Q&A (24-444-22-1484-01)

A:  The site can have recliners vs beds and can limit a guest's stay to 23-hours.  We will require all Living Rooms to operate 24/7.

A:  The site can have recliners vs beds and can limit a guest's stay to 23-hours.  DHS DMH does not currently have a 24/7 hour license requirement.

A:  All 510-RTLR Living Room Programs must be staffed and operate 24/7/365.  The language "A Living Room Program cannot be created within any building, under one continuous roof, in which residential treatment is being provided, which in total would exceed 16 beds, including but not limited to, houses, apartment buildings, and duplexes." is not new for 510-RTLR. It is the legal definition of Institutes for Mental Disease (IMD). DMH cannot be in the business of funding IMD's.

A:  The 510-RTLR Living Room Program serves an essential role as a less restrictive option on the Crisis Continuum-third pillar of "Somewhere to Go." The crisis continuum is being built around access for "anyone, anywhere, anytime." Consistent hours and locations improve access for guests and those who may be referring them to The Living Rooms.

A:  There is a scheduled 510-RTLR Technical Assistance Session on March 13, 2023 at 3:00 pm in which this can be addressed. 

A:  This is a requirement. MHP's [or higher] MUST complete the risk assessment.

A:  The staffing matrix must include an MHP to complete the risk assessment. An individual with the CRSS credential is an MHP, as defined in Rules 132 & 140.

A:  The Living Rooms must be staffed and operated 24/7/365.

A:  The 510-RTLR Living Room Program serves an essential role as a less restrictive option on the Crisis Continuum-third pillar of "Somewhere to Go." The crisis continuum is being built around access for "anyone, anywhere, anytime." Consistent hours and locations improve access for guests and those who may be referring them to The Living Rooms.

A:  All 510-RTLR Living Room Programs must be staffed and operate 24/7/365.

A:  The 510-RTLR Living Room grant is open for competitive application for FY24 award. The grant cycle is a competitive NOFO (Notice of Funding Opportunity) with two 1-year renewals. Current grantees for this award are not guaranteed to receive funding during this competitive cycle.  Because this is not a renewal year, there is not a continuation application for current grantees.  Current grantees must apply/bid on this competitive opportunity along with new applicants.

A:  Services include but are not limited to screening, linkage to another level of care, and on-site support.  The Grantee is expected to determine the maximum safe operating capacity for the program.

A:  For #1, "referred" reflects the guest was directed or otherwise guided by another party to the Living Room. For #2, "walk-in" reflects the guest was "self-referred," and not directed or otherwise guided by another party to the Living Room.

A:  #3 should amount to the sum of #1 and #2

A:  For #5, Linkage to Care may include referrals, warm handoffs, and/or immediate resources.

A:  For this measure, prior Living Room experience refers to the guest having visited the LRP run by your organization.

A:  For #9 and #10, the term "total" is used to refer to every time a guest walks through the door. It can and likely will be a duplicated count.

A:  The Living Room Program can include beds or recliners. If the guest's stay is limited to 23 hours or less, recliners are acceptable. If guests are permitted to stay longer than 23 hours, the Grantee is expected to have beds available.

A:  Performance Standards are per quarter.

A:  Performance Standards are per quarter.

A:  Successful bidders will be given up to six months to meet the 24/7 requirement.

A: Yes

Q: Can you clarify that the two staff have to both be on site at the same time?

A: Both staff members must be on site at the same time.

Q: Are Program 590 providers required to provide transportation or just referrals?

A: Program 590 providers can provide transportation and they can provide referrals. All of our 590 providers have different modes/methods of how they refer or transport.

Q: Are organizations able to hire individuals who have lived experience, but do not have CRSS/CPRS as long as they pursue the certificate within the time frame?

A: Individuals have one year from the date of hire to obtain the certification.

Q: It was mentioned not to bill Medicaid, but to bill the grant. For clarification, can peers bill Medicaid in addition to the grant dollars?

A: Personnel time spent working in the Living Room Program should be billed to the grant. Individuals with CRSS can bill Medicaid as MHP for time spent working outside of the Living Room Program.

Q: Please review the stipulation of not having the Living Room Program in a building with other residential programs?

A: At no time is a Living Room Program to contain more than 16 beds. A Living Room Program cannot be created within any building, under one continuous roof, in which residential treatment is being provided, which in total would exceed 16 beds, including but not limited to, houses, apartment buildings, and duplexes. If there are Substance Use Prevention and Recovery (SUPR) beds in the facility and the provider wants to add Mental Health (DMH) Living Room beds and this would equal more than 16, there would have to be an assessment made as to what the services are, are they segregated, is there separate programming, staffing, etc.

Q: Can you clarify 24/7/365 coverage? Is it required to be open, or have staff available on call or available to meet?

A: The Living Room must be staffed to operate 24 hours a day, 7 days a week, 365 days a year, and it must be staffed at all times by a minimum of two people. The Division of Mental Health is building out the Living Room as part of the "somewhere to go" pillar of the Crisis Continuum. Services on the crisis continuum are to be available for "anyone, anytime." Being available on call or to meet the person in distress would not satisfy the "somewhere to go."

Q: We are having crisis level workforce shortages. Will current grantees lose funding if they aren't able to adapt to the 24/7/365 requirement?

A: The Division of Mental Health sympathizes that there are crisis level workforce shortages across America, and recognizes that this has been an ongoing issue. DMH is providing technical support and resources to assist grantees with the workforce shortage. Grantees will be given 6 months to implement the 24/7/365 requirement. The CRSS Success program will infuse nearly 300 newly certified CRSS and CPRS into the workforce this year alone. DMH staff can provide you with information regarding the closest university in your area where your organization may sign internship agreements, participate in job fairs, and recruit students. DMH is also available to provide technical assistance with ideas to help your organization to recruit.

Q: Is it correct that one of the two staff has to be an MHP to perform the Risk Assessment, and one has to be a person with lived experience?

A: The Living Room requires two staff persons. One of them has to be an Mental Health Professional (MHP), and that same person could also satisfy the lived experience requirement if they have the Certified Recovery Support Specialist (CRSS) credential. If the person with lived experience doesn't have the CRSS, then the other staff member would have to be an MHP.

Q: If one staff member is both an MHP and has lived experience (CRSS), what is the minimum qualification for the remaining person?

 A: The minimum requirement for the other staff member would be a Rehabilitative Services Associate (RSA) with no lived experience.

Q: Is the Licensed Practitioner of the Healing Arts (LPHA) required to be on-site 24/7 or available by phone?

A: The LPHA does not have a role in the Living Room program.

A: The QHMP must have the ability to respond via phone or in person for consultation with the living room staff.

Q: Does DMH intend to be funding crisis stabilization centers in the future as part of "somewhere to go?"

A: DMH is involved in technical assistance with our state partners and exploring options for "somewhere to go."

Q: Does a specific site have to be open and have 2 staff on site at all times?

A: The Living Room Program site has to be open and have 2 staff on site at all times.

Q: Are any other type structures acceptable?

A: The Living Room must be open 24/7. Your organization having other programs that are open 24/7 will not be enough to meet the requirement that the Living Room Site is open 24/7.

Q: There are 590 providers coming to the end of their 2nd year that are not able to fully staff their programs. It is reasonable to be concerned that 6 months won't be enough time to staff Living Rooms?

A: The Division of Mental Health is providing both technical and financial assistance to help your organization to build up it's staffing capacity.

Q: Are providers able to set a maximum length of stay that is less than 23 hours?

A: The individual should be allowed to stay at the Living Room as long as they need to for the crisis to be resolved. Since the Living Room is open 24/7, there would need to be a very solid justification to limit a guest's stay to anything under 23 hours. There are practical reasons to limit a guest's stay to 23 hours related to availability of beds. Because the Living Room model is designed as a place that guests can go to feel safe and get crisis resolution rather than end up in the emergency department, Grantees would need to seek Programmatic Approval to limit a guests stay at their Living Room to under 23 hours.

Q: Has DHS done any research to ensure the grant pool will afford agencies the ability to pay competitive salaries?

A: IDHS and the Division of Mental Health has more than doubled the available funding for the Living Room to help build capacity, which would include funding for salaries.

Q: Can you provide the power point presentation?

A: Applicants can request a copy of the power point presentation by sending a request to DHS.DMHGrantApp@Illinois.gov email.

Q: Can the Living Room be under the same roof as a separate Crisis residential program of under 16 beds?

A: In order to avoid an Institutions for Mental Disease (IMD) violation, which is a Federal Medicaid designation, the Division of Mental Health would need to consult with experts on IMD classification regarding specifics of a location, and that determination would need to be made on a case by case basis.

Q: If a provider needs to relocate the living room to a facility that is zoned for 24/7, can those costs be added to the grant budget?

A: This would have to be determined on a case by case basis after analyzing the specifics of the costs required to relocate the Living Room.

Q: Will the grant cover the cost of onsite security for evening and weekend hours?

A: Any costs, including security, that an applicant feels are reasonable and necessary may be submitted in the applicant's budget. The Division of Mental Health will look at the justification provided in the budget narrative for each expense submitted when assessing whether a budgeted expense is necessary, allowable, allocable and reasonable during the budget review process.

Q: Can you clarify on this further, If there are really no restrictions on the length of stay for individuals in crisis, is it preferred to have beds?

A: The average length of stay for the type of service provided by the Living Room is 3-5 days. The provider may set a limit of 23 hours so that they are working with recliners, or anywhere in between 23 hours and 5 days. In an effort to ramp up the Living Room to the best practice of being able to provide care along the Crisis Continuum, for the Living Room model it is preferable that providers provide some beds, but applicants who offer proposals with only recliners and who limit a guests stay to 23 hours will be eligible to receive an award.

A: In order to avoid an Institutions for Mental Disease (IMD) violation, which is a Federal Medicaid designation, the Division of Mental Health would need to consult with experts on IMD classification regarding specifics of a location, and that determination would need to be made on a case by case basis.

Q: Based on the physical plant requirements listed in the NOFO, will capital expenditures (minor alteration & renovations) be allowed in the budget to support the design of the living room?

A: Any costs that an applicant feels are reasonable and necessary may be submitted in the applicant's budget. The Division of Mental Health will look at the justification provided in the budget narrative for each expense submitted when assessing whether a budgeted expense is necessary, allowable, allocable and reasonable during the budget review process.

Q: Do you know if other providers who have the multiple day length of stay have medical staff as well? Are we able to add those costs to our grant?

A: Medical staff are not part of the Living Room model. Those costs would not be approved by this grant.

Q: How are we differentiating between this model and an overnight shelter?

A: The Living Room is a crisis diversion program based on the Crisis Now approach. The services and supports are provided by recovery support specialists, individuals with personal lived experience, who are trained to support guests in calmly processing the crisis event, prevent future crisis events, and facilitate sustained recovery.

Q: Can we subcontract with 590 providers to assist with staffing? Have shared staff on call for in person response?

A: The Living Room must have two staff on site at all times. The provider may subcontract with another entity for access to a QHMP who has the ability to respond via phone or in person for consultation with the living room staff.

A: A logic model gives the program a framework for charting the links between the program's resources, activities, and outputs and its intended outcomes. It helps you communicate to your stakeholders what you want to accomplish, how you intend to reach your goals, and how you will track your progress. Applicants can use a narrative or visual representation of the components of the logic model being utilized. Though no specific logic model is required, one example of a logic model's components would be resources, activities, outputs, and outcomes.

A:  See NOFO Section E Criteria for narrative instructions.  If the criteria requires the information, it must be included within the body of the narrative to be reviewed and scored.  Any other attachments will not be reviewed or scored.

1. Program administrative assistant: provides direct admin assistance including data collection/management, report submissions, direct in house IT/telephone system/office machine training/troubleshooting with staff members. 4 hours/week assisting in this capacity at this program.
2. HR/Finance admin: This individual handles the recruitment, onboarding, terminations, benefit administration, and other HR duties for staff in the program, also will handle some accounting. 6 hours/week assisting in the program. I would consider this direct as only the portion of time these admins will spend either working directly on program projects/needs or directly with staff of the program will be charged on this line item.

A:  The salaries of administrative and clerical staff should normally be treated as indirect costs. Direct charging of these costs may be appropriate only if all of the following conditions are met per 2 CFR 200.413 Direct Costs (c):

2.  Individuals involved can be specifically identified with the project or activity;

3.  Such costs are explicitly included in the budget or have the prior written approval of the Federal awarding agency; and

4.  The costs are not also recovered as indirect costs.

UPDATE:  Additional Clarification Requested.

UPDATED CLARIFICATION:  If your organization's Cost Allocation Plan allows you to charge the above mentioned positions directly to the grant, then yes you can.

A:  An entity that wishes to fund more than one Living Room Site should submit one application covering all sites. The CSA budget should clearly delineate which site each expense is being budgeted. The funding range listed in the NOFO is a guide and not a maximum award amount.

A:  Providers may be sub-contractors for other providers, assuming all qualifying elements are in place, and it is a separate location.

A:  The 510-RTLR Living Rooms must be staffed and operated 24/7/365. However, the site can have recliners vs beds and can limit a guest's stay to 23-hours. Grantees will be given 6 months to implement the 24/7/365 requirement. DMH program staff will gladly work with a provider to negotiate issues related to zoning ordinances.

The Living Room Program serves an essential role as a less restrictive option on the Crisis Continuum-third pillar of "Somewhere to Go." The crisis continuum is being built around access for "anyone, anywhere, anytime." Consistent hours and locations improve access for guests and those who may be referring them to The Living Rooms.

Providers are encouraged to apply for other grant funding as applicable to the services offered (e.g., 720 Drop-In Center).

A:  IDHS/DMH is not able to directly fund capital improvements as part of startup, however depreciation is the method for allocating the cost of fixed assets to periods benefitting from asset use. Allocation for depreciation must be made in accordance with Appendices III through IX.

A:  The third pillar of the Crisis Continuum, according to SAMHSA's "National Guidelines for Behavioral Health Crisis Care: Best Practice Toolkit," is Crisis Stabilization Centers.

Although the Living Room Program does not fulfill all the necessary criteria to be considered Crisis Stabilization Centers, it does serve as an important component of the "Somewhere to Go" pillar of the crisis continuum in Illinois.

As with all grant-related notifications, including changes in deadlines, etc., are posted at IDHS: Mental Health Grants - FY 2024 (state.il.us)