Please direct all program related information and questions to:

Shellie Harden
401 South Clinton, 4th Floor
Chicago, IL  60607
Phone:  312-793-4647
Fax:  312-793-4666
Email:  Shellie.Harden@illinois.gov

I. Introduction/Definition

The purpose of this grant is to provide case management services to high-risk pregnant women who have been identified by an assessment tool designed by the Department.

II. Policies & Procedures

Maternal and Child Health Services Code, 77 Illinois Administrative Code 630 (77 Ill. Adm. Code 630)

III. Contract and Amendment Process

Contract Process

The contract between the Department and the Provider is generally referred to as the Agreement and consists of several parts:

  1. Community Service Agreement, containing the standard contract language used for all Department contracts
  2. Exhibit A, containing Scope of Services/Purpose of Grant
  3. Exhibit B, containing Deliverables
  4. Exhibit C, containing Payment Information
  5. Exhibit D, containing Contact Information
  6. Attachment E
  7. The Program Manual, attached by reference to the Agreement, contains the program service provisions.

The Department will initiate the contract by having it online for the Provider to obtain and sign. The Provider will fax signature page to the Department to obtain the Secretary's signature and the Department will return a copy of the executed signature page of the contract to the Provider via pdf email.

Amendment Process

There are two types of amendments to an executed Community Service Agreement.

  1. Letters of increase or decrease - A letter is sent to the Provider stating the intent to increase or decrease dollars to specific program services existing in the Community Service Agreement. There is no need for the Provider to sign and return this document.
  2. Formal amendments - A two-party signed agreement to an executed Agreement is a formal amendment. The following process is required for a formal amendment to be processed:
    1. Adding new program services - An amendment to add a new program service must contain a detailed summary of services to be provided under the executed Community Services Agreement and a method of payment.
    2. Extending the service dates of the Community Services Agreement* -An amendment to extend the service dates of the Community Services Agreement must contain the following information:Agreement number as it appears on the original Community Services Agreement; Provider name; clause stating the new term of the Agreement; signatures of the Provider and the Secretary of the Department of Human Services

      *NOTE: A Community Services Agreement end date should be June 30, due to mandates in the State Finance Act regarding audit period. Language on pages one through nine in the Community Services Agreement may not be changed.

    3. Extending the service dates of an existing program attachment - An amendment to extend the date of a specific attachment in the existing Community Services Agreement must contain the following information:  Agreement number as it appears on the original Community Services Agreement; Provider name; clause stating the new term and the specific attachment name and number; signatures of the Provider and the Secretary of the Department of Human Services
    4. Changing language within an existing program attachment - An amendment to change language in an existing program attachment of the Community Services Agreement must contain the following information:  Agreement number as it appears on the Community Services Agreement; Provider name; clause(s) stating the new language; signatures of the Provider and the Secretary of the Department of Human Services

IV. Deliverables/Costs/Payments

  1. Payments to the Provider will be made on a prospective basis, rounded to the nearest $100.00. The final prospective payment may be greater or lesser than the previous payments due to rounding.
  2. The Department will compare the amount of the prospective payments made to date with the documented expenditures provided to the Department by the Provider. In the event the documented services provided by the Provider do not justify the level of award being provided to the Provider, future payments may be withheld or reduced until such time as the services documentation provided by the Provider equals the amounts previously provided to the Provider. Failure of the Provider to provide timely documentation may result in a reduction to the total award.
  3. The final payment from the Department under this Agreement shall be made upon the Department's determination that all requirements under this Agreement have been completed, which determination shall not be unreasonably withheld. Such final payment will be subject to adjustment after the completion of a review of the Provider's records as provided in the Agreement.

V.  Provider Responsibilities

  1. The Provider will provide case management services to high-risk pregnant women who have been identified by an assessment tool designed by the Department. To provide these services, the Provider will employ persons who have either: a Bachelor of Science degree in Nursing with an emphasis on maternal and child health, community health nursing or public health nursing; or a Master of Social Work degree with emphasis on services for women and children; and experience in working with young women and children. The caseload of high-risk pregnant women assigned to these case managers may not exceed 40 at any one time. The case managers will have at least two face-to-face contacts with each assigned client each month between enrollment and the termination of pregnancy. At least half of the contacts should occur in the pregnant woman's home.
  2. The Provider will use the Cornerstone management information system to record demographic, health status and service delivery information about each high-risk pregnant woman who receives services. Data entry must include a risk assessment, (707G), assessments 700, 701, 703, 704, 705, 706, 707D and 710 care plan, each prenatal medical care visit, referrals for mental health, substance abuse treatment, smoking cessation services and domestic violence intervention services, each child's birth date, birth place and birth weight, referrals to family planning.  All referrals (specialty care, mental health, housing, family planning etc.) are documented on the Cornerstone system referral screen (RFO1).  The referral screen is to be used to type in the reason for referral or to give the client written instructions.  Clients are to be given a copy of the referral.  The Provider will document the client's completion or failure to complete the referral in the comment section of the RF01 screen.
  3. In accordance with the PPMD Act, all women will receive information on post-partum mood disorders, and Providers will complete the screening and referral as appropriate.  DHS will provide a Post-partum Depression Brochure which is to be given to clients.

    Licensed health care workers providing TIPCM services shall screen women for PPMD at a prenatal check-up visit during pregnancy and in the six week post-partum period.  The Edinburg Postnatal Depression Scale shall be used for screening fathers and other family members, as appropriate, are to be included in the education and referral process.

  4. The Provider may use some of the funds provided for this program to purchase services for high-risk pregnant women if no other third-party payment source can be identified.
  5. The Provider will conduct additional outreach efforts to identify and recruit high-risk pregnant women to participate in this program. The Provider may use some of the funds provided for this program to purchase supplies of patient incentives or gift certificates to motivate high risk pregnant women to participate in services. Gift certificates may not be used to purchase alcoholic beverages or tobacco products.
  6. The Provider must provide quarterly reports on how "incentive dollars" were spent.  This documentation shall include, but not be limited to:
    1. what incentives were purchased
    2. how much was spent
    3. when/date purchase
    4. client's name and Cornerstone identification number
    5. client's signature receiving incentive and date incentive received
    6. secure signature of staff dispensing incentive
    7. date dispensed
    8. These quarterly reports are to be sent to the DHS TIPCM Program Administration.
  7. The Provider will meet with Department staff and the TIPCM evaluator to provide data as requested.
  8. The Provider will attend meetings with the Department's designated staff as requested.
  9. All clients will be given "All Kids" information and will be given information about "All Kids" application agent closest to them.

    All clients will receive educational materials about the importance of well-child visits and EPSDT services; to include but not limited to, immunizations, dental/oral health, lead, etc.

    All clients will receive information on the availability of free transportation assistance and how to access the transportation.  A notice of "free of charge" transportation service assistance will be posted so all clients can view such information.

  10. The Provider will use professional discretion in managing caseloads so that women at highest risk can receive care.  Prior to the transferring a client to a lower level of care, the agency nurse must review the case and give written approval.  The client must have documentation of keeping prenatal visits and reassessment with 707G in Cornerstone.  Clients may only be transferred to a lower level of care when caseloads are at capacity and a woman at very high-risk is in need of service, following completion of steps noted above.

VI. Department Responsibilities

The Department will provide technical assistance and monitoring for all programs operated under Community Health and Prevention.

VII. Support Services

Utilization of Community Resources

It shall be the responsibility of each project director to coordinate the services provided through the project with other sources of care in the community, such as:

  1. The Illinois Medical Assistance Program
  2. Local Health Departments
  3. Neighborhood Health Centers
  4. Local Child Development Clinics
  5. Division of Specialized Care for Children
  6. Local Hospitals
  7. Local Children and Family Services Programs
  8. Local Schools
  9. Vocational Rehabilitation Services
  10. Regional Perinatal Centers
  11. Local Early Intervention Programs for Infants and Toddlers with Handicaps
  12. Other related social service agencies

Please refer to 77 Ill. Adm. Code 630.160 and 630.170; Other Applicable Rules; and to the program-specific Exhibits for additional requirements.

VIII. Billing Instructions

  1. The Department will pay the Provider a set amount per month for each high risk pregnant woman who is active in the Provider's Targeted Intensive Prenatal Case Management program, as determined by the electronic data system. The Provider will receive notice of the amount to be paid per high risk woman served under separate cover.
  2. The Department will pay the provider an additional set amount per month for each month that each high risk pregnant woman was active in the Provider's Targeted, Intensive's Prenatal Case Management program if the woman delivers a normal birth-weight infant. "Normal birth weight" means a weight of, at a minimum, 5lbs 8oz. The Provider will receive notice of the amount to be paid per high risk woman based on "Normal Birth Weight" under separate cover.
  3. The Department will pay the Provider for outreach activities, services, and incentives as described within Project Description. The provider will document these activities on the Department of Human Services Summary of Expenditure Documentation Form.  Provider will receive notice of the amount to be paid for these services under separate cover.
  4. Providers shall use the following methodology to document the use of these funds:
    1. The Provider shall provide summary documentation by line item of actual expenditures incurred for the purchase of goods and services necessary for conducting program activities. The Provider shall use generally accepted accounting practices to record expenditures and revenues as outlined in DHS Rule 509, Fiscal Administrative Recordkeeping and Requirements.
    2. Expenditures shall be recorded in the Provider's records in such a manner as to establish an audit trail for future verification of appropriate use of Agreement funds.
    3. Expenditure documentation shall be submitted in a format, defined by the Division of Community Health and Prevention, to the Department on a quarterly basis, within 30 days after the end of each calendar quarter. However, the Provider shall have the option to report monthly.
    4. Annual budgets shall be submitted to the Program Manager for approval.  Any and all changes to a budget require prior approval and are to be submitted to the Program Manager with a detailed narrative budget justification outlining all changes and describing why they are necessary.
    5. The Provider shall submit expenditure documentation by one of the following means:
      1. Mailing Address
        Tom Evering
        815-823 East Monroe Street
        Springfield, IL 62701
        Phone:  217-557-2936
      2. Fax
        217-524-2491
      3. Email
        tom.evering@illinois.gov
    6. All financial record keeping on the part of the Provider shall be in accordance with generally accepted accounting principles consistently applied.

Expenditure Documentation Form Instructions

Expenditure Documentation Form

IX. Program Monitoring

Programs operated by the Provider under this contract will be monitored by the Department to review the program's progress according to stated goals, measurable objectives and administrative operations.

X. Program Budget

Providers agree to establish and utilize a budget approved by the Provider's Board of Directors.

XI. Appendices/Forms 

Not applicable.