- Payment Suspension
- Service Claims
- Individual Services
- Group Services
- Units of Service Reimbursement
- Cost Reimbursement
- Match Requirement
All services are expected to have functional and measurable data concerning services provided by funds awarded. Service activities and outcomes are referred to as the contract deliverables. Title XX Social Services Block Grant, Donated Funds Initiative funded service activities and outcomes are detailed in the IDHS approved Program Plan and summarized on the Community Services Agreement Exhibit A. The provider is required to comply with Exhibit A and the program plan and provide the services outlined. Any changes to the Program Plan must be submitted in writing and approved by the Bureau prior to implementation.
The Provider must submit any and all contract deliverable data required by rule or by the Department.
Fee for Service
Payments occur after service has been provided and documentation has been received by IDHS. Payments made as a fee-for-service are not subject to the Illinois Grants Recovery Act (30 ILCS 705 et.seq.). Except for providers of rehabilitation and treatment for substance abuse services, providers request monthly reimbursement using the Donated Funds Initiative Request for Reimbursement form which is also utilized to verify or certify the required match. Providers of approved residential services continue to use a C-13 Invoice Voucher and Verification of Donation IL444-2715 to request reimbursement. All forms must be completed properly and must be signed or they will not be processed. Facsimile signatures are acceptable.
The basis for the reimbursement for all other providers is line item costs. Costs that are not in the approved budget should not be reported to IDHS as they will not be reimbursed. Also, costs and services in excess of the contracted amount are not reimbursed. Budget revisions may be requested as detailed in the Program Budget section.
The Donated Funds Initiative Request for Reimbursement Form, or the C-13 Invoice-Voucher and Verification of Donation IL444-2715 IDHS are submitted by the Provider upon completion of service. The Provider must accurately complete and submit billings within 30 days of the end of the month for which payment is being requested. Payment requests which are not completed correctly or are not signed will be returned to the provider. Facsimile signatures are acceptable.
C. Payment Suspension
Providers must submit accurate and timely service and fiscal information that is traceable to records. Payments will be suspended if required information is not received as specified by IDHS in a timely manner and in the proper format. Providers will receive written notification of payment suspension and given an opportunity to resolve issues prior to the suspension of payments.
If the Provider does not contact the Department within 30 days of the date of the written notification, the Department will initiate action to terminate the Community Services Agreement. The Provider will receive written notification of the Department's intent to terminate the Agreement.
D. Service Claims
Service providers are required to define the activities that constitute services and document the services delivered to support their monthly expenditure claim. The services, as defined in the Program Plan, consist of a staff hour or day in the program (residential programs only). Documentation should demonstrate a benefit to the participant and be consistent with the Title XX Social Services Block Grant service definition.
Services documented should reflect only the actual service time. Time spent writing narratives may be counted as service time if it is reasonable. For example, if the service is provided for 47 minutes and it takes 10 minutes for the case note, a service may be claimed. It is important not to separate documentation time from the service time.
Unsuccessful attempts to contact the participant are not services. Conversely, services for a participant should not be to the point of excessiveness. Staff development should not be claimed as services.
E. Individual Services
Individual service is any activity, therapy, counseling or regimen of treatment involving a participant to a counselor ratio of 1:1. Documentation of the services should reflect the amount of staff time required to provide the service including a reasonable amount of write-up or preparation time.
F. Group Services
Group service is any activity, therapy, counseling or regimen of treatment which involves a participant to a counselor ratio greater than 1:1. As reimbursement for services in most cases is based upon cost of delivering services, documentation of these services should reflect the staff time involved in service delivery. It is not appropriate to document for each group participant the total staff time involved.
G. Units of Service Reimbursement - Approved Residential Service Providers Only.
For programs funded on an ongoing basis, unit rates and the number of units should remain constant from the previous fiscal year unless there is a cost of living increase, change in service, or renegotiation of the unit rate.
When individual services are being provided, unit rates are based on "participant time." This rate can only be utilized when there is a participant to a counselor ratio of 1:1.
Group or staff time rates are used to provide an equitable method of billing service units when services are provided in groups. When group services are being provided the unit rates are based on "group time." The group time rate takes into account the average group size. This rate can only be utilized for group services.
A "staff time" rate may be utilized as a basis for reimbursement instead of the participant time and group time rates. The basis for the rate, i.e., individual time, staff time, group time, should be shown on page 2 of the Title XX DFI Program Plan.
The basis for reimbursement selected should take into consideration the provider's method of service delivery. In requesting reimbursement, it is important for the provider to adhere to the selected basis of reimbursement as stated in the program plan, otherwise, improper billing may result.
Units delivered in excess of the contracted level are not reimbursable unless funding is available and a formal amendment is approved by IDHS. If it is determined that the delivered units will be less than the contracted units (by at least 10%), a formal amendment may also be needed to reduce the contract.
For programs that have an approved residential treatment day unit of service, reimbursement will be negotiated with IDHS. The program plan will clearly define the residential treatment program, contract deliverables, and cost.
H. Cost Reimbursement
Actual cost reimbursement will be based on the submission of invoice vouchers reflecting monthly costs. Service activities and expenditures must support the provider's claim for reimbursement and be traceable to source documentation on file. Reportable service activities should demonstrate a benefit to the participant and be consistent with the Title XX Social Services Block Grant service definitions and the goals established for the program participant. IDHS will negotiate service activities and the reporting format for these activities. At a minimum, service reporting will include the type and quantity of service activities provided to Title XX DFI participants. There must be a direct correlation between the quantity of services delivered and the level of reimbursement requested.
I. Match Requirement
Funding under the Title XX DFI program is contingent upon providers having a commitment from local sources (donors) for 25% of the total award (100 %) or certifying 25% of expenditures if the Provider is a public agency.
Contributing non-federal agencies or individuals make cash transfers of funds directly to the service provider for subsequent expenditure on services or qualifying non-cash contributions. These funds/contributions must be placed in separate accounts, or otherwise separately identified along with the State's share of the funds identified in the Donated Funds Initiative Agreement.
In order for the State to pay its 75% share of the Request for Reimbursement, the provider must first have on hand the 25% required match amount. The Donated Funds Initiative Request for Reimbursement form is the document used to request reimbursement and verify the required match. Instructions for completing the Donated Funds Initiative Request for Reimbursement form are found under Billing Instructions.
The required 25% match must be derived from one of two sources: cash only, or a combination of cash and in-kind contributions. If a combination of cash and in-kind sources is used to meet the match requirement, at least 10% of the match must be from allowable cash sources.
In-kind contributions or co-payment funds from private or public sources may not be derived from restricted federal or state funds, nor may they be used as the match for other state or federal programs.
DFI funding may not be used as match to gain additional federal or state funds, except as provided by law.
Examples of Allowable Sources of Cash Match (at minimum, must be 10%)
- Mental Health Boards
- United Way
- Local Community Foundations
- Fund Raising
- Revenue generated through client vocational training activities
Examples of Allowable Sources of In-Kind Contributions (must not exceed 15%)
- Volunteers, under the supervision of qualified staff, that assist in providing direct services
- Facility space donated for use and provision of direct services program supplies, goods, and services donated to assist in the provision of direct services
- Equipment loaned or donated for the provision of direct services
- Direct services of provider staff after normal work hours - these staff must not be associated with the program
Certification of Expenditures for Match
Units of local government (public sources) may certify that 100% of the program expenditures were incurred for program administration and direct services. Units of government include:
- Mental Health Boards
Calculation of Match
Example: for a state award of $50,000 (75%) =
$66,667 x 25% = $16,667 (required match amount)
$66,667 x 10% (required cash match) = $ 6,667
$66,667 x 15% (required in-kind match) = $10,000
Total Match = $16,667
Additional In-Kind references: OMB Circular 110, CFR Title 45 Public Welfare, 74.23 Cost Sharing or Matching
OMB website: (www.whitehouse.gov/omb/)
CFR website: (http://www.gpoaccess.gov/cfr/)
To receive Title XX DFI reimbursement, the provider must meet the 25% match requirement in one of two methods. The provider's match requirement is specified in the approved program plan.
- Donation Certification - For providers that receive cash donations and certify in-kind contributions, the provider must, on their DFI Request for Reimbursement form, indicate the amount of donation that has been transmitted to the provider and that the donation is documented in the accounting records prior to the request for reimbursement. Providers may also be their own donor.
- Certified Expenditures - For providers that are public agencies, such as local units of government or public universities, the providers must, on the Donated Funds Initiative Request for Reimbursement form, certify that the matching requirements have been met through the documentation of 100% of the program expenditures.
The provider's match requirement is specified in the approved program plan.