Mortality Review (794)
CSFA Number: 444-22-1193
Agency Name
Department Of Human Services (444)
Agency Identification
Agency Contact
Barb Roberson
Short Description
Exhibit A – Scope of Service
Upon notice and receipt of clinical documentation from the Division of Mental Health (DMH), the Grantee will complete Mortality Reviews on Williams Class Members who died after transition from a Nursing Facility (NF)/Institutions for Mental Disease/Specialized Mental Health Rehabilitation Facility (IMD/SMHRF) to independent community living arrangements. The Williams Consent Decree expects consenting residents of current NFs/IMDs/SMHRFs, who have been assessed and determined to be candidates for transition to community-based living arrangements, to do so under the guidance of the Implementation Plan. The most ideal setting is defined as Permanent Supportive Housing self-contained, lease-held rental apartments. However, Class Members have also been approved for transition to Supervised or Supported Residential settings.

DMH contracted Williams Grantee agencies will complete Reportable (Critical) Incident staffing’s and participate in Root Cause Analyses (RCA) reviews on all deaths. An independent assessment of Reportable Incidents resulting in a death, by clinicians with expertise in Mortality Review analyses, is necessary to assure credence with the overall findings. DMH will contract with such entity to conduct these Mortality Reviews.

Exhibit B – Deliverables
The Grantee will provide the following:
1. Review documentation of the death, as collected from DMH, on the Reportable Incident form.
2. Collect information from the Williams Grantee agencies, i.e., Root Cause Analysis (RCA).
3. Review documentation provided via the autopsy report, Medical Examiner’s Report or other medical reports.
4. Convene exploratory discussions with the assigned community mental health center’s staff to explore strategies in addressing risk factors (psychiatric, medical, substance abuse, behavioral, environmental, etc.), mitigation planning, monitoring approaches and service activities/approaches.
5. Conduct interviews with family members, guardians or significant others, as appropriate, about past behaviors and functional level, capabilities and performances before death.
6. Prepare a final comprehensive Root Cause Analysis document on each death.
7. Convene a staffing with DMH and the assigned Grantee agency to review findings and recommendation for each RCA.
8. Submit an annual Root Cause Analysis Summary Report and submit to the DMH Contact by the end of the fiscal year.
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 4.3 Cash Management Improvement Act of 1990 and Section 4.7 Timely Billing Required. Grantee shall submit allowable grant expenses on the appropriate DMH invoice template within 30 days of the end of the service quarter to the email address indicated on the template no later than November 1, February 1, May 1, and August 1. Invoiced expenses should be consistent with the approved annual grant budget. Any expenditure variances require prior Grantor approval in accordance with Article VI of the grant agreement to be reimbursable. All invoices shall be HIPPA compliant and encrypted utilizing DHS approved encryption software if so indicated on the invoice template. Invoices shall serve as the request for reimbursement as well as the Periodic Financial Report.

DMH invoice templates 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:

The following are included in the reporting template:
1. Number of referrals for a death RCA received
2. Number of referrals for a death RCA reviewed and processed
3. Number of unduplicated Williams Grantee agencies from whom RCA information has been collected on the decedent.
4. Number of autopsy reports or Medical Examiner (ME) Reports received.
5. Number of autopsy reports or Medical Examiner (ME) Reports reviewed.
6. Number of RCA discussions held with community mental health center’s staff within two weeks of referral.
7. Number of contacts initiated with family or collaterals.
8. Number of RCAs completed.
Exhibit F – Performance Standards
1. 100% of death referrals received and processed for a Mortality Review RCA.
2. 100% of efforts will be initiated to Williams Grantees to collect RCA information.
3. 100% of autopsy reports or ME records received and reviewed for the RCA.
4. 100% of discussions held with community mental health centers within two weeks of referrals.
5. 100% contacts will be initiated with family or collaterals.
6. 100% RCAs will be completed.
Subject Area
Human Services
Program Function
Enabling Legislation
Mental Health Community Services Act (405 ILCS 30/)

20 ILCS 1705 Sect. 73(a)
Objectives and Goals
The Consent Decree Training Institute will build upon an existing commitment to provide training and support workforce development that will enhance the state’s efforts to comply with the federal requirements of the Williams and Colbert Consent Decrees. These trainings will also enhance the capability of community agencies to better offer and support community-based living options and choices for Williams and Colbert Class Members. These Class Members are transitioning from designated institutional settings (Nursing Facilities (NF) located across the state. The primary mission of the Institute is to support development of the workforce which also includes state officials and provider entities, while offering technical assistance to the state and by fostering the use of informatics.
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 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
Government Organizations; 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
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
Notice of Funding Opportunities
Agency IDAward RangeApplication Range
Details19-444-22-1193-01$40798 - $5079802/02/2018 - 03/19/2018 : 5:00 pm
Details19-444-22-1193-02$40798 - $5079804/06/2018 - 04/20/2018 : 5:00 pm
Agency IDGrantee NameStart DateEnd DateAmount
45CYB03447-45CYB03447THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOI07/01/201906/30/202056,090