Scope of Service

The purpose of this program is to have a mechanism for community mental health centers (Williams providers) to "Advance Pay" to HealthCare and Family Services (HFS) a "deductible" for Williams Class Members to meet monthly Medicaid eligibility (spenddown) in order to ensure that Medicaid services (medical, mental health, etc.) are not disrupted. As a result, Medicaid cards will be available on a continuous basis.

Provides assurance that the cohort of eligible Williams Class Members can successfully transition to the community, have services provided and that the provider agencies can be reimbursed for allowable Medicaid services.

Deliverables

The Provider will facilitate completion of all necessary paperwork and supporting activities to establish the spenddown deductible prior to the Class member moving from the Nursing Facility (NF)/Institution for Mental Disease (IMD). The provider's contract will be adjusted by the number of Class Members' monthly spend down amounts over the HFS established threshold of $1,005.

Provider Shall:

  1. Complete the spenddown enrollment form and mailing and send to HFS,
  2. Obtain a signed agreement from the Class Member that designates the provider agency as the authorized representative payee;
  3. Assist the Class Member in applying for Aid to the Aged, Blind and Disabled (AABD) to determine Medicaid eligibility, if not completed by the NF/IMD;
  4. Monitor monthly Medicaid allowable bills incurred to determine if these bills are sufficient to meet spenddown
  5. Make payment to HFS no later than the 20th day of the month to assure that continuation of Spenddown.

Reporting Requirements:

  1. Financial Report in accordance with Exhibit C.
  2. Performance Report in accordance with Exhibit E.

Payment

Payment will be issued monthly and reconciled on the basis of reported allowable expenses per the Grant Funds Recovery Act [30ILCS 705/7 and 8].

The Provider shall report quarterly allowable grant expenses on the appropriate DMH reporting template to the DMH program contact no later than November 1, February 1, May 1, and August 1, and reported expenses should be consistent with the submitted annual grant budget. If any budget variances are noted, the DMH program contact may request that the provider submit a revised grant budget before subsequent monthly payments will be made. DMH program contacts and reporting templates can be found in the Provider section of the DHS website.

Performance Measures/Reporting Requirements

The Provider shall report quarterly performance on the appropriate DMH reporting template to the DMH program contact no later than November 1, February 1, May 1, and August 1. DMH program contacts and reporting templates can be found in the Provider section of the DHS website.

The following are included in the reporting template:

  1. Number of unduplicated Class Members benefitting from this service with monthly household incomes at or less than $1,005.00
  2. Number of Williams Class Members on spenddown with deductible amounts less than (monthly):
    1. $100
    2. $200
    3. $300
    4. $400
    5. $500
  3. Number of Class Members whose monthly spend down amount is greater than $500.00 but not greater than $600.00, per month.
  4. Number of Williams Class Members with sufficient "bills" incurred that can be applied to offset the monthly spenddown amount
  5. Number of Williams Class Members who, monthly, maintain continuous engagement with the mental health service provider.
  6. Number of Williams Class Members who may self-terminate from mental health services in the reporting quarter - the spenddown advance is canceled;
  7. Number of Class Members on spenddown for whom the agency is serving as their representative payee

Performance Standards

  1. 98% of Williams Class Members with spenddown have monthly household incomes at or less than $1005.
  2. 98% of Williams Class Members will have monthly spenddown deductible amounts less than
    1. $100
    2. $200
    3. $300
    4. $400
    5. $500
  3. 2% of Williams Class Members will have monthly incomes greater than $500.00 but not greater than $600.00 per month.
  4. 100% of Class Members will have sufficient bills that can be applied to offset the spenddown about, monthly
  5. 90% of Class Members will maintain continuous engagement with the community mental health provider on a monthly basis;
  6. No more than 10% of Class Members with spenddown may terminate from mental health services, per month.
  7. 50% of Class Members on spenddown has the agency serving as the representative payee.