OT Assessments (797)
CSFA Number: 444-22-1196
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 Occupational Therapy (OT) assessments on identified Williams Class Members to determine if cognitive impairments or performance delays exist and whether such impairments are severe or persistent to the extent they adversely affect the individual’s ability and capability to transition from a nursing home setting to Permanent Supportive Housing (PSH) or the most appropriate community-based alternative. The outcome of this skill based/performance assessment will recommend the most appropriate level of care setting and, if transition is the outcome, the individuals capability to maintain wellness in the community.

The Williams Consent Decree requires ongoing strength-based assessments that consider goals, interests and desires, as well as, explores other indicators such as risks (medical, behavioral and physical), criminal histories, functional capability and cognitive abilities, are conducted on all remaining, consenting residents of the nursing facilities/Institutions for Mental Disease or Specialized Mental Health Rehabilitation Facilities (NFs/IMDs or SMHRFs). Class Members who have not been recommended for transition due to the suspicion of cognitive impairment/mental retardation (MR) or delay will have a secondary specialized assessment conducted by a licensed Occupational Therapist to determine the existence and/or severity of the impairment.

Exhibit B – Deliverables
The Grantee will:
1. Accept referrals from DMH on behalf of Williams Class Members who require a specialized Occupational Therapy 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 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.

Rates:
$75.00 per hour for 5 hours, per Class Member (on-site assimilation).
$75.00 additional per hour for 3 hours (off-site natural environments), if necessary.

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 for an OT assessment.
2. Number of OT assessments scheduled.
3. Number of interviews scheduled with family and significant others.
4. Number of OT assessments completed.
5. Number of OT assessments completed on-site.
6. Number of Class Members who self-abort completion of 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 community transition.
9. Number of Class Members assessed and not recommended for community transition.

Exhibit F – Performance Standards
1. 100% of the OT assessments referred for an assessment were scheduled.
2. 90% of OT assessments initiated were completed.
3. 50% of interviews where family or significant others were contacted.
4. 100% of OT assessments completed on-site.
5. No more than 20% of OT assessments will be aborted by Class Members.
6. No more than 5% of OT assessments will be aborted by the clinician.
7. 70% of Class Members assessed were recommended for community transition.
8. Less than 30% of Class Members assessed not recommended for community 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
Grantee will facilitate completion of Occupational Therapy (OT) assessments on identified Williams Class Members, to determine if cognitive impairments or performance delays exist and if such impairments are severe or persistent to the extent that it adversely affects the individual’s ability and capability to transition from a nursing home setting to Permanent Supportive Housing (PSH) or the most appropriate community-based alternative. The outcome of this skill based/performance 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.

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 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
Details19-444-22-1196-01$30000 - $5908002/02/2018 - 03/19/2018 : 5:00 pm
Details19-444-22-1196-02$30000 - $5908004/06/2018 - 04/20/2018 : 5:00 pm
Agency IDGrantee NameStart DateEnd DateAmount
45CYB03374-45CYB03374THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOI07/01/201906/30/202057,772