Please direct all program related information and questions to:

Glendean Sisk
401 South Clinton, 4th Floor
Chicago, IL  60607
Phone:  312-814-1354
Fax:  312-793-4666

I. Introduction/Definition

The purpose of this grant is to provide Maternal and Child Health efforts through the Chicago Department of Public Health.

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. 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

In administering the programs and activities funded hereunder, the Provider shall:

  1. Provide Maternal and Child Health (MCH) primary care services to the non- Medicaid, non-All-Kids, medically indigent population (those persons or families with incomes between 200% and 300% of the federal poverty level) in city clinics operated by Chicago Department of Public Health, as well at Near North Health Services Corporation and University of Illinois. 
  2. The Provider will submit a written plan in May prior to the commencement of the next fiscal year, describing target population to be served, specific services to be delivered at each clinic site and expected volume that will be reached.  The plan will identify expected outcomes and plan for monitoring service delivery.  Expected outcomes must mirror those identified by the Title V Federal initiative.  Areas of focus may include prenatal and postnatal healthcare, reproductive health, STD testing and treatment, pediatric health services including well-child visits and immunizations, reduction of unintentional and intentional injuries in children, high-risk infant follow-up, smoking cessation efforts, screening for perinatal mood disorders and identification and referral for substance abuse.

    The internal Continuous Quality Improvement (CQI) Plan will describe the processes that will be utilized, and include both fiscal and clinical components.  Periodic Provider and client satisfaction surveys must be included in the CQI Plan.

    The Plan must include a description of how data is tracked and reported, including identification of various databases and logs.  The Plan must also identify how the Provider will coordinate with, but not duplicate existing program services including Title X Family Planning, Family Case Management, Targeted Intensive Prenatal Case Management, All Our Kids Network, and the Community Health Center grants at all identified service sites.

  3. The Provider will submit quarterly status reports within 30 days after the end of each calendar quarter and a composite annual report to the Department.  The reports will include:
    1. The number of unduplicated clients served.
    2. Total number of encounters provided for each type of service identified in work plan.  The report will include the following:
      1. Age of client
      2. Income level of client or client's family
      3. Race and ethnicity
      4. Medicaid eligibility status
      5. All Kids eligibility status
  4. Make every effort to inform clients of the services available from the expanded Medicaid and All Kids Programs, including Illinois Healthy Women. The Provider will assist recipients in completing the Maternal and Child Health (MCH) Medical Assistance Application and will function as an off-site application agent. It is expected by both parties that through these efforts there will be a reduction in the need for primary care resources from this Attachment, and that these resources will be redirected to other MCH system development and support activities.  Any change to the submitted work plan must be approved by the Department.  The Provider agrees to meet at least quarterly with the Department to discuss utilization of the funds and outcomes achieved.
  5. Confidentiality - Client information will be kept confidential.  Any and all client information must be shredded before it is discarded.  Providers will have a policy in place that addresses storage, proper disposal and sharing of confidential information.

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 Physical, Mental and Emotional Disabilities
  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. Payments to the Provider for the provision of primary care services will be based on information submitted on the Department's Primary Care Monthly Claim Form. Payments shall be made on a fee-for-services basis at the current Illinois Department of Healthcare and Family Services CPT Code rate. The Provider shall submit the Primary Care Monthly Claim Form on a monthly basis throughout the grant period. The final claim form for primary care services shall be submitted within 30 days of the end of the grant period.
  2. For all other payments the Provider 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 of reporting 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
      3. Email
    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.