Scope of Services

Provider shall deliver recovery-oriented residential level of care to individuals in DMH Eligibility Group 1. This program shall fund the non-rehabilitative and non-therapeutic costs, such as facility depreciation or rent, utilities, food or staff costs, associated with providing this level of care and shall not include any costs associated with the delivery and billing of any other available service reimbursable by the Illinois Department of Healthcare and Family Services (HFS) or DHS/DMH. Provider shall have at least one awake, onsite staff person available 24 hours per day, 7 days per week. Definitions and requirements for eligible individuals can be found in the Consumer Eligibility and Enrollment section of the Provider Manual.

Deliverables

Provider shall deliver residential care to eligible individuals who meet medical necessity criteria prescribed by DMH that need 24 hour/ 7 day a week supervision including skills training and supports. Provider shall register all individuals served under this Exhibit in accordance with the requirements of the Provider Manual and shall report individuals served in this level of care through the submission of claims according to requirements prescribed by the Community Mental Health Service Definition and Reimbursement Guide available at http://www.hfs.illinois.gov/assets/cmhs.pdf 

Provider shall exhaust all other resources, including but not limited to Medicaid, Medicare or other insurance, to assure that DHS/DMH is the funder of last resort for this level of care. Provider shall comply with all other requirements of the Provider Manual, including but not limited to provider monitoring and utilization management.

Reporting Requirements:

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

Payment Terms

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

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. Percentage of individuals for whom registration is submitted in accordance with Provider Manual requirements
  2. Number of individuals served in DMH Eligibility Group 1
  3. Percentage of individuals for whom claims for nights of care are reported
  4. Percentage of available capacity used for this level of care as reported via claims submissions and monthly capacity reports
  5. Level of Care Utilization System (LOCUS) is administered to individuals according to the requirements in the DHS/DMH provider manual
  6. Percentage of individuals receiving Rule 132 services
  7. For the purpose of reporting, claims and monthly reporting should reflect individuals in this level of care at 11:59 pm.

Performance Standards

  1. 100% of individuals are registered in accordance with Provider Manual requirements
  2. 100% of individuals served are in DMH Eligibility Group 1
  3. 100% of claims for nights of care are submitted in accordance with DHS/DMH requirements
  4. At least 85% of the available capacity for this level of care is utilized in each quarter
  5. 100% of individuals have LOCUS scores meeting residential level of care need or have a transition plan in place
  6. 100% of individuals will be receiving Rule 132 services according to their individually assessed and planned needs.*

*Post payment reviews will confirm Rule 132 and other services were provided according to individually assessed and planned needs.