Neuropsych Assessments (796)
CSFA Number: 444-22-1195
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 Grantee will facilitate completion of neuropsychological assessments/evaluations on identified Williams Class Members when there is a suspicion of dementia or other organic brain syndrome and, if so, to determine whether the disease is so severe or persistent it adversely affects the individual’s ability and capability to transition from a nursing home setting to independent living (Permanent Supportive Housing (PSH)) or other appropriate community-based housing alternatives. The outcome of this clinical battery/assessment will recommend the most appropriate level of care setting and, if transition is the outcome, the individual’s capability to maintain wellness in the community.
The Williams Consent Decree requires that a strength-based assessment, one that considers individual goals, interests and desires, as well as, explores other indicators such as risks (medical, behavioral and physical), criminal histories, functional capability and cognitive abilities, is conducted on consenting residents of the nursing facilities/Institutions for Mental Disease/Specialized Mental Health Rehabilitation Facility (NF/IMDs/SMHRFs). Class Members who have not been recommended for transition due to the suspicion of dementia, Alzheimer’s or other organic brain syndrome may have a secondary, specialized assessment conducted by a Board-Certified neuropsychologist to determine the severity of the disease.

Exhibit B – Deliverables
Each assessment is estimated at an average of nine hours to complete.
The Grantee will:
1. Accept referrals from DMH on behalf of Williams Class Members who require a specialized neuropsychological assessment.
2. Schedule time slots for each Class Member referred.
3. Review medical, clinical charts and/or other pertinent documents made available by the nursing facility (NF/IMD) and documentation from the community mental health center, as appropriate.
4. Conduct interviews with family members, guardians or significant others, as appropriate, about the Class Member’s past and present functional levels, capabilities and performances.
5. Conduct a face-to-face interview with the Class Member using state-of-the art batteries or appropriate assessment tool.
6. Complete narrative reports on assessment outcomes with recommendations.
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 to the email address indicated on the template no later than the 30th day of the month following the end of the service month. 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.

Rate: $252 per hour
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 Class Members referred by DMH for a neuropsychological assessment.
2. Number of Class Members referred by DMH who received a neuropsychological assessment, annually.
3. Number of referrals scheduled for a neuropsychological assessment.
4. Number of referrals neuropsychological assessments initiated.
5. Number of referrals neuropsychological assessments completed.
6. Number of Class Members who self-aborted the assessment.
7. Number of Class Members whose assessment was aborted by the clinician due to distress
or other symptoms.
8. Number of Class Members assessed and recommended for transition.
9. Number of Class Members assessed and not recommended for transition.

Exhibit F – Performance Standards
1. 15 Class Members referred by DMH will receive a neuropsychological assessment, annually.
2. 100% of referrals scheduled for an assessment.
3. 100% of referrals neuropsychological assessments initiated.
4. 70% of referrals neuropsychological assessments completed.
5. Less than 10% of Class Members self-abort the assessment.
6. Less than 10% of Class Members s assessment session aborted by the clinician due to
distress or other symptoms.
7. 40% of Class Members assessed were recommended for transition, based on clinical appropriateness.
8. 60% of Class Members assessed were not recommended for transition.
Subject Area
Human Services
Program Function
Health
Enabling Legislation
Mental Health Community Services Act (405 ILCS 30/)

20 ILCS 1705 Sect. 73(a)


Objectives and Goals
The Grantee will facilitate completion of neuropsychological assessments/evaluations on identified Williams Class Members when there is a suspicion of dementia or other organic brain syndrome and, if so, to determine whether the disease is so severe or persistent it adversely affects the individual’s ability and capability to transition from a nursing home setting to independent living (Permanent Supportive Housing (PSH)) or other appropriate community-based housing alternatives. The outcome of this clinical battery/assessment will recommend the most appropriate level of care setting and, if transition is the outcome, the individual’s capability to maintain wellness in the community.
The Colbert Consent Decree requires that a strength-based assessment, one that considers individual goals, interests and desires, as well as, explores other indicators such as risks (medical, behavioral and physical), criminal histories, functional capability and cognitive abilities, is conducted on consenting residents of the nursing facilities/Institutions for Mental Disease/Specialized Mental Health Rehabilitation Facility (NF/IMDs/SMHRFs). Class Members who have not been recommended for transition due to the suspicion of dementia, Alzheimer’s or other organic brain syndrome may have a secondary, specialized assessment conducted by a Board-Certified neuropsychologist to determine the severity of the disease.
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 grant 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;
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 submit quarterly Periodic Performance Report (GOMBGATU-4001 (N-08-17)) on the Periodic Performance Report Template by Program 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.

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
Details19-444-22-1195-01$45360 - $4536002/02/2018 - 03/19/2018 : 5:00 pm
Details19-444-22-1195-02$35360 - $4536004/11/2018 - 04/25/2018 : 5:00
Agency IDGrantee NameStart DateEnd DateAmount
45CYB04038-45CYB04038THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOI07/01/201906/30/2020103,200
45CYB03373-45CYB03373THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOI07/01/201906/30/202067,596