Medicaid Spend-Down (700)
CSFA Number: 444-22-1187
Agency Name
Department Of Human Services (444)
Agency Identification
DMH
Agency Contact
Barb Roberson
217-557-5876
Barb.roberson@illinois.gov
Short Description
Exhibit A – Scope of Services
The purpose of this program is to have a mechanism for community mental health centers (Williams Grantees) to “Advance Pay” to HealthCare and Family Services (HFS) a “deductible” for Williams Class Members to meet monthly Medicaid eligibility (spenddown) to ensure Medicaid services (medical, mental health, etc.) are not disrupted. As a result, Medicaid cards will be available on a continuous basis.
Provides assurance that the cohort of eligible Williams Class Members can successfully transition to the community, have services provided and Grantee agencies can be reimbursed for allowable Medicaid services.

Exhibit B – Deliverables
The Grantee will facilitate completion of all necessary paperwork and supporting activities to establish the spenddown deductible prior to the Class member moving from the Nursing Facility (NF)/Institution for Mental Disease (IMD). The Grantee’s contract will be adjusted by the number of Class Members’ monthly spend down amounts over the HFS established threshold of $1,005.
The Grantee Shall:
1. Complete the spenddown enrollment form and mailing and send to HFS;
2. Obtain a signed agreement from the Class Member that designates the Grantee agency as the authorized representative payee;
3. Assist the Class Member in applying for Aid to the Aged, Blind and Disabled (AABD) to determine Medicaid eligibility, if not completed by the NF/IMD;
4. Monitor monthly Medicaid allowable bills incurred to determine if these bills are sufficient to meet spenddown;
5. Make payment to HFS no later than the 20th day of the month to assure continuation of spenddown.

Reporting Requirements:
1. Financial Report in accordance with Exhibit C.
2. Performance Report in accordance with Exhibit E.

Exhibit C – 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

PFR Email Address for Williams Consent Decree: DHS.DMHWilliamsInvoices@Illinois.gov

PFR Email Address for Colbert Consent Decree:
DHS.DMHColbertInvoices@illinois.gov


DMH reporting templates and detailed instructions for submitting reports can be found in the Provider section of the DHS website.


Exhibit E – 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. Reporting templates and instructions for submitting reports can be found in the Provider section of the DHS website.

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


The following are included in the reporting template:
1. Number of unduplicated Williams Class Members benefitting from this service.
2. Number of unduplicated Williams Class Members benefitting from this service with spenddown having monthly household incomes at or less than $1,005.
3. Number of Williams Class Members on monthly spenddown with deductible amounts less than:
a. $100
b. $200
c. $300
d. $400
e. $500
4. Number of Class Members whose monthly spend down amount is greater than $500 but not greater than $600 per month.
5. Number of Class Members whose monthly spend down amount is greater than $600.
6. Number of Williams Class Members with sufficient “bills” incurred that can be applied to offset the monthly spenddown amount.
7. Number of Williams Class Members who maintain continuous monthly engagement with the mental health service Grantee.
8. Number of Williams Class Members with monthly spenddown who may self-terminate (the spenddown advance is canceled) from mental health services in the reporting period.
9. Number of Class Members on spenddown for whom the agency is serving as their representative payee.

Exhibit F – Performance Standards
1. 98% of Williams Class Members with spenddown have monthly household incomes at or less than $1005.
2. 98% of Williams Class Members will have monthly spenddown deductible amounts less than:
a. $100
b. $200
c. $300
d. $400
e. $500
3. 2% of Williams Class Members will have monthly incomes greater than $500 but not greater than $600 per month.
4. 100% of William Class Members will have sufficient “bills” applied to offset the monthly spenddown amount.
5. 90% of William Class Members will maintain continuous monthly engagement with the community mental health Grantee.
6. No more than 10% of William Class Members with spenddown terminated from monthly mental health services during the period.
Subject Area
Human Services
Program Function
Health
Enabling Legislation
Mental Health Community Services Act (405 ILCS 30/)

20 ILCS 1705 Sect. 73(a)

Consent Decree - http://www.dhs.state.il.us/page.aspx?item=51836
Objectives and Goals
Community Mental Health Williams Clients Providers provide “Advance Pay” to the State of Illinois Department of Healthcare and Family Services (HFS) a deductible for Williams Class Members to meet monthly Medicaid eligibility spenddown in order to ensure that Medicaid services (medical, mental health, etc.) are not disrupted. As a result, Medicaid cards will be available for the Williams Class Members on a continuous basis which provides assurance that the Williams Class members can successfully transition to the community, have services provided and that Community Mental Health Providers can be reimbursed for allowable Medicaid services.
Types of Assistance
Direct Payments for Specific Use
Uses and Restrictions
Funding for this award will come from the State's General Revenue Fund and does NOT have a Funding for this award will come from the State's General Revenue Fund and does NOT have a match or cost sharing requirement.

Funding Restrictions
DHS/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.

Allowable Costs
Allowable costs are those that are necessary, and reasonable and permissible under the law and can be found in 2 CFR 200 - Subpart E - Cost Principles.

Unallowable Costs
Please refer to 2 CFR 200 - Subpart E - Cost Principles to see a collection of unallowable costs.

Indirect Cost Rate Requirements
Please refer to 2 CFR 200.414 regarding Indirect (F&A) Costs.

In order to charge indirect costs to a grant, agencies must have an annually negotiated indirect cost rate agreement (NICRA). There are three types of NICRAs: a. Federally Negotiated Rate; b. State Negotiated Rate and c. De Minimis Rate

5. Renewals
This program is a 12 month contract with 2, one-year renewal options. Renewals are at the discretion of the DHS/DMH and are contingent on the meeting the following criteria:
a. Applicant has performed satisfactorily during the past six months; b. All required reports have been submitted on time, unless a written exception has been provided by the Division; and c. No outstanding issues are present (i.e. in good standing with all pre-qualification requirements and no outstanding corrective action, etc.)

This program was competitively bid through the Notice of Funding Opportunity (NOFO) process in FY 2019 with 2 one-year extensions. FY 2022 will be considered competitive opportunity.
Eligibility Requirements
1. Be certified by IDHS as a Community Mental Health Provider or a Community Mental Health Center;
2. Be in good-standing with the Illinois Secretary of State (not applicable to governmental entities)
3. Not be on the Federal Excluded Parties List;
4. Not be on the Illinois Stop Payment list;
5. Not be on the Department of Healthcare and Family Services Provider Sanctions List;
6. Complete one Fiscal and Administrative Risk Assessment (ICQ);
7. Complete a Programmatic Risk Assessment for each competitive program;
8. Register and access both the Illinois Department of Human Services Community Service Agreement (CSA) tracking system and the Centralized Repository Vault (CRV);
9. Obtain a Dun and Bradstreet University 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: DUNS Request Service. It is recommended that service providers register at least 30 days before the application due date.
10. 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 DHS/DMH.
Eligible Applicants
Nonprofit Organizations;
Application and Award Processing
1. 3 page Uniform Application for State Grant Assistance completed, signed and dated.
2. Uniform Grant Budget completed and submitted in the CSA tracking system
3. Notice of State Award to be accepted or declined. The NOSA shall include:
a. The terms and conditions of the award.
b. Specific conditions assigned to the grantee based on the fiscal and administrative, programmatic risk assessments and merit-based review conditions.
c. The NOSA is not an authorization to begin performance or incur costs.
d. Upon acceptance of the NOSA, announcement of the grant award shall be published by the awarding agency to www.Grants.Illinois.gov
4. Grant Agreement prepared in CSA Tracking system
5. Grant Agreement signed by Grantee and returned to DHS
6. Grant Agreement signed by DHS
7. Grant Agreement obligated at Comptroller Office
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
a) Reporting
The Grantee shall report quarterly allowable grant expenses on the appropriate DMH reporting template to the DMH program contact no later than November 1, February 1, May 1, and August 1, and reported expenses should be consistent with the submitted annual grant budget. If any budget variances are noted, the DMH program contact may request that the provider submit a revised grant budget before subsequent monthly payments will be made. DMH program contacts and reporting templates can be found in the Provider section of the DHS website.

The Grantee shall report quarterly performance on the appropriate DMH reporting template to the DMH program contact no later than November 1, February 1, May 1, and August 1. DMH program contacts and reporting templates can be found in the Provider section of the DHS website.

b) Audits
Grantee shall be subject to the audit requirements contained in the Single Audit Act Amendments of 1996 (31 USC 7501-7507) and subpart F of 2 CFR Part 200, and the audit rules set forth by the Governor’s Office of Management and Budget. See 30 ILCS 708/65(c).

c) Records
Grantee shall maintain for three (3) years from the date of submission of the final expenditure report, adequate books, all financial records and, supporting documents, statistical records, and all other records pertinent to this Award, adequate to comply with 2 CFR 200.333, unless a different retention period is specified in 2 CFR 200.333. If any litigation, claim or audit is started before the expiration of the retention period, the records must be retained until all litigation, claims or audit exceptions involving the records have been resolved and final action taken.




Regulations, Guidelines, Literature
Title 59: Mental Health of the Administrative Code

2 CFR 200/45 CFR Part 75 Uniform Administrative Requirements, Cost Principles, and Audit Requirements

DHS/DMH Attachment B
DHS/DMH Program Manual
Federal Funding
None
Notice of Funding Opportunities
Agency IDAward RangeApplication Range
Details19-444-22-1187-01$3185 - $6771702/02/2018 - 03/19/2018 : 5:00PM
Agency IDGrantee NameStart DateEnd DateAmount
45CYB03005-45CYB03005THE THRESHOLDS07/01/201906/30/202028,410
45CYB03969-45CYB03969Heritage Behavioral Health Center, Inc.07/01/201906/30/202020,500
45CYB03970-45CYB03970ASSOCIATION HOUSE OF CHICAGO07/01/201906/30/202011,016
45CYB03006-45CYB03006TRILOGY, INC.07/01/201906/30/20203,265