Types of Grants and General Reporting
The Division of Mental Health (DMH) uses two approaches to making grant agreement payments to providers:
- Grants with monthly payments (installments) throughout the year, each for about 1/12th of the annual grant amount. These require "expense reporting" using a standard GOMBGATU-4002 Periodic Financial Report (PFR).
- Grants with payments based on the provider invoicing. These use customized invoice forms.
Both types of grants also require performance reporting, which has two parts and is described below. The reporting period for each grant is specified in Exhibit E of the grant's Uniform Grant Agreement. If you have questions about the combination of forms to be used for a particular grant, please contact the assigned Program Contact for that type of grant. The current list of contacts is found at: Program Contact.
It is important to submit all three report elements together attached to a single email. If a provider has more than one grant agreement with DMH, a separate email for each grant is requested to document timely delivery and to reduce handling errors. Additional reporting guidance can be found in DMH Grants Reporting (pptx).
Part I - Financial Reporting/Program Invoicing
Financial Reporting
Most grants deliver monthly payments (installments) to the provider during the fiscal year, and for these a standard GOMBGATU-4002 form is used to comply with Exhibit C of the grant agreement. This writable PDF template contains a table the provider can customize by using ADD or DEL buttons (on the far right of the table). Providers are asked to customize the table so that it contains the same expense categories used when creating the CSA Budget during the grant-making process.
The link for the FY19 4002 is: Periodic Financial Report template GOMBGATU-4002 (N-08-17) (pdf)
Program Invoicing
Some grants use an invoice and payment method and templates are available for each type of grant agreement. No further customization of these templates is needed. Any questions about completing a particular invoice template can be directed to the assigned Program Contact.
Links for the invoice templates are as follows:
Fiscal Year 2019:
510 - Data Infrastructure for Quality Improvement (DATA) - invoice template (xlsx)
510 - First Episode Presentation Program (FEPP) - invoice template (xlsx)
510 - IL CHR-P Stepped Care Initiative (FCHR) - invoice template (xlsx)
510 - Federal Promoting Behavioral Health (FPBH) - invoice template (xlsx)
510 - Federal Supported Employment IPS (FIPS) - invoice template (xlsx)
515 - Juvenile Inpatient Forensic Services (JIFS) - invoice template (xlsx)
520 - Regions Donated Funds Initiative - invoice template (xlsx)
780 - Transition Coordination (Use for July - December 2018) - invoice template (xls)
780 - Transition Coordination (Use for January - June 2019) - invoice template (xls)
790 - Clinical Review - invoice template (xls)
793 - Consent Decree Training Institute - invoice template (xlsx)
794 - Mortality Review - invoice template (xlsx)
795 - Resident Review - invoice template (xls)
796 - Neuropsychological Assessments - invoice template (xlsx)
797 - Occupational Therapy Assessments - invoice template (xlsx)
800 - Front Door Diversion Project - invoice template (xlsx)
Parts II & III - Performance Reporting
Exhibit E of the Uniform Grant Agreement requires periodic reporting on deliverables. Most grants require quarterly reporting, but a few require more frequent reporting. If you need clarification on the frequency of reporting for a specific grant, please contact the assigned Program Contact . All performance reporting has two elements:
- Part II - a standard GOMBGATU-4001 template, which is required for all DMH grants; and,
- Part III - a grant specific DMH Excel Performance Report Template by Program (PRTP). Each PRTP is designed to capture deliverables specified by the corresponding grant agreement.
Part II
The link for the GOMBGATU-4001 template is: Periodic Performance Report template GOMBGATU-4001 (N-08-17) (pdf)
Instructions for the form are contained within the document. Please complete items 1-13. Items 14-22 can be skipped because the corresponding PRTP captures needed details. NOTE: Be sure to check the red box under item #13 and enter "DHS/DMH provided program template" in the text box immediately below the checkbox.
PART III
The Performance Report Template by Program (PRTP) documents for each type of grant are available via the below links. Any question about a template can be directed to the assigned Program Contact . If you have difficulty using the below links, please contact Kim.Benson@illinois.gov
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)
420 - Eligibility and Disposition Assessment (xlsx)
430 - Community Support Team (xlsx)
510 - Children's Mental Health Partnership (CMHP) (xlsx)
510 - Data Infrastructure for Quality Improvement (DATA) (xlsx)
510 - IL Stepped Care Initiative (FCHR) (xlsx)
510 - Promoting Integration of Primary and Behavioral Healthcare (FPBH) (xlsx)
510 - First Episode Psychosis Program (FEPP) (xlsx)
510 - Federal Supported Programs (FIPS) (xlsx)
510 - Regions Special Mental Health Services (NAMI) (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 - 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)
Report Submission
Please refer to Exhibits C and E of each grant agreement for the required frequency of reporting. Reporting deadline is always 30 days following the end of the reporting period, and late reporting will mean additional steps to avoid a payment sanction. Any questions about timely reporting can be directed to the assigned Program Contact.
A complete periodic report requires three parts;
- Part I - Either a GOMBGATU-4002 or a Program Invoice (see above);
- Part II - A GOMBGATU-4001 Periodic Performance Report (PPR); and,
- Part III - An Excel Performance Report Template by Program (PRTP).
For a handful of Williams Consent Decree grants, special emailing instructions apply to protect consumer PHI that is required on the invoice template. For these grants (listed below), the Part I invoice is mailed independent of Parts II & III. An encrypted email box has been created to receive these Williams invoices, it is: DHS.DMHwilliamsinvoices@illinois.gov
This email address is used for the Part I invoice document for the following grants:
780 - Transition Coordination
790 - Clinical Review
793 - Consent Decree Training Institute
794 - Mortality Review
795 - Resident Review
796 - Neuropsychological Assessments
797 - Occupational Therapy Assessments
All other documents are to be emailed to: DHS.DMHQuarterlyReports@illinois.gov
This includes Part II and Part III for any of the above seven (7) Williams grants, and all three Parts for all other grants. Please send a separate email for each type of grant. Scanned copies cannot be processed by DMH, so please be sure to attach original copies.
A full list of grants to be mailed to DHS.DMHQuarterlyReports@illinois.gov is as follows:
121 - Mental Health Juvenile Justice
200 - Housing Bridge Subsidy Administrators
220 - Housing MI Supportive
410 - Capitated Community Care
430 - Community Support Team
510 - Children and Adolescent IL United for Youth (CIUY)
510 - Data Infrastructure for Quality Improvement (DATA)
510 - First Episode Psychosis Program (FEPP)
510 - Federal Supported Employment IPS (FIPS)
510 - Housing Money Follows the Person (HMFP)
510 - Rural Behavioral Health Access (RBHA)
510 - Regions The Living Room (RTLR)
515 - Juvenile Inpatient Forensic Services (JIFS)
515 - Regions Deaf Special Program (RDSP)
515 - Regions IPS Trainers (RIPS)
515 - Regions Extended MISA Detox (RMSD)
520 - Regions Donated Funds Initiative
574 - Psychiatric Medications
575 - Projects for Assistance in Transition from Homeless (PATH) Grant
580 - Crisis Staffing
620 - Mental Health CILA
700 - Medicaid Spend Down
710 - Williams Outreach
720 - Drop-In Center
730 - Quality Administrator
740 - ACT Start Up
750 - CST Start Up
760 - Integrated Health Care
780 - Transition Coordination (PARTS II & III ONLY)
785 - Cluster Permanent Supported Housing
790 - Clinical Review (PARTS II & III ONLY)
793 - Consent Decree Training Institute (PARTS II & III ONLY)
794 - Mortality Review (PARTS II & III ONLY)
795 - Resident Review (PARTS II & III ONLY)
796 - Neuropsychological Assessments (PARTS II & III ONLY)
797 - Occupational Therapy Assessments (PARTS II & III ONLY)
800 - Front Door Diversion
820 - Supported Residential
830 - Supervised Residential
840 - Reintegrated Residential
860 - Crisis Residential
866 - In Home Recovery Support
Contact Kim Benson at Kimberly.benson@illinois.gov for accessible versions of templates.
