Bureau of Maternal and Child Health

Instructions

For FY14, Family Case Management (FCM) provider agencies must use the FCM Summary Expenditure Documentation Form (EDF) (xls) to report the reimbursable services and activities that contribute to building assigned caseload, and to supporting and maintaining the active caseload.

A portion of the Family Case Management grant - not to exceed 10% - can be earned by detailing qualifying expenditures for Outreach and System Support.  However, there is no requirement to report all of the Outreach or Support Services costs of the agency on the EDF, nor is there a requirement to report any other program costs on the EDF.

It is possible to earn the entire grant during the fiscal year from payments out of Cornerstone for Active Cases and Case-finding. For agencies that spend down the grant in this manner on direct service, there is a requirement to submit a monthly EDF for $0 for the course of the fiscal year. For those agencies that reach the allowable limit for Outreach and Support, there is no expectation to continue documenting costs that will not be reimbursed; however, a monthly EDF for $0 is required for the remainder of the fiscal year.

The electronic format of the EDF is in Excel so that calculations will automatically occur as expenses are entered. The instructions below will assist you in completing the EDF:

  • Person Completing Form: Contact person (Mandatory)
  • Phone & Email: List the phone number and email address for a contact person who will be able to answer questions concerning the submitted expenditure form. (Mandatory)
  • Cumulative Amount year-to-date: please enter an updated amount each month in the designated box. (Mandatory)
  • Allowable limit FY14: Please enters 10% of the total FCM grant in the designated box. (Mandatory)
  • Components - The components under Family Case Management include:
    • Support Services - Client Transportation represents costs specific to the provision of client-related transportation, including but not limited to bus tokens/tickets, cab fair, train fair, use of an agency-owned vehicle, etc. Other Support Services must contribute to the goals and objectives of the Provider's case management program.
    • Outreach - These expenditures include activities to locate and enroll high-risk pregnant women within the assigned geographic area, and expenditures for systems-building and community networking activities to promote awareness of Family Case Management.
  • Authorized Agency Official: This form must be signed and dated by an authorized official of the provider agency. (Mandatory)

Submission of EDF

EDFs are due to DHS by the 15th of each month, for costs incurred the prior month. One copy of the EDF is submitted to the contact person specified in Exhibit C of the Family Case Management contract.

Program Contact

Questions regarding EDF documentation can be directed to Dean Conrad via email at dean.conrad@illinois.gov. Technical assistance will be available at both the program and regional monitoring level.