Division of Developmental Disabilities

The Division of Developmental Disabilities (DDD) Dental Grant Program seeks to increase access to dental services that are not reimbursable through Medicaid or are above the benefit limitation allowed through Medicaid for individuals with intellectual and developmental disabilities (I/DD). The DDD Dental Grant Program strives to meet the oral health care needs of individuals with I/DD. It is recognized that many individuals living with I/DD qualify for Illinois' Medicaid Dental Program. This Dental Program will cover only those services that exceed the benefit limitations and are services not covered under Medicaid, Medicare, or private insurance plans.

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2 CFR 200 : https://www.gpo.gov/fdsys/granule/CFR-2014-title2-vol1/CFR-2014-title2-vol1-part200/content-detail.html Developmental Disabilities CSA Attachment A: http://www.dhs.state.il.us/page.aspx?item=103251 Developmental Disabilities Program Manual: http://www.dhs.state.il.us/page.aspx?item=103254 Mental Health and Developmental Disabilities Code 405 ILCS 5 http://www.ilga.gov/legislation/ilcs/ilcs5.asp?ActID=1496 Adult Protective Services Act 320 ILCS 20: http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1452 Abused and Neglected Child reporting Act: (325 ILCS) 5/1: http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1460&ChapterID=32 Community Services Act (405 ILCS 30/4.3) http://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=1501

The Dental Program is intended to: 1. Provide a comprehensive array of dental care services for individuals with I/DD who are unable to secure dental care and services in traditional community settings because of their disability. These services will include preventive dental services, dental education, hygiene, and various dental repairs, such as, periodontics, restorative, endodontics, and oral surgery. 2. Expand access to dental services beyond benefit limitations or services not covered under Medicaid, Medicare, or private insurance plans for individuals with I/DD. Note: Services delivered to individuals and billable through Medicaid, Medicare or Private insurance may not be claimed/charged to or paid/reimbursed through this grant. 3. Provide dental services through grantees who are able to demonstrate a service record of experience and expertise in serving and providing dental care to individuals with I/DD. Services include, but are not limited to partial dentures, bridges, additional cleanings, behavior management, and/or case management. 4. Fund at least one qualified and ready grantee in each of the four (4) geographic areas of the state: Northeast (NE), Northwest (NW), Central (C), and South (S).

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Deliverables Each quarter, the grantee will submit a Periodic Performance Report (PPR), which includes the following reporting requirements: 1. The grantee will provide documentation that details the dental care services provided by completing the Dental Services spreadsheet in the required data section. a. Required data: Documentation regarding individuals served during the reporting period: (Spreadsheet (xlsx)). 2. The grantee will provide a list of unduplicated individuals who requested or are receiving dental services that exceed benefit limits or are not covered by Medicaid, Medicare, or private insurance plans. a. The grantee must provide the individual’s full name, age, date of birth, gender identity, last four of their Social Security Number (SSN), Recipient Identification Number (RIN) (if applicable), private insurance carrier (if applicable), race/ethnicity, and county they reside. b. If dental services were requested but not provided, the grantee must indicate a reason why dental services weren’t provided and if any referrals were made elsewhere. c. Indicate if the individual is a new participant who has not previously received any dental service(s) through the DD Dental grant. d. Provide the total number of unduplicated individuals who received dental services. 3. The grantee will develop a satisfaction survey, provide a copy of the satisfaction survey, and a summary of satisfaction survey results from the satisfaction survey. Surveys should be distributed to the individual or individual’s representative after service has been provided. a. Provide a blank copy of the satisfaction survey (annually). b. Provide the total number of surveys distributed to individuals or their representative. c. Provide percentage and total number of overall positive satisfaction survey results received. d. Provide summary of responses to each question listed on the survey and provide an explanation for missing survey responses. Performance Measures and Standards 1. A full-time equivalent dentist funded by the DD grant will provide dental care services to at least 500 participants, with an intellectual or developmentally disability, annually. 2. A minimum of 80 percent of individuals with an I/DD who request dental care services, must be provided dental care services. 3. A minimum of 20 percent of individuals with I/DD who are provided dental care services, must be from a minority group or underserved community. 4. A minimum of 80 percent satisfaction is required by individuals with I/DD, served through this funding. 5. Grantee will provide satisfaction surveys to all I/DD individuals being provided dental care services and receive an overall customer satisfaction score of an average of 80 percent or higher with their dental care services they received. 6. Requires grantees to be enrolled as Medicaid providers and have the ability to accept private insurance. 7. Allow grantees to bill usual and customary charges only up to those amounts as defined by the State of Illinois Delta Dental Fee Schedule. 8. Have a $2,000 per individual per fiscal year annual maximum for supplies and services. At the end of the year, successful applicants will also submit a cumulative report with the cumulative totals from above. Failure to comply with these reporting requirements could result in the Department placing you on the stop pay list, withholding of funds, termination of the grant agreement and subject to the Grant Funds Recovery Act.

Nonprofit Organizations;

A. Program Specific Eligibility 1. Has demonstrated experience providing services and supports to individual with intellectual/developmental disabilities and their families. 2. Has demonstrated the ability to meet all the program goals described in this NOFO. 3. Has met the criteria Laid out in Section VI Application Review Information, Criteria and Weighting of Each Criteria in NOFO. 4.Must be an established dental provider. B. Prequalification Requirements 1. The applicant must meet the Registration, Pre-qualification and any other Mandatory Requirements listed in this funding opportunity. 2. Applicants must provide the following information via the Grantee Portal annually to be registered with the State of Illinois as an awardee: a. Organization name and contact information. b. Federal Employee Identification Number (FEIN). c. Unique Entity Identifier (UEI). d. Organization type. 3. Applicants must be prequalified; therefore, applications from entities that have not prequalified prior to the due date of this application will NOT be reviewed and will NOT be considered for funding. Items (a) through (e) below are the prequalification requirements. a. Unique Entity Identifiers and SAM Registration: Each applicant (unless the applicant is an individual or State awarding agency that is exempt from those requirements under 2 CFR § 25.110(b) or (c), or has an exception approved by the Federal or State awarding agency under 2 CFR § 25.110(d)) is required to: i. Be registered in SAM.gov before the application due date. ii. Provide a valid Unique Entity Identifier (UEI) in its application. iii. Continue to maintain an active SAM registration with current information at all times during which it has an active award or an application or plan under consideration by the awarding agency. iv. The State Agency may not make an award until applicant has fully complied with all UEI and SAM requirements. v. The State Agency may determine that an applicant is not qualified if they have not complied with requirements and use that determination as a basis to award another applicant or applicants. b. Must be in "good standing" with the Illinois Secretary of State if the Illinois Secretary of State requires the entity's organization type to be registered. c. Must not be on the Illinois Stop Payment List. d. Must not be on the Sam.gov Exclusion List. e. Must not be on the Medicaid Sanctions List. C. Successful applicants will not receive an award if pre-award requirements are not met. Qualified status is verified at time of application. Applicants who are not eligible due to registration or pre-qualification issues, or late applications will be notified that they are ineligible for consideration when the requirements of the grant application or pre-qualification, have not been met. This will be done through email contact, to the corresponding contact information, on the application submission.

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Cooperative Agreements

Human Services

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I. Content and Form of Application Submission Applications must include the required documents and demonstrate that the program eligibility requirements have been met. The Department will not contact applicants for missing items listed below. Applicants that do not include all the following documents will be considered substantially incomplete and will not be considered for funding. Refer to Section V for Submission Instructions. 1. Program Narrative and Proposal Narrative Content with Attachments a. Program Narrative: IMPORTANT, the program (proposal) narrative makes up the bulk of the application. Please provide a complete response to the following sections. If the program narrative is missing from your application packet, your application will receive a score of zero points and your agency will not meet the criteria to receive a grant under this notice of funding opportunity. b. Proposal Narrative Content and Attachments: If the applicant believes that the subject has been adequately addressed in another part of the application narrative, then provide the cross-reference to the appropriate part of the narrative. If a cross-reference is not included in the section, the reviewer will consider content contained within that specific section. 2. Budget and Budget Narrative - Applicants must enter a budget electronically in the CSA and provide a copy of the completed budget in PDF format. a. The budget entered in the CSA system will include a narrative or detailed description/justification for each line in the budget, a describe why each expenditure is necessary for program implementation, and how you arrived at the specific amount. Please include cost allocations as necessary. This narrative must clearly identify indirect costs, direct program costs, direct administrative costs, and match within each line item as appropriate. The budget (including MTDC base exclusions as appropriate) should clearly describe how the specified resources and personnel have been allocated for the tasks and activities described in your plan. b. The budget and narrative must tie fiscal activity to program objectives and deliverables, and demonstrate that all proposed costs are: i. Reasonable and necessary ii. Allocable iii. Allowable as defined by program regulatory requirements and the Uniform Guidance (2CFR 200), as applicable. c. If indirect costs are included in the budget and the applicant has a currently approved NICRA, you must ensure the NICRA has been uploaded in the State of Illinois Indirect Cost System. d. The budget submitted in the CSA system must be electronically signed by the Provider's Chief Executive Officer and/or Chief Financial Officer. This is the same requirement for the PDF version that is required. IMPORTANT: Please be sure the budget status in CSA says "GATA Budget signed and submitted to program review." This status will appear after the budget is electronically signed by the agency CEO or CFO and submitted to IDHS. See IDHS CSA Tracking System webpage for additional information on CSA at IDHS CSA Tracking System. e. Additional information for entering a Uniform Grant Budget can be found at Budget Template and Budget Template Instructions. Be sure to follow instructions on website on how to download the Template. 3. Required Forms a. Uniform Application for State Grant Assistance – This is a three-page document used to formalize organization's request to apply for funding. The document requires the signature and email address of the organization's authorized representative. This email address will be used for official communication between the Department and the applicant organization for matters regarding this application. IL444-5262 - UNIFORM APPLICATION FOR STATE GRANT ASSISTANCE (.pdf) b. Grantee Conflict of Interest Disclosure – This is required for all grant award programs. The document requires agencies to identify actual or potential conflicts of interest. The form must be signed by a representative of the organization. IL444-5205 - GRANTEE CONFLICT OF INTEREST DISCLOSURE (.pdf) 4. Required Format a. Application Format Requirements: Electronic submission is required in PDF format. b. Document Submission Requirements: i. 8.5” X 11” Paper size, Single spaced, 12-size font, Calibri typeface, one-inch margins, and display page numbers. ii. The applicant should not use agency letter head or agency identification formatting features on the application. Limit reference to the agency’s name, specifically, in the program narrative. The agency’s name and identifiers will be redacted, from the documentation, for the Merit Review Process. This ensures a fair and unbiased scoring process. iii. File name should be “Funding Opportunity Number, Program Name, and Agency Name. iv. All forms must be signed and dated. v. The application must be no more than 25 pages. This includes the application and narrative. (Uniform Grant Budget and Grantee Conflict of Interest Disclosure form are not included in this count) c. The narrative portion must follow the page maximums where prescribed and must be organized in the format outlined or points may be deducted. d. The Department may determine that an applicant is not qualified if they have not complied to requirements and use that determination as a basis to award to another applicant. II. Submission Instructions A. Actions needed prior to applying: Applicants must be registered with the State of Illinois and Pre-qualified in the GATA portal prior to applying for Illinois awards. Instructions for creating an account and registering are located at the following link: Illinois GATA Grantee Portal. Additionally, detailed instructions for registration and prequalification requirements, including the expected amount of time for completion are located here: Grant Applicant Pre-Qualification and Pre-Award Requirements. B. The methods for submitting the application: 1. Applicants must electronically submit the complete application including all required narratives and attachments in the prescribed order: a. Program Narrative b. Uniform Application for State Grant Assistance c. Grantee Conflict of Interest Disclosure d. Budget- entered into the CSA system and copy in PDF format. 2. Applications must be sent electronically to: • Email: DHS.DDDGrantProg@illinois.gov • Subject Line: “26-444-24-0829, NOFO Dental Services Program Application, your Agency’s Name” IMPORTANT: The Department will ONLY accept applications submitted by electronic mail sent to this email address. Application submissions or delivery to any other email address or contact, including other IDHS offices or employees, will not be considered for review or funding. Applications will not be accepted if received by fax machine, hard copy, disk, thumb drive, password protected emails, password protected documents, and emails from encrypted email protection companies (such as, Prevail, Barracuda Network, Trustifi, etc. list not full inclusive). The application will be electronically time-stamped upon receipt. 3. Software or electronic capabilities required are as follows: Internet access, preferable high-speed, Email capability, Microsoft Word, Microsoft Excel, and Abode Reader. The purchase of this technology would be an allowable expenditure under the grant and may be budgeted for as part of this application. 4. Applicants are required to notify the Department within 48 hours of the deadline, if they did not receive an email notifying them that their application was received. If the applicant does not receive an email and does not notify the Department within 48 hours, their application will be considered a late submission and will NOT be reviewed or scored. The applicant will NOT have the right to protest the submission/receipt of their application to the Department after the 48 hours. In the event of a dispute, the applicant bears the burden of proof that the application was received on time at the email location listed above (and that the budget was submitted into the CSA system on time). C. If you are experiencing system problems or technical difficulties submitting your application, you may contact us at: • Name: Erica O’Neal • Email: DHS.DDDGrantProg@illinois.gov • Subject line: “NOFO Technical Difficulties, Dental Services Program” III. Submission Dates and Times. A. Full applications are due on the following date ********, at the following time 5:00 p.m. (CST). B. Missed Deadlines 1. Applications received after the due date and time will not be considered for review or funding. All applicants/applications determined to be non-compliant or otherwise determined to be disqualified from consideration will be separately notified in writing, by email, upon determination. This email will be sent to the email addresses provided in the application and will identify the reason for disqualification. 2. For your records, please keep a copy of your submission with the date and time the application was submitted along with the email address to which it was sent. The deadline will be strictly enforced. 3. IMPORTANT: It is strongly recommended that the applicant not wait until the last minute to submit an application in case they experience technical difficulties with the submission process. Applicants should keep copies of all documentation that may prove their application was submitted to the correct location and that it was received by IDHS on or before the deadline. Applicants should also maintain all electronic documentation, including screen shots, email correspondence, help desk ticket numbers, etc. that would document any unforeseen difficulties the applicant may have encountered regarding the timely submission of the application.

A. The process for evaluation of the application is as follows: The numerical score may not be the sole award criterion. The Department reserves the right to consider any factors such as: geographical distribution, demonstrated need, and agency past performance as a State of Illinois grantee, etc. While the recommendation of the review panel will be a key factor in the funding decision, the Department maintains final authority over funding decisions and considers the findings of the reviewers to be non-binding recommendations. Any internal documentation used in scoring or awarding of grants shall not be considered public information. B. In the event of a tie with insufficient funding for all tied applications, the Department may choose to elect one or more of the following options: 1. Apply one or more of the additional factors for consideration described above to prioritize the applications; or 2. Partially fund each of the tied applications; or 3. Not fund any of the tied applications. The Department reserves the right to negotiate with successful applicants to adjust award amounts, targets, deliverables, etc. Risk Review A. IDHS conducts risk assessments for all awardees, prior to the award being issued. 1. An agency wide Internal Control Questionnaire (ICQ) to be completed by the awardee within the Grantee Portal. The ICQ evaluates fiscal, administrative, and programmatic risk in the following categories: a. Quality of Management Systems b. Financial and Programmatic Reporting c. Ability to Effectively Implement Award Requirements d. Awardee Audits 2. A program specific Programmatic Risk Assessment conducted by the awarding agency to evaluate the following categories: a. Programmatic financial stability. b. Management systems and standards that would affect the program. c. Programmatic audit and monitoring findings. d. Ability to effectively implement program requirements. e. External partnerships. f. Programmatic reporting. 3. Risk assessments are not intended to be punitive in nature, rather they are conducted in order to evaluate the support, technical assistance, and training that may be needed for the awardee and the level of monitoring that is needed for the award. 4. Risk assessments may result in Specific Conditions being placed on the award to include more frequent monitoring or the implementation of a corrective action plan. B. Simplified Acquisition Threshold - Federal and State awards 1. This award is not anticipated to exceed the Simplified Acquisition Threshold defined in 48 CFR part 2, subpart 2.1.

A. State Award Notices 1. Applicants recommended for funding under this NOFO following the review and selection process will receive a Notice of State Award (NOSA). The NOSA shall include: a. Grant award amount. b. The terms and conditions of the award. c. Specific conditions, if any, assigned to the applicant based on the fiscal and administrative risk assessment (ICQ), programmatic risk assessments (PRA), and the Merit Review. 2. Note: The Department cannot issue a NOSA until the successful applicant has an approved budget entered into the CSA system. The applicant shall receive the NOSA through the Grantee Portal. The NOSA must be signed by the agency’s grants officer (or equivalent). This signature effectively accepts the state award amount, and all conditions set forth within the notice. The signed NOSA is the document authorizing the Department to proceed with issuing an agreement. The agency signed NOSA must be remitted to the Department as instructed in the notice. 3. The notice is not an authorization to begin performance (to the extent that it allows charging to State awards of pre-award costs; pre-award costs are incurred at the non-State entities own risk unless they have received written prior approval to begin performance). 4. The authorizing document to begin performance is the fully executed Uniform Grant Agreement (UGA) signed by the grants officer, or equivalent. This is the official document that obligates funds. The UGA is sent to the non-State entity via the CSA system. The non-State entity will print and sign the signature page of the UGA and return signature page to DHS.OCA.SignaturePages@illinois.gov. A final signed copy of the UGA will be provided to the non-State entity via an upload into the CSA Tracking system. 5. Applicants who are not eligible due to registration or pre-qualification issues, or late applications will be notified that they are ineligible for consideration when the requirements of the grant application or pre-qualification, have not been met. This will be done through email contact, to the corresponding contact information, on the application submission. Resubmission of the complete and updated application will be allowed for consideration if received prior to the application closing date noted in the NOFO Basic Information Section. 6. A written Notice of Denial shall be sent to the applicants not receiving an award, following the Merit Review process. Administrative and National Policy Requirements. A. The agency awarded funds shall provide services as set forth in the IDHS grant agreement and shall act in accordance with all State and Federal statutes and administrative rules applicable to the provision of the services. B. Payment Terms The Illinois Department of Human Services (IDHS) payment policy complies with 2 CFR 200.302, 2 CFR 200.305, and 44 Ill. Admin. Code 7000.120 (GOMB Adoption of Supplemental Rules for Grant Payment Methods) and the Cash Management Improvement Act and the Treasury-State Agreement (TSA) default procedures codified at 31 CFR 205. IDHS Payments to grantees will be governed in accordance with the established criteria. Grantees will receive payment by one of the three payment methodologies (Advance Payment, Reimbursement or Working Capital Advance). Grantees will automatically be paid via Reimbursement Method unless a request for Advance Payment Method or Working Capital Advance Method is made using the IDHS Advance Payment Request Cash Budget Template (Cash Budget). C. Payment Forms 1. Monthly Invoice (IL444-5257) (https://www.dhs.state.il.us/page.aspx?item=95429) 2. Advance Payment Request Cash Budget Form (IL444-4985) (https://www.dhs.state.il.us/page.aspx?item=31637) Only if requesting an advance payment

The Division must receive the Full Application Packet: Due on March 15, 2022, 5:00 p.m. CST

45-60 days post application

Appeals pursuant To IL Admin Code 123.456. Merit Review Appeal Process 1. In accordance with GATA Administrative Rules, Section 350, Merit Review of Grant Applications, a merit review is required for applications of competitive (discretionary) Grants and Cooperative Agreements, unless prohibited by State or federal statute. (44 Ill. Adm. Code 7000.350) 2. Competitive grant appeals are limited to the evaluation process. Evaluation scores may not be protested. Only the evaluation process is subject to appeal and shall be reviewed by IDHS' Appeal Review Officer (ARO). 3. Submission of Appeal contact information: • Contact Name: Erica O’Neal • Email address: DHS.DDDGrantProg@illinois.gov • Email Subject Line: “Appeal Review Requested, Dental Services Program, Agency’s Name” 4. Appeal Instructions a. An appeal must be submitted in writing to the appeals submission IDHS contact listed above, who will send to the IDHS Appeal Review Officer (ARO) for consideration. b. An appeal must be received within 14 calendar days after the date that the grant award notice has been published. c. The written appeal shall include at a minimum the following: i. Name and address of the appealing party ii. Identification of the grant iii. Statement of the reasons for the appeal iv. Supporting documentation, if applicable 5. Response to appeal a. IDHS will acknowledge receipt of an appeal within 14 calendar days from the date the appeal was received. i. IDHS will respond to the appeal within 60 days or supply a written explanation to the appealing party as to why additional time is required. ii. The appealing party must supply any additional information requested by IDHS within the time period set in the request. 6. Resolution a. The ARO will make a recommendation to the Agency Head or designee as expeditiously as possible after receiving all relevant, requested information. i. In determining the appropriate recommendation, the ARO shall consider the integrity of the competitive grant process and the impact of the recommendation on the State Agency. ii. The Agency will resolve the appeal by means of written determination. iii. The determination shall include, but not be limited to: • Review of the appeal. • Appeal determination; and • Rationale for the determination.

This program will be awarded as a 36-month term agreement. Funding for the budget cycle has been appropriated in the state's approved fiscal year budget.

This grant does not require an in-kind or financial match requirement.

Pre-Award Costs A. Pre-award costs are not allowable. B. IDHS grants are governed by 2 CFR. Part 200, Subpart E-Cost Principles and 30 ILCS 708 which include information on allowable costs, audit requirements, and financial records. Indirect Costs A. Indirect Costs (https://www.dhs.state.il.us/page.aspx?item=151738) may be applied to this grant award. Indirect Cost Rates (https://www.dhs.state.il.us/page.aspx?item=95073#a_IndirectCostRate) must be approved through the Illinois Indirect Cost Rate Election System (ICRES) (https://gata.illinois.gov/indirect-cost/centralized-indirect-cost-system.html).

Upon execution of the grant agreement, reporting shall be in accordance with the requirements set forth in the Uniform Grant Agreement and related Exhibits which includes, but is not limited to the following: Reporting Requirements: A. Time Period for Required Periodic Financial Reports. Unless a different reporting requirement is specified in Exhibit E, Grantee shall submit financial reports to Grantor pursuant to Paragraph 10.1 and reports must be submitted no later than 30 days after the quarter ends. B. Time Period for Close-out Reports. Grantee shall submit a Close-out Report pursuant to Paragraph 10.2 and no later than 30 days after this Agreement's end of the period of performance or termination. C. Time Period for Required Periodic Performance Reports. Unless a different reporting requirement is specified in Exhibit E, Grantee shall submit Performance Reports to Grantor pursuant to Paragraph 11.1 and such reports must be submitted no later than 30 days after the quarter ends. D. Time Period for Close-out Performance Reports. Grantee agrees to submit a Close-out Performance Report, pursuant to Paragraph 11.2 and no later than 30 days after this Agreement's end of the period of performance or termination. Non-compliance with any of the above reporting requirements, including timeliness of reports may lead to being placed on the Illinois Stop Payment List. • PPR and PFR Email Address: DDDGrantProg@illinois.gov • Monthly Invoice Email Address: DHS.DDDBCR@illinois.gov

See JCAR Title 44 Illinois Administrative Code 7000.90 for audit requirements

See JCAR Title 44 Illinois Administrative Code 7000.430 Record Retention

The source of funding for this program is State funds

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Award range is up to $400,000. Average Previous Award Funding was $365,000.

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The state regulations governing the program can be found at 59 Ill. Adm. Code 117.200. The rules governing appeals can be found at 59 Ill. Adm. Code 117.145.

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The Division of Developmental Disabilities Hotline 1-888-DD-PLANS (1-888-337-5267) (TTY: 1-866-376-8446) is available to persons and the family of people with developmental disabilities to answer questions on community programs, respite care, and other state services available to persons with a disability. More information is also available visit the Developmental Disabilities Web site.

If you have questions about this NOFO, please contact DHS.DDDGrantProg@illinois.gov.

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2/1/2022

FY 2020 : $916,400
FY 2023 : $986,000
FY 2024 : $986,000
FY 2025 : $986,000