Please direct all program related information and questions to:

Kennye Westbrook
401 South Clinton, 4th Floor
Chicago, IL  60607
Phone:  312-793-4605
Fax:  312-793-4666
Email:  Kennye.Westbrook@illinois.gov

I. Introduction/Definition

The Provider will work with the Department of Human Services staff to develop and implement a fetal and infant mortality review (FIMR) program serving the metropolitan Chicago Area.

II. Policies & Procedures

Policies and Procedures specific to the operation of a special project may be found in the application for federal or foundation funds that support the special project.

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. Exhibit E, containing Performance Measures
  7. Exhibit F, containing Performance Standards
  8. Exhibit G, containing State Agency Contracts
  9. Attachment E
  10. 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 only 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 work with the Department of Human Services staff to develop and implement a fetal and infant mortality review (FIMR) program serving the metropolitan Chicago Area. The Provider's activities will include, but are not limited to, the following:
    1. Specify the nature and extent of the fetal and infant mortality review, 
    2. Determine FIMR's relationship to other types of death reviews,
    3. Establish systems to maintain confidentiality, 
    4. Establish a system to identify cases, 
    5. Develop a working agreement with the City of Chicago Health Department to work collaboratively with the reviews required by the State of Illinois' Adverse Pregnancy Outcome Report as it relates to Fetal and Neonatal Deaths,
    6. Formalize policies and procedures,
    7. Participate in regular meetings to update DHS and the Chicago Department of Public Health of the project status, 
    8. Abstract medical records - Abstraction tool that indicates if a client is in the DHS Healthy Start Program,
    9. Conduct home interviews,
    10. Establish in conjunction with DHS staff a community case review (CRT) team, 
    11. Conduct CRT meetings,
    12. Participate in the activities of the Perinatal Care Statewide Quality Council,
    13. Collaborate and partner with staff working in HIV/FIMR project,
    14. By December 31, 2012 in cooperation and collaboration with DHS and the Illinois Maternal Child Health Coalition (IMCHC), will develop a strategic plan to decrease infant mortality in targeted communities.
    15. Develop and maintain an electronic data collection in conjunction with the State Perinatal Data System.  This System shall identify those clients enrolled in Healthy Start Programs.
    16. Prepare an annual summary report identifying findings of client interviews and chart abstractions.  This report is due June 30, 2013.

VI. Department Responsibilities

The Department will provide technical assistance and monitoring for all programs operated under Family and Community Services.

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

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 Family and Community Services, 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. The Provider shall submit expenditure documentation by one of the following means:
    1. Mailing Address
      Tina Finley
      100 South Grand Ave East 2nd FL
      Springfield, IL 62762
      Phone:  217-785-2991
    2. Fax
      217-524-2491
    3. Email 
      tina.finley@illinois.gov
  5. 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 (pdf)

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.