Short Description
SSM Health St. Mary’s Hospital – Centralia
CSFA # 444-80-2700
Exhibit A
Scope of Service:
The purpose of the funding from the State of Illinois is to expand access to evaluation and treatment services for Illinois children referred for autism and developmental concerns. After a comprehensive evaluation, children are frequently referred for speech therapy, occupational therapy, behavioral therapy, and medical follow-up care.
In March 2020, the Centers for Disease Control and Prevention indicated the prevalence of autism in the United States showed 1 in 54 children have autism spectrum disorder. A comprehensive multi-disciplinary evaluation is recommended to diagnosis autism in children. This evaluation may include a physician, psychologist, speech and language pathologist, and an occupational therapist. Currently, there are limited resources for autism evaluations in central and southern Illinois.
The key personnel in this program include a child psychiatrist, two part-time psychologists, a nurse practitioner, two nurse navigators, a social worker, two behavioral therapists/social workers, a speech pathologist, an occupational therapist, a medical assistant and two office assistants. Additional staffing not covered by the proposed IL funding such as physicians collaborating with the nurse practitioner will be provided to support the delivery of the program.
Exhibit B
Reporting Requirements:
A. Time Period for Required Periodic Financial Reports. Unless a different reporting requirement is specified in Exhibit G, Grantee shall submit financial reports to Grantor pursuant to Paragraph 13.1 and reports must be submitted no later than 15 days after the quarter ends.
B. Time Period for Close-out Reports. Grantee shall submit a Close-out Report pursuant to Paragraph 13.2 and no later than 60 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 G, Grantee shall submit Performance Reports to Grantor pursuant to Paragraph 14.1 and such reports must be submitted no later than 15 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 14.2 and no later than 60 days after this Agreement’s end of the period of performance or termination.
The Providers will submit reporting to the Division of Developmental Disabilities (DDD) on a quarterly basis, utilizing the Periodic Performance Report (GOMBGATU-4001). Quarterly reports will be submitted no later than 15 days after end of each report period. 1st Quarter Reports are due No Later Than (NLT) October 15th, 2nd Quarter Reports are due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter Reports are due NLT July 15th.
Deliverables:
SSM Health St. Mary’s Hospital will provide quarterly reports for the program goals. The goals stated in the workplan will be reported as outcomes. Quarterly reports must provide the level of performance of the stated outcomes for the quarter to date in raw numbers and as percentage of completion.
Deliverables:
1. Provide the total number of unduplicated Individuals that received diagnostic evaluation for Autism or developmental concerns between ages birth to attainment of 6 years.
a. Provide the customer’s full name, county reside, age, sex, last 4 of their SSN# (Social Security Number), RIN# (Recipient Identification Number), and race/ethnicity
b. Provide summary of diagnoses made
c. Provide summary of follow up care and/or referral to support services
d. Due dates: 1st Quarter Reports are due No Later Than (NLT) October 15th, 2nd Quarter Reports are due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter Reports are due NLT July 15th.
2. Provide the total number of unduplicated Individuals that received diagnostic evaluation for Autism or developmental concerns between ages 6 years to 18 years old.
a. Provide the customer’s full name, county reside, age, sex, last 4 of their SSN# (Social Security Number), RIN# (Recipient Identification Number), and race/ethnicity
b. Provide summary of diagnoses made
c. Provide summary of follow up care and/or referral to support services
d. Due dates: 1st Quarter Reports are due No Later Than (NLT) October 15th, 2nd Quarter Reports are due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter Reports are due NLT July 15th.
3. Provide the total number of unduplicated Individuals that received evaluations for other concern excluding Autism from birth to attainment of age 6.
a. Provide the customer’s full name, county reside, age, sex, last 4 of their SSN# (Social Security Number), RIN# (Recipient Identification Number), and race/ethnicity
b. Provide the type of evaluation individual received (Speech Therapy, Occupational Therapy, Behavioral Therapy, or Psychiatric care).
c. Provide summary of diagnoses made.
d. Provide summary of follow up care and/or referral to support services
e. Due dates: 1st Quarter Reports are due No Later Than (NLT) October 15th, 2nd Quarter Reports are due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter Reports are due NLT July 15th.
4. Provide the total number of unduplicated Individuals that received evaluations for other concern excluding Autism from age 6 to 18 years old.
a. Provide the customer’s full name, county reside, age, sex, last 4 of their SSN# (Social Security Number), RIN# (Recipient Identification Number), and race/ethnicity.
b. Provide the type of evaluation individual received (Speech Therapy, Occupational Therapy, Behavioral Therapy, or Psychiatric care).
c. Provide summary of diagnoses made.
d. Provide summary of follow up care and/or referral to support services
e. Due dates: 1st Quarter Reports are due No Later Than (NLT) October 15th, 2nd Quarter Reports are due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter Reports are due NLT July 15th.
5. Grantee will develop a quarterly satisfaction survey for individuals in the program; and will report the result of the survey with results for each question and provide a copy of the survey form. Survey results are due at the end of each quarter.
a. Provide a blank copy of the survey.
b. Provide the number of surveys disturbed (each client should have been provided with a survey) and the number of surveys that were returned.
c. Provide a summary of responses to each question (this can be one survey with totals noted on each question.
d. Due dates: 1st Quarter Reports are due No Later Than (NLT) October 15th, 2nd Quarter Reports are due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter Reports are due NLT July 15th.
Exhibit C
Payment:
Payments will be made in accordance with Administrative Code (Title 44, Subtitle F, Chapter I, Part 7000.120.
1. Reimbursement. Reimbursement is the preferred method. When the reimbursement method is used, the State awarding agency or pass-through entity must make payment within 30 calendar days after receipt of the billing, unless the State awarding agency or pass-through entity reasonably believes the request to be improper. However, in Fiscal Year 2020 if the awardee requests to receive advance and reconcile payments the payments will be authorized, unless the State awarding agency sets a specific condition per UR section 200.207 (Specific conditions).
a. Advance payments must be limited to the minimum amounts needed and be timed to be in accordance with the actual, immediate cash requirements of the awardee in carrying out the purpose of the approved program or project. The timing and amount of advance payments must be as close as is administratively feasible to the actual disbursements by the awardee for direct program or project costs and the proportionate share of any allowable indirect costs. The awardee entity must make timely payment to contractors in accordance with the contract provisions.
b. The awardee must submit a yearly spending plan to the Department prior to the first payment of the grant. The yearly spending plan must be based on known expenses or historical spending patterns. The Department will make the initial advance payment based on the amount projected in the spending plan. Subsequent payments will be issued based on the previous month's expenditures documented in the Expenditure Documentation Forms (EDFs) provided by the Department. Subsequent payments may need to be adjusted to account for shortages/overages from the initial projection.
c. The final payment from the Department under this Agreement shall be made upon the Department's determination that all requirements under this Agreement have been completed, which determination shall not be unreasonably withheld. Such final payment will be subject to adjustment after the completion of a review of the Provider's records as provided in the Agreement.
In future fiscal years, the awardee may be required to meet the requirements in subsection (b)(1) of 2 CFR 200 to qualify for advance and reconcile payments. When implemented awardees will be required to provide and maintain documentation that demonstrates their willingness to maintain both:
(i) written procedures that minimize the time elapsing between the transfer of funds and disbursement by the awardee; and
(ii) financial management systems that meet the standards for fund control and accountability as established in UR section 200.302.
2. Working Capital Advances. If the awardee entity cannot meet the criteria for advance payments as stated in subsection (b)(1) and the State awarding agency or pass-through entity has determined that reimbursement is not feasible because the awardee lacks sufficient working capital, the State awarding agency or pass-through entity may provide cash on a working capital advance basis. Under a working capital advance, the State awarding agency or pass-through entity must advance cash payments to the awardee to cover its estimated disbursement needs for an initial period, generally geared to the awardee's disbursing cycle. This would include initial start-up cost and normal monthly grant expense not to exceed two months of monthly grant expenses. Thereafter, the State awarding agency or pass-through entity must reimburse the awardee for its actual cash disbursements.
i) A working capital advance requires the State awarding agency or pass-through entity to provide timely advance payments to awardees to meet the awardee's actual cash disbursements.
ii) A working capital advance must not be used if the reason for the working capital advance is the unwillingness or inability of the State awarding agency or pass-through entity to provide timely advance payments to the awardee to meet the awardee's actual cash disbursements.
iii) State agencies must implement written policies and procedures for each grant payment method utilized by the agency: advance payments, reimbursements and working capital advances. The policies and procedures must be approved by State agency staff responsible for federal and State cash drawdowns and reporting.
iv) Standards governing the use of banks and other institutions as depositories of advance payments under awards are as follows:
1. Advance payments of federal funds must be deposited and maintained in insured accounts whenever possible.
2. The awardee must maintain advance payments of federal awards in interest-bearing accounts, unless the following apply:
a. The awardee receives less than $120,000 in federal awards per year.
b. The best reasonably available interest-bearing account would not be expected to earn interest more than $500 per year.
v. Parameters Regarding Interest Earned
c. Interest earned by the awardee up to $500 per year may be retained by the awardee for administrative expense.
d. Interest earned by the awardee more than $500 per year on federal advance payments deposited in interest-bearing accounts must be returned to the State awarding agency in accordance with UR section 200.305(9).
e. Payment Withholding
i. Unless otherwise required by State statute, payments for allowable costs shall not be withheld at any time during the period of performance unless the conditions of Section 7000.80 apply, the awardee is determined to be "not qualified" in accordance with Section 7000.320, or one or more of the following conditions exists:
f. The awardee has failed to comply with the project objectives, State statutes or regulations, or the Grant Agreement; or
g. The awardee is delinquent in a debt to the State of Illinois (see the Illinois State Collection Act of 1986). Under these conditions, the agency may, upon reasonable notice, inform the awardee that the awardee shall not make payments for obligations incurred after a specified date until the delinquency is corrected or the indebtedness to the State is liquidated.
i. If the grant is suspended and payment is withheld because of the awardee's failure to comply with the Grant Agreement, payment must be released to the awardee upon subsequent compliance. Refer to Section 7000.80 for the Grantee Compliance Enforcement System and the Illinois Stop Payment List.
Payments will not be made to an awardee for amounts to be paid to contractors that the awardee retains to assure satisfactory completion of work. Payments will be made when the awardee disburses the withheld funds to the contractors or to escrow accounts established to assure satisfactory completion of work.
1. The Department will compare the amount of the prospective payments made to date with the documented expenditures provided to the Department by the Provider. In the event the documented services provided by the Provider do not justify the level of award being provided to the Provider, future payments may be withheld or reduced until such time as the services documentation provided by the Provider equals the amounts previously provided to the Provider. Failure of the Provider to provide timely documentation may result in a reduction to the total award.
2. The final payment from the Department under this Agreement shall be made upon the Department's determination that all requirements under this Agreement have been completed, which determination shall not be unreasonably withheld. Such final payment will be subject to adjustment after the completion of a review of the Provider's records as provided in the Agreement.
3. Quarterly reporting will be completed utilizing the Periodic Financial Report (GOMBGATU-4002) excel spreadsheet. Quarterly reports will be submitted no later than 15 days after end of each period. (1st Quarter Reports are due NLT October 15th, 2nd Quarter Reports are due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter Reports are due NLT July 15th.
The Grantees must provide a spreadsheet of all quarterly expenses. These expenses must reconcile with the Current Period Grant Expenses reported on the Periodic Financial Report.
a. Required data: Expenses will be categorized by Program Expense (Personnel, Fringe
Benefits, Travel, Supplies, etc.) Each line will include item/service
description or employee name, date expense incurred, amount expended and
justification if necessary.
b. Due dates: (1st Quarter Reports are due NLT October 15th, 2nd Quarter Reports are
due NLT January 15th, 3rd Quarter Reports are due NLT April 15th, 4th Quarter
Reports are due NLT July 15th.
Under the terms of the Grant Funds Recovery Act (30ILCS 705/4.1), Grantor agencies may withhold or suspend the distribution of grant funds for failure to file required reports. If the report is more than 30 calendar days delinquent, without any approved written explanation by the grantee, the entity will be placed on the Illinois Stop Payment List. (Refer to the Grantee Compliance Enforcement System for details about the Illinois Stop Payment List: https://www.illinois.gov/sites/GATA/Pages/ResourceLibrary.aspx.).
Exhibit E
Performance Measures:
Required Performance Measure Reporting: The Provider will submit a report to the Department on a quarterly basis including:
1. Grantee will ensure that all individuals who receive respite services must have a developmental disability.
2. Grantee will report the total number of Illinois children served each quarter.
3. Grantee will report the number of children below the age of 6 years seen for evaluation each quarter.
4. Grantee will provide the number of children ages 6 to 18 seen for an evaluation each quarter.
5. The satisfaction survey results for each quarter will contain at least 85% positive reviews.
Exhibit F
Performance Standards:
1. Increase the total number of unique IL children served as compared to the number of unique children served prior to the receipt of state funding.
2. Provide a 20% increase in the number of IL children below the age of 6 who complete an evaluation as compared to the number of evaluations prior to the receipt of state funding.
3. Provide a 20% increase in the number of diagnostic evaluations for IL children ages 6 to 18 as compared to the number of evaluations prior to the receipt of state funding.
4. Increase the total number of patient visits for evaluations and follow-up care for IL children as compared to the number of patient visits prior to the receipt of state funding.
5. The satisfaction survey results for each quarter will contain at least 85% positive reviews.