Scope of Services

Program services provided to Medicaid eligible persons who, without such services, might incur a referral and/or admission to a Nursing Facility (Nursing Facility level of care). Services are provided to consumers so that they might be maintained in a lesser level of care after experiencing a mental health crisis and to remain in a community-based setting.

  1. Such services may, depending on individualized consumer need, be initiated at one or multiple intercept points as of the following:
    1. Offering Alternative Care for Consumers at Community Hospital Emergency Departments (EDs): Provider shall have capacity to respond to referrals of Consumers experiencing a psychiatric crisis from Emergency Departments (EDs) at identified Hospitals. This program shall fund costs associated with sending program staff to EDs to make a face-to-face, first contact, with a referred individual or costs in #2 below.
    2. Offering Alternative Care for Consumers at Community and State Hospitals: Provider shall have the capacity to respond to referrals of Consumers receiving acute inpatient psychiatric care at identified Hospitals, complete an assessment of need, and recommend an alternative(s) to nursing facility level of care. This program shall fund costs associated with sending program staff to the Inpatient Psychiatric unit at identified Hospitals to make an assessment of need and provide recommendations for alternative community based care or costs in #2 below.
    3. Offering Alternative Care for Consumers that have exited EDs or Acute Inpatient Psychiatric Care Units: Provider shall have the capacity to provide outreach contacts in the community or other settings to continue efforts to alternative care options identified during an assessment completed by the Front door Diversion Pilot Project Team at a community or State hospital. This program shall fund costs associated with sending program staff into the community to provide continuing outreach and engagement services or costs in #2 below.
  2. These programs shall fund the non-rehabilitative and non-therapeutic costs, such as;
    1. Agency costs developing the infrastructure necessary to provide this service,
    2. Travel incurred by staff providing the service;
    3. Consumer travel expenses such as temporary transportation costs or vouchers for accessing treatment programs and/or to return transportation to residence;
    4. Emergency medications due to loss of Medicaid status or for non-formulary prescriptions (excludes over the counter);
    5. Funds for other alternative or non-traditional temporary housing options such as Single Room Occupancy or motel housing, apartment lease retainers, related expenses;
    6. Other housing allowable expenses are:
      1. Security Deposit,
      2. Landlord fees,
      3. Utility deposit(s),
    7. Emergency food is an allowable expense only if there are no other resources available and other food benefit sources, like local food banks, are exhausted. For example, this may occur if a Front Door Participant is in the process of waiting for a LINK card. Documentation will be required to prove that all other options were exhausted;
    8. Emergency clothing is an allowable expense, especially those items that are deemed necessary for protection from weather conditions. All other Community Partners like Salvation Army and Goodwill, etc., must be exhausted. Documentation will be required to prove all other options were exhausted; and
    9. Emergency replacement of durable medical equipment or assistive devices, including prescription eye wear or hearing aids, in which delay in retrieving these items through ordinary channels would impair the consumer's activities of daily living. Documentation will be required to prove all other options were exhausted.

Description and justification for all above items (B-I), by consumer must be included in monthly performance reports as provided in Exhibit B: General Provisions - C as below.

Use of grant funds shall not allow (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.

Deliverables

  1. Responding to ED Referrals: Provider shall have the capacity available with appropriately trained and credentialed staff to respond to referrals made by local EDs at identified Hospitals. Providers shall have the capacity to perform face-to-face assessments by an Mental Health Professional (MHP), with immediate - 24/365/7 - access to a Qualified Mental Health Professional (QMHP), or by a QMHP within 90 minutes of identification and referral of a crisis or potential crisis for individuals presenting in identified hospital emergency departments as the result of a psychiatric crisis.
  2. Responding to Referrals from Acute Psychiatric Inpatient Unit Settings: Provider shall have the capacity available with appropriately trained and credentialed staff to respond to referrals made by identified local community or State hospitals. Provider shall have the capacity to perform face-to-face assessments by an MHP (with immediate 24/365/7 access to a QMHP) or QMHP no later than 3 business days of referral.
  3. Outreach to Continued Engagement of Consumers Leaving EDs or Inpatient Units without Agreeing to Alternative Care Options: To increase the likelihood of avoiding institutional level of care, the Provider shall have the capacity to conduct telephone or face-to-face outreach:
    1. To consumers who were provided recommendations for alternative care options but left the ED or inpatient unit without agreeing to active services;
    2. Provide continuing care management for consumers accepting alternative care options until a hard hand-off is accomplished with the next level care provider.
    3. To all consumers referred from identified Hospital's Inpatient Unit (IPU) and NOT seen face-to-face prior to discharge.

      First outreach will be attempted within 24 hours following the individuals exit from the ED or hospital unit where the Front door Diversion Pilot Project Team made its first contact.

      General Provisions:

  4. Provider shall register all individuals served using the unique Front door Diversion Pilot Project identifier in accordance with the requirements of the Provider Manual and shall report individuals served in this level of care through the submission of Fee For Service (FFS) 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
  5. Provider shall exhaust all other resources, including but not limited to Medicaid, MCO provider Medicare or other insurance, to assure that DHS/DMH is the funder of last resort for these levels of care. Provider shall comply with all other requirements of the Provider Manual, including but not limited to provider monitoring and utilization management.

Provider shall submit registration claims information on a weekly basis.

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 monthly performance on the appropriate DMH reporting template to the DMH program contact no later than the 15th day of the month following the reporting period. 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. Engagement at Emergency Departments:
    1. Number of individuals for whom registration is submitted using the unique Front Door Diversion Pilot project identifier in accordance with Provider Manual requirements,
    2. Number of first contacts completed, and
    3. Number of full assessments completed, including: identified hospitals' emergency department and recommended disposition for each completed assessment (e.g. admit to inpatient care etc.),
  2. Engagement/linkage at Hospital Psychiatric Inpatient Units:
    1. Number of individuals for whom registration is submitted using the unique Front Door Diversion Pilot project identifier in accordance with Provider Manual requirements,
    2. Number of first contacts completed, and
    3. Number of full assessments completed, including: Hospital inpatient Psychiatric unit, discharge to supervised residential, discharge to supportive residential, discharge to existing home in community with continuing support by the Front door Diversion Pilot Project team, discharge to community using temporary housing assistance and continuing support of the Comparable Services Team, and discharge refusing services.
  3. Outreach to engage persons leaving ED or Inpatient Settings without agreement for active enrollment in Front door Diversion Pilot Project Team care:
    1. Total number of outreach visits for consumers not agreeing to active services,
    2. Number of individuals receiving outreach visits in attempt to engage post ED or inpatient discharge, and
    3. Number of individuals successfully linked to community mental health (CMH) services (hard hand-off).

Performance Standards

  1. Engagement at Emergency Departments:
    1. 100% of registrations and information including Front door Diversion Pilot Project Identifier submitted and in accordance with Provider Manual requirements;
    2. 80% of identified hospital emergency departments result in a face-to-face contact performed by an MHP (with immediate 24/365/7 access to a QMHP) or QMHP within 90 minutes of referral, and
    3. 80% of first face-to-face contacts by the Front door Diversion Pilot Project Team result in completed assessment and a recommended disposition.
  2. Engagement/linkage at Hospital Psychiatric Inpatient Units:
    1. 100% of registrations and information including Front door Diversion Pilot Project Identifier submitted and in accordance with Provider Manual requirements,
    2. 90% of referrals result in a face-to-face first contact, performed by an MHP (with immediate 24/365/7 access to a QMHP) or QMHP no later than 3 business days of referral, and
    3. 90% of first contacts result in a completed assessment and a recommended service disposition.
  3. Outreach to engage persons leaving ED or Inpatient Settings without agreement for active enrollment in Front door Diversion Pilot Project Team care:
    1. 100% of persons refusing engagement to Front Door Diversion Pilot Project Team at time of exit from an ED or Psychiatric Inpatient Unit will be offered follow-up contact at whatever community or institutional setting they were transferred or discharged to upon departure,
    2. 80% of persons will receive at least one follow-up contact from the Front door Diversion Pilot Project Team, and 80% of individuals provided outreach services were successfully linked to CMH services (hard hand-off), defined as the consumer attending at least one appointment with the next level of care CMH services provide.