Grants Billing

Grantees must submit the following applicable invoice templates in order to request reimbursement for services provided.

520 - Regions Donated Funds Initiative (doc)

780 - Transition Coordination (xls)

790 - Clinical Review (xls)

793 - Consent Decree Training Institute (xlsx)

794 - Mortality Review (xlsx)

795 - Resident Review (xls)

796 - Neuropsychological Assessments (xlsx)

797 - Occupational Therapy Assessments (xlsx)

Grants Reporting

Below are the Periodic Financial Report and Periodic Performance Report templates and their instructions for your use in accordance with the uniform grant agreement Exhibits C and E.

  1. The Periodic Financial Report template (GOMBGATU-4002 (N-08-17)) as required by Exhibit C allows you to add or delete rows in section (x) Category/Program Expenses of the template by clicking on ADD or DEL in the far right column. This will enable you to capture all line items that are included in your approved budget.

    Periodic Financial Report template GOMBGATU-4002 (N-08-17) (pdf)

  2. The Periodic Performance Report templates as required by Exhibit E consist of two separate templates, one general template (GOMBGATU-4001 (N-08-17)) as well as a specific template for each program identified by program number and name. Both forms are required. When completing the GOMBGATU template, you must complete items 1-13 and 23-26. You will see a note in red that states, "Responses to Sections 14 - 22 may be provided in a separate format."  Check the box beside "Alternative file or database used."  In the box labeled, "File Name or Database Source," state "DHS/DMH provided program template."  DMH requires that you use the specific template identified by program number and name in lieu of Sections 14 - 22 for each grant agreement. The submission of the Periodic Performance Report should include both documents for each grant agreement.

    Periodic Performance Report template GOMBGATU-4001 (N-08-17) (pdf)

    DMH Performance Report Templates by Program:

    121 - Mental Health Juvenile Justice (xlsx)

    200 - Housing Bridge Subsidy Administrators (xlsx)

    220 - Housing MI Supportive (xlsx)

    410 - Capitated Community Care (xlsx)

    430 - Community Support Team (xlsx)

    510 - Children and Adolescent IL United for Youth (CIUY) (xlsx)

    510 - Data Infrastructure for Quality Improvement (DATA) (xlsx)

    510 - First Episode Psychosis Program (FEPP) (xlsx)

    510 - Federal Supported Programs (FIPS) (xlsx)

    510 - Housing Money Follows the Person (HMFP) (xlsx)

    510 - Rural Behavioral Health Access (RBHA) (xlsx)

    510 - Regions The Living Room (RTLR) (xlsx)

    515 - Juvenile Inpatient Forensic Services (JIFS) (xlsx)

    515 - Regions Deaf Special Program (RDSP) (xlsx)

    515 - Regions IPS Trainers (RIPS) (xlsx)

    515 - Regions Extended MISA Detox (RMSD) (xlsx)

    520 - Regions Donated Funds Initiative (xlsx)

    574 - Psychiatric Medications (xlsx)

    575 - Projects for Assistance in Transition from Homeless (PATH) Grant (xlsx)

    580 - Crisis Staffing (xlsx)

    620 - Mental Health CILA (xlsx)

    700 - Medicaid Spend Down (xlsx)

    710 - Williams Outreach (xlsx)

    720 - Drop In Center (xlsx)

    730 - Quality Administrator (xlsx)

    740 - ACT Start Up (xlsx)

    750 - CST Start Up (xlsx)

    760 - Integrated Health Care (xlsx)

    780 - Transition Coordination Non-Billable (Generic) (xlsx)

    780 - Transition Coordination Non-Billable (Specific) (xlsx)

    785 - Cluster Permanent Supported Housing (xlsx)

    790 - Clinical Review (xlsx)

    793 - Consent Decree Training Institute (xlsx)

    794 - Mortality Review (xlsx)

    795 - Resident Review (xlsx)

    796 - Neuropsych Assessments (xlsx)

    797 - OT Assessments (xlsx)

    800 - Front Door Diversion (xlsx)

    820 - Supported Residential (xlsx)

    830 - Supervised Residential (xlsx)

    840 - Reintegrated Residential (xlsx)

    860 - Crisis Residential (xlsx)

    866 - In Home Recovery Support (xlsx)

    All three templates for each grant agreement should be submitted to the program contact.  Program Contact (xlsx)

    Please refer to your individual grant agreements, Exhibits C and E for the required frequency of reporting for each grant agreement.

If you have problems accessing the DMH Performance Report Templates by Program, please email Mary.Hebert@illinois.gov