0629 Clinical Review

Scope of Service

The Provider will provide a second level, post clinical review of the Resident Review assessments that are conducted on all consenting Class Members when the determination is that the Williams Class Member is not being recommended for transition to the community, at this time. This second level review is to assure that all reasonable services, resources and supports, within the existing DMH service taxonomy and other State Plan services have been considered to seamlessly facilitate the Class Members' transition from the Nursing Facilities/Institutions for Mental Disease (NF/IMD) to the community. This Clinical Review process will assure the efficacy of the Resident Review assessment and that the initial reviewer's recommendations were not overly conservative or restrictive in its conclusion. The provider will incorporate the expertise of the following professionals as part of the Clinical Review composition as needed: Lead Clinician (Licensed Practitioner of the Healing Arts (LPHA)), Nurse, Psychiatrist, Internist, and Administrative Assistant.


The provider will be responsible for the following:

  1. Receives referrals from the DMH Contact on Resident Review assessments with a determination of 'not appropriate for transition' (at this time).
  2. Convenes and schedules weekly Clinical Review team meetings, as appropriate, based on the volume of Resident Review cases received.
  3. Assures that the Clinical Review process has, at a minimum, participation from the lead clinician, social worker and nurse, with other consultants as required.
  4. Assures full review and discussion from the Resident Review documentation, recommendations and determination.
  5. Assures completion of the required paperwork with the Clinical Review team findings with appropriate signatures.
  6. Submits required paperwork with documentation on the Clinical Review recommendation to the DMH Contact within 7 business days after conclusion of the review process.
  7. Provides DMH with a weekly list of Class Members who have had a Clinical Review and the status determinations - supported or overturned (recommended for transition).
  8. Participates in weekly teleconferences with the DMH Clinical Review Coordinator.

Reporting Requirements:

  1. Financial Report in accordance with Exhibit C.
  2. Performance Report in accordance with Exhibit E.


Payment will be issued in response to Provider submitted quarterly invoices on the appropriate DMH invoice template at the established rate(s) (if applicable). Invoices shall be submitted to the DMH program contact no later than November 1, February 1, May 1, and August 1, and will be reconciled on the basis of reported allowable expenses per the Grant Funds Recovery Act [30 ILCS 705/7 and 8]. (The Grant Funds Recovery Act is not applicable to Fixed-Rate Grants.) All invoices shall be HIPPA compliant and encrypted utilizing DHS approved encryption software.

The Provider shall report quarterly allowable grant expenses on the appropriate DMH reporting template to the DMH program contact no later than November 1, February 1, May 1, and August 1, and reported expenses should be consistent with the submitted annual grant budget. If any budget variances are noted, the DMH program contact may request that the provider submit a revised grant budget before subsequent monthly payments will be made. DMH program contacts and reporting templates can be found in the Provider section of the DHS website.

Rate: $349 per review

Performance Measures

Each provider will monitor the following:

  1. Number of weekly Clinical Reviews assigned by DMH.
  2. Number of Clinical Review staffings convened weekly (based on referral/assignments)
  3. Number of clinical staff assigned to the Clinical Review team who meet required academic credentials
  4. Number of weekly Resident Review case files received will be reviewed by the Clinical Review team based on assignment
  5. Number of Clinical Reviews completed full participation signatures
  6. Number of Clinical Reviews processed and returned to DMH within 7 business days after conclusion.
  7. Weekly agency submission of spreadsheets to the DMH contact
  8. Weekly agency participation is scheduled (teleconferences).

Performance Standards

  1. 100% of Resident Reviews received from DMH for Clinical Review will be assigned to the Clinical Review Team.
  2. One Clinical Review staffing will be scheduled weekly or more frequently, if necessary.
  3. 100% of Clinical Reviews conducted will have the required complement of necessary clinical staff, by academic discipline
  4. 100% of all Clinical Review case files received weekly will be reviewed by the Clinical Review team.
  5. 100% of Clinical Reviews will have signature of the reviewing clinical staff
  6. 100% of Clinical Reviews completed will be returned to DMH within 7 business days
  7. 100% of all Clinical Reviews weekly spreadsheet will be returned according to the designated schedule
  8. 100% agency participation will occur on a Clinical Review calls, as scheduled by DMH