IDHS/Division of Mental Health

Program Summary • The program is designed to provide limited medical services to men, women and children in the Chicago who may be missing those much needed services. Funding Priorities or Focus Areas • IDHS is working to counteract systemic racism and inequity, and to prioritize and maximize diversity throughout its service provision process. This work involves addressing existing institutionalized inequities, aiming to create transformation, and operationalizing equity and racial justice. It also focuses on the creation of a culture of inclusivity for all regardless of race, gender, religion, sexual orientation, or ability. Project Description • South Shore Community Mental Health Program (SSCMHP) is a community-based program providing prevention, treatment, and rehabilitation mental health services. Services include mental health screening and full diagnostic evaluation as necessary; outpatient individual and group psychotherapy; and 24-hour crisis intervention services. • SSCMHP will focus on providing Attention Deficit Hyperactivity Disorder (ADHD) testing, trauma assessment and treatment and mental health services to children/adolescents (ages 4-17).

NA

• 59 Ill. Admin, Code 132 (Rule 132), Section 132.150g • Mental Health Community Services Act (405 ILCS 30/ Section (f)) • Public Act 103-0589, Section 470, Page 534

Illinois Administrative Code Part 7000 Grant Accountability and Transparency Act

Performance Requirements The Grantee will provide the following services on behalf of 100 children (ages 4-17) on the Southside of Chicago: 1. Screen children and adolescents for ADHD if they have academic or behavioral problems and show inattention, hyperactivity, or impulsivity. 2. Obtain reports on the child/adolescent’s symptoms from parents or guardians, school staff and mental health workers involved with their care and collect information from the child or adolescent as well. 3. Use rating scales and other sources to document symptoms and ensure that (Diagnostic and Statistical Manual) DSM-5 criteria have been met. 4. Rule out any other possible conditions that can cause similar symptoms. 5. Screen for other conditions that might coexist with ADHD, including emotional or behavioral disorders (such as anxiety, depression, and behavior problems), developmental disorders (such as learning and language disorders or Autism Spectrum Disorder) and physical conditions (such as tics, sleep disorders, or apnea). 6. Refer to a specialist if co-occurring conditions are detected. 7. Provide treatment in the form of medication and education. Performance Measures 1. Number of children/adolescents referred for ADHD screening. 2. Number of children/adolescents screened for ADHD. 3. Number of children/adolescents diagnosed with ADHD. 4. Number of children/adolescents screened for ADHD but did not meet criteria for ADHD diagnosis. 5. Number of children/adolescents diagnosed with ADHD and provided education regarding symptoms and treatment. 6. Number of children/adolescents diagnosed with ADHD and prescribed medication. 7. Number of children/adolescents screened for ADHD and a co-occurring mental health disorder. 8. Number of children/adolescents diagnosed with ADHD and a co-occurring mental health disorder. 9. Number of children/adolescents diagnosed with ADHD and a co-occurring mental health disorder referred to mental health specialists for treatment. 10. Number of children/adolescents screened and did not meet criteria for ADHD and diagnosed with another mental health disorder. 11. Number of children/adolescents screened who did not meet criteria for ADHD and diagnosed with another mental health disorder who are referred to a mental health specialist. 12. Number of children/adolescents screened for ADHD who are not covered by Medicaid or private insurance. 13. Number of children/adolescents screened for ADHD for whom physician fees were paid. Performance Standards 1. 50 children/youth screened for ADHD per quarter. 2. 90% of children/adolescents referred for ADHD screening are screened for ADHD. 3. 90% of children/adolescents diagnosed with ADHD are provided education regarding symptoms and treatment. 4. 90% of children/adolescents diagnosed with ADHD and a co-occurring mental health disorder are referred to a mental health specialist for treatment. 5. 90% of children/adolescents who did not meet criteria for ADHD but met criteria for another mental health disorder are referred to a mental health specialist for treatment. 6. Physician fees paid for 100% of the children/adolescents not covered by Medicaid or private insurance.

Yes

(Grantor-Specific Terms) • This Notice of State Award (NOSA) is not an agreement nor a guarantee of an agreement. IDHS will publish its agreements in the CSA Tracking System after the NOSA is accepted. A signed hard copy is not needed. You also have the option to decline. • If your response(s) to the ICQ questions indicate a weakness in the identified area below, a Corrective Action Plan (CAP) is required to be submitted to your cognizant agency. If IDHS is your Cognizant Agency, please send an email to DHS.DMHGrantApp@Illinois.gov to begin communicating the direction and requirements of the CAP. (Program-Specific Terms) • The eligibility and program requirements outlined in this funding opportunity must be adhered to as the funded project is implemented. Grantees must comply with the milestones and deliverables, performance standards, performance measures, performance data collection and specific conditions as reflected in the grant agreement, DMH Attachment B and Program Manual. Additional terms and/or conditions may be applied to this award if outstanding financial or programmatic compliance issues are identified by IDHS.

Nonprofit Organizations;

• This non-discretionary funding opportunity is limited to applicants that meet the following requirements: • This funding opportunity is a Legislative Add-On and the award will be issued in totality to South Shore Hospital. o The type of applicant for the grant award is a Nonprofit Organization o The applicant has met the Prequalification and Mandatory Requirements listed in this funding opportunity.

NA

Direct Payments for Specific Use

Human Services

NA

Prequalification • Applicant entities will not be eligible to apply for a grant award until they have prequalified through the Grant Accountability and Transparency Act (GATA) Grantee Portal. (https://grants.illinois.gov/portal/). Registration and prequalification are required annually. During prequalification, verifications are performed including a check of federal Debarred and Suspended status on the Illinois Stop Payment or the Illinois Debarred and Suspended List and good standing with the Secretary of State. An automated email notification is sent to the entity alerting them of "qualified" status or providing information about how to remediate a negative verification (e.g., inactive UEI, not in good standing with the Secretary of State). A federal Debarred and Suspended status cannot be remediated. • For assistance navigating government application prequalification procedure, refer to Grant Applicant Pre-Qualification and Pre-Award Requirements (state.il.us). https://www.dhs.state.il.us/OneNetLibrary/27896/documents/Grants/Grant Applicant Pre-Qualification and Pre-Award Requirements_041223.pdf • Applicants must be prequalified; therefore, applications from entities that have not prequalified prior to the due date of this application will NOT be reviewed until applicant is prequalified. • The following information is required to complete registration: o Organization's Unique Entity Identifier (UEI); For additional information on UEI, refer to Section Unique Entity Identifier and System for Award Management (SAM) below; o Organization's Federal Employer Identification Number (FEIN); o Organization type; o Illinois Secretary of State File ID (required for non-profits, for-profits and limited liability corporations); o Organization's name; o Organization's mailing address; o Organization's primary email address; o Organization's primary phone number; o Organization's fiscal year-end date • Applicants will not receive an award if pre-award requirements are not met (https://www.dhs.state.il.us/page.aspx?item=95073#a_InternalIDHScontractProcess) Indirect Cost Rates Indirect Costs may be applied to this grant award. Indirect cost rates must be approved. Indirect Cost Requirements and Restrictions • In order to charge indirect costs to this grant, the applicant organization must have a Federal or State annually negotiated indirect cost rate agreement (NICRA) or must elect to use the De Minimis Rate. • Every organization that receives a state award must make an indirect cost rate proposal or election in the State of Illinois Grantee Portal, Centralized Indirect Cost Rate Election System, including organizations that are choosing not to claim payment for indirect costs. • The Illinois Centralized Indirect Cost Rate System will allow your organization to document your already established federally approved indirect cost rate or complete an indirect cost rate proposal (see State Negotiated Rate above). Submission requirements are located on page 2 of the Uniform Budget Template as well as 2 CFR 200 Appendices IV, V & VII. • Organizations which have not previously made an indirect cost rate election must submit an election (and indirect cost rate proposal, if necessary) immediately and no later than 3 months after receiving an award notification. If the organization elects to submit a Federally Negotiated Rate or a State Negotiated Rate, they will receive an invitation to submit their proposal in the Illinois Centralized Indirect Cost Rate System. • Organizations that have previously established an indirect cost rate election and would like to continue with a Federal or State Negotiated Rate must submit a new indirect cost rate election immediately and no later than 6 months after the close of their organization's fiscal year. • Organizations that do not make a submission inside the Illinois Centralized Indirect Cost Rate System within the required timeframes will not be allowed to claim indirect cost reimbursement. Registration in CSA The Community Service Agreements (CSA) Tracking System is the system the IDHS utilizes for approving budgets and issuing grant awards. It is strongly recommended that if an applicant entity is not already registered in the CSA Tracking System, they should begin the registration as soon as possible so they may submit a signed budget in CSA. While registration in CSA is not part of the prequalification process, successful applicants will NOT be issued an award without a fully approved budget in the CSA System.

Address to Request Application Package • The complete application package is available through the Illinois Catalog of State Financial Assistance and throughout this opportunity. • Each applicant must have access to the internet. The Department's website will contain information regarding the materials necessary for submission. Content and Form of Application Submission Required Content • 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. • All Application Materials should be submitted in one email (size permitting), as separate pdf documents: o Uniform Application for State Grant Assistance o Conflict-of-Interest Disclosure o Subcontractor Budgets, if applicable o Advance Payment Request Cash Budget Form, if applicable Required Forms • The Uniform Application for State Grant Assistance 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. • Page one of the application is pre-populated with the appropriate information. Applicants must not complete anything on Page one. The correct application must be used. • On Page three, applicants will need to include the amount for which they are applying and sign. • The applicant submission email address will be used for official communication between the Department and the applicant organization for matters regarding this application. Budget Requirements • Deadline for submission of the budget, in the CSA Tracking System, is the same as the application deadline. • The CSA Tracking System is where the IDHS requires all applicants to enter their GATA Budget information. It is also where IDHS staff will review and take action on the proposed budget. The CSA Tracking system requires that you have different credentials than what you have for the Illinois GATA Grantee Portal. • A budget and budget narrative must be completed, electronically signed, and submitted in the CSA tracking system with the status as “GATA Budget signed and submitted to program review”. A copy is not to be submitted along with the application packet. • There is space when preparing the budget on each line item for the budget narrative. For each line in the budget the applicant will describe why each expenditure is necessary for program implementation and how the amount was determined. Please include cost allocations as necessary. The Budget narrative (including MTDC base exclusions as appropriate) must clearly identify indirect costs, direct program costs, direct administrative costs, and describe how the specified resources and personnel have been allocated for the tasks and activities within each line item. See instructions for the CSA Tracking System and Budget Information. The budget should be prepared to reflect 12 months. • A Budget Template can be used as a tool to assist in determining expenses; however, the final budget must be completed in the CSA Tracking System. The pdf budget or paper copy will not be accepted. Applicants will NOT be issued an award without the applicant’s fully approved budget in the CSA System. Subcontractor budget(s) • If applicant is planning to use a subcontractor, a pdf copy of the subcontractor budget must be submitted as a separate pdf document with the other application materials. • Subcontractor budgets shall be submitted on the GATA Uniform Grant Budget Template (GOMBGATU—3002) Grant Fund Use Requirements • All applicants will use grant funds according to the guidelines, conditions, and parameters set forth in this funding notice and in compliance with federal statutes, regulations and the terms and conditions of any applicable federal awards. • Please refer to 2 CFR 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, PART 200 Subpart E - Cost Principles to determine the appropriateness of costs. • Allowable costs are those that are necessary and reasonable based on the activity(ies) contained in the scope of work, are justified in the Budget Narrative, and are allowable under Subpart E of 2 CFR 200. It is expected that administrative costs, both direct and indirect, will represent a small portion of the overall program budget. Any budget deemed to include inappropriate or excessive administrative costs will not be approved. Program budgets and narratives must detail how all proposed expenditures are necessary for program implementation. • Unallowable costs: Please refer to 2 CFR 200 - Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, PART 200 Subpart E - Cost Principles to determine the appropriateness of costs. In addition, and specific to this grant, the following costs will be unallowable without specific prior written approval from IDHS: o Entertainment costs, except where specific costs that might otherwise be considered entertainment have a programmatic purpose and are authorized in the approved budget (2 CFR 200.438) o Capital expenditures for general purpose equipment, including any vehicle regardless of cost, buildings, and land (2 CFR 200.439) o Capital expenditures for improvements to land, buildings, or equipment which materially increase their value or useful life (2 CFR 200.439) o Food, and other goods or services for personal use of the grantee's employees, contractors, or consultants of the grantee unless authorized as per diem under the State of Illinois Governor's Travel Control Board (2 CFR 200.445). o Deposits for items, services, or space Pre-Award Requirements All applicants are required to complete a risk assessment prior to execution of a grant award. The Internal Controls Questionnaire (ICQ) is the instrument used to assess risk of grantees by identifying an organization's potential weaknesses. The ICQ is accessed through the Grantee Portal. Unique Entity Identifiers and SAM Registration • Each applicant (unless the applicant is an individual or Federal 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: o Be registered in SAM.gov before the application due date. o Provide a valid unique entity identifier (UEI) in its application. o Continue to maintain an active SAM registration with current information at all times during which it has an active Federal, Federal pass-through or State award or an application or plan under consideration by a Federal or State awarding agency. o The Department may not make an award until applicant has fully complied with all UEI and SAM requirements. o The Department 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. Application Submission Dates and Times Application Due Date and Time: • The Department must receive the Full Application: o Due on November 20, 2024, at Noon Central Time. • Applicants must electronically submit the complete application including all required narratives and attachments to DHS.DMHGrantApp@Illinois.gov. • Documents must NOT include a password nor be encrypted. • Emails into this box are electronically date and time stamped upon arrival. For your records, please keep a copy of your email submission with the date and time it was submitted, along with the email address to which it was sent. The email of the original sender of the application will be used for official communication between the Department and the applicant organization for matters regarding this application. • Applicants will receive an email to notify them that the application was received. The email reply will be sent to the original sender of the application materials. • The subject line of the email MUST state: o South Shore Hospital o Program 515-TATS Trauma Assessment Treatment Services Grantee Conflict of Interest Disclosures • Every grantee and subcontractor must disclose in writing any actual or potential Conflict of Interest as part of the grant application packet using the Grantee Conflict of Interest Disclosure Form IL444-5205. • Grantee Conflicts of Interest include, but are not limited to: o Grantee has an employee, board member, trustee, or immediate family member who: ? Holds an elected or appointed office in Illinois. ? Holds a seat in the Illinois General Assembly. ? Is an officer or employee of any State board, commission, authority, or holds an elected or appointed position or is employed in any of the offices or agencies of State government. o Grantee has a financial interest, including ownership of stocks or bonds, in a firm which is a vendor or contractor. o Grantee has outstanding financial commitments to any vendor or contractor. o Grantee has a close personal relationship. such as a spouse, dependent child, or member of the technical advisor's household, that may compromise or impair the fairness and impartiality of the technical advisor and grants officer during the solicitation development, proposal evaluation, award selection process, and management of an award. o Grantee has any negotiation of employment with current or potential subcontractor or vendor. • Additional examples of Grantee Conflicts of Interest can be found in the Grant Accountability and Transparency Act (GATA) Website Resource Library. Mandatory Forms • Uniform Application for State Grant Assistance • Uniform Grant Budget (Submit in CSA) | Instructions • Subcontract Budget, if applicable submit as a separate attachment • Conflict of Interest Disclosure Conflict of Interest Disclosure submit as a separate attachment • Advance Payment Request Cash Budget Form (IL444-4985) https://www.dhs.state.il.us/page.aspx?item=31637 submit as a separate attachment (no submission will result in default to Reimbursement Method) Simplified Acquisition Threshold – Federal and State Awards • It is anticipated that grants under this award may receive over $250,000. Potential grantees under this funding announcement may receive an award in excess of the Simplified Acquisition Threshold (currently $250,000) (Refer to 2 CFR 200 Section 200.1 Definitions). Therefore, the grantee is subject to Simplified Acquisition Threshold and related requirements. • IDHS prior to making an award with a total amount greater than the Simplified Acquisition Threshold, is required to review and consider any information about the applicant that is in the designated integrity and performance system accessible through SAM (currently FAPIIS) (see 41 U.S.C. 2313); • (From 2 CFR 200.1 Definitions): Simplified Acquisition Threshold means the dollar amount below which a non-Federal entity may purchase property or services using small purchase methods (see § 200.320). Non-Federal entities adopt small purchase procedures in order to expedite the purchase of items at or below the simplified acquisition threshold. The simplified acquisition threshold for procurement activities administered under Federal awards is set by the FAR at 48 CFR part 2, subpart 2.1. The non-Federal entity is responsible for determining an appropriate simplified acquisition threshold based on internal controls, an evaluation of risk, and its documented procurement procedures. However, in no circumstances can this threshold exceed the dollar value established in the FAR (48 CFR part 2, subpart 2.1) for the simplified acquisition threshold. Recipients should determine if local government laws on purchasing apply.

NA. This is a non-discretionary opportunity; criteria for selecting applicants are not required. This is a Legislative Add-On and the award will be issued in totality to South Shore Hospital.

State Award Notices • Applicants recommended for funding under this non-discretionary opportunity will receive a Notice of State Award (NOSA). This notification is sent to the main contact listed in the Grantee Portal; therefore, it is important to keep contact information in the Grantee Portal updated. The NOSA shall include: o Grant award amount o The terms and conditions of the award o Specific conditions, if any, assigned to the applicant based on the fiscal and administrative risk assessment (ICQ). • Note: The Department cannot issue a NOSA until the successful applicant has an approved budget entered into CSA. The applicant shall receive the NOSA through the Grantee Portal. The NOSA must be Accepted or Declined by the grants officer (or equivalent). This acceptance of the NOSA effectively accepts the state award amount and all conditions set forth within the notice. This accepted NOSA is the document authorizing the Department to proceed with issuing a grant agreement. The NOSA must be Accepted or Declined through the Grantee Portal. A hard copy is not required. • The NOSA is NOT an authorization to begin performance (to the extent that it allows charging to State awards of pre-award costs at the non-State entity's own risk). • After the Uniform Grant Agreement is published in the CSA Tracking System, it must be signed, and the signature page submitted to the Office of Contract Administration at DHS.OCA.SignaturePages@illinois.gov • An award is NOT considered to be fully executed until both parties have signed the grant agreement. IDHS/DMH is not obligated to reimburse applicants for expenses or services incurred prior to the complete and final execution of the grant agreement and filing with the Illinois Office of the Comptroller. Administrative and National Policy Requirements • 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. • You can find a sample of the grant agreement at IDHS Uniform Grant Agreement. Payment Terms • It is the policy of the Illinois Department of Human Services (IDHS) that this policy complies with 2 CFR 200.302, 2 CFR 200.305, 31 CFR 205 (procedures implementing Cash Management Improvement Act and Treasury-State Agreement (TSA)), and 44 Ill. Admin. Code 7000.120 (GOMB Adoption of Supplemental Rules for Grant Payment Methods). Three different award payment method exist, namely Advance Payment, Reimbursement, and Working Capital Advance. • Grantees selecting the Advance Payment Method, or the Working Capital Advance Payment Method must complete the Advance Payment Request Cash Budget Template as described in the procedures above. In addition, please note: If you will be submitting the Advance Payment Request Cash Budget, it must be submitted with the application materials as a separate document. • The Monthly Invoice IL444-5257 Template must be used for all DMH programs and submitted no later than 15 days after the end of the month. All invoices shall be HIIPA compliant and encrypted utilizing DHS approved encryption software and emailed to DMH at the email address listed above. • Invoice and PFR Email Address for General Grants: DHS.DMHQuarterlyReports@illinois.gov • Invoice and PFR Email Address for Williams Consent Decree: DHS.DMHWilliamsInvoices@Illinois.gov • Invoice and PFR Email Address for Colbert Consent Decree: DHS.Colbert.Invoices@illinois.gov • Payment Forms o Monthly Invoice IL444-5257 o Advance Payment Request Cash Budget Form (IL444-4985) Only if requesting an advance payment

November 20, 2024, at Noon Central Time

20 - 30 days

NA

• This program will be awarded as a 12-month term agreement. • This funding opportunity is a Legislative Add-On and the award will be issued in totality to South Shore Hospital. • IDHS/DMH does not anticipate there will be renewals.

Cost Sharing or Match Requirement • Providers are not required to participate in cost sharing or provide match. • Serves as Maintenance of Effort to the Federal Substance Abuse and Mental Health Services Administration Community Mental Health Block Grant

Procurement Contract Allowability • Subcontract Agreement(s) and budgets must be pre-approved by the Department and on file with the Department. Subcontractors are subject to all provisions of this Agreement. The applicant Agency shall retain sole responsibility for the performance and monitoring of the Subcontractor. • The release of this funding opportunity does not obligate the Illinois Department of Human Services to make an award. Funding Restrictions Pre-Award Costs • Pre-award costs are not allowable. • 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.

• 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: o Periodic Financial Reports. o Close-out Reports. o Periodic Performance Reports. o Close-out Performance Reports. o Other Unique Programmatic Reporting Requirements: Additional annual performance data may be collected as directed by the Department and in a format prescribed by the Department. • If the State share of any State award may include more than $500,000 over the period of performance, applicants are also subject to the reporting requirements reflected in Appendix XII to 2 CFR 200. • Non-compliance with any of the identified reports may lead to being placed on the Illinois Stop Payment List (SSPL). • Grantee shall submit these reports) to the appropriate email address listed below. Reported expenses should be consistent with the approved annual grant budget. Any expenditure variances require prior Grantor approval in accordance with Article VI of the UGA to be reimbursable. o PFR Email Address for General Grants: DHS.DMHQuarterlyReports@illinois.gov o PFR Email Address for Williams Consent Decree: DHS.DMHWilliamsInvoices@Illinois.gov o PFR Email Address for Colbert Consent Decree: DHS.Colbert.Invoices@illinois.gov • The Grantee must submit quarterly Periodic Performance Report (GOMBGATU-4001 (N-08-17)) and the Periodic Performance Report Template by Program (PRTP) to the appropriate email address below. Reporting templates and instructions for submitting reports can be found in the Provider section of the DHS website o PPR and PRTP Email Address for All Grants: DHS.DMHQuarterlyReports@illinois.gov • DMH reporting templates and detailed instructions for submitting reports can be found in the Provider section of the IDHS website.

See JCAR Title 44 Illinois Administrative Code 7000.90 Auditing Standards

See JCAR Title 44 Illinois Administrative Code 7000.430 Record Retention

State

Anticipated Availability: $956,455

NA. This funding opportunity is a legislative add-on and the award will be issued in totality to South Shore Hospital. Expected Amounts of Individual Grant Awards NA. Only one grant is being awarded

NA

• Title 59: Mental Health of the Administrative Code • Public Act 103-0589, Section 470, Page 534

NA

IL Department of Human Services, Division of Mental Health

Program Websites • Mental Health Grants – FY25 • IDHS website: www.dhs.state.il.us • Community Service Agreements (CSA) Tracking System: https://www.dhs.state.il.us/page.aspx?item=61069 • Centralized Repository Vault (CRV): https://vault.dhs.illinois.gov/crvsecure/crv • GATA Learning Management System (LMS): https://gata.illinois.gov/training.html

NA

NA

10/22/2024

FY 2024 : $43,545
FY 2025 : $956,455