to our system.

Status of Service Authorization Requests at DDD Central Office

As you know, requests for services were growing exponentially. Funds were not available to handle the many requests from families with children aging-out of the school system, individuals with aging caregivers, and others in similar circumstances of need, on top of the emergency requests being processed. In order to more fairly and effectively manage this situation, we issued the January 4, 2008 guidelines that provided for a transition to the PUNS selection process.

The release of the portion of revenue generated by the hospital tax for expansion of waiver services is allowing us to process approximately 800 service authorization awards, which will not only relieve the situation with the pending requests but will also help us to select individuals from PUNS for services. An additional $3 million is available from the developmental disabilities dedicated fund to further these efforts. In addition, we continue to use existing funding as vacancies occur.

We are continuing to process requests that were submitted prior to the January 31, 2008 deadline discussed in the January 4, 2008 memorandum. We are issuing authorization letters as quickly as staff time and funding will allow. Request packets that do not meet the priority population and/or emergency review criteria are being returned to the pre-admission screening/individual service coordination provider. It is our goal to process all these remaining packets by the end of this fiscal year. Due to the number of packets yet to be processed, we do not expect to make our first selections from the PUNS database until the end of May for an average anticipated service start date of August 2008.

New Procedures

The new procedures are being established in accordance with the priority population criteria set forward in Attachment A to the providers' service agreements. All selections and authorizations for services will be made following these criteria.

The new procedures are applicable to individual authorizations for the Medicaid Waiver programs, as well as Child Care Institutions (CCI). They are not currently applicable to enrollments in Intermediate Care Facilities for Persons with Developmental Disabilities (ICFs/DD), Skilled Nursing Facilities for Pediatrics (SNF/Peds), Community Living Facilities (CLFs), Grant Programs, and Respite Programs.

The Division authorizes service capacities through a point count system, whereby a Community Integrated Living Arrangement (CILA) capacity is equal to one point and a Home-Based Support Services (HBS) capacity is equal to 1/3 point, etc. At present, the Division authorizes services for new individuals at a rate of 40 points per month based on attrition from services. The number of individuals authorized each month depends on the types of services authorized. That is, one point could be used to serve one child in a group home or to serve three adults in the HBS program.

Based on the current available 40 points per month, we expect to provide services to approximately 780 children and adults in Fiscal Year 2009, based only on attrition, not additional funding. This is consistent with the number of people that have been added to service on an annual basis for the past several years. The move to identify people to serve from PUNS will not change the number of capacities the Division has made available each month.

It is the Division's intention to use the available points as described below.

Reserve for Crisis Requests

18 points will be reserved each month to process crisis requests that cannot be predicted by the database. (For example, an individual experiences the sudden and unanticipated death of the care giver.) This reserve will be used for both adults and children. Should not all of the 18 points be needed each month, the remainder will be added to the PUNS selection described below.

See the attachments for the adult and children crisis criteria. Comments on the attached crisis criteria may be submitted along with comments on this memorandum, but given the amount of public input that has gone into the current versions of these documents, the Division will use the criteria in approving requests involving crisis situations effective immediately.

Requests to be Processed without PUNS Selection

The following applications will be recorded on PUNS but processed through direct submission without requiring available points or waiting for PUNS selection:

  • Discharges from State-Operated Developmental Centers,
  • Discharges from State-Operated Mental Health Hospitals (anticipate two per month),
  • Bogard class members residing in nursing facilities and remaining on the list of individuals to move from the final round of choice per the consent decree,
  • Transfers within the CILA program, and
  • Transfers due to ICF/DD downsizing agreements.

PUNS Selection Criteria for Requests to be Approved through Available Funds

22 points will be distributed as follows:

  1. CILA

    • 8 individuals who are recorded on the database as being in an emergency situation (i.e., needing services immediately) and needing out-of-home supports. 
    • Within this category, we will select 2 individuals from the Chicago network and 1 individual from each of the remaining networks by the length of time on the database. 
    • 2 individuals residing at home with a primary caregiver age 75 or over. 
    • Within this category, we will select individuals by the length of time on the database on a statewide basis. 
    • 2 individuals residing in private ICFs/DD. 
    • Within this category, we will select individuals by the length of time on the database on a statewide basis.
  2. HBS Adult

    • 6 individuals who are recorded on the database as being in an emergency (i.e., needing services immediately) or critical (i.e., needing services within the year) situation and needing in-home or day supports. 
    • Within this category, we will select individuals by the length of time on the database on a statewide basis. 
    • 16 individuals leaving the Public School System in the last 5 years.
    • Within this category, we will select 4 individuals from the Chicago network and 2 individual from each of the remaining networks by the length of time on the database. 
    • 8 individuals residing at home with a primary caregiver age 60 or over. 
    • Within this category, we will select 2 individuals from the Chicago network and 1 individual from each of the remaining networks by the length of time on the database 
  3. HBS Children

    Note: At present, we are not assigning points to this category since we will be reinvesting all the Medicaid funds from the children's support waiver to expansion. As we identify a vacancy rate for this new waiver, we will assign points accordingly. PUNS selection will be used for both the new expansion and the authorizations due to vacancies in accordance with the criteria below. Also note that we do not have selection criteria for children's residential services as those capacities are used only in crisis situations and will be addressed by the crisis reserve.

    • Children who are recorded on the database as being in an emergency (i.e., needing services immediately) or critical (i.e., needing services within the year) situation. 
    • Within this category, we will make selections by region: 
      • Children who have been on the database the longest length of time. 
      • Children who are recorded on the database and will be selected at random 
    • Within this category, we will make selections by region

Next Steps

We welcome additional input as we finalize programming for the PUNS selection criteria. In addition, comments are always welcome throughout the year. We anticipate that, as the needs recorded on the PUNS database change over time and as we gain experience with PUNS selection, the selection criteria will be adjusted accordingly.

We will re-evaluate the number of capacities routinely available each month due to vacancies in light of the significant expansion that is occurring this year. We hope we will be in a position to increase the number of points available for authorizations each month.

The processing of the packets currently at the central office will continue as quickly as possible. Requests involving crisis situations and direct submissions (such as SODC discharges) will also continue without interruption.

Thank you all for your cooperation and assistance through this transition period. If you have any questions, please contact your region facilitator.