2539 Q&A - Crisis Care System (590)

Program 590 TA Session Presentation (pdf)

Q: Do we need special certification for a mobile crisis response team?
A: Because all entities funded under the 590 Program will be required to provide services to individuals with Medicaid, providers will need to comply with HFS Certification requirements for Mobile Crisis Response.
Q: Does the full time project director need to be 1 FTE?
A: Given the work that will be involved in supervision, program development and ongoing collaboration with the Division and community resources in developing the crisis continuum, it is expected that there be an FTE in a leadership role.
Q: Can you tell me more about the 988 regional crisis rollout?
A: The Division, along with mental health authorities of all states, are currently in the process of planning for 988 implementation. This includes the development of a plan for 988 regional coverage. It is expected that grantees involved in Program 590 will collaborate with the Division in planning for this rollout during FY22.
Q: Is there special certification for an MCR team, is it the same as MCR? Maybe I was focused on the word "team" and thought it meant more than existing MCR staffing.
A: At this time, the only certification requirements would be those consistent with requirements of the Medicaid authority for the purpose of billing for services provided to Medicaid eligible individuals. In addition to pursuing necessary certification for that purpose, providers must plan to establish teams that are consistent with the staffing plan as described in the NOFO.
Q: The Communication Alert said that Program 590 combines three existing community-based programs that have provided Someone to Respond in certain instances, but did not fully address statewide access. DMH has combined Programs 410 (Capitated Community Care), 420 (Eligibility Disposition and Assessment) and 580 (Crisis Staffing) into a comprehensive program intended to preserve existing approaches to crisis care and services to unfunded individuals, as well as expand capacity to provide crisis services consistent with SAMHSA's recommendations for evidence based practices. In addition to the funding that was previously split between these three legacy programs, IDHS/DMH is adding significant additional resources to this NOFO to ensure development of adequate statewide resources.

We are not sure if this means that 580 Grants will be renewed (or another grant application submitted) and the 590 should be used to expand the Crisis System further to include all the elements listed in the NOFO?

What about the smaller organizations or more rural locations where it might be difficult to organize such a system of care but where the organization has had a 580 grant for years? Or if the 580 grants are totally being rolled into this new Grant 590?

So if the money is all being rolled into 590 what happens if an organization that has had 580 funds does not apply for funding or is not chosen to be a 590 recipient?

A: The nationwide 988 implementation planned for July, 2022 requires that all states develop community based crisis responses statewide. By combining the scope and deliverables of these programs, we have preserved the functions of all three - services to unfunded individuals, outreach and assessment and support for crisis staffing - which actually expands the ability for agencies across the state to provide a more robust response to individuals in their communities in times of crisis.

Please also note that the intention of the Division is to provide technical assistance, training and learning collaboratives to Program 590 participants with the intention of developing the robust continuum during the course of the Program. We expect that smaller agencies and those operating in more rural areas who currently have less robust/less organized programs will benefit from this aspect of the Program.

Further, it is important to note that the program scope plans for and expects a period of development across the state. It is not the expectation that full statewide capacity will exist on the first day of the Program 590 grants becoming effective. Applicants are encouraged to describe the currently unmet needs in their communities in their NOFO responses and how they are suited to meet those needs.

The three "legacy programs" of 410, 420 and 580 were all at the end of their current NOFO cycle. As such, there is no option available to simply renew them. A NOFO is required. All community entities interested in participating in the community crisis continuum are encouraged to apply for Program 590.
Q: In terms of budgeting, should it be assumed that the level of funding received in year 1 of the NOFO cycle will be consistent with the following two years (assuming state appropriations continue at the same level for the program). If so, if some aspects of the program aren't developed and implemented until later in FY22, should the budget submitted for this NOFO reflect a full year of operation so that funding will be at a level needed in years 2 and 3?

A: While IDHS/DMH recognizes not all elements for all awarded programs will be operational by July 1, 2021 the intention is to obtain a robust Statewide crisis care system as early as possible. We know the 988 line will not be operational until July 2022 however the need for crisis services already exists. Budgets should be submitted assuming programs are operational as soon as possible and while we are committed to funding FY23 at no less than FY22 levels there is never a guarantee of future funding including increases.
Q: Within the NOFO, it indicates that a goal of the 590 grant is to build capacity to provide a team-based mobile crisis response. Is it required that an engagement specialist/staff member with CSSRS credential be a part of every crisis response (both during business hours and afterhours)?
A: Research indicates that when a person with lived experience is part of the MCR team the outcomes for the individual in crisis result in less adverse outcomes. Thus the expectation is that every mobile crisis response involves a person with lived experience. The agency must determine as a part of their proposed staffing plan, consistent with their assessment of community needs, whether this will be achieved through shifts or an on-call arrangement.
Q: It is unlikely that our small rural agency will apply for the 590 grant. Will our agency still be allowed to bill H2011 Crisis Intervention services, to our existing clients and potentially walk-in appointments?
A: Providers who bill for Medicaid services need to do so consistent with the Medicaid Authority (Department of Healthcare and Family Services) rules. 590 is a grant program, not a fee for service program, and as such is intended to support infrastructure and otherwise non-billable provider costs. We want all providers to know that this program was designed with the intention to better support the work that you have been doing, as well as create the additional capacity that states are required to develop by the time the federal 988 mandates are in place in July 2022. This NOFO is intended to provide all agencies, large and small, the ability to submit budgets reflective of the costs of doing business in their communities.
Q: Is the budget & narrative only submitted through the CSA portal? Do we also need to include information regarding the budget in the 20 page document?
A: That is correct. The budget and budget narrative must be submitted in the CSA Tracking System. See Section D - Application and Submission Information, Budget Requirement of the NOFO.
Q: If [agency] doesn't get this grant and another agency does, then could [agency] apply for our catchment area too? If so will we both be responsible for Crisis for the same geographic region? If we don't do the 590 would we still receive the 9-8-8 calls?
A: Any applicant responding to the NOFO is required to indicate the counties that they propose to serve. This is to ensure coverage and allow DMH to complete a gap analysis for any counties that are not covered based on initial responses. It is possible that there could be multiple awards made that include overlap of counties. Program 590 is about developing infrastructure for "someone to respond" which is different than "someone to call" which is the 988 hub as described in the NOFO.
Q: Based on the short turnaround for applications, are there organizations who have already been in talks with DMH regarding this grant possibility (prior to NOFO release) and whom would have the capacity to fill the grant? I'm a realist, and the last thing I want to do is waste time applying for something that has already (essentially) been decided.
A: GATA regulations do not allow the state to have any discussions with any potential respondents to NOFOs before the NOFO is published nor to have any interactions with potential respondents outside the communication channels as described - the TA session as published in the NOFO, and questions submitted through the official email box, which are then posted for all potential respondents to review on the Q&A page. No decisions on any awards are made outside the official competitive process that culminates with merit based review, which will not be initiated until the NOFO deadline is reached.
Q: We are current recipients of 580 funding. Since 590 is a combination that includes 580, do we add the costs and program components from our existing 580 into this request or is this an expansion and we can only include the request for new funding?
A: Program 580 is at the end of its NOFO cycle. As such it can not be included in the non-competitive FY22 grant opportunities. All costs to continue what you have built as a part of 580 should be included in your new, competitive application for 590, as should a description of what you have built through 580.
Q: Do the members of the mobile crisis team need to respond as a full team or can they respond individually to crisis situations?
A: A mobile crisis team would be expected to respond consistent with the guidance in SAMHSA's crisis toolkit.
Q: Do we need to have a CRSS available 24 hours a day for response?

A: Mobile crisis teams are expected to be staffed consistent with the NOFO, which includes a person capable of pursuing the CRSS within a year of hire.
Q: The NOFO states that DMH is committed to preserving existing community-based programs including 580 Crisis Staffing. How will 580 Crisis Staffing be preserved when 580 Crisis Staffing is not on the list as a non-competitive grant opportunity for SFY22? As 590 is competitive bid what will happen to the CMHC's that do not receive this funding as all are required under rule 140 to have 24/7/365 crisis coverage?
A: 580 was at the end of its NOFO cycle and could not be included in FY22 non-competitive grant opportunities. There will not be a new competitive NOFO for 580 as its scope was not sufficient to create the infrastructure that will be required for 988 implementation.
Q: Is the workforce there to support the mobile crisis teams? This will require deep pools of engagement specialists and MHP's across the state and centers are currently experiencing difficulty recruiting for open positions.
A: DMH acknowledges that workforce development is a challenge and is committed to working with providers on strategies to address these issues. We anticipate this may be one focus of the learning collaborative developed for 590 grantees. In addition, the NOFO was written with the requirement of a staffing plan, not hired staff, at the onset of the grant. This was an intentional part of the design; allowing providers time to build up their workforce.
Q: How will catchment areas be addressed?
A: It is the intention that crisis services be as local as possible. Applicants for 590 are expected to provide the areas for which they can respond with coverage. Outside of Cook County, this is to be by county. Inside Cook County, zip codes can be used. Once 590 grants are awarded, DMH will be completing a gap analysis to identify any areas that may not be covered.
Q: If a mobile team assesses an unfunded individual in the community that requires inpatient care how will they care for the individual while waiting for a state bed?
A: The 590 program is for anyone (all ages of individuals living in Illinois regardless of insurance status), anywhere (the location that the crisis is occurring) at any time (24/7/365). The SASS program is only for children/adolescents who are Medicaid eligible. There is an expectation that this program will work collaboratively with SASS/CARES/MCR for Medicaid eligible individuals.
Q: The NOFO has technical language that references "letters of support" and "linkage agreements" as it relates to the format for submission. This looks like stock language included in most NOFOs. However, the be clear, is there any expectation or desire or additional points for applications to include linkage agreements or letters of support?
A: That language is put in every NOFO. You do not receive additional points for those. They are not scored.
Q: Is there any guidance on when a crisis situation can be handled via phone versus sending out a mobile crisis response team?
A: It is not possible for us to provide this guidance, as it would be based on a number of clinical factors. It is important to note that Program 590 is about creating the infrastructure to have someone to respond. There will be ongoing work once the 590 grants are awarded that will help us to develop policies and procedures that guide operations and referrals from 988 call hubs to 590 providers among other things, and we anticipate this to be a focus of local community planning discussions at that time.
Q: Does the budget and budget narrative need to be entered in the CSA Tracking System AND included in the Program Proposal document (not to exceed 20 pages)?
A: No. The "Budget and "Budget Narrative" under the criteria will be reviewed using the budget submitted in the CSA Tracking System and does not require an additional page to be submitted in the Program Proposal as it was stated; this has been updated in the NOFO under Criteria.
Q: Is the budget and budget narrative only to be entered in the CSA Tracking System?
A: Yes
Q: Is a public school district an eligible applicant? Are you aware of any past awards for this or similar funding that was awarded to a public school district?
A: Applicants will need to review the information posted in the NOFO to determine their eligibility. DMH cannot make a blanket determination of qualifications without a full application submission consistent with the NOFO requirements.
Q: [Agency] previously had a MH license, but surrendered it a few years ago. [Agency] will be re-applying for their license. They are also interested in responding to this NOFO. The NOFO does not require that the applicant is currently licensed and certified at the time of application. Is it possible to apply for the license and the NOFO concurrently?
A: Yes.
Q: Section A of the NOFO states "Grantee is expected to provide services and supports to individuals experiencing mental health crises, with services consisting primarily of the services eligible for Medicaid reimbursement consistent with the Department of Healthcare and Family services Rule 140 and operated through Certified Community Mental Health Centers certified by Department of Human Services Rule 132....". Our organization is certified as a Community Mental Health Center through the Department of Children and Family Services (DCFS) - are we eligible to apply and provide services as a CMHC or would only those providers who are directly certified by DHS in Rule 132 be eligible as Section C Eligible Applicants does not provide this information stating only "all potential applicants are eligible"?
A: Eligibility to apply is not restricted to CMHCs certified by DHS under Rule 132.
Q: We have managed the Crisis 580 for multiple counties over the last two years and feel our organization would be able to meet the majority of requirements set forth. However, the requirement for the provision of a Crisis Receiving and Stabilization (non-hospital) facility is a difficult one to accomplish in rural communities. Is there any way that this requirement is able to be modified, allowing the use of a hospital setting with modifications to current crisis intervention and plans? After speaking with numerous agencies in our geographical area regarding the deliverables of Crisis 590, many have elected to not apply. This is going to create additional hardships accessing Crisis services within our rural communities.
A: There is no requirement to provide Crisis Receiving and Stabilization Units as a part of Program 590. That is a separate part of the infrastructure described by SAMHSA - a "Place to go." Program 590 is intended to ensure capacity for "Someone to respond."
Q: Does the 590 grant replace 580 Crisis Staffing and 420 Eligibility and Disposition Assessment?
A: 580 and 420 are at the end of their current contract renewals, and under GATA they must be rebid. DMH has included these programs into the 590 Program continuum.
Q: If so, does the same performance standards apply (580 and 420) or will the 590 performance measures apply moving forward in FY22?
A: As 590 is a new program, the performance measures described in the NOFO will apply.
Q: If 590 grant replaces Crisis Staffing and EDA, are we able to complete crisis response in a way that meets the community needs? For example, allowing MHPs respond to unfunded crisis response and having a crisis team that includes a variety of credentials (MHP, QMHP, and CRSS) that respond if they are supervised by a QMHP.
A: MHPs and individuals eligible to pursue a CRSS within one year of hire, with immediate access to a QMHP for supervision, are the minimum staffing requirements for mobile crisis team response.
Q: Is the 590 grant primarily intended to strengthen the existing crisis grants by providing the opportunity to have dedicated time to implement new initiatives in crisis care identified by SAMHSA intentionally?
A: The intention of the 590 program is to build the crisis infrastructure to support the expanded needs as a result of 988 and guidance from SAMHSA. This includes building capacity and reimbursing for anticipated additional non-billable expenses such as participation of providers within the crisis continuum in a in its design.
Q: Would this be an opportunity to build the infrastructure for the future 988 system into our agency?
A: The infrastructure required for the future 988 system includes three specific components which are described in detail within the SAMHSA crisis toolkit. The 590 program is intended to support the "Someone to Respond" component specifically.
Q: Is the budget & narrative just submitted through the CSA portal? Do we need to include anything regarding the budget in the 20 page document?
A: The budget and budget narrative must be submitted in the CSA Tracking System. You do not need to include anything regarding the budget in the 20-page Program Proposal.
Q: For clarity, as we build capacity and start billing for services, will this be a reduction on claims or in addition to claimed expenses?
A: For Medicaid billable services provided, you will bill and be reimbursed for services as you normally do. These expenses do not hit against the grant award funding. For grant funded services that are not Medicaid billable, DMH will make monthly advance payments to grantees from the grant award that will be reconciled with expenses reported on your quarterly PFR. The requested amount for the grant award should not include estimated Medicaid billable services.
Q: Would you please clarify Non-billable and expenses? Non-billable: Does this mean we reduce budgets by any billable hours staff provide?
A: Yes, any Medicaid billable services are not chargeable to the grant, but must be billed through HFS Medicaid.
Q: Expenses: Do these include all program expenses outside of salary expenses (i.e. Supplies, maintenance, utilities)?
A: Yes, expenses include all estimated costs that are not covered by Medicaid billing that will be necessary to carry out the deliverables of the grant agreement. Grantee staff may provide some Medicaid billable services for program 590 clients and bill Medicaid for those services. They may also provide treatment to individuals without Medicaid funding, and so the time spent providing services to those individuals would be included in "Non-billable" and charged to the grant.
Q: Is there any Fee-for-service component within Program 590? The answer for Question 8 in the Q & A webpage indicates that Program 590 is not fee-for-service: 590 is a grant program, not a fee for service program, and as such is intended to support infrastructure and otherwise non-billable provider costs. Where on Page 2 of the NOFO reads: Grant resources will also be applied to crisis assessment, crisis intervention and mental health treatment needs for individuals with no insurance coverage, or for the portion of crisis and treatment response not covered by an individuals' insurance plan.
A: Grantees will not be reporting Medicaid billable services/submitting Medicaid claims for Program 590 services covered by the grant funding. It is anticipated that crisis assessment crisis intervention, and mental health treatment needs for individuals with no insurance coverage, as well as the portion of crisis and treatment response not covered by an individual with insurance, will be covered by Program 590.
Q: Would anticipated expenses for providing these services to individuals without insurance, be placed on the UNIFORM GRANT BUDGET TEMPLATE 15). GRANT EXCLUSIVE LINE ITEM?
A: Applicants should show expenses in all applicable line items with regard to staff time, fringes, etc.
Q: We have only rarely billed for Mobile Crisis Response Team before and since capture of Medicaid billing will help support part of this crisis team, we have a basic question about that. We always thought the if we provided MCR-Team, that the second person on the team also needed to be at least an MHP. A closer reading of Rule 140 leads us to think this might not be the case. It states that MCR shall be provided By a crisis team trained in crisis de-escalation techniques, led by a QMHP, LPHA or MHP with immediate access to a QMHP and at least one other individual meeting any of the qualifications detailed in subsection (b). The referenced subsection (b) includes the definition for an RSA. Therefore, are we correct that even prior to obtaining their CRSS credential, an individual with lived experience who also qualifies as an RSA could be a part of the MCR-Team lead by an MHP for the purposes of billing?
A: A 590 Program provider would be expected to bill for services provided to Medicaid eligible individuals consistent with the Medicaid service definitions contained within Rule 140 and the requirements for claiming set by HFS.
Q: We have a question about the intersection of CARES and the requirements of this NOFO for Medicaid eligible individuals. The NOFO appears to reference a more strict requirement for CARES involvement for the purpose of Medicaid billing of MCR than HFS' provider handbook. Our question is whether that is DMH's intent - That is to require CARES to be called on all MCR events involving Medicaid eligible individual even if HFS is not requiring it. The NOFO states the following: It should be noted that Mobile Crisis Response services provided to individuals funded by Medicaid will continue to require a call to CARES and to follow Rule 140 for billing and implementation. HFS's Community Based Behavioral Services Provider Handbook indicated medical necessity can be met by a CARES referral but also leaves the door open to other ways to access MCR which would also meet that standard. Here is the language from the provider handbook: Medical Necessity for this service is established by direct referral from the Crisis and Referral Entry Service (CARES) Line or acceptance of a crisis referral from a local community resource (law enforcement, hospital, etc.), stakeholder or other entity or individual concerned for the mental health and wellbeing of someone believed to be in a behavioral health crisis, so long as the MCR service includes either a referral back to their existing treatment provider for ongoing services, or a consumer-driven referral to a community-based provider of MRO-MH services for follow up, assessment and ongoing service delivery. Given the above, is DMH's intent by the language in the NOFO be that 590 providers would need to call CAREs for all MCR referrals involving Medicaid eligible individuals even if the referral met the non-CARES standard listed above?
A: It is not DMH's intent to be more strict than HFS' requirements for Medicaid billing. The meaning within the NOFO is that Program 590 providers must comply with HFS's requirements for Medicaid billing.
Q: If the 590 grant replaces Crisis Staffing and EDA, are we able to complete crisis response in a way that meets the community needs? For example, allowing MHPs respond to unfunded crisis response and having a crisis team that includes a variety of credentials (MHP, QMHP, and CRSS) that respond if they are supervised by a QMHP?
A: The intention is to maintain currently available resources and build upon them to be able to provide mobile crisis response consistent with the terms described in the NOFO by the deadline issued in the NOFO. MHPs and individuals eligible to pursue a CRSS within one year of hire, with immediate access to a QMHP for supervision, are the minimum staffing requirements for mobile crisis team response.
Q: Is the 590 grant primarily intended to strengthen the existing crisis grants by providing the opportunity to have dedicated time to implement new initiatives in crisis care identified by SAMHSA intentionally?
A: The intention of the 590 program is to build the crisis infrastructure to support the expanded needs as a result of 988 and guidance from SAMHSA. This includes building capacity and reimbursing for anticipated additional non-billable expenses such as participation of providers within the crisis continuum in a in its design.
Q: Are the awards one per county?
A: Not necessarily. The requirement to identify the county(ies) in which a provider operates is to help the Division evaluate any gaps in coverage.
Q: Do you have to be a SASS provider to apply?
A: No
Q: Under this new program, will agencies also serve Medicaid clients? In other words, will this grant replace the contract that serves Medicaid and MCO recipients?
A: Providers receiving a grant for Program 590 will be expected to serve anyone that is in need of the services, regardless of funding source. However, the grant monies are intended to support the non-billable expenses of the program, meaning time spent in activities outside of service provision, as well as treatment services to individuals who are unfunded. Providers should anticipate providing services to a mix of funded and unfunded individuals, and will be expected to submit claims for services provided to individuals with a funding source to pay for those services. This would include Medicaid and MCO recipients, and providers would need to submit claims consistent with the requirements of Medicaid/MCO.
Q: After receiving the award, how long do agencies have to hire and train staff, before expecting to provide services?
A: There should be immediate access to any existing crisis services described in the NOFO response, and also immediate ability to provide walk-in and phone responses to individuals contacting the agency. NOFO timeline should also detail a plan to hire staff to provide the full array of services consistent with the NOFO requirements for mobile crisis response teams no later than the end of the first year of operation.
Q: With respect to the staffing plan, can the Program Director role be the same as the clinical supervisor? Does the "active member and liaison to the ongoing system collaboration" need to be different from the Program Director?
A: The program director may fill all those roles, or a provider may propose to cover the roles through a variety of qualified staff, whose total commitment to the program equals at least one FTE.
Q: Must agencies be deemed a Mobile Crisis Response Team in IMPACT in order to apply for the 590 NOFO?
A: Providers do not have to be deemed in IMPACT at the time of an application
Q: For the equity advancement portion of the Executive Summary, what kinds-of things are you looking for to be included in that section?
A: DHS is committed to ensuring that all people in Illinois have access to mental health care regardless of racial and ethnic background, ability to pay, or where in the state they live. As we work on advancing equity, we ask that our providers do so as well. Please describe the efforts your organization has taken to provide racially and culturally responsive services and close the gaps in services. These may include but are not limited to DEI planning, staffing, program models, training, materials, etc. You may also want to utilize the CLAS standards link within the published NOFO for additional guidance.
Q: In the body of the application, can we include data presented graphically in color?
A: Graph presentations may be done in color.
Q: We have a number of staff who have driver's licenses but do not have cars. And we are seeing this more and more with our new staff. In order provide mobile services, we would like to know if we will be able to charge car lease payments and other related vehicle expenses to the grant? Or should we require staff in the program to have their own cars?
A: Vehicle purchases are not an allowable expense, but vehicle leases are permissible as long as the lease agreements are not "lease-to-own or rent-to-own". The budget narrative must indicate number of staff per vehicle leased that will utilize the vehicle along with the purpose of the travel. It is also permissible to reimburse staff for mileage up to the state rate of $0.56 if personally owned vehicles are used for travel related to the project.
Q: We request to delay the application deadline enough to allow for continuous coverage and for adequate applications to be submitted. We are concerned about the lack of coverage in certain areas if providers are unable to submit an application because of the short timeline. We further think that hiring people from the communities served may also be lost if organizations are from miles away.
A: There is no viable way to delay the application deadline without jeopardizing crisis coverage, which is not something that IDHS/DMH can let happen. Regarding adequate community representation in the crisis network, IDHS/DMH is working hard to ensure this.
Q: In the proposal, can tables be submitted in a different font size, or must we maintain the 12 point font size requirement for tables as well?
A: REVISED: You may use Times New Roman 10 only for charts or tables. In addition color is may be used for charts and tables only.
Q: We are not familiar with the 420 or 410 programs. Can you please tell us who currently holds those grants in southern Illinois.
A: While we cannot provide a list through this process, this information would be available via a FOIA request.
Q: If we are MCR/SASS provider in a township and there is another 590 provider in the same township, would we get called or would CARES say-"590 provider you take it-even though the township is technically our MCR/SASS region?
A: As has been stated in the TA session as well as on other Q&A responses, the exact interface between CARES and 988, once it becomes active, has not yet been determined. This is one of many issues that will be discussed and determined through ongoing collaboration between 590 programs, DMH and HFS as we plan for the implementation of 988 and the interface with CARES. DMH considers the collaboration and planning with local community providers an essential function of Program 590.
Q: We have staff (Mental health workers) in our emergency room to crisis assessments, intervention and facilitate placement to least restrictive environment. We understand the current 580 grant will be replaced with a revised combination (410,420,580). If we are awarded the grant, can our Mobile Crisis Response team (psychotherapist and Engagement Specialist) provide crisis assessment and crisis interventions in the community to our patients and our mental health workers in the Emergency Room provide crisis assessment and crisis interventions to individuals not previously known to us?
A: Applicants may propose a staffing plan to cover crisis services for their proposed coverage area that maintains any existing crisis service capacity and addresses the projected needs of that area, and may do so with a combination of staff that meets at least the minimum requirements as stated in the NOFO.
Q: Regarding Social Determinants of Health (SDoH)
1. What is DMH's planned approach to being 'health strategists' as this State initiative is being implemented?
2. Will DMH expect providers submitting for 590 grants to address more immediate SDoH needs (e.g. Transportation, emergency medications, etc.) for their clients in crisis in this RFP?
3. In a separate RFP?
4. Other?
A: DMH anticipates that additional planning work will be central to the 590 Program and has intentionally included within the deliverables a framework for ongoing meetings, potential for data gathering, input, discussion and analysis through the Learning Collaborative that is to be established with Program 590 Leadership.

Applicants should include in their proposed budgets projected costs to include activities and supports consistent with the language of the NOFO which states: Grant resources will also be applied to crisis assessment, crisis intervention and mental health treatment needs for individuals with no insurance coverage, or for the portion of crisis and treatment response not covered by an individuals' insurance plan. This may also include supports for SDoH for individuals in mental health crisis, however, applicants should not include costs for services or supports that are covered through other existing DMH Programs, such as Psychiatric Medications (Program 574).

DMH is restricted from commenting on any plans for future RFPs within the 590 NOFO Q&A
Q: Regarding Substance Use Disorder care: a. Would you give direction on how providers should generally plan for services to clients with SUD in 590 programs? b. If you could clarify specifically if clients who have a primary SUD diagnosis with no co-morbid mental health are intended to be served by 590 programs? c. Under Performance Measure E, (Number of individuals served who meet criteria for Serious Mental Illness or Serious Emotional Disturbance and are unfunded), SMI/SED unfunded is being counted, will SUD uninsured clients be counted?
A: Because it may not be possible to determine diagnostic issues prior to responding to crisis situations, providers should anticipate that their crisis programs may include response to individuals with SUD diagnoses. Performance Measure E is consistent with reporting that DMH, as the State Mental Health Authority, is required to track. It is not meant to limit eligibility for Program 590.
Q: Regarding Justice involved individuals: * How will Justice involved individuals receive culturally appropriate, best practice crisis services across the State of Illinois? * Is the learning collaborative going to support all 590 providers addressing the complexities of courts, criminal justice, etc.? * If the learning collaborative is the plan, can you provide as much clarity as possible to how extensive and comprehensive will the learning collaborative guidance provide to ensure safe appropriate care for Justice Involved individuals?
A: DMH will be providing a Learning Collaborative of 590 program leadership, during which we anticipate identifying a variety of training and technical assistance needs. DMH will further be providing technical assistance and training on topics as identified within the Learning Collaborative as well as additional sources such as SAMHSA's toolkits, and these opportunities will be available to all staff working within Program 590. Given the interest as you identified within SAMHSA's toolkit, we plan for one focus of this training/TA to be on serving justice involved individuals.
Q: Regarding DMH's interest in providers submitting a Statewide Justice Involved Crisis support service application: * The provider applicant would meet all requirements of the 590 grant. * Provider applicant would support the DMH learning collaborative as well all organizations statewide who request educational assistance regarding best practice in all areas of crisis criminal justice core competencies. * Provider applicant would clinical support and education 24/7/365 to all 590 Statewide providers who request assistance in addressing justice involved crisis presentations. This 24/7/365 Crisis Service would be provided by video or phone conference, depending upon the request of the 590 provider and client.
A: This proposal is outside the scope of the 590 Program.
Q: In the Staffing Table sample, can you describe what "% lived experience" means as it relates to personnel? What would be an example of 50%, 75? 100% be?
A: It means the percent of staff that identify as having lived experience. If you had ten staff, and six identified as having lived experience, it would be 60%. DMH is not asking applicants to ask their employees about their mental health but if that information is readily and unobtrusively available, it can be used. DMH is asking that applicants consider those who have "lived experience" in their staffing plans.
Q: Is this grant available any county in Illinois?
A: Yes
Q: We are a currently an MCR/SASS provider. Specifically an MCR provider for adults and children. Would we qualify for this grant? And how would this grant differ from the MCR and SASS that we are already providing?
A: We cannot say whether you would qualify until you have submitted an application and it has been scored. MCR and SASS funds services to individuals eligible as defined within your terms with HFS. Program 590 is a grant that funds non-billable costs for providing crisis services and meeting the other deliverables as described in the NOFO, including services to individuals whose care is not reimbursed through public or private insurance.
Q: Can an individual agency ask for an award higher than $2,000,000, which was the ceiling on the NOFO? It was noted in the training that it is possible to request less than $100,000 which is lower than the bottom cap?
A: The applicant may request a higher amount if they believe it is necessary to accomplish the deliverables outlined in the NOFO. However, during the budget review process, DMH may request a budget revision. It is also important to note that the budget scoring criteria consider the reasonableness and necessity of the costs outlined in the budget.
Q: Can you please clearly define "lived experience" in reference to this requirement of an engagement specialist?
A: Lived experience refers to the expertise that an individual who has received mental health services develops from that experience. It is widely understood that individuals who have received treatment from the system are in a uniquely beneficial position to be of assistance to others who are experiencing similar challenges. Additionally, research has shown that services delivered by people with lived experience generate superior outcomes in terms of engagement and reduced rates of hospitalization.
Q: Does the engagement specialist have to possess (or obtain within 1 year) the CRSS credential? If some of our staff have what we consider to be lived experience and are already an MHP, QMHP, etc., do they also have to obtain the CRSS credential?
A: Yes, regardless of prior training, education, or degrees, the engagement specialist must possess (or obtain within 1 year) the CRSS credential. Among other things, CRSS training and education is designed to assist the individual in the appropriate use of their lived experience to the benefit of those they serve, which is outside the academic training received through the college coursework that the person may have pursued that resulted in their MHP/QMHP status.
Q: We have certain staff who we think would qualify as engagement specialists but would not want their names identified in any reporting to DHS, etc.? Is this feasible or would we eventually have to identify by name the engagement specialists we would have on staff?
A: In order for the person with lived experience to effectively use that lived experience in their work as a benefit to those they serve, they must be willing to self-identify to the individuals being served as someone who has that lived experience. Also, to obtain the CRSS, the staff must be willing to sign a Statement of Self-Disclosure as part of the application process through the Illinois Certification Board.
Q: As per my understanding application includes following documents - * Uniform Application for State Grant Assistance * The Program Proposal * Sub-recipient budget(s) please let me know if we have to include any attachments.
A: Attachments would include sub-recipient budgets. You will also need to submit your budget in the CSA System.
Q: Will the NOFO and related information be posted on the GATA CSFA page or only on DMH's website?
A: It is posted at both places.
Q: Does the Division have the authority/ability to revise the NOFO - scope, content, deliverables, and application deadline?
A: No revisions to the NOFO scope, content, deliverables or deadlines are expected.
Q: Please describe more fully the role of the Engagement Specialist.
A: Crisis Services programs should employ individuals who have lived expertise that comes from their experience recovering from mental illness or co-occurring substance use disorder to serve as Engagement Specialists on the crisis services team. The Engagement Specialist will be deployed to implement the program's outreach and engagement plan for direct connection with individuals who would benefit from services but may be otherwise unaware of their availability or otherwise reluctant to engage in such services. The Engagement Specialist will be an active member of the Crisis Services program and, as MCR is more fully developed, will be part of the team-based mobile response. Research has shown that individuals with these qualifications can be particularly effective in engaging those who may be reluctant to engage with behavioral health professionals or first responders by building trust, providing reassurance, and enhancing a sense of safety for the individual in crisis.
Q: If our agency receives 580 and 420 contract/funds will 590 funds replace those contracts for FY 22.
A: 580 and 420 are at the end of their current contract renewals, and under GATA they must be rebid. DMH has included these programs into the 590 Program continuum.
Q: Are sub-contracts allowed?
A: Yes.
Q: For the person on the team with lived experience, if the grant is the payor of last resort, what service are we billing to Medicaid for services provided by that individual in this model?
A: The Division recognizes that not all services provided under this Program are billable to Medicaid and Private Insurance, and therefore the applicant needs to include in their budget the cost necessary to ensure capacity to meet program needs.
Q: We have an existing 580 grant. We plan to apply for 590. I am considering if we expand to a larger geography. Can I submit 2 applications, one for existing counties and another for creating another crisis team at a different area?
A: One application identifying the entire coverage area the entity plans to cover.
Q: Is this program designed primarily for adults in crisis or must it also include children and adolescents? There is already a substantial program for C&A (SASS).
A: The 590 program is for anyone (all ages of individuals living in Illinois regardless of insurance status), anywhere (the location that the crisis is occurring) at any time (24/7/365). The SASS program is only for children/adolescents who are Medicaid eligible. There is an expectation that this program will work collaboratively with SASS/CARES/MCR for Medicaid eligible individuals.
Q: If an organization is going to cover two separate, large geographic areas, will two team members be allowed, i.e. two Directors, two Engagement Specialists, etc.
A: The entity will need to provide a staffing plan and budget that will meet the needs of their proposed geographic coverage area.
Q: Is this funding opportunity made possible from the Mobile Crisis money in the federal COVID relief bill (American Rescue Plan Act)?
A: No
Q: Confirming, this is for mental health crisis only and not substance abuse crisis too (SAMHSA Crisis Services document covers both).
A: Thank you for reviewing the SAMHSA tool Kit, this is one area that our planning and community coordination will help us better understand moving forward. As part of your response if this is an identified need please include your plan for addressing this need.
Q: Outside of Cook County, can more than 1 agency be awarded within a single county?
A: Yes
Q: As 590 is competitive bid what will happen to the CMHC's that do not receive this funding as all are required under rule 140 to have 24/7/365 crisis coverage?
A: Rule 140 is the HFS administrative rule that defines Medicaid Services. If you have concerns or questions about any requirements in Rule 140 they need to be addressed to HFS.
Q: Would the engagement specialist (CRSS) need to be available on every shift, or just on the overall team?
A: Mobile Crisis Response Teams developed under this funding opportunity work as a team, and the provider's staffing plan must ensure availability of a team 24/7. This may be through shifts or an on-call arrangement. Research indicates that when a person with lived experience is part of the MCR team, the outcomes for the individual in crisis result in less adverse outcomes. Thus, the design of the Mobile Crisis Response Teams includes individuals with lived experience as an integral part of the team at all times that the team provides services.
Q: Does the Community Engagement specialist have to be a Certified Recovery Support Specialist?
A: The community engagement specialist must be capable of receiving the CRSS within one year of hire.
Q: Will crisis services provided via telehealth be billable? If not, will you consider making streamline process for Calm4Calm referrals via text to increase access/bandwidth by expanding options with telehealth?
A: a. The 590 program is not a fee for service crisis response service. We are funding the capacity to provide 24/7/365 access to crisis services, entities that receive funding under this program will be required to bill services to other resources first and then fund non-billable services through this funding opportunity. During the planning process for the crisis system there may be the need to expand the capability within the state to develop additional technology-based approaches.
Q: How do you propose that we maintain the safety of our staff when responding to crisis situations where law enforcement backup is not readily available if they discover it is an unsafe situation when they arrive? We have only 2 responding officers available for an entire county at many times.
A: We acknowledge the need to ensure the safety of staff and individuals experiencing a mental health crisis and want to ensure the safe operation of the Mobile Crisis Response Team. The SAMHSA tool kit refers to, "specific safety protocols that help determine when back up law enforcement response is needed and how it should be coordinated."
Q: We are already delivering mobile crisis response to 2 communities. Is expansion to another community advised, or can we simply address service gaps/need for enhancement?
A: The Division is unable to advise you on what you can propose in your application. Please refer to the other questions and see if there is additional information available. Remember that your proposal should be in response to the needs assessed in your community.
Q: Is the mobile crisis response team expected to be working (on shift) 24 hours/day or can that be available on an on-call basis after normal business hours?
A: Mobile Crisis Response team must be available 24/7/365.
Q: 24. If a mobile team assesses an unfunded individual in the community that requires inpatient care how will they care for the individual while waiting for a state bed?
A: While Program 590 addresses "someone to respond" we recognize that the continuum of crisis care will also require "a place to go", we anticipate addressing identified gaps in the system as part of the statewide planning process.
Q: Is the expectation the 590 grantees work in tandem with MCR/SASS providers if they are not one in the same?
A: Yes
Q: What is the "Hub" and how can we begin to implement? How many staff would be needed?
A: We believe that the reference to the "Hub" is related to a separate piece of SAMSHA crisis continuum, specifically the 988 regional crises call hub services (someone to call), which is not part of this funding opportunity. While program 590 is not about answering 988 crisis calls, grantees will need to coordinate with the hub serving their area once developed.
Q: What is the expected pay rate for Engagement Specialist and how do we link with workforce development plans to recruit? What can managed care do to support with workforce development and address barriers to entry of the field?
A: Pay rates for Engagement Specialists should be commensurate with their work experience, lived expertise and education. Thus, an ES with no previous work experience would be paid on the same scale as an RSA. An ES with a CRSS, 5 years' work experience, or a BA, would be paid on the same scale as an MHP. As you may be aware the the capacity/agency qualification section of the NOFO specifically requires you to describe your hiring approach and staffing plans, you may want to reference to the CRSS Provider Workbook for additional information.
Q: Can you speak more to program implementation that is required as of July 1, 2021, versus aspect of ongoing capacity building that is allowable across the first year of implementation to be established and operational in the second year rollout?
A: Existing providers of 580 must maintain staffing at the level consistent with what currently exists. At a minimum, all applicants must have the capacity to respond to walk in and telephonic crisis needs on July 1, 2021 and by July 1, 2022 the full Mobile Crisis Response Team must be operational.
Q: Are match funds required?
A: No
Q: Can you please discuss if there is any planned enhancement to the current inpatient crisis bed capacity which would support the entire state?
A: While Program 590 addresses "someone to respond" we recognize that the continuum of crisis care will also require "a place to go", we anticipate addressing identified gaps in the system as part of the statewide planning process.
Q: Are individuals to respond as a team 24/7, or as an individual?
A: Mobile Crisis Response team as defined in the SAMSHA toolkit is a team service.
Q: Is the mobile crisis response team expected to be working (on shift) 24 hours/day or can that be available on an on call basis after normal business hours?
A: Mobile Crisis Response team must be available 24/7/365.
Q: Also is there any planned enhancement for SOF placement for inpatient psychiatric hospitalization?
A: While Program 590 addresses "someone to respond" we recognize that the continuum of crisis care will also require "a place to go", we anticipate addressing identified gaps in the system as part of the statewide planning process.
Q: We are going to apply for 2 mobile crisis teams (one in the north and one in the south). Should we submit one Gata budget with all expenses combined or two separate ones?
A: Only one application and one budget is allowed per entity.
Q: In order to submit a subrecipient or contract - do they only complete C6 or C7 in the attached document OR should they complete the entire document?
A: The entire GOMBGATU-3002 needs to be completed with the supporting narrative if applicable.
Q: Are there any other requirements that sub-recipients must complete for the 590 grant application process?
A: If sub-recipient, who does not make election in the State of Illinois Indirect Cost Rate Election System, is claiming indirect cost, copy of sub-recipient's indirect cost rate agreement is required along with GOMBGATU-3002.
Q: I'm currently in the process of inputting the budget for this new grant - could you please advise if the fringe component can be input as total cost (ie, 3 individual lines: Fica: total for all budgeted staff; Retirement: total for budgeted staff; Health Ins.: total for all budgeted staff)?
A: Yes. There are many ways one can enter fringe benefits in budget schedule. One of them is the way you described. However, we require an adequate information in budget narrative section to support detailed budgeted costs.
Q: I am working on entering the Crisis Care System 590 grant into the portal. We are building the 590 budget from the 580 grant budget that we already started in the portal. Is there a way that I can copy over the 580 budget in the portal to the 590 grant so that I can make adjustment without starting from scratch entering staff by line item.
A: Program 590 is a new competitive program with its own unique requirements and open to all current and new applicants. As such, all budgets for this program should be entered specifically for this program and not copied from any other programs.
Q: I have written my 590 grant request to incorporate both a Crisis Stabilization Program (CSP) and a Mobile Crisis Response team (MCR). May I proceed with the submission of this grant or do I need to omit the CSP piece?
A: NOFOs are evaluated based on the response to the scope of the program described in the opportunity. Items outside the scope as proposed in the NOFO can not be funded as a part of the NOFO.
Q: Do sub contracts have to complete the entire document? Do consultants have to complete the entire form?
A: Subrecipients are required to complete GOMBGATU-3002 and submit, as a separate document, with the application. Individual consultant is not required to complete GOMBATU-3002. Applicant may utilize 2 CFR § 200.331 to determine whether the recipient is a subrecipients or a contractor.
Q: Do subcontractors submit the budget document to the lead agency and the lead agency includes it in their CSA submission? If so, In what format does the sub complete the budget document? The Uniform grant budget template does not allow necessary space to include all required components. Or - does a subcontractor submit their budget information into their organizations CSA portal? If that is the case, how would the grant award be navigated, managed with the lead agency?
A: If the Lead Agency (prime) has subrecipient(s) in their CSA budget, then the Lead Agency is responsible for submitting each subrecipient's detailed budget in GOMBGATU-3002 along with the application/proposal.
Q: Using the GATA budget portion of the CSA portal, it does not appear as though there is a place to enter the total for subrecipient budgets. Thereby, it appears as though our state total requested will not match what is entered through the portal. Is it assumed that evaluators will look at the subrecipient budget included with the application and program narrative and add it to the budget entered in the portal to equal the sum requested? We have explored various FAQs and links on the State's GATA site and don't see clarification on this, and want to ensure it's entered and submitted correctly.
A: Total for each sub-award (subrecipient) can be entered into the Contractual category along with the proper justifications in the CSA budget. Detailed subrecipient budget for each subrecipient must be submitted with the application using GOMBGATU-3002.
Q: We are also helping to get some clarification on the parameters surround "telecommunications" the DHS budget training manual does little to differentiate this from other sections and we were wondering if software contracts, used in the course of telecommunications, such as office 365 or Microsoft Teams would be included?
A: Contractual services can be entered into the Contractual category along with the proper justifications.