This document serves as an attachment to the Illinois Department of Human Services (IDHS) Uniform Grant Agreement (UGA) and sets forth supplemental obligations between the Provider and the Department. The Attachment provides the provider's requirements beyond those in the Agreement and is intended to clarify programmatic areas of the Department of Human Services Division of Mental Health (IDHS/DMH) programs. Providers are strongly advised to consult the IDHS/DMH Provider Manual for additional information on requirements and guidelines regarding the delivery of and payment for services under this Uniform Grant Agreement. The IDHS/DMH Provider Manual is incorporated into this attachment by reference and is made part of the contract and attachment requirements.
The Provider shall comply with all applicable federal, state and local rules and statutes, including, but not limited to, the following:
More information on Federal Rules and Codes may be obtained on the Internet at the following address:
Through this agreement with the Provider, the Department purchases one or more mental health programs or services, which are to be provided and then reported or billed to the Department and/or HFS under the following broad categories.
- Services Purchased by Fee-for-Service
- Medicaid Services
- Pre-Admission Screening (PAS/MH)
- Capacity Grant Programs
This Uniform Grant Agreement may include grant funding for programs or portions thereof that involve some services and activities that have not been converted to a fee-for-service basis.
The Provider's obligation in receiving capacity grant funds is to expend the funding for allowable expenses required to meet the program's objectives or reconcile with services based on Exhibits in the Uniform Grant Agreement and to report to the Department on appropriate deliverables. As it meets the program objectives, a Provider may determine that some program activities supported by these grant funds are billable services. However, when a Provider bills for an activity under a capacity grant program, the Provider is not to report the activity or the expenses as part of the grant funded deliverable, as this would result in counting the activity more than once in meeting the Provider's obligation.
The Department must track capacity grant awards through its accounting system, please see the Uniform Grant Agreement, Part One, Article I, Paragraph 1.2 for funding amounts. In the reconciliation of allowable expenses, the Department expects the provider to demonstrate allowable expenses for the total of these lines for each program, not portions of the award that may be associated with specific accounting service codes or Provider service sites.
The programs that comprise capacity grants vary among Providers, and not all Providers are currently funded for each of these programs. Full descriptions of capacity grant programs are located in Exhibit A of the appropriate contract.
The capacity grant programs must meet the following guidelines:
- The ratio of expenditures for the delivery of services and related activities to administrative costs shall be in accordance with the standards established in the Uniform Grant Agreement and the Provider Manual.
- Capacity Grant funds may be used to provide capacity services for individuals enrolled in the Managed Care Initiatives. In the event that the Managed Care Initiatives begin making payments for capacity services, no additional funding will be provided by DMH for these services.
- IDHS/DMH will specify any additional reporting requirements.
- Donated Funds Initiative/Local Initiative Funds / Title XX
Services and Programs covered by the federal Social Services Block Grant are included in the Donated Funds Program. If you have any questions or require further information, please contact IDHS Division of Family and Community Services at (312) 793-0683.
- Central Registry and Background Checks
- Health Care Worker Registry
The Provider shall not employ an individual in any capacity until the Provider has inquired with the Illinois Department of Public Health as to information in the Health Care Worker Registry and has inquired with the Illinois Department of Children and Family Services as to the information in the Child Abuse and Neglect Tracking System (CANTS) concerning the individual. For new employment applicants, if the Registry and/or CANTS has information substantiating a finding of abuse or neglect against the individual, the Provider shall not employ him or her in any capacity. For currently employed staff, if the Registry and/or CANTS has information substantiating findings of abuse or neglect, the Department will expect the Provider to act in accordance with its personnel policies and procedures, and take steps to ensure the protection of individuals served by the Provider as deemed appropriate.
- Health Care Worker Background Check Act
The Provider certifies that it is in compliance with all requirements and regulations issued pursuant to the Health Care Worker Background Check Act (225 ILCS 46).
- Reporting and Investigating Incidents and Allegations of Abuse and Neglect
- Provider Requirements
- The Provider shall develop and implement a policy and procedure on Reporting and responding to Abuse and Neglect ensuring reporting incidents as required by 59 Ill Admin Code, Ch. 1, Part 50 including definitions of abuse and neglect, screening prohibition, time frames for reporting and preservation of evidence and best practice response to disclosure,
- The Provider shall ensure that all OIG liaisons successfully complete the IDHS/OIG Basic Investigative Skills training and then every two years thereafter,
- The Provider shall ensure that the individual, as well as the parent or guardian are notified regarding an individual's involvement when an allegation is under investigation by the Office of the Inspector General,
- The Provider shall have a formalized ongoing systemic review process at least quarterly for evaluating all injuries, including those not definable as abuse and neglect, including and not limited to deaths, suicide attempts, and other adverse events within the agency. The review processes shall include, but are not limited to:
- Examining the circumstances and data to determine how and why the injury or other adverse event occurred, including determining all related processes and systems;
- Identifying risk points and their potential contribution to the event, such as evaluating the appropriateness of the individual's treatment plan and level of supervision;
- Identifying, communicating, documenting, implementing, and evaluating improvements in processes, systems, or treatment to prevent future such injury or other adverse event, including specifying:
- The staff responsible for implementation;
- When the actions will be implemented; and
- How the effectiveness of the action will be evaluated.
- It is the policy of the Division of Mental Health that all requirements pertaining to the reporting of licensed health care practitioners to the Illinois Department of Financial and Professional Regulation (IDFPR) and the National Practitioners Data Bank be followed. The Provider shall make such reports when and to the extent required by law.
- The Provider shall endeavor to reinforce the responsibility of health care practitioners to report appropriate matters to IDFPR by such actions, as it deems reasonably necessary, including posting notice that individual practitioners shall comply with applicable licensing and reporting requirements.
- Representative Payee Support
For individuals receiving DMH services under this Uniform Grant Agreement, the Provider shall, if clinically appropriate and as directed by a physician, serve as representative payee or arrange for representative payee for benefit payments under the Social Security Disability Insurance program and/or the Supplementary Security Income program.
For each individual receiving representative payee support, the Provider will ensure that the individual's treatment plan includes goals, objectives and rehabilitation interventions designed to build the skills needed for the individual to progress toward self-management of their own funds.
Where the Provider will function as the representative payee of record, the Provider may be compensated for administrative and clerical support activities related to the management of funds per the rules and procedures of the Representative Payee Program of the Social Security Administration. Information about the SSA Payee Program is available at: http://www.ssa.gov/payee/
- Monitoring
- 1. The Provider shall allow the Department or its agent access to its facilities, records and employees for the purposes of monitoring this Agreement. The Department or its agent will monitor compliance with the conditions specified herein. However, for conditions specifically covered by accreditation standards, the Provider's current accreditation status with full compliance on all relevant standards (as submitted per section V.A.) of this agreement) is accepted by the Division of Mental Health in lieu of administrative and program monitoring requirements (per 405 ILCS 30/3). (Licensure and certification reviews per 59 Ill Admin Code 115 and 132 will continue to provide deemed status as currently included).
The Provider shall notify Program Staff if a specific monitoring activity is believed to be redundant with specific accreditation standards for which the Provider has been previously determined to be currently in full compliance. If satisfactory resolution of the issue is not achieved with Program Staff the issue should be advanced to the Director of IDHS/DMH for resolution.
Monitoring will be conducted by Department staff and its agent or contractors within various offices of the Department, including but not limited to, the IDHS/DMH; Bureau of Accreditation, Licensure, and Certification; Office of Contract Administration; and Office of the Inspector General.
Monitoring may consist of, but is not limited to, the following review activities:
- Reviews of all required licenses and certifications;
- Reviews of all Provider service and funding plans;
- Reviews of direct service provision;
- Reviews of substantiated cases of abuse and neglect including follow-up actions and support of victims;
- Review of appropriate team staffing based on Rule 132 and Rule 140 requirements;
- On-site reviews of individual clinical records, personnel files, Provider and program policies and procedures, and financial records;
- On-site observations and interviews of individuals receiving services, guardians, and Provider staff (including, but not limited to, program supervisory and direct care staff);
- Reviews of electronic data submissions and verification of data submissions or data accepted in lieu of electronic submission;
- Reviews of utilization patterns;
- Reviews of training records;
- Key indicators of the fiscal viability of the Provider;
- Measures of the degree of individual access to services, such as waiting lists;
- Evidence Based Programs; and Title XX.
- Performance Measures: The Provider shall provide all provider data for performance outcome measures at the request of the Department.
- Data and Data Security
The Provider shall adhere to IDHS policies and procedures for submitting data to the Department and for maintaining data security for all data submitted to, or received from, the Department.
- Individual and Family Input and Participation
The Provider shall have policies and practices which reflect formal mechanisms, which ensure the outreach toward, and participation of individuals, their families, and/or other interested parties in the planning, development, delivery, and evaluation of and satisfaction with clinical services.
Providers are expected to educate individuals receiving services or the parent/guardians of children/youth receiving services toward participation in developing their plan for care, treatment and services including a crisis plan. The individual's, child's parent/guardian's, and when appropriate, youth's participation in developing his or her plan for care, treatment, services, and crisis plan is documented on the individual treatment plan as well as a separate note in the individual's clinical record. The note includes the Provider's process for involving individuals, and child/youth parent/guardians in their care, treatment, and service decisions. The process shall consider and respect the individual's, and parent/guardian's and youth's views. All efforts to involve individuals in consumer-generated crisis planning are to be made and documented before employing a provider-generated crisis planning. Provider-generated crisis planning is to be replaced with consumer-generated crisis plan that is consistent with trauma-informed care. A copy of the written treatment plan will be provided to the individual, parent/guardians and youth. The expectation is that services delivered to children will be Family Driven, as defined by the Federal-Substance Abuse Mental Health Services Authority.
- IDHS/DMH Individual and Family Grievance Process
In addition to maintaining an internal process for receiving and responding to grievances from individuals, families or members of the community, IDHS/DMH Providers utilized to deliver community-based mental health services (i.e., excluding PAS/MH Providers) shall make available the IDHS/DMH Consumer and Family Handbook and contact information for the IDHS/DMH grievance process.
http://www.illinoismentalhealthcollaborative.com/consumers/consumer_handbook.htm
- Requests for Information
The Provider shall respond to a request by the Department for general information (for example, a legislative inquiry) within ten (10) working days of the written request for information. For emergency forensic inquiries, the Provider shall respond within forty-eight (48) hours of receipt of the request.
- Federal Mental Health Services Block Grant Funds
Federal Mental Health Services Block Grant funds (CFDA 93.958) allocated to a mental health grant Provider shall not be used for the following:
- To provide inpatient services;
- To make cash payments to intended recipients of health services;
- To purchase or improve land, purchase, construct, or permanently improve (other than minor remodeling) any building or other facility; or purchase major medical equipment;
- To satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt of Federal funds; or
- To improve financial assistance to any entity other than a public or nonprofit public entity.
- Federal Housing Development
The Provider agrees to notify the DMH Housing Coordinator thirty (30) days in advance of making any application to the federal Department of Housing and Urban Development (HUD) for HUD Section 811 or Continuum of Care programs for community-based Permanent Supportive Housing development funding for persons with mental illnesses.
The Provider further agrees not to include the Department as a funding source on any application without the express written consent of the DMH Housing Coordinator.
- Consumer Registration Information
The Provider shall ensure that consumer registration data on file with the Department or its agent are complete and are updated per department requirements to accurately reflect for each consumer receiving services their current status and condition, including information on diagnosis and functional capacity, whenever the consumer's treatment plan is updated or the Provider discontinues serving the consumer. For required data elements refer to the Provider Manual.
- Continuity of Care
Continuity of care is a core tenet of responsible community mental health care. The Provider is required to participate in a continuity of care activity to minimize barriers between and among inpatient, outpatient, emergency room, and other key health care boundaries in the local community. The Division will facilitate this planning process during the fiscal year and send notice to its providers about local service coordination event(s) that support continuity of care for customers of mental health services and supports.
- Disaster Response
In the event of a State-declared disaster, agencies funded through this contract for Medicaid, Non-Medicaid, and/or capacity grant programs shall participate in training for, and response to, an IDHS/DMH activated emergency response plan.
- Evidence-based Practices
Providers receiving a Uniform Grant Agreement or who are under another business agreement with IDHS/DMH to provide evidence-based practices must demonstrate fidelity to evidence-based practice models.
- Distribution of Materials to HFS or DHS/DMH Eligible Individuals
IDHS/DMH or its agent may develop and produce electronic and paper products designed to inform individuals about services, benefits, rights or the service delivery system such as updated copies of the IDHS/DMH Consumer and Family Handbook, notices for consumer and/or family telecalls. Providers shall assist IDHS/DMH or its agent with distributing these materials by placing or posting copies of written material produced and provided by IDHS/DMH or its agent in waiting areas, and by notifying individuals of available electronic information by providing and posting the website address for the information starting at the time of registration/enrollment and continuing throughout the consumer's service contract.
