FY 2026 Ligas Implementation Plan.pdf

Ligas Implementation Plan

FY 2026

State of Illinois

Department of Human Services, Division of Developmental Disabilities

This FY 26 Implementation Plan has been developed by the Division of Developmental Disabilities, with input from the Plaintiffs, Intervenors, and Monitor, to accomplish the obligations and objectives set forth in the Ligas v. Quintero et al. Consent decree (Case: 1:05-cv- 04331 Document #549).

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Introduction

The Ligas Consent Decree (Decree) requires the development of an annual Implementation Plan (IP).1 The purpose of the plan is to establish strategies and activities for reaching substantial compliance with the obligations and objectives set forth in the Decree. Defendants reserve the right to seek leave of court to further clarify or modify the requirements of this Implementation Plan in the event of a court order limiting the scope of remaining issues under the Decree.

The Proposed SFY 26 IP is intended to function as a multi-year plan under which measurable metrics and compliance activities are reviewed and/or renewed each year until the broad Pillars (formerly “Metrics”) are satisfied with respect to Ligas Class Members, as defined by the measurables identified in the IP. The Monitor will measure compliance with the Plan on an annual basis evaluating Defendant’s completion of the key actions contained in the IP. Overall substantial compliance with the Decree will be determined in accordance with the provisions of the Decree and relevant law. The Proposed 2026 IP incorporates by reference the findings and recommendations from the April 24, 2025, and June 10, 2025, court orderedi State Operated Developmental Center (SODC) report focusing on Ligas Class Members (Class Members) placed in SODCs.

Proposed SFY 2026 Implementation Plan

The Proposed 2026 IP was developed to identify and address barriers that continue to impact Class Members’ access to home and community-based services, and access to supports and resources of sufficient quality, scope and variety to meet the requirements of the Decree, whether they choose to receive services in a waiver setting or in an ICF/DD.

The Proposed 2026 IP outlines strategic approaches to strengthen home and community based services and supports for Class Members with complex mental health (MH), behavioral management, mobility, medical and/or physical health (PH) challenges; enhance independent service coordination (ISC) capacity for providing transitional supports from institutions to home and community based care; enhance home and community-based service provider capacity for serving Class Members, including those with complex conditions; focus on informed choice for all Class Members regarding all available services, including HCBS, and elicit information about Class Members’ satisfaction with services.

The Monitor will submit yearly reports measuring Defendants’ compliance with the Decree and in accordance with Paragraph 34 of the Decree. The Monitor shall also develop measurable standards for evaluating compliance in accordance with the process outlined in Paragraph 32(a) of the Decree. When the requirements of the IP have been achieved, the Court Monitor will

1 Ligas et al v. Eagleson et al 1:05-cv-04331, ECF No. 549

Case: 1:05-cv-04331 Document #: 917 Filed: 12/05/25 Page 2 of 11 PageID #:15692 perform an evaluation of the systems impacting Ligas Class Members within the scope of the Decree and assess Defendants’ overall compliance with the terms of the Decree.

Pillar #1: Evaluate the current statewide clinical model that addresses Class Members’ complex physical health (PH), mental health (MH), and /or behavioral management needs. To the extent gaps are identified that impact Class Members’ ability to attain and maintain home and community-based services, or result in crisis driven institutionalization of Class Members, identify specific areas for improvement to achieve timely access to home and community-based services as required by law. See Decree, Par. 4 (Development of Resource Capacity) and Par. 21 (Crisis), and Par. 22 (Reasonable Pace).

Key Actions:

1. Map the current clinical treatment model designed to effectively support Class Members with complex MH and/or behavioral management challenges and complex PH challenges and identify gaps and/or areas of improvement (See June 10, 2025, SODC Report, Recommendation 2, 3, and 5). Action 1 will be completed by June 30, 2026.

Review utilization data for all services in the current clinical model for LCM that are currently admitted into a SODC and seeking community services, and those LCM admitted into an or ICF/DD for FY24, 25, and FY26 (YTD) 12 months prior to their admission by June 30, 2026.

Determine if all appropriate components of the clinical model have been utilized or offered to LCM and/or guardian (if applicable) prior to a crisis driven admission into an institutional setting.

a. A tracking system will be developed and implemented to document the clinical model services that have been utilized and/or offered within the 12 months prior to a crisis driven admission into an SODC or interim placement in an ICF/DD. Tracking system will be implemented by June 30, 2026.

b. Defendants will continue to provide a monthly report on the placement status of current LCM in SODCs.2

c. Defendants will increase the reporting frequency for reporting on the status of all Ligas CM with an interim crisis placement in an ICF/DD from semi-annually to monthly to focus on timely transition to HCBS and addressing barriers to transition.

2. Community-based service array will be improved such that admissions to SODC for any LCM in crisis will only be permitted if required by court order, by the specific request of a

2 “Reports” as referenced throughout this Implementation Plan will generally include a written summary containing factual information and analysis, where appropriate. The parties will meet and confer about which reports will include a written summary. Reporting will be done on a 6-month basis unless otherwise stated.

Case: 1:05-cv-04331 Document #: 917 Filed: 12/05/25 Page 3 of 11 PageID #:15693 guardian who has placement authority, or as a placement of last resort in instances where no other placement is available and the CM would be subjected to homelessness, or significant risk of abuse or neglect (including if the individual is a danger to themselves or others). In those circumstances, admission of an LCM to an SODC must have the prior approval of the Deputy Director SODC operations or their designee. Discharge planning for all SODC residents begins at admission, with continued efforts to identify the least restrictive environment that meets the individual’s needs. All LCM admissions to SODC will be included in the SODC reporting under Pillar 5, as well as efforts and outcomes for transitions to community-based settings.

3. Research and evaluate evidence-based/evidence informed clinical treatment models designed to effectively support Class Members with complex MH and/or behavioral management challenges beyond crisis-driven short term/long-term stabilization services to identify possible changes based on best practices.

Action 3 will be completed by June 30, 2026.

4. Utilize research in subparts 1 (gap analysis and evaluation of current system) and 3 (other evidence-based/evidence-informed clinical treatment models) above to identify feasible improvements to the current statewide clinical model waiver service array or other existing state plan services.

Develop analysis/findings report and develop implementation plan for identified improvements.

Discuss and review findings/recommendations report and implementation plan with court monitor and parties.

Action 4 will be completed by December 31, 2026.

5. Implement improvements identified in subpart 4 above, in furtherance of an evidence-based/evidence informed clinical treatment model designed to effectively support Class Members with complex PH, MH, and /or behavior management needs to both reduce Class Member admissions to institutional settings and increase transitions (from both ICF/DD and SODC) of Class Members to community-based settings.

Implementation will begin within 60 days of the completion of Action 4, above.

Quarterly reports on the status of implementation and associated outcome data will begin in the quarter following implementation as identified above.

6. Develop a system for oversight, monitoring and evaluation to ensure the clinical treatment models implemented under subpart 4 above are effective and result in reduced reliance on institutional placement of Class Members with complex PH, MH and /or behavior management needs.

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During FY27, in conjunction with implementation of recommendations stemming from the gaps analysis, develop a system of oversight, monitoring and evaluation to ensure implementation of the recommended clinical model modifications support reduced use of institutional settings for CM with complex PH, MH and/or behavioral needs. Oversight and monitoring system will be in place by FY27 Q4.

Oversight and monitoring data and information will be included in the 6-month reports beginning August 15, 2027.

Substantial Compliance with these key actions will be achieved when (1) the state has demonstrated completion of the key actions, and implementation of the recommended improvements, sufficient to establish an operational statewide clinical model that addresses Class Members’ PH, MH and behavioral management needs, as well as a system for ongoing oversight, evaluation and improvement of that model; (2) use of SODCs for interim placement for LCM in crisis is used only as a last resort where no other options are available and the individual will be left at significant risk of abuse, neglect or homelessness; and (3) Class Members experience reduced admission to institutional placements in crisis, and for those CM who do admit to an institutional placement, that transition to appropriate Home and Community Based Services is effectuated in accordance with the requirements outlined in the Decree.3

Pillar #2: Enhance ISC capacity to effectively support Class Members to access home and community-based services, decrease the need for crisis driven institutionalization of Class Members and assertively support Class Members who are currently institutionalized to transition to home and community-based services by developing and following detailed transition plans (which may vary depending on current setting) in accordance with the requirements of the Decree (and per the June SODC Report, Recommendation 2, 3, and 5). See Decree, Par. 4 (Development of Resource Capacity), Par. 22 (Reasonable Pace).

Key Actions:

1. Evaluate the current referral process to enhance Person-Centered thinking and ensure a current planning model that results in the creation of individualized strength-based referral packets for providers. The model should ensure that Class Members are presented to potential service community service providers in a way that clearly outlines their strengths, provides information about their current behavioral management and/or PH challenges in an objective and respectful way and recommends the amount and type of staffing and funding necessary for them to succeed in a home and community-based setting.

3 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.

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Defendants will continue to engage in an internal workgroup to fully evaluate current referral process and identify potential modifications to the process to encourage positive outcomes for LCM.

Among other things, the internal work group’s process will include developing and issuing strength-based referral packets for LCM in SODCs and for any additional “in-before” LCM, as different formats and approaches are tested.

These referral packets will be circulated on a targeted basis, and one or more designated representatives of Defendants will contact the community service providers receiving the packets to facilitate acceptance of the LCM. Information regarding the outcomes for the LCMs, the providers’ responses and Defendants’ further responsive actions, as described in Pillar 3, will be tracked and reported.

Action 1 will be completed by June 30, 2026.

2. Based on the findings and recommendations from the evaluation of the current referral process, implement feasible improvements to the current referral process(es) as follows:

Develop implementation plan/proposal for improvements to current referral process that includes timeline for implementation and resources needed.

Review and discuss plan/proposal with parties and CM.

Obtain necessary DHS or other state or federal approvals to implement the proposed modifications.

Action 2 will be completed by June 30, 2026

3. Enhance and build on the current system for oversight, monitoring and evaluation to ensure ISCs are creating individualized strength-based referral packets and effectively supporting Class Members to avoid institutional placement, and, for those who currently reside in ICF/DD and SODCs, to transition into home and community-based services in accordance with the requirements of the Decree.

Conduct review of current referral database (Birdseye System) to determine if modifications or other measures can be implemented to utilize the system for real-time tracking of referrals for ISCs statewide. This review will be completed by June 30, 2026.

Based on the outcome of the system review, identify feasible modifications and provide updates to the Parties and Monitor on the status of implementation.

4. Utilize information/data from oversight and monitoring efforts to inform quality improvement efforts and ISC contracting, including review of contract terms to encourage providers to serve individuals with higher needs, as feasible.

5. Review current yearly outreach materials to ensure individuals receive information on all settings, including ICF/DD. Conduct trainings for ISCs to reinforce respect of individual

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The review of current materials will be completed by June 30, 2026.

Modifications as needed will be completed by June 30, 2026, with training and/or

Informational Bulletin to reinforce individual choice within 60 days of the final revisions.

These Key Actions will be achieved when (1) the state has demonstrated substantial compliance with developing a Person-Centered thinking and planning model that results in the creation of individualized strengths-based referral packets that results in successful and prompt placements in HCBS, and has built the capacity of ISCs through training, tools, and accountability systems to effectively apply this model in practice; (2) ISCs are providing consistent, high-quality support to Class Members to avoid institutional placement, and, for those who are currently institutionalized, transitions to HCBS is in compliance with the requirements of the Decree.

Pillar #3: Increase Community Integrated Living Arrangement (CILA) Providers’ capacity to effectively support Class Members to live in home and community-based settings and avoid institutional placement, and to expand capacity as needed to meet demand. Ensure CILA Providers are supported to enhance their capacity within the current service array consistent with the requirements of the Decree, and address barriers that may limit access to CILA placement for Class Members due to complex MH, behavioral management and/or PH challenges. See June 2025 SODC Report, Recommendation 2, 3, and 5; see also Decree, Par. 4 (Development of Resource Capacity and Par. 22 (Reasonable Pace).

Key Actions:

1. Develop and implement a system for oversight, monitoring and evaluation of CILA providers to ensure they are working in partnership with the state to serve Class Members with complex MH, behavior management, and PH challenges.

Examine current system to review and identify CILA providers who currently serve LCM with complex MH, PH and/or BH challenges, as well as those providers who historically reject referral packets for high-need LCM. Utilize HRST and ICAP data and rates to identify individuals with complex needs and provide summary of provider base by June 30, 2026.

2. Implement an oversight system that includes monitoring of CILA service provider referral rejections and provider terminations related to Class Members, focusing on LCM with high medical, mental health, physical health and/or behavioral health needs.

Identify primary reasons providers reject referrals. Obtain information from providers via trade associations, families, ISC agencies, etc. by June 30, 2026.

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Require providers to identify barriers to serving individuals referred and require identification of what services/supports within the current service array are needed and unable to be provided.

3. Monitoring will track repeated rejections of high-need LCM for further inquiry with the provider by DDD. Findings will be included in the six-month reports. Utilize information/data from oversight and monitoring efforts to inform capacity development, quality improvement, and CILA provider performance and contracting.

Explore possible revisions to Attachment A. (DDD contract with providers) regarding DDD authority and provider expectations to serve complex MH and PH individuals. Analysis will be completed by June 30, 2026, and the Monitor and parties will be notified and provided the opportunity for input on any planned modifications or revisions and the timeline for implementation.

Investigate other states’ use of value-based payment systems to determine if that model can be implemented.

4. Continue Defendants’ implementation the “Guidehouse” rate study recommendations, related to waiver and ICF-DD funding.

Substantial Compliance with these Key Actions will be achieved when (1) There is a reduction of LCM diverted to institutional settings due to rejection of funding and placement packets by CILA providers; (2) when the state has implemented an oversight and monitoring system that promptly identifies and remedies performance and capacity issues of CILA Providers, especially in relation to serving individuals with higher needs; and (3) the state effectively increases capacity across CILA Providers (including adding providers as needed in accordance with existing licensing other provider-based rules and regulations) to ensure appropriate and timely service for Class Members with complex MH, behavioral management, mobility, and PH challenges.

Pillar #4: Evaluate Class Members’ satisfaction with the services they are receiving, including where they are living, the community service providers/staff who are supporting them and the ISC supports they are receiving. See Decree, Par. 4 (Development of Resource Capacity:

“...availability of services, supports, and other resources of sufficient quality, scope and variety...”).

Key Actions:

1. Develop and implement a system for annual inquiry into Class Members’ satisfaction with services, utilizing a valid and reliable survey tool/method. Ensure all settings in which current LCM reside are included in the survey sample.

Review and evaluate previous Quality review process related to satisfaction with services by June 30, 2026.

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Review current BQM process by June 30, 2026.

Review NCI data by June 30, 2026.

2. Develop process for sample satisfaction review. Process will be shared with the Court Monitor and parties by June 30, 2026.

3. Utilize the data collected to inform quality improvement efforts focusing on Ligas Class Members’ satisfaction with services. A summary of the satisfaction survey will be included in the six-month reports, beginning with the first report post-implementation of the survey.

4. Utilize the data collected as part of the state’s approved 1915c Waiver reporting requirements specific to service-related complaints to evaluate whether the state is responding in a timely and meaningful way to Class Member complaints.

These Key Actions will be achieved when (1) the state has implemented an annual Satisfaction Survey, identifying Class Members’ satisfaction with services, utilizing a valid and reliable survey tool/method; and (2) appropriate investigative and corrective action within the Defendants’ statutory and regulatory authority, is taken in response to any reports of substandard care or provider-related concerns identified in the survey.

Pillar #5: Address the findings and recommendations in the June 10, 2025, SODC report submitted by the Court Monitor. Findings and recommendations 2, 3, and 5, are also incorporated in Pillars 1, 2, and 3, and the related metrics/compliance activities. See Decree, Par.

4 (Development of Resource Capacity) and Par. 21 (Crisis); see also Court order dated March 19, 2025.

Key Actions:

1. A progress report on the findings and recommendations in the June 10, 2025, SODC report was submitted to the Court Monitor by Defendants on October 15, 2025.

2. Defendants will continue to provide quarterly reports on progress toward addressing the findings and recommendations in the June 10, 2025, SODC report.

Quarterly progress reports shall be submitted 45 days after the end of the quarter.

Quarterly reporting will begin the first quarter after the 2026 IP is filed. Quarters are based on the state fiscal year.

3. In response to the June 10, 2025, SODC report (recommendation 8), the state will develop a system to ensure regular (no less than monthly) face to face visits from an unbiased entity to adequately safeguard each LCM living in an SODC until they can safely transition into community-based services. The entity identified for this process will also be responsible for advancing the goals of the LCM and working with DDD staff to promptly resolve any issues identified.

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These actions will be achieved when the above actions are complete and all of the findings and recommendations in the June 10, 2025, SODC reports have been addressed. The State will be in substantial compliance when there is a system created consistent with the Key Actions.

Pillar # 6: Ensure the availability of services, supports and other resources of sufficient quality, scope and variety to meet [Defendants’] obligations” under the Decree consistent with Individuals’ choice of ICF/DD or home and community-based services. See Decree, Par. 4 (Development of Resource Capacity).

Key Actions:

1. If a rate increase is authorized by the General Assembly for calendar year 2027, HFS will work diligently with its necessary partners to file a State Plan Amendment in accordance with applicable federal requirements and procedures.

2. Updates to ICF/DD funding, implementation status of Guidehouse recommendations and other related activities will be included in the six-month report.

These Key Actions will be achieved through Defendants implementation of the “Guidehouse” specific recommendations through applicable federal and state processes and other actions necessary to result in the state’s system, as implemented through the applicable federal and state processes and requirements, sufficiently providing services and supports as required by the Consent Decree to serve individuals according to their choice of ICF/DD or home and community-based services.

Pillar #7: Continue to meet Reasonable Pace via a maximum 60 month wait time on PUNS, with a minimum of 630 individuals entering service each year. In addition, increased focus will be placed on the transition of all “in-before” LCM to community-based settings, as well as on the timely transition of residents of ICF/DDs who enroll on PUNS to seek community-based placement.

Key Actions:

1. Provide a PUNS selection letter to all current/remaining “in-before” LCM within 30 days of the finalization of the IP.

2. Identify all “in-before” LCM and review their status to ensure they are indeed currently seeking community-based services. ISCs will focus on those individuals who are actively seeking community-based services to expedite placement. For those who do not want to pursue community-based services, they will be able to utilize the PUNS selection

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3. By 6/30/26, transition 65% of the “in-befores” identified as actively pursuing HCBS (as of February 15, 2026) to community-based settings.

4. The PUNS selection for July 2026 will include 10% ICF/DD residents. For future years, the ICF/DD percentage of the primary PUNS selection(s) will be up to 10% (depending on whether there are a sufficient number of ICF/DD residents enrolled on PUNS to reach the 10% threshold).

5. Individuals selected from PUNS who are not interested in community-based services and wish to continue with their Annual PUNS meeting will stay on PUNS designated as Planning. Like all recipients of a PUNS selection, these individuals will remain eligible to receive services once they are ready and will be contacted by their ISC annually at a minimum.

6. The status of ICF/DD residents on PUNS as well as the status on all “in-before” LCM currently seeking community placement will be included in the six-month reports.

Substantial Compliance with these Key Actions will be achieved when (1) All “in-before” Class Members in ICF/DDs who have a current record of wanting to transition to a Community- Based Setting have received an offer of placement with an HCBS provider that meets their needs and reasonably meets their preferences; (2) Individuals in ICF/DDs who desire to move to the community are prioritized via PUNS selections as defined above; and (3) individuals seeking community placement after selection from PUNS are served in accordance with their preference consistent with the requirements of the Reasonable Pace.

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