Regions Extended MISA Detox (515-RMSD)
CSFA Number: 444-22-1186
Agency Name
Department Of Human Services (444)
Agency Identification
DMH
Agency Contact
Barb Roberson
217-557-5876
barb.roberson@illinois.gov
Short Description
1. Scope of Services
The Grantee will provide hospital-based extended Mental Illness/Substance Abuse (MISA) detox. The Grantee will serve clients from their own Emergency Room and the Emergency Room of other Community Hospitals and community service Grantees. After the clients have completed detox, the Grantee will refer the clients to community agencies. This grant is for coverage throughout the State of Illinois.
2. Deliverables/Milestones
The Grantee must serve at least 40 clients for 4-day MISA detox, 20 of whom may receive extended rehabilitation service for 3 extra days if necessary. These clients must have co-occurring MISA with current need for detox.

Clients will receive stage-appropriate MISA interventions, per the Substance Abuse and Mental Health Services Organization (SAMHSA) guidelines and current evidence-based practices. Clients in detox will receive customary psychosocial assessment to determine level of treatment required upon discharge for both diagnoses. Whenever possible the client will be referred to the nearest MISA capable agency for integrated treatment.
Reporting Requirements:
a. Financial Report in accordance with A, 3, Payment.
b. Performance Report in accordance with Section A, 4, Performance Measures.

3. Payment
Reference the Uniform Grant Agreement, Article IV Payment, Section 4.2 Return of Grant Funds and 4.3 Cash Management Improvement Act of 1990. Payment will be issued monthly and reconciled with reported allowable expenses. Grantee shall submit a quarterly Periodic Financial Report (GOMBGATU-4002 (N-08-17)) to the appropriate email address below no later than November 1, February 1, May 1, and August 1. Reported expenses should be consistent with the approved annual grant budget. Any expenditure variances require prior Grantor approval in accordance with Article VI of the Uniform Grant Agreement to be reimbursable.

PFR Email Address for General Grants:
DHS.DMHQuarterlyReports@illinois.gov
DMH reporting templates and detailed instructions for submitting reports can be found in the Provider section of the IDHS website at http://www.dhs.state.il.us/page.aspx?item=95429. FY21 reports will be uploaded prior to the due date of the first report.

4. Performance Measures
The Grantee shall submit quarterly Periodic Performance Report (GOMBGATU-4001 (N-08-17)) and the Periodic Performance Report Template by Program (PRTP) to the appropriate email address below no later than November 1, February 1, May 1, and August 1. DMH reporting templates and detailed instructions for submitting reports can be found in the Provider section of the IDHS website at http://www.dhs.state.il.us/page.aspx?item=95429. FY21 reports will be uploaded prior to the due date of the first report.

PPR and PPRT Email Address for All Grants:
DHS.DMHQuarterlyReports@illinois.gov

The following are included in the reporting template:
a. Number of consumers receiving services
b. Number of consumers receiving services who meet the criteria for the DMH Target/priority population
c. Number of consumers receiving services who meet the criteria for the DMH Eligible population
d. Number of consumers receiving services who have income levels of 200% or below the Federal poverty level
e. Number of consumers receiving services who are not eligible for Medicaid
f. Number of consumers receiving extended rehabilitation services

5. Performance Standards
The below standards are minimum performance levels.
a. 80% of consumers meet the criteria for the DMH Target/ priority population
b. 20% of consumers receiving services meet the criteria for DMH Eligible population
c. 75% of consumers have income levels of 200% or below the Federal poverty level
d. 30% of consumers receiving services are not Medicaid eligible
e. 50% of consumers must receive extended rehabilitation services

Subject Area
Human Services
Program Function
Health
Enabling Legislation
Mental Health Community Services Act (405 ILCS 30/)
Objectives and Goals
4. Performance Measures
The Grantee shall submit quarterly Periodic Performance Report (GOMBGATU-4001 (N-08-17)) and the Periodic Performance Report Template by Program (PRTP) to the appropriate email address below no later than November 1, February 1, May 1, and August 1. DMH reporting templates and detailed instructions for submitting reports can be found in the Provider section of the IDHS website at http://www.dhs.state.il.us/page.aspx?item=95429. FY21 reports will be uploaded prior to the due date of the first report.

PPR and PPRT Email Address for All Grants:
DHS.DMHQuarterlyReports@illinois.gov

The following are included in the reporting template:
a. Number of consumers receiving services
b. Number of consumers receiving services who meet the criteria for the DMH Target/priority population
c. Number of consumers receiving services who meet the criteria for the DMH Eligible population
d. Number of consumers receiving services who have income levels of 200% or below the Federal poverty level
e. Number of consumers receiving services who are not eligible for Medicaid
f. Number of consumers receiving extended rehabilitation services

5. Performance Standards
The below standards are minimum performance levels.
a. 80% of consumers meet the criteria for the DMH Target/ priority population
b. 20% of consumers receiving services meet the criteria for DMH Eligible population
c. 75% of consumers have income levels of 200% or below the Federal poverty level
d. 30% of consumers receiving services are not Medicaid eligible
e. 50% of consumers must receive extended rehabilitation services
Types of Assistance
Direct Payments for Specific Use
Uses and Restrictions
B. Funding Information
This NOFO is considered a competitive application for funding. It is not a guarantee of funding.
This award utilizes state appropriated funds.
Applicant must submit a program plan which supports the level of funding and detailed service delivery and deliverables.
1. Funding Restrictions
IDHS/DMH is not obligated to reimburse applicants for expenses or services incurred prior to the complete and final execution of the grant agreement and filing with the Illinois Office of the Comptroller.
2. Allowable Costs
Allowable costs are those that are necessary, reasonable and permissible under the law and can be found in 2 CFR 200 - Subpart E - Cost Principles.
3. Unallowable Costs
Please refer to 2 CFR 200 - Subpart E - Cost Principles to see a collection of unallowable costs.
4. Indirect Cost Rate Requirements
Please refer to 2 CFR 200.414 regarding Indirect (F&A) Costs. To charge indirect costs to a grant, agencies must have an annually negotiated indirect cost rate agreement (NICRA). If the agency has multiple NICRAs, IDHS will accept only the lesser rate. There are three types of NICRAs:
a. Federally Negotiated Rate;
b. State Negotiated Rate; and
c. De Minimis Rate
5. Renewals
This program will be awarded as a 12-month term agreement with two, one-year renewal options. Renewals are at the sole discretion of the IDHS and are contingent on meeting the following criteria:
a. Applicant has performed satisfactorily during the most recent past-funding period;
b. All required reports have been submitted on time, unless a written exception has been provided by the Division;
c. No outstanding issues or outstanding Corrective Action Plans (CAPs) are present (i.e. in good standing with all pre-qualification requirements); and
d. Funding for the budget year has been appropriated in the state's approved fiscal year budget.
Eligibility Requirements
C. Eligibility Information
1. Eligible Applicants
This funding opportunity is not limited to those who currently have an award from the IDHS; however, applicants must:
a. Be in good standing with the Illinois Secretary of State (not applicable to governmental entities)
b. Not be on the Federal Excluded Parties List;
c. Not be on the Illinois Stop Payment list;
d. Not be on the Department of Healthcare and Family Services Provider Sanctions List;
e. Complete one Fiscal and Administrative Risk Assessment (ICQ);
f. Complete a Programmatic Risk Assessment (PRA) for each grant at the following link: http://www.dhs.state.il.us/page.aspx?item=121876 by the due date listed in Box 17 of the NOFO Summary above;
g. Register and access both the IDHS Community Service Agreement (CSA) tracking system and the Centralized Repository Vault (CRV);
h. Obtain a Dun and Bradstreet Universal Numbering System (DUNS) number. The DUNS number does not replace an Employer Identification Number. DUNS numbers may be obtained at no cost by calling the DUNS number request line at (866) 705-5711 or by applying online: https://www.dandb.com/. It is recommended that service providers register as soon as possible before the application due date.
i. Register with the System for Award Management (SAM) and maintain an active SAM registration until the application process is complete, and if a grant is awarded, throughout the life of the award. SAM registration must be renewed annually. It is recommended that service providers finalize a new registration or renew an existing one at least two weeks before the application deadline to allow time to resolve any issues that may arise. Applicants must use their SAM-registered legal name and address on all grant applications to IDHS.

Applicants that do not comply with these requirements are not eligible to receive an award.’
2. Cost Sharing or Matching: Not applicable.
3. Indirect Cost Rate: See Section B Funding Information, #4 Indirect Cost Rate Requirements.
Eligible Applicants
Nonprofit Organizations;
Application and Award Processing
D. Application and Submission Information
1. Application Packet
Each applicant must have access to the internet. Applicants may obtain this application form at the Division’s Grant Information website http://www.dhs.state.il.us/page.aspx?item=121808. Questions from applicants and their respective responses (Q&A) will be posted at http://www.dhs.state.il.us/page.aspx?item=121996. It is the responsibility of each applicant to monitor that website and comply with any instructions or requirements relating to the NOFO.
2. Content and Form of Application Submission
a. Each applicant is required to submit a Uniform Application for State Grant Assistance. This is a 3-page document with the first page already completed by the Division of Mental Health. This document must be signed and dated.
b. Each applicant is required to submit a Program Proposal. The Program Proposal must include the following:
i. Executive Summary,
ii. Need,
iii. Capacity,
iv. Quality,
v. Data Collection, Evaluation and Reporting and
vi. Resource Availability
c. The Program Proposal shall not exceed 10 pages. Items included as Attachments are NOT included in the page limitations.
d. The Program Proposal, including attachments should be sequentially page numbered.
e. The Program Proposal must be typed single-spaced with 1-inch margins on all sides.
f. All documents must be typed using 12-point type and at 100% magnification.
g. The PDF submission must be on 8 1/2 x 11-inch page size.
h. Except for letterhead and stationery for letter(s) of support, the entire application and program proposal packet should be in black typeface on a white background.
3. Budget Requirements
a. A budget and budget narrative need to be completed in the CSA tracking database. There is space when preparing the budget on each line item for the budget narrative. Instructions for the CSA Tracking System can be found at http://www.dhs.state.il.us/page.aspx?item=61069.
b. A Budget Template and Instructions can be used as a tool to assist in determining expenses; however, the final budget must be completed in the CSA Tracking System. The pdf budget or paper copy will not be accepted nor should be included in the application packet.
c. The budget narrative should describe how the specified resources and personnel have been allocated for the services and activities described in the budget narrative.
d. The budget should be prepared to reflect a full fiscal year.
4. Dun and Bradstreet Universal Numbering System (DUNS) Number and System for Award Management (SAM)
a. See Section C Eligibility Information, #1 Eligible Applicants, letters h and i.
5. Submission Dates and Times
a. To be considered for award, application materials must be in the possession of the IDHS email address DHS.GrantApp@illinois.gov and by the designated date and time listed in Box 17 of the NOFO Summary Information. Emails into this box are electronically date and time stamped upon arrival. For your records, please keep a copy of your email submission with the date and time the proposal was submitted, along with the email address to which it was sent. The deadline will be strictly enforced. In the event of a dispute, the applicant bears the burden of proof that the proposal was received on time at the location listed above.
b. Applications and Program Proposals will only be accepted electronically and should be emailed to: DHS.GrantApp@illinois.gov. Those that are delivered by any other means will not be accepted and will be immediately disqualified. IDHS/DMH is under no obligation to review applications that do not comply with the above requirements. There will be no exceptions.
c. Within 72 hours of receipt, applicants will receive an email to notify them that the application was received and if it was received by the due date and time. The email reply will be sent to the original sender of the application and program proposal. Applications and program proposals received after the due date and time will not be considered for review and funding.
d. All proposals must include the following mandatory documents:
i. Uniform Grant Application for State Grant Assistance
ii. Program Proposal
iii. Uniform Grant Budget submitted in the CSA Tracking System.

e. Submit the completed application and program proposal as a single document to: DHS.GrantApp@illinois.gov
i. The subject line of the email MUST state: “Provider Organization Name; Program 515-RMSD; 21-444-22-1186-01; Barb Roberson”.
ii. The submission must be in the following order:
o Uniform State Grant Application (3-page document) (Not included in page limit)
o Program Proposal
o Attachments (Not included in page limit). This would include Linkage Agreements (if applicable).
f. The term of the agreement will be July 1, 2020 continuing through June 30, 2021 and will require the mutual consent of both parties, be dependent upon the Grantee's performance and adherence to program requirements and the availability of funds.
g. IDHS may withdraw this Notice of Funding Opportunity at any time prior to the actual time a fully executed agreement is filed with the State of Illinois Comptroller’s Office.
h. The FY 2021 Fiscal and Administrative Risk Assessment, also known as the Internal Control Questionnaire (ICQ), must be completed in the Illinois Grantee Portal.
i. The FY 2021 Programmatic Risk Assessment (PRA) must be completed at the following link: http://www.dhs.state.il.us/page.aspx?item=121876 by the due date listed in Box 17 of the NOFO Summary above;

E. Application Review Information
All applicants must demonstrate that the NOFO requirements are met as identified in Section C, #1, a - i.
1. Review and Selection Process
Proposals will be reviewed by IDHS/DMH staff familiar with the requirements of the program including services to be performed in specified geographic locations, if applicable. Review team members will have no conflicts of interest and will read and evaluate proposals independently.
The maximum possible score is 50 points. All submissions will be reviewed, evaluated and based on the following criteria:
Criteria Purpose Score
Executive Summary The purpose of this section is for the applicant to present the agency description, history, achievements, service description, financial overview and future.
5

Capacity - Agency Qualifications/Organizational Capacity The purpose of this section is for the applicant to present an accurate picture of the agency's ability to meet the program requirements.
1. 10
Need - Description of Need The purpose of this section is for the applicant to provide a clear and accurate picture of the need for these services within the community and how the proposed project will address these needs. 5

Quality - Description of Program Services The purpose of this section is for the applicant to provide a detailed, clear and accurate picture of its intended program design. 15
Data Collection, Evaluation and Reporting To ensure accountability at all levels of service provision, IDHS is implementing the practice of performance-based contracting with its Grantee agencies. The articulation and achievement of measurable outcomes help to ensure that we are carrying out the most effective programming possible. At a minimum, Grantees will be expected to collect and report data indicators and measures as described in this NOFO. 5
Resource Availability Describe what resources and other knowledge, skill and abilities in addition to those specific to the duration of the funding cycle the applicant possesses or will budget for in order to support the objective of this program. These may include, but not limited to the availability of space like meeting rooms, space to carry out this program, etc. 10
2. Merit-Based Evaluation Appeal Process
a. Competitive program grant appeals are limited to the merit-based evaluation process only. Evaluation scores cannot be protested.
b. An appeal must be submitted electronically, in accordance with the grant application document.
c. An appeal must be received within 14 calendar days after the date that the grant award notice has been published.
d. The written appeal shall include at a minimum the following:
o the name and address of the appealing party;
o identification of the grant;
o a statement of reasons for the appeal
e. Appeals are to be submitted to Barb Roberson, via email, to the following address: Barb.Roberson@illinois.gov.
f. Response to appeal:
i. IDHS/DMH will acknowledge receipt of an appeal within fourteen calendar days from the date the appeal was received by the applicant.
ii. The appealing party must supply any additional information requested by IDHS/DMH within a reasonable time period.
F. Award Administration Information
1. State Award Notices
It is anticipated that Notices of State Award (NOSA) will be made in May 2020.
Applicants recommended for funding under this NOFO following the above review and selection process will receive a Notice of State Award (NOSA). The NOSA shall include:
a. The terms and conditions of the award.
b. Specific conditions assigned to the grantee based on the potential grantee answers on the Fiscal and Administrative Risk Assessment (ICQ), the Programmatic Risk Assessment and the Merit-Based Review.
c. The NOSA is not an authorization to begin services or incur costs.
d. Once grantee accepts the NOSA, announcement of the grant award shall be published by IDHS/DMH at www.grants.Illinois.gov. The grant agreement will also be published in the CSA Tracking System for signature.
e. A written Notice of Non-Selection shall be sent to the applicants not receiving awards.
2. Administrative and National Policy Requirements
a. Applicants awarded these funds shall provide services as set forth in the IDHS grant agreement and shall act in accordance with all state and federal statutes and administrative rules applicable to the provision of the services including indirect cost rate requirements in Section B: Funding Information, #4 Indirect Cost Rate Requirements.
b. The legal agreement between IDHS and the successful applicant(s) will be the standard IDHS Uniform Grant Agreement. If selected for funding, the applicant will be provided an IDHS grant agreement for signature and return. A sample of the agreement may be found at http://www.dhs.state.il.us/page.aspx?item=29741

State Awarding Agency Contact(s)
1. IDHS encourages inquiries concerning this funding opportunity and welcomes the opportunity to answer questions from applicants. Questions from applicants and their respective answers (Q&A) will be posted at the following link: http://www.dhs.state.il.us/page.aspx?item=121996.
2. Questions about this NOFO, must be sent via email to Barb.Roberson@illinois.gov. The subject line of the email MUST state: “Provider Organization Name; Program 515-RMSD; 21-444-22-1186-01; Barb Roberson”.
3. Questions will only be accepted electronically. Those that are delivered by any other means will not be addressed

Assistance Consideration
Serves as Maintenance of Effort to the Federal Substance Abuse and Mental Health Services Administration Community Mental Health Block Grant
Post Assistance Requirements
3. Reporting
Reporting requirements for the grant agreement shall be in accordance with the requirements set forth in Section A, Payment Terms and Performance Measures.
Regulations, Guidelines, Literature
Title 59: Mental Health of the Administrative Code

DHS/DMH Attachment B
DHS/DMH Program Manual
Federal Funding
None
Notice of Funding Opportunities
Agency IDAward RangeApplication Range
Details18-444-22-1186-01$79600 - $7960003/20/2017 - 05/01/2017 : 12:00 pm
Details18-444-22-1186-01$79600 - $7960005/05/2017 - 05/22/2017 : 12:00 PM
Agency IDGrantee NameStart DateEnd DateAmount
45CYB00412-45CYB00412LORETTO HOSPITAL07/01/201906/30/202081,680