Clinical Review (790)
CSFA Number: 444-22-0629
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 provide a second level, post clinical review of the Resident Review assessments conducted on all consenting Class Members when the determination is that the Williams Class Member is not being recommended for transition to the community, at this time. This second level review is to assure all reasonable services, resources and supports, within the existing DMH service taxonomy and other State Plan services have been considered to seamlessly facilitate the Class Members’ transition from the Nursing Facilities/Institutions for Mental Disease (NFs/IMDs) to the community. This Clinical Review process will assure the efficacy of the Resident Review assessment and that the initial reviewer’s recommendations were not overly conservative or restrictive in its conclusion. The Grantee will incorporate the expertise of the following professionals as part of the Clinical Review composition, Lead Clinician (Licensed Practitioner), Nurse, LCSW, LCPC and as needed: Psychiatrist, Internist and Administrative Assistant.

Exhibit B – Deliverables
The Grantee will be responsible for the following:
1. Receives referrals from the DMH Contact on Resident Review assessments with a determination of ‘not appropriate for transition, at this time’.
2. Convenes and schedules weekly Clinical Review team meetings, as appropriate, based on the volume of Resident Review cases received.
3. Assures the Clinical Review process has, at a minimum, participation from the lead licensed clinician, licensed clinical social worker, licensed clinical professional counselor, registered nurse, with other consultants, as required.
4. Assures full review and discussion from the Resident Review documentation, recommendations, and determination.
5. Assures completion of the required paperwork with the Clinical Review team findings with appropriate signatures.
6. Submits required paperwork with documentation on the Clinical Review recommendation to the DMH Contact within 7 business days after conclusion of the review process.
7. Provides DMH with a weekly list of Class Members who have had a Clinical Review and the status determinations – supported or overturned (recommended for transition).
8. Participates in weekly teleconferences with the DMH Clinical Review Coordinator.

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: $349 per review

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 weekly Clinical Resident Reviews assigned by DMH.
2. Number of Resident Reviews received from DMH for Clinical Review assigned to the Clinical Review Team.
3. Number of Clinical Review staffings convened per week (based on referral/assignments).
4. Number of Clinical Reviews conducted by a team with the required complement of necessary clinical staff, by academic discipline, who meet required academic credentials.
5. Number of Clinical Reviews completed with full participation and signatures of the reviewing clinical staff.
6. Number of Clinical Reviews processed and returned to DMH within 7 business days after conclusion.
7. Number of Clinical Reviews weekly spreadsheet returned to the DMH contact according to the designated schedule.
8. Number of Clinical Reviews weekly spreadsheet not returned to the DMH contact according to the designated schedule.
9. Number of weekly agency participation Clinical Review calls (teleconferences), as scheduled by DMH.
10. Number of weekly agency participation Clinical Review calls (teleconferences) as scheduled by DMH with 100% agency participation.

Exhibit F – Performance Standards
1. 100% of Resident Reviews received from DMH for Clinical Review assigned to the Clinical Review Team.
2. One or more weekly Clinical Review staffing.
3. 100% of Clinical Reviews conducted have the required complement of necessary clinical staff, by academic discipline.
4. 100% of all Clinical Review case files reviewed by the Clinical Review team.
5. 100% of Clinical Reviews have signature of the reviewing clinical staff.
6. 100% of Clinical Reviews completed and returned to DMH within 7 business days.
7. 100% of all Clinical Reviews weekly spreadsheet returned according to the designated schedule
8. 100% agency participation on Clinical Review calls, as scheduled by DMH.
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
Grantees will provide a second level, post clinical review of the Resident Review assessments that were conducted on all consenting Class Members when the determination was that the Williams Class Member was not being recommended for transition to the community at this time. This second level review is to assure that all reasonable services, resources and supports, within the existing Division of Mental Health (DMH) service taxonomy and other State Plan services have been considered to seamlessly facilitate the Class Members’ transition from the Nursing Facilities/Institutions for Mental Disease (NF/IMD) to the community. This Clinical Review process will assure the efficacy of the Resident Review assessment and that the initial reviewer’s recommendations were not overly conservative or restrictive in its conclusion. The providers will incorporate the expertise of the following professionals as part of the Clinical Review composition as needed: Lead Clinician (Licensed Practitioner of the Healing Arts (LPHA)), Nurse, Psychiatrist, Internist, and Administrative Assistant.

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
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
Details19-444-22-0629-01$7329 - $1920002/02/2018 - 03/19/2018 : 5:00 pm
Details19-444-22-0629-02$7329 - $1920004/30/2018 - 05/04/2018 : 5:00 pm
Agency IDGrantee NameStart DateEnd DateAmount
45CYB00824-45CYB00824ASSOCIATION HOUSE OF CHICAGO07/01/201906/30/202028,640
45CYB00832-45CYB00832TRILOGY, INC.07/01/201906/30/202025,061
45CYB00831-45CYB00831THE THRESHOLDS07/01/201906/30/202024,702
45CYB00828-45CYB00828HUMAN RESOURCES DEVELOPMENT INSTITUTE, INC. HRDI07/01/201906/30/202023,270
45CYB00826-45CYB00826GRAND PRAIRIE SERVICES07/01/201906/30/202022,912