1195 Neuropsych Assessments (Prog 796)

Helping Families. Supporting Communities. Empowering Individuals.

Summary Information

1. Awarding Agency Name: Department of Human Services, Division of Mental Health
2. Agency Contact: Name:  Shanna Frank
Email:  shanna.frank@illinois.gov
Phone:  217-785-9656
3. Announcement Type: Initial announcement
4. Type of Assistance Instrument: Grant
5. Funding Opportunity Number: 19-444-22-1195-02
6. Funding Opportunity Title: 1195 Neuropsych Assessment
7. CSFA Number: 444-22-1195
8. CSFA Popular Name: Neuropsych Assessment
9. CFDA Number(s): Not Applicable
10. Anticipated Number of Awards: 1
11. Estimated Total Program Funding: $45,360 for the Williams Consent Decree
12. Award Range $35,360 - $45,360
13. Source of Funding: State
14. Cost Sharing or Matching Requirement: No
15. Indirect Costs Allowed Yes
Restrictions on Indirect Costs No
16. Posted Date: April 11, 2018
17. Application Range:

April 11, 2018 - April 25, 2018

Deadline:April 25, 2018 at 5:00 pm

18. Technical Assistance Session: Session Offered: No
Session Mandatory: No

NOFO Supplemental

(Agency-specific Content for the Notice of Funding Opportunity)

A. Program Description

Exhibit A - Scope of Service

The Provider 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 such, to determine if the disease is so severe or persistent to the extent that 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.

Provider 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

Payment will be issued in response to Provider submitted quarterly invoices on the appropriate DMH invoice template at the established rate(s) (if applicable). Invoices shall be submitted to the DMH program contact no later than November 1, February 1, May 1, and August 1, and will be reconciled on the basis of reported allowable expenses per the Grant Funds Recovery Act [30 ILCS 705/7 and 8]. (The Grant Funds Recovery Act is not applicable to Fixed-Rate Grants.) All invoices shall be HIPPA compliant and encrypted utilizing DHS approved encryption software.

The Provider 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.

Rate: $252 per hour

Exhibit E - Performance Measures

The Provider 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. The following are included in the reporting template.

The following are included in the reporting template:

  1. Number of Class Members referred for a neuropsychological assessment
  2. Number of neuropsychological assessments scheduled
  3. Number of neuropsychological assessments initiated.
  4. Number of neuropsychological assessments completed
  5. Number of Class Members who self-aborted the assessment
  6. Number of Class Members whose assessment was aborted by the clinician due to distress or other symptoms
  7. Number of Class Members assessed and recommended for transition
  8. 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 will be scheduled for an assessment
  3. 100% of referrals scheduled will be initiated
  4. 70% of assessments initiated will be completed
  5. Less than 10% of Class Members' scheduled will self-abort the assessment
  6. Less than 10% of Class Members' scheduled will have the assessment session aborted by the clinician
  7. 40% of Class Members assessed will be recommended for transition, based on clinical appropriateness
  8. 60% of Class Members assessed will not be recommended for transition, if based on clinical appropriateness

B. Funding Information

Funding for this award will come from the State's General Revenue Fund and does NOT have a match or cost sharing requirement.

This NOFO is considered a competitive application for funding.  It is not a guarantee of funding.

In FY 2019, the Department (DHS/DMH) anticipates awarding approximately $45,360 in General Revenue (State) funds.

Subject to appropriation, the grant period will begin upon execution of the grant agreement and will continue through June 30, 2019. Anticipated start date is July 1, 2018.

  1. 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.

  2. 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.

  3. Unallowable Costs

    Please refer to 2 CFR 200 - Subpart E - Cost Principles to see a collection of unallowable costs.

  4. 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:

    1. Federally Negotiated Rate;
    2. State Negotiated Rate and
    3. 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:

    1. Applicant has performed satisfactorily during the past six months;
    2. All required reports have been submitted on time, unless a written exception has been provided by the Division; and
    3. No outstanding issues are present (i.e. in good standing with all pre-qualification requirements and no outstanding corrective action, etc.)

C. Eligibility Information

Applicant organization/agency must document that the provision of the service(s), as identified in this contract, remain Conflict Free from the provision of providing or subcontracting direct care mental health services, i.e., therapy, counseling, ACT, CST or case management.

  1. Applicant's staff must be board certified Psychologists with specialized training in neuropsychology
  2. Applicant's staff must have 3-5 years of demonstrated experience performing neuropsychological assessments/evaluations.
  3. Applicant must not be an IDHS community mental health center or a Medicaid (Rule 132) certified provider organization.
  4. Eligible Applicants

    The funding opportunity is not limited to those who currently have a Division of Mental Health contract or an award from the Department of Human Services; however, applicants must:

    1. Not be an IDHS community mental health center or a Medicaid (Rule 132) certified provider organization.; 
    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.
  5. Applicants that do not comply with these requirements by the application deadline may become ineligible to receive an award.
  6. Cost Sharing or Matching: See Section B Funding Information.
  7. Indirect Cost Rate: See Section B Funding Information, #4 Indirect Cost Rate Requirements.

D. Application and Submission Information

  1. Address to Request Application Package

    Each applicant must have access to the internet. Applicants may obtain application forms at the Department's website www.dhs.state.il.us Questions and answers will also be posted on the Department's website. It is the responsibility of each applicant to monitor that website and comply with any instructions or requirements relating to the NOFO.

  2. Content and Form of Application Submission

    Each applicant is required to submit a Uniform Application for State Grant Assistance.

    Format Requirements

    1. All applications must be typed using 12-point type and at 100% magnification.
    2. The PDF submission must be on 8 1/2 x 11-inch page size.
    3. With the exception of letterhead and stationery for letter(s) of support, the entire proposal should be in black typeface on a white background.
    4. The proposal narrative must be typed single-spaced with 1-inch margins on all sides.
    5. Proposal narrative shall not exceed 10 pages. Items included as Attachments are NOT included in the page limitations.
    6. The entire application, including attachments, should be sequentially page numbered and must be compiled in the following order:
      1. Uniform State Grant Application (Not included in page limit)
      2. Proposal Narrative (10 page limit) addressing the following areas:
        1. Executive Summary 
          The purpose of this section is for the applicant to present the agency description, history, achievements, service description, financial overview and future plans.
        2. Capacity - Agency Qualifications/Organizational Capacity
          The purpose of this section is for the applicant to present an accurate picture of the agency's ability to meet the program requirements.
        3. Need - Description of Need
          The purpose of this section is for the applicant to provide a clear and accurate picture of the need for these services within the community and how the proposed project will address these needs. It is understood that the need for these services is statewide and this NOFO intended to identify and fund applicants to serve the most at-risk communities with the greatest identified need in the target population.
        4. Quality - Description of Program Services
          The purpose of this section is for the applicant to provide a detailed, clear and accurate picture of its intended program design.
        5. Data Collection, Evaluation and Reporting
          To ensure accountability at all levels of service provision, IDHS is implementing the practice of performance-based contracting with its Grantee agencies. The articulation and achievement of measurable outcomes help to ensure that we are carrying out the most effective programming possible. At a minimum, Grantees will be expected to collect and report data indicators and measures as described in this NOFO.
        6. Resource Availability
          Describe what resources and other knowledge, skill and abilities in addition to those specific to the duration of the funding cycle the applicant possesses or will budget for in order to support the objective of this program. These may include, but not limited to the availability of space like meeting rooms, space to carry out this program, etc.
      3. Attachments (Not included in page limit)
        1. Linkage Agreements (if applicable)
        2. Approved NICRA
      4. Budget Requirements

        A budget and budget narrative need to be completed in the CSA tracking database. The budget is not scored. The budget narrative should describe how the specified resources and personnel have been allocated for the services and activities described in the proposal narrative. The budget should be prepared to reflect a full fiscal year.

  3. Dun and Bradstreet Universal Numbering System (DUNS) Number and System for Award Management (SAM)

    See Section C Eligibility Information, Eligible Applicants, #3, letters i and j.

  4. Submission Dates and Times
    1. In order to be considered for award, proposals must be in the possession of the DHS/DMH email address DHS.GrantApp@illinois.gov and by the designated date and time listed in Box 17 of the NOFO. Emails into this box are electronically date and time stamped upon arrival. In the event of a dispute, the applicant bears the burden of proof that the application was received on time at the email address listed above. If an applicant experiences technical difficulties, you must contact Shanna Frank at shanna.frank@illinois.gov prior to the submission deadline. If State systems are deemed to be working properly, it is the applicant's responsibility to ensure their application package arrives at the appropriate email address before the submission deadline date and time.
    2. Proposals will only be accepted electronically. Those that are delivered by any other means, and/or late will not be accepted and will be immediately disqualified. DHS/DMH is under no obligation to review applications that do not comply with the above requirements. There will be no exceptions.  Applicants will receive an email to notify them that the application was received.
    3. Submit the completed grant application as a single document to: DHS.GrantApp@illinois.gov 
      Specifically, the subject line of the email MUST state: "Your Organization's Name; 19-444-22-1195-02; Shanna Frank"
    4. DHS/DMH anticipates that the term of the agreement resulting from this NOFO will be July 1, 2018 continuing through June 30, 2019 and will require the mutual consent of both parties, be dependent upon the Grantee's performance and adherence to program requirements and the availability of funds.
    5. DHS/DMH may withdraw this Notice of Funding Opportunity at any time prior to the actual time a fully executed agreement is filed with the State of Illinois Comptroller's Office.
    6. If it becomes necessary or appropriate for DHS/DMH to change any part of this NOFO, a modification to the NOFO will be available from the DHS website as well as change made to the www.grants.illinois.gov website. In case of such an unforeseen event, DHS/DMH will issue detailed instructions on how to proceed.

E. Application Review Information

  1. Criteria
    Points
    Executive Summary 5 points
    Capacity - Agency Qualification/Organizational Capacity 10 points
    Need - Description of Need 5 points
    Quality of Program/Services 15 points
    Data Collection, Evaluation and Reporting 5 points
    Resource Availability 10 points
    TOTAL 50 points
  2. Review and Selection Process
    1. Proposals will be reviewed by a team of DHS/DMH staff familiar with the requirements of the program including services to be performed in specified geographic location, if applicable. Review team members will have no conflicts of interest and will initially read and evaluate proposals independently. Then, team members will collectively review the application, their scores and comments to ensure team members have not missed items within the application that other team members identified. Application highlights and concerns will be discussed. Scores will then be sent to the Proposal Review Coordinator to be compiled and averaged to produce the final application score.
    2. Merit-Based Evaluation Appeal Process
      1. Competitive program grant appeals are limited to the merit-based evaluation process only. Evaluation scores may not be protested; only the evaluation process is subject to appeal.
      2. Appeals Review Officer
        DHS or designee may appoint one or more Appeal Review Officers (ARO) to consider the grant-related appeals and make a recommendation to DHS or designee for resolution.
      3. Submission of Appeal
        1. An appeal must be submitted in writing to DHS/DMH.
        2. An appeal must be received within 14 calendar days after the date that the grant award notice has been published.
        3. The written appeal shall include at a minimum the following:
          1. The name and address of the appealing party;
          2. Identification of the grant;
          3. A statement of reasons for the appeal.
      4. Response to Appeal
        1. DHS/DMH will acknowledge receipt of an appeal within 14 calendar days from the date the appeal was received;
        2. DHS/DMH will respond to the appeal within 60 days or supply a written explanation to the appealing party as to why additional time is required;
        3. The appealing party must supply any additional information requested by IDHS within the time period set in the request.
      5. Resolution
        1. DHS/DMH shall make a recommendation to the Agency Head or designee as expeditiously as possible after receiving all relevant, requested information.
        2. In determining the appropriate recommendation, DHS/DMH shall consider the integrity of the competitive grant process and the impact of the recommendation on the State Agency.
        3. The Agency will resolve the appeal by means of written determination. The determination shall include, but not be limited to:
          1. Review of the appeal;
          2. Appeal determination; and
          3. Rationale for the determination
  3. Anticipated Announcement

    Notice of State Award (NOSA) will be made by the end of June 2018.

F. Award Administration Information

  1. State Award Notices

    Applicants recommended for funding under this NOFO following the above review and selection process will receive a Notice of State Award (NOSA). The NOSA shall include:

    1. The terms and conditions of the award.
    2. Specific conditions assigned to the grantee based on the fiscal and administrative, programmatic risk assessments and merit based review conditions.
    3. The NOSA is not an authorization to begin performance or incur costs.
    4. Upon acceptance of the NOSA, announcement of the grant award shall be published by the awarding agency to www.Grants.Illinois.gov
    5. A written Notice of Denial shall be sent to the applicants not receiving awards.
  2. Administrative and National Policy Requirements
    1. The agency awarded these funds shall provide services as set forth in the DHS grant agreement and shall act in accordance with all state and federal statutes and administrative rules applicable to the provision of the services including indirect cost rate requirements in Section B: Funding Information, #4 Indirect Cost Rate Requirements.
    2. The legal agreement between DHS/DMH and the successful applicant(s) will be the standard DHS Uniform Grant Agreement. If selected for funding, the applicant will be provided a DHS grant agreement for signature and return. A sample of the agreement may be found at http://www.dhs.state.il.us/page.aspx?item=29741.  The FY19 Uniform Grant Agreement will be available in March 2018. No material changes are anticipated.
  3. Reporting

    Reporting requirement for the grant agreement shall be in accordance with the requirements set forth in Section A, Payment Terms and Performance Measures and shall also comply with the requirements of Exhibits C and E of the Uniform Grant Agreement.

    G. State Awarding Agency Contact(s)

    1. DHS/DMH encourages inquiries concerning this funding opportunity and welcomes the opportunity to answer questions from applicants. Frequently asked "Questions and Answers" will be posted to the DHS website and updated periodically.
    2. Notice of Funding Opportunity Contact
      Name:Shanna Frank
      Email: shanna.frank@illinois.gov
    3. Indirect Cost Contact
      Name:  Rhonda Mitchell, CPA
      Email: rhonda.mitchell@illinois.gov

    H. Other Information, if applicable

    1. DHS/DMH reserves the right to request additional information that could assist with its award decision. Applicants are expected to provide the additional information within a reasonable period of time. Failure to provide the information could result in the rejection of the proposal.
    2. The release of this Notice of Funding Opportunity does not compel DHS/DMH to make an award.
    3. This funding opportunity is considered a new application.
    4. Useful websites
      1. Grant Accountability and Transparency Act website:
        https://www.illinois.gov/sites/gata/Pages/default.aspx
      2. Illinois Grant Accountability and Transparency Act (GATA) (30ILCS 708/)
        http://ilga.gov/legislation/ilcs/ilcs3.asp?ActID=3559&ChapterID=7
      3. Illinois Administrative Code Part 7000 - Grant Accountability and Transparency Act (44 Ill. Adm. Code Part 7000) ftp://www.ilga.gov/JCAR/AdminCode/044/04407000sections.html
      4. Uniform Administrative Requirements, Cost Principles and Audit Requirements (2 CFR 200)
        https://www.ecfr.gov/cgi-bin/text-idx?tpl=/ecfrbrowse/Title02/2cfr200_main_02.tpl
      5. OMB Uniform Guidance
        https://www.grants.gov/web/grants/learn-grants/grant-policies/omb-uniform-guidance-2014.html
      6. Electronic Code of Federal Regulations at http://www.ecfr.gov/
      7. DHS website:  www.dhs.state.il.us
      8. CSA tracking database