Quality Assurance and Data Analytics (792) (DMH)
CSFA Number: 444-22-2239
Agency Name
Department Of Human Services (444)
Agency Identification
Division of Mental Health
Agency Contact
Barb Roberson
217-557-5876
barb.roberson@illinois.gov
Short Description
Scope of Services

The purpose of this grant is to allow for activities that would facilitate the effective and efficient administration of the Department of Human Services (DHS) long- term care rebalancing efforts under the Colbert and Williams Consent Decrees. These services allow for a coordinated, effective, and responsive program for transition of Colbert and Williams Class Members from nursing facilities to community­ based settings. In doing so, the grantee will provide clinical expertise and technical assistance consultation to DHS for its quality improvement system, care coordination and risk mitigation processes, assessment and service planning tool development, policy and procedure implementation and database development and maintenance. Grantee will provide quality assurance services to DHS through data collection and analysis, quality management studies, and provider training and technical assistance using the outcomes of clinical reviews, clinical review team process, CAST, case, reportable incident and mortality reviews, assessment and service plan reviews and quality of life surveys. This work will include developing training modules on the following:

1. Care Management and Care Management Processes and Procedures
2. Health and Community Supports and Services
3. Management of Chronic Health Conditions
4. Management of Serious Mental Illness
5. Assessment, 4-Quadrant Assignments and Service Planning

The training should be provided through multiple methodologies, including but not limited to webinars, face-to-face, pre-recorded trainings and other methods upon DHS request.


Deliverables

1. The grantee will develop training modules on:

a. Care Management and Care Management Processes and Procedures
b. Health and Community Supports and Services
c. Management of Chronic Health Conditions
d. Management of Serious Mental Illness
e. Assessment, 4-Quadrant Assignments and Service Planning

2. Develop supportive guides for members to manage chronic conditions and post on website.

3. Maintain a training website. Website shall include "Links" to evidence-based guides/tools for managing chronic health conditions.

4. Provide care management process training as needed for implementing the standard assessment, clinical review team (CRT), Integrated Four Quadrant Model, Service Planning, Case Review, Reportable Incident Review and Mortality Review.

5. Provide training to staff identified by DHS and the Grantee through multiple methodologies, including, but not limited to:

a. Webinars
b. Face-to-Face
c. Pre-recorded trainings
d. Participation on Colbert & Williams QA Committee and relevant workgroups
e. Attendance at Colbert Large Party meetings upon DHS request


6. Provide outcomes of Quality of Life Surveys for Colbert & Williams Class Members Transitioning into the Community. These are administered for pre-transition activities by Grantee and administered again one-year post transition by the Grantee.

7. The Grantee will provide Quality Assurance Services for the following:

a. Conduct Complexities Affecting Seamless Transition (CAST) by a review of Medicaid claims from Illinois Department of Healthcare and Family Services (HFS) for health service utilization, and other clinical documents submitted and prepare reports of findings and recommendations.
b. Conduct case reviews on Quad III and Quad IV members by a review of Medicaid claims from Illinois Department of Healthcare and Family Services (HFS) for health service utilization, and other clinical documents submitted and prepare reports of findings and recommendations.
c. Conduct case review follow-up and prepare reports of findings and recommendations.
d. Conduct reportable incident reviews and hold weekly calls to review documentation and findings of the incident analysis report submitted by Colbert & Williams Care Coordinators and prepare reports of findings and recommendations.
e. Conduct 2nd level review as part of the Clinical Review Team and will review documentation of Class Members who have been denied the chance to transition at the resident review level.
f. Conduct reportable incident follow-up on the reports and action steps taken to mitigate further re-occurrence of incidents and prepare reports of findings and recommendations.
g. Conduct mortality reviews which includes review of all clinical documentation, interviews with key representatives who worked with the Class Member and hold a teleconference with all necessary providers and other identified staff to offer recommendations for changes in practice and to mitigate risks and prepare reports of findings and recommendations.
h. Conduct quality reviews on a representative sample of comprehensive evaluations and service plans submitted by Colbert and Williams Providers to provide clinical support and the implementation of person-centered planning and prepare reports of findings and recommendations.

8. Conduct Care Management Process Analysis of assessment outcomes, including evaluation attempts, declines, CMs excluded, CMs recommended and not recommended after comprehensive assessment, including analysis of reasons CMs decline to be evaluated.

9. Conduct analysis of 4-Quadrant assignments (levels I – IV) which uses a standardized assessment tool to ensure best practices in the collection and analysis of assessment data to achieve consistency across Providers performing evaluations in the information obtained about CMs needs, abilities, strengths, service patterns and preferences; to develop clinically informed decisions regarding the CM’s readiness for transition and development of a person-centered Service Plan with specific goals and objectives most likely to result in successful transition.

10. Conduct analysis of the validity of the 6-month Service Plan Updates for CMs who were not recommended for transition based on a representative sample.

11. Develop Audit/Rating process and audit tools for Desk and On-Site Compliance Auditing by Colbert & Williams Program.


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


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.


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 trainings conducted during period
2. Number of in person trainings conducted during the period
3. Number of webinars conducted during the period
4. Number of participants at trainings and webinars
5. Number of updates to website identified/needed.
6. Number of updates to website completed
7. Number of Quality of Life Surveys for pre-transition activities attempted by Grantee at transition of Colbert and Williams members
8. Number of Quality of Life Surveys for pre-transition activities completed by Grantee at transition of Colbert and Williams members
9. Number of Quality of Life Surveys attempted by Grantee post-transition at year one
10. Number of Quality of Life Surveys completed by Grantee post-transition at year one
11. Number of notified case reviews required
12. Number of notified case reviews completed within twenty-one (21) business days of receiving all clinical documentation
13. Number of teleconferences held within five (5) business days of preliminary case review and notes of case reviews and
14. Number of teleconferences scheduled within five (5) business days after the call
15. Number of CAST reviews needed for Class Members who appear to meet CAST criteria with required documentation received
16. Number of CAST reviews completed within 30 days of notification that Class Member appears to meet CAST criteria and receipt of required documentation
17. Number of level 1 and level 2 incidents reported
18. Number of level 1 and level 2 reportable incident reviews with weekly calls completed
19. Number of notified mortality reviews and weekly teleconferences required
20. Number of notified mortality reviews and weekly teleconferences completed, including demographics on all known mortalities; with a final report submitted within five (5) business days of the teleconference
21. Number of quality reviews needing Comprehensive Evaluations and report completed on findings and recommendations
22. Number of quality reviews completed on defined sample of received Comprehensive Evaluations and report completed on findings and recommendations
23. Number of quality reviews needed on defined sample of received Service Plans and report completed on findings and recommendations
24. Number of quality reviews completed on defined sample of received Service Plans and report completed on findings and recommendations
25. Number of evaluations reviewed by the Clinical Review Team process
26. Number of care management process analysis conducted on the evaluations
27. Number of Evaluation Attempts
28.Number of Declines
29.Number of Class Members excluded
30. Number of Class Members Recommended for Transition
31.Number of Class Members Not Recommended for Transition
32.Number of evaluations assigned to the 4 Quadrants:
34.Number of Level I – low behavioral health/low physical health
35.Number of Level II – high behavioral health/low physical health
36.Number of Level III – low behavioral/high physical health
36.Number of Level IV – high behavioral/high physical health
37. Number of 6 Month Service Plan updates received
37.Number of 6-Month Service Plan updates completed


Performance Standards

1. 4-6 trainings conducted during the period
2. 6 or more webinars conducted during the period
3. 100% of updates to website completed
4. 100% of Quality of Life Surveys attempted were completed for pre-transition activities
5. 100% of Quality of Life Surveys attempted were completed post-transition at year one
6. 85% of notified case reviews completed within twenty-one (21) business days of receiving all clinical documentation; with teleconferences held within five (5) business days of preliminary case review and notes of case review and teleconference issued within five (5) business days after the call
7. 100% of notified CAST reviews completed within 30 days of notification that Class Member appears to meet CAST criteria and receipt of required documentation.
8. 100% of notified level 1 and level 2 reportable incident reviews with weekly calls completed
9. 100% of notified mortality reviews and teleconferences completed, including demographics on all known mortalities; with a final report submitted within five (5) business days of the teleconference
10. 100% of quality reviews completed on defined sample of received Comprehensive Evaluations and report completed on findings and recommendations
11. 100% of quality reviews completed on defined sample of received Service Plans and report completed on findings and recommendations
12. 100% of care management process analysis conducted on outcomes of evaluations received
13. 100% of received evaluations assigned to the 4 Quadrants:
14. 100% of received 6-Month Service Plan
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
1. The grantee will develop training modules on:

a. Care Management and Care Management Processes and Procedures
b. Health and Community Supports and Services
c. Management of Chronic Health Conditions
d. Management of Serious Mental Illness
e. Assessment, 4-Quadrant Assignments and Service Planning

2. Develop supportive guides for members to manage chronic conditions and post on website.

3. Maintain a training website. Website shall include "Links" to evidence-based guides/tools for managing chronic health conditions.

4. Provide care management process training as needed for implementing the standard assessment, clinical review team (CRT), Integrated Four Quadrant Model, Service Planning, Case Review, Reportable Incident Review and Mortality Review.

5. Provide training to staff identified by DHS and the Grantee through multiple methodologies, including, but not limited to:

a. Webinars
b. Face-to-Face
c. Pre-recorded trainings
d. Participation on Colbert & Williams QA Committee and relevant workgroups
e. Attendance at Colbert Large Party meetings upon DHS request


6. Provide outcomes of Quality of Life Surveys for Colbert & Williams Class Members Transitioning into the Community. These are administered for pre-transition activities by Grantee and administered again one-year post transition by the Grantee.

7. The Grantee will provide Quality Assurance Services for the following:

a. Conduct Complexities Affecting Seamless Transition (CAST) by a review of Medicaid claims from Illinois Department of Healthcare and Family Services (HFS) for health service utilization, and other clinical documents submitted and prepare reports of findings and recommendations.
b. Conduct case reviews on Quad III and Quad IV members by a review of Medicaid claims from Illinois Department of Healthcare and Family Services (HFS) for health service utilization, and other clinical documents submitted and prepare reports of findings and recommendations.
c. Conduct case review follow-up and prepare reports of findings and recommendations.
d. Conduct reportable incident reviews and hold weekly calls to review documentation and findings of the incident analysis report submitted by Colbert & Williams Care Coordinators and prepare reports of findings and recommendations.
e. Conduct 2nd level review as part of the Clinical Review Team and will review documentation of Class Members who have been denied the chance to transition at the resident review level.
f. Conduct reportable incident follow-up on the reports and action steps taken to mitigate further re-occurrence of incidents and prepare reports of findings and recommendations.
g. Conduct mortality reviews which includes review of all clinical documentation, interviews with key representatives who worked with the Class Member and hold a teleconference with all necessary providers and other identified staff to offer recommendations for changes in practice and to mitigate risks and prepare reports of findings and recommendations.
h. Conduct quality reviews on a representative sample of comprehensive evaluations and service plans submitted by Colbert and Williams Providers to provide clinical support and the implementation of person-centered planning and prepare reports of findings and recommendations.

8. Conduct Care Management Process Analysis of assessment outcomes, including evaluation attempts, declines, CMs excluded, CMs recommended and not recommended after comprehensive assessment, including analysis of reasons CMs decline to be evaluated.

9. Conduct analysis of 4-Quadrant assignments (levels I – IV) which uses a standardized assessment tool to ensure best practices in the collection and analysis of assessment data to achieve consistency across Providers performing evaluations in the information obtained about CMs needs, abilities, strengths, service patterns and preferences; to develop clinically informed decisions regarding the CM’s readiness for transition and development of a person-centered Service Plan with specific goals and objectives most likely to result in successful transition.

10. Conduct analysis of the validity of the 6-month Service Plan Updates for CMs who were not recommended for transition based on a representative sample.

11. Develop Audit/Rating process and audit tools for Desk and On-Site Compliance Auditing by Colbert & Williams Program.


Reporting Requirements:
1. Financial Report in accordance with Exhibit C.
2. Performance Report in accordance with Exhibit E.
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.)
Eligibility Requirements
All Applicants must make certain the following are completed before an award can be made.
1. Complete and submit a Grant Application to DHS.GrantApp@illinois.gov. Each application must be sent in a separate email. Links are provided under the "GA" column at http://www.dhs.state.il.us/page.aspx?item=120031. Page 1 of the applications are pre-populated.
a. The subject line of the email MUST state:
i. Provider Organization Name
ii. CSFA Number (444-22-XXXX)
iii. Contact Name (Barb Roberson)
2. Complete and submit the Fiscal and Administrative Risk Assessment, also known as the ICQ, (short for Internal Control Questionnaire). This is done only once per entity per fiscal year via the GATA Grantee Portal https://www2.illinois.gov/sites/GATA/Pages/default.aspx. While it does not have to be completed prior to submitting the application, this step must be done before an applicant or their application can be considered for an award.
3. Complete and Submit the Programmatic Risk Assessment (PRA) for each grant opportunity. Links are provided under the "PRA" column below;
4. Complete and submit the FY 2021 Uniform Grant Budget in the IDHS CSA Tracking System (http://www.dhs.state.il.us/page.aspx?item=61069);

In addition, the following are eligibility requirements:
a. Register with the Illinois Grant Accountability and Transparency Act Grantee Portal.
b. Have a current DUNS number;
c. Have a current FEIN Number;
d. Have a current System for Award Management Account SAM.gov account;
e. Be in Good Standing with the Illinois Secretary of State, (government entities are exempt);
f. Register and access both the Illinois Department of Human Services Community Service Agreement (CSA) tracking system and the Centralized Repository Vault (CRV);
g. If indirect costs are included in the budget, have an annually negotiated indirect cost rate agreement (NICRA).
h. Not be on the Department of Healthcare and Family Services Provider Sanctions list;
i. Not be on the Federal Excluded Parties List.
Eligible Applicants
Nonprofit Organizations; Government Organizations;
Application and Award Processing
1. Complete and submit a Grant Application to DHS.GrantApp@illinois.gov. Each application must be sent in a separate email. Links are provided under the "GA" column at http://www.dhs.state.il.us/page.aspx?item=120031. Page 1 of the applications are pre-populated.
a. The subject line of the email MUST state:
i. Provider Organization Name
ii. CSFA Number (444-22-XXXX)
iii. Contact Name (Barb Roberson)
2. Complete and submit the Fiscal and Administrative Risk Assessment, also known as the ICQ, (short for Internal Control Questionnaire). This is done only once per entity per fiscal year via the GATA Grantee Portal https://www2.illinois.gov/sites/GATA/Pages/default.aspx. While it does not have to be completed prior to submitting the application, this step must be done before an applicant or their application can be considered for an award.
3. Complete and Submit the Programmatic Risk Assessment (PRA) for each grant opportunity. Links are provided under the "PRA" column below;
4. Complete and submit the FY 2021 Uniform Grant Budget in the IDHS CSA Tracking System (http://www.dhs.state.il.us/page.aspx?item=61069);
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
Reporting Requirements
1. Financial Report in accordance with Payments
2. Performance Report in accordance with Performance Measures.
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.
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
None
Agency IDGrantee NameStart DateEnd DateAmount
45CYB04057-45CYB04057THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOI12/31/201906/30/20201,009,050
45CYB04056-45CYB04056THE BOARD OF TRUSTEES OF THE UNIVERSITY OF ILLINOI12/31/201906/30/2020417,976