19-444-26-1725-01 Access to Medication Assisted Treatment (MAT) - SOR

Helping Families. Supporting Communities. Empowering Individuals.

Summary Information

1. Awarding Agency Name: Illinois Department of Human Services
2. Agency Contact: Agency contact information for the application process:
name, email address and phone number
3. Announcement Type:

Joseph Tracy

joseph.tracy@illinois.gov

(312) 814-6359

4. Type of Assistance Instrument: Grant
5. Funding Opportunity Number: 19-444-26-1725-01
6. Funding Opportunity Title: Access to Medication Assisted Treatment (MAT) - SOR
7. CSFA Number: 444-26-1725
8. CSFA Popular Name: Access to Medication Assisted Treatment (MAT) - SOR
9. CFDA Number(s): 444-26-1725
10. Anticipated Number of Awards: 3
11. Estimated Total Program Funding: $1,500,000
12. Award Range A single application budget may not exceed $500,000
13. Source of Funding: Federal
14. Cost Sharing or Matching Requirement: No
15. Indirect Costs Allowed Yes
Restrictions on Indirect Costs 2 CFR 200 /45 CFR Part 75
16. Posted Date: 8/13/2018
17.Application Range: 8/13/2018 - 10/15/2018
18. Technical Assistance Session: Session Offered: Yes
Session Mandatory: No

August 23, 2018 1:00pm to 2:30pm

A copy of the Webinar will be posted on this website when available.

to only view slides AMAT SOR Bidders Conf.pdf (pdf)

NOFO Supplemental

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

A. Program Description

Medication Assisted Treatment (MAT) - SOR Grant

Background

In June 2018, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued Funding Opportunity Announcement (FOA) # TI-18-015, State Opioid Response Grants (SOR). This SAMHSA grant program expands upon the federal funds made available to states and territories to address the opioid crisis in this country. This grant program's stated aim is "to address the opioid crisis by increasing access to medication-assisted treatment (MAT) using the three FDA-approved medications for the treatment of opioid use disorder (OUD), reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD) (including prescription opioids, heroin, and illicit fentanyl and fentanyl analogs)." To be considered MAT in Illinois, with the exception of services provided in a hospital setting, patients must be receiving one of the three FDA-approved medications for OUD in combination with participation in IDHS/SUPR-licensed treatment services. The grants awarded to states and territories are formula-based. Illinois is targeted to receive $28,569,209 in each of two years through this Grant program. The service initiatives included in the Illinois SOR grant application are designed to expand upon the services supported through the SAMHSA-STR grant that was awarded to Illinois in May 2017.

While various population groups and areas of the State of Illinois have been differentially impacted by opioid use-related problems, virtually all communities and residents of our state have in some way been impacted by the opioid crisis. Perhaps none of the problems that are associated with the national opioid crisis has heightened the awareness of the general public as the dramatic increase in opioid overdose deaths. From 1999 to 2016, more than 350,000 Americans died from an overdose involving any opioid. In 2016, there were about 42,000 opioid-related overdose deaths in this country which was about five times higher than the comparable number in 1999 (Centers for Disease Control and Prevention (CDC), 2018). Like most states, Illinois has experienced a notable increase in drug overdose deaths that can primarily be attributed to an increase in opioid overdose deaths. Death records obtained from the Illinois Department of Public Health (CDPH) showed 2,110 drug-related overdose deaths during 2017. The majority of these were heroin-related fatalities either alone or in combination with a synthetic opioid, primarily fentanyl. From 1999 to 2016, the population rate of opioid overdose deaths in Illinois increased from 3.9 to 15.3 per 100,000 persons (National Institute on Drug Abuse). The 1,947 opioid-related overdose deaths among Illinois residents in 2016 represented an over 300% increase in the number of such deaths that were reported in 1999. Based on their review of multiple national databases, the CDC has concluded that for every opioid overdose death it can be concluded that there are 130 individuals who have some form of OUD. If this estimation factor is applied to Illinois, it can be estimated that there are over 250,000 persons in our state with an OUD.

Need for Expanded MAT Services

According to the Centers for Disease Control and Prevention (CDC), expanding access to MAT is essential to an effective response to the dramatic increase in opioid-related problems in this country (https://www.cdc.gov/vitalsigns/heroin/). Research evidence indicates that MAT for opioid clients, particularly OMT, has the potential to save significantly more money than other forms of treatment (http://www.who.int/whr/2004/en/report04_en.pdf?ua=1). These cost-saving impacts of MAT are attributable to a wide range of improvements in the health inequities that are commonly experienced by primary opioid clients, to include reduced rates of drug use, increased access to health care and other recovery support services, improved interpersonal relationships and living conditions, and decreased involvement in high-risk behaviors such as injection drug use. It has been observed that the regular long-term involvement of opioid users in MAT plays a significant role in overall harm reduction practices. Additionally, there is evidence of harm reduction benefits among both primary opioid clients who continue to use while in MAT, and those who prematurely discontinue treatment (Thiede, H, Hagan, H & Murrill, CS. Methadone treatment and HIV and Hepatitis B and C risk reduction among injectors in the Seattle area. Journal of Urban Health. September 2000, Volume 77, Issue 3, pp 331-345. SAMHSA estimates that there are approximately 2.5 million patients who need specialty treatment for opioid use disorder (OUD), but only a small fraction of the population is able to access it (Park-Lee, E., Lipari, R. N., Hedden, S. L., Kroutil, L. A., & Porter, J. D. (2017, September). Receipt of services for substance use and mental health issues among adults: Results from the 2016 National Survey on Drug Use and Health. NSDUH Data Review. Retrieved from https://www.samhsa.gov/data/)

All IDHS/SUPR-licensed treatment organizations that provide services supported by public funding, except services reimbursed by Managed Care Organizations, are required to report client demographic and service provision data through our Division Automated Reporting and Tracking System (DARTS). Based on an analysis of our DARTS data for State Fiscal Year 2016 (SFY16), there were 49,887 total admissions to IDHS/SUPR funded treatment services. A total of 14,885 (29.8%) of these SFY16 admissions were persons who indicated opioids as their primary substance of abuse, with heroin accounting for 83.8% of these primary opioid admissions. Based on the available information, only 9.1% of these primary opioid patients were admitted to IDHS/SUPR-licensed MAT services.

Medication Assisted Therapy (MAT) is the use of one of three FDA-approved medications coupled with behavioral therapy and supportive services and is a highly effective way of treating opioid use disorder. Each of the three medications - buprenorphine, methadone and naltrexone - is covered by Medicaid in Illinois. IDHS/SUPR has been evaluating the availability of MAT services in the state to identify areas of the state that may have insufficient or no access to MAT services in order to strategize ways to expand those services.

IDHS/SUPR licenses 79 outpatient methadone treatment (OMT) sites in Illinois, but there are 84 counties with no methadone providers, representing 20.2% of the state's population. One approach to increasing access to OMT is to increase the number of sites, but there are various infrastructure requirements associated with the establishment of OMT service sites. In the United States, the treatment of opioid dependence with medications is governed by the Certification of Opioid Treatment Programs, 42 Code of Federal Regulations (CFR) 8. This regulation created a system to accredit and certify opioid treatment programs (OTPs). OTPs provide medication-assisted treatment (MAT) for people diagnosed with an opioid-use disorder. MAT patients also must receive counseling, which can include different forms of behavioral therapy. An OTP must be certified by SAMHSA and accredited by a SAMHSA-approved accrediting body. IDHS/SUPR must license OTPs as part of the Federal regulatory process. The whole process is quite lengthy making it difficult to quickly develop new OTPs in the state.

The Drug Abuse Treatment Act of 2000 (DATA 2000) expanded access to a then new medication approved for OUD treatment; buprenorphine is now allowed to be dispensed or prescribed in settings other than OTPs. Physicians may apply for and receive a waiver from the requirements of the Controlled Substances Act, allowing them to prescribe this medication in an office-based setting. In order to apply to receive a waiver a practitioner must complete a SAMHSA-approved training. The waiver application is then submitted to the Drug Enforcement Administration (DEA) and they assign a special number to the physician which must be included on prescriptions of buprenorphine. More information about this process, including the details of the application format can be found on SAMHSA's website: https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/training-materials-resources/buprenorphine-waiver

National efforts to increase the number of physicians waivered to prescribe buprenorphine has significantly expanded access in recent years; however, 72% of certified physicians are treating only 30 patients, with under 20% certified for treating up to 100 patients (Physician and Program Data. (2017, March 14). Retrieved April 18, 2018, from https://www.samhsa.gov/programs-campaigns/medication-assisted-treatment/physician-program-data).

In Illinois, there are 1150 physicians waivered to prescribe buprenorphine. Of this total number 714 physicians, or 62%, are active, having prescribed in the past year. Of these active prescribers, 396 or 56%, are certified to treat only 30 patients and 31% are certified for treating up to 100 patients, leaving 13% of active Illinois prescribers certified to treat up to 275 patients. In addition to increasing the number of buprenorphine prescribers, Illinois aims to increase the number of patients that waivered physicians are serving, as well as increasing the access to waivered physicians throughout the state. There are 47 counties with no active buprenorphine prescribers, representing 7.3% of the population.

Naltrexone (Vivitrol is the registered trade name) is the third medication approved by the Food and Drug Administration (FDA) to treat opioid or alcohol use disorders. It is available in a pill or a 30-day injectable form. Naltrexone can be prescribed by any health care provider who is licensed to prescribe medications as it is not a controlled substance. A patient must be abstinent from opioids for 7-10 days prior to beginning this treatment in order to reduce the risk of precipitated withdrawal. As with the other opioid treatment medications, Illinois aims to increase both the number of patients with access to this treatment and the number of prescribers using the medication to treat their patients with OUD. Currently, 79 counties have no physicians listed on the public Vivitrol directory; this represents 18.6% of the population without access to this medication.

Access to all three medications is of critical importance given unique needs and circumstances of individual persons in need. There are many people who live in Illinois counties that do not have any providers of MAT services, severely limiting access to these evidence-based treatments. Of the 102 counties in Illinois, 57 have no providers of any of the three FDA-approved medications for MAT. We are defining these areas as "MAT deserts". These areas comprise approximately 10.4% of Illinois' population and represent a significant portion of the state's geography.

Recently IDHS/SUPR issued a NOFO titled Access to Medication Assisted Treatment Pilot Grants and is in the process of establishing grants with entities that will begin or expand MAT services to counties including Williamson, Johnson, Franklin, Saline, Jackson, Union; and Sangamon, Christian, Morgan, Logan and Mason. However, many MAT deserts still remain.

Inclusion of Expanded MAT in Illinois SOR Grant Goals and Objectives

Illinois SOR Project Goal 2 aims to increase the availability of evidence-based information, outreach, linkage/referral, medication-assisted treatment (MAT), recovery support, and prevention services that are available for Illinois residents with opioid use disorders (OUD). Specifically, this goal calls for funding in support of additional Hub and Spoke Programs to increase availability of MAT services in targeted Illinois geographic areas.

Three additional MAT grants will be funded through this NOFO; these grants are consistent with the SAMHSA-funded Illinois SOR goals and objectives. The focus will be on those geographic areas that are still "MAT deserts", having no access to any forms of MAT. Excluded will be areas targeted by the recently funded Hub & Spoke pilots (Williamson, Johnson, Franklin, Saline, Jackson, Union; and Sangamon, Christian, Morgan, Logan and Mason).

During this fiscal year, IDHS/SUPR has allocated $1,500,000 to fund these three(3) additional A-MAT Hub and Spoke grants.

It is estimated that nearly 1.3 million people in Illinois do not have access to MAT services (57 counties). This NOFO will offer opportunities in three areas to increase access to MAT services. These funds will provide a foundation for community providers and partners to create a network of services that will be sustainable following the initial grant funding period. The focus will be on areas that contain a substantial population center surrounded by more rural areas. The population of the MAT desert counties is attached for your reference in Attachment 2.

Based upon published information about effective MAT models for rural populations Illinois plans to implement projects in three additional geographic areas that will be based upon the Hub and Spoke Model (Brooklyn, J. R., & Sigmon, S. C. (2017). Vermont Hub-and-Spoke Model of Care for Opioid Use Disorder: Development, Implementation, and Impact. Journal of Addiction Medicine, 11(4), 286-292. http://doi.org/10.1097/ADM.0000000000000310). This model is adapted from the design developed by the State of Vermont (2014).

The Hub and Spoke Model is recognized as an evidence-based regional approach for delivering Medication Assisted Treatment (MAT) to clients who suffer from opioid use disorders. This approach is designed to coordinate opioid use disorder treatment with medical care and counseling, supported by community health staff and services, to effectively treat the whole person as they make their way along the path to recovery.

  • A Hub is a regional opioid treatment center responsible for coordinating the care and support services for patients who have complex substance use disorders and/or co-occurring mental health conditions. Patients who need methadone must be treated here. Patients who need buprenorphine or naltrexone may be treated here.
  • A Spoke is a primary care practice, specialty practice or health center responsible for coordinating the care and support services for patients with opioid use disorders who have less complex medical needs. Only patients who are treated with buprenorphine or naltrexone receive treatment in the spokes.
  • Depending on the patient's needs, Support Services may include mental health and/or substance use disorder treatment, pain management, family supports, life skills, job development, and recovery supports.

Illinois MAT Project Performance Goals

IDHS/SUPR is committed to supporting the development of local, rural infrastructures that can improve access to treatment in communities that are currently unserved. These projects will use the Hub and Spoke Model to develop a network of services serving a defined geographic area.

Within the projected total amount of $1,500,000 that will be allocated towards supporting expanded MAT services, there is a maximum funding award of $500,000 for a single application.

Performance

Successful applicants will be responsible for developing a comprehensive collaborative network approach to delivering MAT services, including medication and counseling, in a defined geographic area.

While we are seeking responses consistent with a Hub and Spoke approach, we encourage innovative solutions consistent with challenges in the applicant's defined "MAT desert" area. New approaches to partnerships with local pharmacists/pharmacies, use of telemedicine, or other concepts are encouraged. Keep in mind that these are start-up funds to be used to create the infrastructure for ongoing services that are reimbursable or can become reimbursable and otherwise sustainable through funding sources other than the Illinois SAMHSA-SOR grant.

Telemedicine has been shown to successfully support linkages to evidence-based medical treatment in a variety of areas. There is strong evidence that telemedicine increases access to care (Franek 2012, Brown 2007, Wootton 2012, Clark 2007, McLean 2011, Eland-de Kok 2011, Hailey 2008, IHE-Ohinmaa 2010), especially for individuals with chronic conditions (McLean 2011, Wootton 2012) and those in rural and other traditionally underserved areas (Kehle 2011, Bashshur 2009, Penate 2012). This is a particular area that SUPR will support in these grants. Preference will be given to applications that demonstrate use of these funds to support development or expansion of telemedicine in rural areas.

Successful applicants will be responsible for providing services in compliance with the programmatic and reporting requirements specified in the current IDHS/SUPR Contractual Policy Manual Service Protocols for Substance-Related Disorder Treatment/Ancillary Services for Opioid Maintenance Therapy. Successful applicants will also be responsible for collecting and reporting data that will allow IDHS/SUPR to comply with SAMHSA SOR grantee expectations. This data will also assist IDHS/SUPR in evaluating the patient outcomes that are associated with these enhanced services. Required data collection will consist of administration of the baseline version of an interview tool to each patient who is admitted to MAT services provided through the Hub and Spoke network. Successful applicants will also be expected to administer a follow-up version of this tool to admitted MAT patients at six-months following their date of admission. SUPR will provide training on administration of this tool as well as instructions regarding the submission of completed interview tools. The development of applicant staffing patterns should take into account consideration of these data collection and reporting requirements. SUPR also anticipates supporting a process evaluation of the development, implementation, and functioning of the funded Hub and Spoke projects. Successful applicants will be expected to cooperate with the information and additional data collection requirements that will be associated with this process evaluation. This NOFO's program narrative must include a statement that the applicant agrees to comply with these data collection and reporting expectations.

Each applicant will serve its defined area and provide access to comprehensive opioid use disorder treatment services to patients meeting appropriate American Society of Addiction Medicine (ASAM) patient placement clinical criteria. In addition, these networks will assure the provision of recovery support services based upon client needs; services may include mental health and/or substance use disorder treatment, pain management, family supports, life skills, job development, and peer recovery supports. Each network will provide access to specialized Medication Assisted Treatment (MAT) for clients and include the following key components:

  • Identification of a lead agency to coordinate the planning of services; lead agency must be licensed by SUPR
  • Ability to expand and enhance methadone services (preference will be given for an agreement to include an existing OTP, if lead agency is not an OTP); if no methadone providers are currently in the area, the ability to submit a plan for the development of these services; SAMHSA accreditation required for Opioid Treatment Programs (OTP)- guidelines: http://www.samhsa.gov
  • Expansion of buprenorphine and naltrexone providers
  • Linkage to hospital emergency departments to provide services following overdose
  • Plan for creating a system of care for people with OUDs, including the provision of counseling and care management including recovery support
  • Description of how you will develop the role of your medical champion; this is the person or team that will provide your expertise and leadership for MAT services, and will provide consultation to other physicians or partners who need clinical technical assistance
  • Ability to require key team members to participate in a learning collaborative
  • Provide access to buprenorphine providers within 60 minute travel time and to methadone services within 30 minute travel time for defined catchment area; if no methadone providers currently serve the area, provide a development plan to create these services
  • Creation of community-based advisory council
  • Plan for access to all three evidence-based MAT medications (methadone, buprenorphine, naltrexone)
  • Buprenorphine treatment delivered by qualified and SAMHSA-waivered physicians;
  • Comprehensive and non-duplicative services in collaboration with area substance use disorder, mental health, and other behavioral health and human services providers;
  • Coordinated and integrated health care services in collaboration with the area health services providers;
  • Use of or plan to incorporate telemedicine in the network design/operation;
  • Ability to serve a minimum of 100 new patients annually during the project period;
  • Successful applicants will be expected to begin operation of the project within 60 days of award. This must include ways to inform and include the local community and people in need of proposed services.

Deliverables

Successful applicants will be responsible for the following deliverables and associated timelines:

  • Development of an approved project implementation plan within 30 days of award that will enable the delivery of services within the first 60 days of receiving the award. This must include the organizational structure of the project, staffing and chart of key milestones along the way to the overall goal of increasing access to MAT services and creating a Hub and Spoke network. In particular, this must include recruiting and onboarding additional Spoke practices.
  • Successful applicants will be expected to achieve 100% of their target for admission of MAT patients during the first 12 months of funding.
  • Successful applicants will ensure that an IDHS Recipient Identification Number (RIN) has been assigned to each person admitted to MAT services provided through the Hub and Spoke network. The IDHS RIN will be used as the unique non-identifying number that will be used for all baseline and follow-up data collection tools.
  • Successful applicants will be responsible for the submission of monthly reports of quantitative service delivery data and narrative information detailing the development of the network. The report format will be developed by IDHS/SUPR to be compliant with SAMHSA -SOR grantee reporting requirements as stated in the federal FOA, and which may be communicated to state grantees by SAMHSA post-award. IDHS/SUPR will provide directions for the completion of these reports and their submission. The monthly reports will be due within 15 calendar days of the end of the reporting month.
  • Successful applicants will be responsible for administration of the SAMHSA/CSAT GPRA data collection to each person admitted to MAT services provided by the Hub and Spoke network. The baseline version of this tool shall be administered within 7 calendar days of admission to MAT services. The funded organization will be responsible for completion of the CSAT/GPRA tool that is completed at time of discharge from the MAT services. The applicant will also be responsible for administering a SAMHSA/CSAT GPRA tool at six-month post-admission follow-up. IDHS/SUPR will provide training on the administration and completion of these SAMHSA/CSAT GPRA tool versions, along with instructions for the submission of completed tools.
  • Successful applicants will be expected to participate in additional information and data collection activities that will be associated with a process evaluation of the development, implementation, and functioning of the Illinois Opioid-SOR Hub and Spoke Projects.
  • Successful applicants will identify key staff who will attend required meetings and learning collaborative sessions.
  • Successful applicants will be expected to participate in site visits by IDHS/SUPR and/or contractor staff that will include sample reviews of MAT patient medical records.

B. Funding Information

  1. This grant program is 100% Federally-funded. Funding for this award will come from the SAMHSA SOR grant award to IDHS/SUPR and does not have a match requirement. This NOFO is considered a new application.
  2. In SFY2019, IDHS anticipates the availability of approximately $1,500,000 for eligible applicants.
  3. There is a maximum amount of $500,000 for an award to a qualified organization within the limit of available funding.
  4. Subject to appropriation, the project period will begin upon the execution of the grant agreement and will continue through September 29, 2020, contingent upon Federal funding conditions.
  5. Pre-award costs for services in anticipation of an award are not allowable.
  6. Applicants may submit more than one proposal; however, only one geographic service area may be included in a single application. Applicants should submit one complete application per geographic service area for consideration. There must be one lead applicant that is prequalified via Illinois GATA processes (http://www.dhs.state.il.us/page.aspx?item=101591), but the proposal should be a collaboration between multiple entities, and may propose sub-agreements for components of the work. The specific geographic area to be included in the project network must be specifically described. The scope of the area should include at least one larger population center that is a MAT desert, and should include additional, more rural counties according to local service patterns. Multiple geographic service areas may be included in a single application however the area and site specific information requested in this NOFO must be provided for each proposed geographic service area. IDHS reserves the option of selecting among a provider organization's proposed geographic service areas in the award.
  7. Subcontractor Agreement(s) approved by IDHS/SUPR. Subcontractors are subject to all provisions of the Agreement(s). The successful applicant agency shall retain sole responsibility for the performance of the subcontractor.

NOTE: The release of this NOFO does not obligate IDHS to make an award.

C. Eligibility Information

Eligible Applicants. This competitive funding opportunity must include a lead entity that is currently licensed by IDHS/SUPR and who will be able to perform the services of the Hub, and together with other partners:

  1. Are in good standing with the Secretary of State.
  2. Complete the GATA pre-qualification process.
  • All applicants are required to provide the requested information as outlined in this NOFO to be considered for funding. Successful proposals will serve as the applicant's program plan and budget for the SFY2019 grant period.
  • Applicant agencies will not be eligible for a grant award until they have pre-qualified through the Grant Accountability and Transparency Act (GATA) Grantee Portal, www.grants.illinois.gov. During pre-qualification, Dun and Bradstreet verifications are performed including a check of Debarred and Suspended status and good standing with the Secretary of State. The pre-qualification process also includes a financial and administrative risk assessment utilizing an Internal Controls Questionnaire (ICQ). If applicable, the agency will be notified that it is ineligible for award as a result of the Dun and Bradstreet verification. The entity will be informed of corrective action needed to become eligible for a grant award.

Cost Sharing or Matching.

Not applicable.

Indirect and Direct Administrative Costs.

Federally Negotiated Indirect Cost Rate Agreement (NICRA) - Organizations that receive direct federal funding may have an indirect cost rate that was negotiated with the Federal Cognizant Agency. Illinois will accept the federally negotiated rate. The organization must provide a copy of the Federal NICRA letter which confirms a valid federal rate for the SFY2019 time period.

  1. State Negotiated Rate - The organization must negotiate an indirect cost rate with the State of Illinois if it does not have a Federally Negotiated Indirect Cost Rate or the organization may elect to use a de minimis rate. The indirect cost rate proposal must be submitted to the State of Illinois within 90 days of the notice of award.
  2. De Minimis Rate - An organization that has never received a Federally Negotiated Indirect Cost Rate may elect a de minimis rate of 10% of modified total direct costs (MTDC). Once established, the de minimis rate may be used indefinitely. The State of Illinois must verify the calculation of the MTDC annually in order to accept the de minimis rate.

Training and Technical Assistance:

Programs must agree to receive consultation technical assistance from authorized representatives of the Department. This technical assistance may include training on the administration and submission of SAMHSA/CSAT Government Performance and Results Act (GPRA) tools for each person admitted to MAT services through this grant. The program and collaborating partners will be required to be in attendance at any site visits by IDHS/SUPR staff. Programs will be required to attend regular meetings and trainings as provided by IDHS or a subcontractor of IDHS. This will include team participation in a learning collaborative.

Sectarian Issue:

Applicant organizations may not expend federal or state funds for sectarian instruction, worship, prayer, or to proselytize. If the applicant organization is a faith-based or a religious organization that offers such activities, these activities shall be voluntary for the individuals receiving services and offered separately from the program.

Background Checks:

Background checks are required for all program staff and volunteers who have the potential for one-on-one contact with children and youth. Funded programs will be required to have a written protocol on file requiring background checks, as well as evidence of their completion.

Other: In NO case will more than one proposal be funded within the same geographic area or in overlapping geographic areas. Applicants may be asked to revise their originally proposed catchment area to ensure that this is the case.

Other:

The applicant that is awarded funds through this NOFO must demonstrate the ability to provide and maintain the personnel and technical infrastructure required to successfully fulfill the conditions of the contract.

Agencies awarded funds through this NOFO must have a computer that meets the following minimum specifications for the purpose of utilizing the required IDHS reporting forms and the receipt/submission of electronic program and fiscal information:

  • Internet access, preferably high-speed
  • Email capability
  • Microsoft Excel
  • Microsoft Word

D. Application and Submission Information

Materials are provided throughout the announcement. Appendices will be made available in user/printer friendly format and may be found on the Illinois Department of Human Services web site at: http://www.dhs.state.il.us/page.aspx?item=101591. Please click on the corresponding link to the right. Additional copies may be obtained by contacting the contact person listed below.

Contact:

Joseph Tracy

Illinois Department of Human Services

Division of Substance Use Prevention and Recovery

401 South Clinton, 2nd Floor

Chicago, IL 60607

email: Joseph.Tracy@illinois.gov

phone: 312.814.6359

Each applicant must have access to the internet. The IDHS website will contain information regarding the NOFO and materials necessary for submission. Questions and answers will also be posted on the Department's website as described later in this announcement. It is the responsibility of each applicant to monitor that website and comply with any instructions or requirements relating to the NOFO.

LETTER OF INTENT REQUESTED

A letter of intent is requested to allow Division staff to estimate the potential review workload and plan the review. The letter is not required, is not binding, and does not enter into the review of a subsequent application.

Applicants are requested to submit a letter of intent on or before September 28, 2018, and should include the following:

  • Number and title of this funding opportunity
  • A brief description of the proposed project
  • Name, email address and telephone number(s) of the lead agency contact
  • A description of the geographic area to be served
  • A list of participating partners

The letter of intent should be sent to: Joseph.Tracy@illinois.gov

The Agency, Opportunity Number and the label "LOI" (letter of intent) must be in the subject line. Specifically, the subject line must be:

* Your Organization Name, 19-444-26-1725-01, LOI

E. Application Review Information

Proposal Narrative Content:

Applicants must submit a proposal that contains the information outlined below. Each section must have a heading that corresponds to the headings in bold type listed below. Within each section, you must indicate the Section letter and number in your response, i.e., type "A-1", "A-2", etc., before your response to each narrative item. If the applicant believes that the subject has been adequately addressed in another part of the application narrative, then provide the cross-reference to the appropriate part of the narrative. The narrative portion must follow the page guidelines set for each section and must be in the order requested.

Formatting:

The Proposal Narrative text must be legible. Pages must be typed in black on letter-size (8 1/2 x 11) paper, single-spaced, using a font of Times New Roman 12, with all margins (left, right, top, bottom) at least one inch each. You may use Times New Roman 10 only for charts, tables, and footnotes. Pages must be numbered consecutively from beginning to end of the Proposal Narrative. The page limit for the Proposal Narrative is 10 pages. Any narrative information that exceeds the 10-page limit will be discarded and excluded from the review process.

Applicant organizations must provide the following information.

  1. Organization Qualifications (20 Points)- Expertise and experience in MAT Treatment (20 points). The purpose of this section is for the applicant to provide a description of the organization's experience and qualifications generally, and specific to the provision of MAT services.
    1. Provide a brief description of the full array of services provided by your organization and partners included in this application. Include numbers of persons served annually in your service programs, types of services delivered, and the general demographics of service program participants.
    2. Describe the MAT services currently provided by your organization and partners, to include the site locations of these services, the number of persons served during SFY2017 or SFY2018 (please indicate which year you choose), and the demographic characteristics of these persons (e.g. race, gender, average age, Hispanic/Latino ethnicity, and sexual identity). Describe any focus on special populations, particularly families involved with DCFS, clients involved in the criminal justice system.
    3. Provide a brief description of the staff members that will be responsible for the delivery of the MAT services including their educational background, organizational affiliation, years of experience and other relevant information.
    4. Provide a summary of existing linkages between the key partners and with external community resources and services, particularly with organizations addressing employment, human, and health services not provided by the applicant organization. Highlight any linkages with state or local human services or correctional organizations.
  2. Population of Focus and Statement of Need (20 points).
    Identify the geographic area(s) in which the organization plans to deliver the pilot services and the sites at which these services will be provided. Describe the characteristics of the general population of the proposed geographic service area(s), and the expected characteristics of the persons who will be served through the expanded MAT services. If the applicant proposes to provide expanded MAT services in multiple distinct geographic areas, provide this information for each area.
    1. Identify the geographic area(s) in which you plan to deliver the proposed MAT services, the physical location(s) at which these services will be delivered, and the current SUPR licensure status of the physical location(s). Provide a demographic profile of the general population of this geographic area in terms of race, ethnicity, language, gender, age, rural/urban population, and socioeconomic (including insurance) status. Provide an expected demographic profile of the persons who will be served through the Hub and Spoke network MAT services.
    2. Provide a summary of the impacts of the opioid crisis among residents of the proposed geographic service area(s). Include mention of your organization's involvement in local activities and strategies in response to the opioid crisis.
    3. Provide evidence of the need to expand the organization's MAT services in the proposed geographic service area(s).
  3. Description of Program Services (40 points).
    Provide the following information regarding the proposed expanded Hub and Spoke network MAT services that will be delivered in the identified geographic service area(s). Address each point listed below and make sure your document follows the order listed:
    1. Provide an overview of your plan to create a Hub and Spoke Model network, addressing the key components and deliverables from section A of this NOFO as well as the following points:
      1. Your short-term start-up plan (6 months) with goals, objectives and timeframes.
      2. The longer-term plan with goals, objectives and timeframes for the development of your service network. If there are currently no methadone providers in your targeted area, include a specific plan for the development of these services.
      3. A plan for developing network MAT service delivery procedures and protocols. Describe which individuals will be responsible for developing and managing the clinical and program protocols. If you will be developing new methadone services (OTP) describe the process for serving all OUD patient needs while these services are being developed. Describe the process of phasing in the OTP.
      4. Describe the role of your medical champion and how this individual or team will provide leadership for the MAT service delivery, and consultation to physician partners who may need technical assistance
      5. Provide a detailed staffing plan for both the Hub site and the Spoke practices. (see example ATT. A)
    2. Describe your use of the Illinois Prescription Monitoring Program in patient monitoring.
    3. Describe your plan and timelines to identify, recruit and retain additional physicians, care managers and clinicians in the proposed services. Describe your in-service training plan to support key staff.
    4. Describe the clinical and care management approaches that you will use to ensure coordination of care for patients and with partners. Describe how telemedicine will be used to support components of your care. Include:
      1. Evidence-based practices that your Hub and Spoke network organizations will use in the delivery of expanded MAT services; state whether these evidence-based practices will be implemented as part of the Hub and Spoke Model services, and describe how the delivery of these practices will be documented.
      2. Your approach for managing induction and stabilization for new patients; describe points of entry to services and how care will be managed differently depending on where patients access treatment (Hub or Spoke). Explain assessment protocols including how you determine needs for counseling and recovery support services.
      3. Describe the development of treatment guidelines and protocols for health teams to use in specific practice settings (e.g., primary care, specialty care) for transitions of care, for identified health conditions (e.g., opioid dependence with depression or chronic pain), and for prevention and management of substance relapse.
      4. Describe your plan for monitoring MAT patients' health status, treatment progress, and service use to improve care and address gaps in care.
      5. Describe how you will deliver the co-existing medical and support services needed by your clients. This can include health services, recovery support services and adjunct services such as transportation and child care. Describe supportive services for family members, as a minimum to include education about opioid use disorders.
      6. Describe your procedures for preventing the diversion of methadone and other prescribed medications.
      7. Describe how you will deliver individual and family support services to assist individuals to fully participate in treatment, to reduce barriers to accessing care, to support age and gender appropriate adult role functioning, and to promote recovery.
    5. Describe current barriers that you face and explain how you plan to approach them; for example, recruitment of physicians, engagement of law enforcement partners, others.
    6. State the unduplicated number of patients that you propose to admit to the expanded MAT services during SFY2019. State the total funds being requested and the estimated average cost per patient during this funding period.
  4. Performance Data Collection and Reporting (20 points).
    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, applicants will be expected to collect and report data indicators and measures as described in this NOFO. The applicant agency must address the following items in regard to performance data collection and reporting.
    1. Describe your experience with the collection and reporting of program service and performance data. Include mention of your organization's record of submitting the Medication Log and DARTS patient and service data that is required as part of your IDHS/SUPR contract (if applicable). Make mention of any experience that your organization has with administration of the SAMHSA/CSAT GPRA tool.
    2. Describe your organizational procedures for collection, maintenance, and reporting of patient demographic and service data.
    3. Describe your organization's capacity and commitment to collect and report the service and performance data specified in this NOFO, as well as participation in the IDHS/SUPR Hub and Spoke Project process evaluation.
    4. Describe your experience developing and using data to assess use of care guidelines in practice settings, patient outcomes, and patient experience of care.
    5. Describe your experience in designing and implementing quality improvement activities to improve the provision of care (e.g., learning collaboratives, PDSA cycles).
    6. Describe how you have shared information (measures and results) with community stakeholders, institutions, and community representatives for planning and evaluation purposes.
    7. The following elements are key in improving care in a network model; please describe your capacity to track the following elements:
      1. Patient transitions between levels of care
      2. Hospital admissions for MAT patients
      3. Presence of co-occurring mental health disorders/treatment
      4. Concurrent treatments for chronic medical conditions (diabetes, heart disease, etc.)
  5. Budget and Budget Narrative
    (No page limit-include as Attachment A), Not Scored
    The SFY2019 A-MAT Project service contracts of successful applicants will contain expense-based budgets. Monthly invoices will be submitted that will summarize services delivered, goals and objectives accomplished, challenges encountered and other information specified for project evaluation. The reports submitted will need to demonstrate compliance with the components of the contact.

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

Each applicant is required to:

  • Be registered in SAM before submitting the application. The following link provides a connection for SAM registration: www.sam.gov
  • Provide a valid DUNS number in its application.
  • Continue to maintain an active SAM registration with current information at all times in which the applicant has an active Federal, Federal pass-through or State award or an application or plan under consideration by a Federal or State awarding agency.

IDHS may not make a Federal pass-through or State award to an applicant until the applicant has complied with all applicable DUNS and SAM requirements and, if an applicant has not fully complied with the requirements by the time IDHS is ready to make the award, IDHS may determine that the applicant is not qualified to receive the award and use that determination as a basis for making the award to another applicant.

Submission Dates and Times:

Applications must be received no later than 12:00 p.m. on October 15, 2018. The application container will be date and time-stamped upon receipt via email. The Department will not accept applications submitted by mail, overnight mail, diskette, or by fax machine.

Submit the completed grant proposal to DHS.GrantApp@Illinois.gov and submit the proposal electronically on or before October 12, 2018 at 12:00 p.m. Applications must be emailed.

* If you have trouble emailing the document due to the file size, please utilize the CMS File Transfer Utility located at https://filet.illinois.gov/filet/PIMupload.asp Please follow the instructions to attach your application. Remember to include the subject line above.

To be considered, proposals must be emailed by the designated date and time listed above. For your records, please keep a copy of your email submission with the date and time the application was submitted along with the email address to which it was sent. The deadline will be strictly enforced. In the event of a dispute, the applicant bears the burden of proof that the proposal was received on date and time and to the email address listed above.

Intergovernmental Review --Not Applicable

Funding Restrictions:

  1. The grant program is subject to the cost principles found in Subpart E 2 CFR 200.
  2. Examples of unallowable costs include, but are not limited to:
    • Bad debts
    • Contingencies or provision for unforeseen events
    • Contributions and donations
    • Entertainment, food, alcoholic beverages, gratuities
    • Cash incentives to participate in treatment/recovery support sessions
    • Housing costs
    • Fines and penalties
    • Interest and financial costs
    • Legislative and lobbying expenses
    • Real property payments or purchases
  3. Grant funds cannot be used for existing services provided by the applicant organization; the use of these funds to supplant existing resources is not allowed
  4. The use of a federally-approved indirect cost rate for research is not allowable.

Other Submission Requirements:

  1. Proposal Container and Format Requirements: All applications must be typed on 8 1/2 x 11-inch paper using 12-point type and at 100% magnification. Tables may be used to present information with a 10-point type.
  2. The program narrative must be typed single-spaced, on one side of the page, with 1-inch margins on all sides. The program narrative must not exceed the page totals specified in Section D: Application and Submission Information, #2 - Content and Form of Application Submission.
  3. The entire application, including appendices, must be sequentially page numbered (hand written page numbers are acceptable). Items included in other than the program narrative NOT included in the page limitations. The program narrative has a maximum of 10 pages.
  4. Applicants must submit the proposal via an email. Submit the proposal to DHS.GrantApp@Illinois.Gov. The Department is under no obligation to review applications that do not comply with the above requirements.
  5. The Agency Opportunity Number and the program contact must be in the subject line. Specifically, the subject line must be:
    • Your Organization Name, 19-444-26-1725-01 , Joseph Tracy
  6. Successful applicants will be required to submit a complete electronic version of their approved application and budget.
  7. The Uniform State Grant Application can be found at GA 19-444-26-1725-01.pdf (pdf), Uniform Grant Budget Template can be found at https://www2.illinois.gov/sites/GATA/Documents/Resource%20Library/GATA%20Spring%202018%20Training%20for%20FY19/GOMBGATU-3002.pdf
  8. Applicants must submit a single proposal in pdf format. All items, including attachments and appendices, must be scanned or "pdf'd" and sent in a single e-mail.
  9. ALL Applications MUST include the following mandatory forms/attachments in the order identified below and the files must be sent in three separate pdf files matching the sections below. Each file should be labeled to correspond with the subject line of your e-mail and then labeled with the appropriate section name:
    1. Uniform State Grant Application
    2. Grant Expense-Based Budget Template (pdf)
    3. Proposal Narrative (following the headings in Section E)
      • Your Organization Name, 19-444-26-1725-01 , Uniform State Grant Application

      • Your Organization Name, 19-444-26-1725-01, Grant Expense-Based Budget

      • Your Organization Name, 19-444-26-1725-01, Proposal Narrative

Please use your organization's full legal name on all forms and documents. (An abbreviation in the filename and subject line is allowed as long as it is consistent throughout.)

F. Award Administration Information

  1. Criteria: Funding is not guaranteed. All applicants must demonstrate that they meet all requirements under this NOFO as described throughout. Applications that fail to meet the criteria described in "Eligible Applicants" as identified in Section C "Eligibility Information" will not be scored and considered for funding.
    • Review teams comprised of three individuals in IDHS serving in the Division of Substance Use Prevention and Recovery will be assigned to review applications. Applications will first be reviewed and scored individually. Scores will be sent to the application Review Coordinator to be compiled and averaged to produce the final application score.
    • Proposal Scoring: Application Narratives will be evaluated on the following criteria:
    • Organizational Qualifications - 20 points
    • Population of Focus and Statement of Need - 20 points
    • Description of Program Services - 40 points
    • Performance Data Collection and Reporting - 20 points
    • Budget and Budget Narrative - Not scored
    • TOTAL 100 POINTS
    • The application criteria to be reviewed and scored are found under each category in this announcement in Section E. Content and Form of Application Submission. Please include relevant information in the appropriately headed section; otherwise, your information may not be reviewed. Do not refer back to information in other sections of the application.
  2. Review and Selection Process:
    Proposals will be reviewed by a team consisting of qualified individuals assigned by staff from IDHS. Panel members will read and evaluate applications independently using guidelines furnished by IDHS. Scoring will be on a 100-point scale. Scoring will not be the sole award criteria. While recommendations of the review panel will be a key factor in the funding decisions, IDHS considers the findings of the review panel to be non-binding recommendations. IDHS maintains final authority over funding decisions and reserves the right to consider additional factors, such as geographical distribution of proposed service areas and patient population characteristics, when making final award decisions.
    • Final award decisions will be made by the Secretary, at the recommendation of the Director of the Division of Substance Use Prevention and Recovery. IDHS reserves the right to negotiate with successful applicants to cover under-served areas that may result from this process.
    • In NO case will more than one proposal be funded for the same provider organization. IDHS may contact applicants to obtain clarification regarding any aspects of an application prior to making any awards. IDHS is not obligated to make any State award as a result of the announcement. The issuance of grants under this NOFO is contingent upon federal funds awarded to IDHS/SUPR in response to the Illinois Opioid-STR application to SAMHSA.

Merit-Based Evaluation Appeal Process

Competitive grant appeals are limited to the evaluation process. Evaluation scores may not be protested. Only the evaluation process is subject to appeal, and shall be reviewed by the IDHS' Appeal Review Officer (ARO).

Submission of Appeal.

  1. Competitive grant appeals are limited to the evaluation process. Evaluation scores may not be protested. Only the evaluation process is subject to appeal, and shall be reviewed by the IDHS' Appeal Review Officer (ARO).
  2. Submission of Appeal.
  3. An appeal must be submitted in writing to Danielle Kirby of IDHS/SUPR who will send to the ARO for consideration.
  4. An appeal must be received within 14 calendar days after the date that the grant award notice has been published.
  5. 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.

Response to Appeal.

  1. IDHS will acknowledge receipt of an appeal within 14 calendar days from the date the appeal was received.
  2. IDHS 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.
  4. Resolution
    1. The ARO 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, the ARO 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.
    4. The determination shall include, but not be limited to:
      1. Review of the appeal;
      2. Appeal determination; and
      3. Rationale for the determination.

G. State Awarding Agency Contact(s)

  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 Finalist." This notice will identify additional grant award requirements that must be met before a grant award can be executed. These will include one or more of the following:
    • Grantee Pre-Qualification Process
    • Financial and Administrative Risk Assessment - Internal Control Questionnaire
    • Conflict of Interest and Mandatory Disclosures
  2. A Notice of State Award (NOSA): A NOSA will be issued to the review finalists that have successfully completed all grant award requirement. Based on the NOSA, the review finalist is positioned to make an informed decision to accept the grant award. The NOSA shall include:
    • The terms and condition of the award.
    • Specific conditions assigned to the grantee based on the fiscal and administrative and programmatic risk assessments.
    • Upon acceptance of the grant award, announcement of the grant award shall be published by the awarding agency to Grants.Illinois.gov.
    • A Notice of Non-Selection as a State Award Finalist shall be sent to the applicants not receiving awards.
    • The NOSA must be signed by the grants officer (or equivalent). This signature effectively accepts the state award and all conditions set forth within the notice. This signed NOSA is the authorizing document. The Agency signed NOSA must be remitted to the Department as instructed in the notice.
  3. Administrative and National Policy Requirements: The agency awarded funds shall provide services as set forth in the IDHS grant agreement and shall act in accordance with all state and federal statutes and administrative rules applicable to the provision of the services.
    • To review a sample of the FY2019 IDHS contract/grant agreement, please visit the IDHS website at Sample FY19 Uniform Grant Agreement (UGA) (pdf)
    • The agency awarded funds through this NOFO must further agree to comply with all applicable provisions of state and federal laws and regulations pertaining to nondiscrimination, sexual harassment and equal employment opportunity including, but not limited to: The Illinois Human Rights Act (775 ILCS 5/1-101 et seq.), The Public Works Employment Discrimination Act (775 ILCS 10/1 et seq.), The United States Civil Rights Act of 1964 (as amended) (42 USC 2000a-and 2000H-6), Section 504 of the Rehabilitation Act of 1973 (29 USC 794), The Americans with Disabilities Act of 1990 (42 USC 12101 et seq.), and The Age Discrimination Act (42 USC 6101 et seq.). Additional terms and conditions may apply.
  4. Indirect Cost Rate Requirements:
    • Federally Negotiated Indirect Cost Rate Agreement (NICRA) - Organizations that receive direct federal funding may have an indirect cost rate that was negotiated with the Federal Cognizant Agency. Illinois will accept the federally negotiated rate. The organization must provide a copy of the Federal NICRA letter which confirms a valid federal rate for the SFY2019 time period.
    • State Negotiated Rate - The organization must negotiate an indirect cost rate with the State of Illinois if it does not have a Federally Negotiated Indirect Cost Rate or the organization may elect to use a de minimis rate. The indirect cost rate proposal must be submitted to the State of Illinois within 90 days of the notice of award.
    • De Minimis Rate - An organization that has never received a Federally Negotiated Indirect Cost Rate may elect a de minimis rate of 10% of modified total direct costs (MTDC). Once established, the de minimis rate may be used indefinitely. The State of Illinois must verify the calculation of the MTDC annually in order to accept the de minimis rate.
  5. Reporting:
    1. The Provider will submit monthly expenditure documentation forms (EDFs) in the format prescribed by IDHS. The EDFs must be submitted no later than the 15th day of each month for the preceding month by email.
    2. The Provider will be responsible for the deliverables and data collection and reporting expectations listed in Section A of this NOFO.
    3. The Provider will submit audits and/or Financial Reports in a format provided by the Department and by the established deadlines.

H. Other Information, if applicable

Questions and Answers: If you have questions related to this NOFO, please send them via email to: Joseph.Tracy@illinois.gov with "Illinois SOR - A-MAT Project - NOFO" in the subject line of the email.

NOTE: The final deadline to submit any written questions regarding the Illinois SOR - A-MAT Project - NOFO is September 28, 2018.

Mandatory Forms -- Required for All Agencies

  1. GA 19-444-26-1725-01.pdf
  2. IDHS Grant Forms - Budget: Excel Version may be used for Application submission, but Final Budget must be entered into CSA Tracking before an Agreement can be issued.

Important Dates For this NOFO

What? When? Who?/Where?
Bidders' Conference

August 23, 2018

1pm-2:30pm

Webinar
Letter of Intent September 28, 2018 Joseph.Tracy@illinois.gov
Questions Submitted September 28, 2018 Joseph.Tracy@illinois.gov
Proposals Due October 15, 2018

12:00pm

Joseph.Tracy@illinois.gov

Attachments

GA 19-444-26-1725-01.pdf (pdf) 

Attachment A

BASIC HUB STAFFING DESIGN (EXAMPLE - BASED UPON ANNUAL CENSUS OF 400 CLIENTS)

Staffing

1 FTE Program Director

50% FTE MD

2 FTE RN Supervisors

3 FTE LPN Dispensing

8 FTE LADC/MA Counselors

2 FTE Case Managers

3 FTE Lab Technicians

2 FTE Office Admin/Data Manager

20% FTE Consulting Psychiatry

Attachment B

MAT Deserts Dashboard (pdf)