ISSUE:
All individuals enrolled in the following programs should receive Individual Service and Support Advocacy (ISSA) Services:
- Adult Developmental Disabilities Waiver
- Children's Support Waiver
- Children's Residential Waiver
ISSA is a critical component of the Department's quality management system. These services are provided by 17 Individual Service Coordination (ISC) Agencies located throughout Illinois that have contracts with the Division of Developmental Disabilities (DDD). ISC agencies monitor each Waiver participant's circumstances to ensure their general health and well-being and ensure needed services are being delivered in accordance with approved service plans. ISC provides support to individuals, guardians and providers in working through a variety of issues, including conflict resolution, increased communication, and possible changes in support levels.
BASIS FOR REVIEW:
This post payment review is being done to ensure that ISC services are being provided to individuals in a timely manner. ISC services are a requirement of our federal waiver and an integral component of our quality management plan. In order to comply with the provisions of the waivers, it is imperative that the ISC takes immediate steps to ensure that individuals authorized receive the required ISSA services.
METHOD OF REVIEW:
To ensure that individuals eligible for ISSA are receiving the services, the DDD staff created an inquiry report from the ISSA Monitoring Access database. The Database contains information downloaded from the DHS mainframe billing files. The report included all individuals authorized for ISSA services who, as of July 23, 2016, had no paid FY16 ISSA bills. There were a total of 376 individuals on the July 2016 report. DDD staff used information in the database to identify which of the 17 ISC agencies contracted should be providing the ISSA services for each individual on the report.
TABLES:
The following tables represent the ISC Agencies and the number of individuals identified for each and the findings of the audit.
| ISC AGENCY |
# of Individuals |
| Community Service Options, Inc. |
100 |
| Community Alternative Unlimited |
60 |
| DayOne / PACT |
48 |
| Service Inc. |
37 |
| Suburban Access |
37 |
| Central IL Service Access |
27 |
| Access Services of Northern IL |
13 |
| Southern IL Case Coordination |
13 |
| DDSME |
12 |
| Prairieland Service Coordination |
8 |
| Great River Service Coordination |
7 |
| Mental Health Authority |
4 |
| Champaign Regional Planning |
3 |
| Livingston County 708 Board |
2 |
| Options & Advocacy |
2 |
| Western IL Service Coordination |
2 |
| CSO/RIM |
1 |
| TOTAL |
376 |
| AUDIT FINDINGS |
# of Occurrences |
| Termination Forms Completed |
251 |
| Out Of Compliance |
62 |
| No Record |
30 |
| New Services |
22 |
| ISC Change |
9 |
| 100% Funded, Not Legal Resident, No ISC Services |
1 |
| Un-Waiverized AHBS / Granfathered |
1 |
| TOTAL |
376 |
FINDINGS:
There were 376 individuals identified in this audit. As indicated in Table 2:
- 251 of the individuals have since had termination forms corrected or submitted. These individuals were determined to not need ISSA services during the time frame. Reasons varied from being in an ineligible setting, no longer receiving waiver services, moved out of state, or deceased.
- There were 62 individuals in which the ISC agency was out of compliance with the required monitoring visits and should have provided ISSA services. Reasons included staff errors and incorrect information regarding the individual. These issues were corrected, and services have resumed.
- There were 30 individuals for whom ISC agencies did not have a record. These most commonly are incorrect entries of information and have been addressed by the ISC agencies.
- There were 22 individuals who started new services at the time of this audit, or services were being changed with regard to settings or location. The ISSA services are now being provided.
- There were 9 individuals who had moved to other ISC areas but the ISC agencies had failed to ensure the transfer. The ISC agencies have corrected this.
- There were 2 individuals of special circumstance where it was deemed that ISC services were not to be provided because the individuals were not enrolled in the Waiver due to eligibility issues.
