NOFO: TELEHEALTH

In 2013, 1,072 people in Illinois died of an opioid overdose; by 2022, this number had jumped to 3,261.[1] The opioid overdose epidemic has accelerated nationwide.[2] To hold companies responsible for their roles in the opioid crisis, the Illinois Attorney General has engaged in multiple investigations, lawsuits, and settlements with opioid manufacturers, distributors, and chain pharmacies. The funds from the settlements will support recovery in communities hardest hit by the opioid crisis and throughout the state. 

The Illinois Office of Opioid Settlement Administration (OOSA) is the entity responsible for planning, administering, and managing fifty-five percent (55%) of the funds received from opioid settlements according to the Illinois Opioid Allocation Agreement and Executive Order 2022-19. The established processes ensure transparency and consideration of regional needs such as overdose rates, disparities created for specific populations, and resources to address opioid-related harms. OOSA is housed within IDHS’ Substance Use, Prevention and Recovery (SUPR) division. 

About IDHS/SUPR 

The mission of IDHS/SUPR is to provide a recovery-oriented system of care along the continuum of prevention, intervention, treatment, and recovery support where individuals with substance use disorders, those in recovery, and those at risk are valued and treated with dignity and where stigma, accompanying attitudes, discrimination, and other barriers to recovery are eliminated. IDHS/SUPR is working to counteract systemic racism and inequity and to prioritize and maximize diversity throughout its service provision process. This work addresses existing institutionalized inequities, aims to create transformation, and operationalizes equity and racial and social justice. It also focuses on creating a culture of inclusivity for all, regardless of race, gender, religion, sexual orientation, or ability. 

Funding Source 

The Office of the Illinois Attorney General has certified—and the Governor’s Opioid Overdose Prevention and Recovery Steering Committee has approved—the use of up to an estimated $5 million over three (3) years from the Illinois Opioid Remediation State Trust Fund (Fund) for implementing additional telehealth services in accordance with the Illinois Opioid Allocation Agreement and the Fund allocation process.  

In April 2023, IDHS/SUPR awarded Advocates for Human Potential, Inc. (AHP) a grant to serve as the RCCA. The RCCA administers subawards with organizations providing prevention, intervention, treatment, and harm reduction services for people with substance use disorders in accordance with state-approved strategies and the scope of services provided by IDHS. 

The funds from the settlements will support prevention efforts in communities hardest hit by the opioid crisis and throughout the state. Fund distributions must be used equitably in service areas disproportionately affected by the opioid crisis as outlined in the Illinois Opioid Allocation Agreement, for example, areas with the following characteristics: 

• High opioid fatality rates, including the following: 

• Counties other than Cook County with a crude rate of 1.8 or greater per 100,000 people 

• Zip codes within Cook County with more than 100 overdoses (fatal and nonfatal) within the most recent year included in the Illinois Opioid Data Dashboard, http://idph.illinois.gov/opioiddatadashboard/ 

• Concentrated poverty, including the following:  

• Counties other than Cook County with a poverty rate greater than twelve percent (12%) 

• Zip codes within Cook County with a poverty rate greater than twelve percent (12%), per the U.S. Census Bureau, https://www.census.gov/quickfacts/fact/map/IL/ 

• Concentrated firearm violence, including communities eligible for Reimagine Public Safety Act funding, https://www.dhs.state.il.us/page.aspx?item=144282 

• Other conditions that hinder the communities from reaching their full potential for health and well-being, including counties other than Cook with a crude nonfatal overdose rate of 4.0 or greater per 100,000 people, as listed in the Illinois Opioid Data Dashboard, http://idph.illinois.gov/opioiddatadashboard/ 

The availability and use of telehealth services increased dramatically during the COVID-19 pandemic, generating heightened awareness of their value to communities that lack healthcare resources and providers, are geographically isolated, or have limited transportation options. Yet, telehealth is not available to everyone for a variety of reasons, including the cost of acquiring necessary technology infrastructure and software licenses. 

Compared to in-person healthcare services, the initial investment for a telehealth platform can be significant but offers long-term benefits in terms of accessibility and efficiency. 

This funding is intended to support establishment of telehealth services for people with opioid use disorder (OUD) in communities that have been disparately impacted by the opioid crisis, as well as in rural communities with few or no appropriate services. Marginalized groups (e.g., individuals experiencing homelessness, indigenous communities, veterans) will receive priority consideration. 

Applications will be prioritized based on overdose data in the applicant’s proposed service area, current availability of other services, and plans to specifically outreach to populations that reflect the social and racial disparities that persist in the opioid crisis. 

A minimum of sixteen (16) organizations will be awarded TELEHEALTH funding to increase access to prevention, treatment, harm reduction, and recovery support services for people with or at risk for OUD and other co-occurring substance use disorders (SUDs). 

To achieve this goal, subrecipients shall establish telehealth services in areas and communities of Illinois not adequately served by existing resources and/or are historically underserved. Program objectives are as follows: 

• Design a telehealth system, including technology infrastructure, compliance with regulatory requirements, documentation of processes and procedures, and training and technical support. 

• Acquire and maintain necessary hardware and healthcare devices, platform / software licensing, and functionality support (e.g., security systems, cloud services). 

• Provide training and technical support to telehealth providers. 

Of the three (3) anticipated years of funding, startup expenses, which include Tasks 3, 4, and 5, will be allocated for the first two (2) years only. Year three (3) expenses may be used to support technology, software, and staffing to support the program.  Funded organizations must accept people who receive Medicaid/Medicare and/or are uninsured. 

The tasks required and associated performance measures, standards, and potential metrics to be collected are as follows: 

Task 1. Fulfill Award Administration Requirements 

Subrecipients must fulfill obligations detailed in Section H.10. Reporting and Grants Administration Requirements, including the following: 

1. Complete an organizational needs assessment (ONA) survey. 
2. Develop and update an implementation and sustainability plan (ISP), which informs the performance metrics used for program activities. 
3. Develop and implement an equity and racial justice (ERJ) plan. 
4. Complete periodic performance reports (PPRs). 
5. Complete periodic fiscal reports (PFRs).  
6. Participate in status meetings and training/technical assistance (TTA) as prescribed.  
7. Conduct evaluation data collection and complete monthly evaluation reporting. 

Anticipated performance measures for these activities are detailed in Section C.4. Deliverables and Performance Measures. 

Task 2. Staff and Administer Program 

The subrecipient must allocate or hire sufficient staff to support the design, implementation, and monitoring of telehealth services. As described by the U.S. Department of Health and Human Services, staff roles may include the following: 

• Telehealth champion, to provide leadership for all aspects of the program.  

• Program manager, to oversee daily logistics, goal setting, and data gathering. 

• Education manager, to ensure familiarity and comfort with telehealth provision among patient-facing staff (e.g., physician, physician’s assistant, registered nurse, care manager, scheduler).  

• Technical lead, to manage all devices and create procedures and best practices for their use.  

• Installers, to educate patients on remote patient monitoring devices and to track their connectivity to medical services.  

• Technical support staff, who provide support to address technical issues during telehealth sessions. Upon implementation, support should be available during the organization’s standard business hours. 

If new staff are to be hired, interim staff must be available at the beginning of the period of performance. Leadership must be supported by appropriate staff to ensure program operations comply with fiscal, legislative, administrative, and technical requirements pursuant to the subaward agreement.  

Staff should be reflective of the community/population being served. Preference is given to subrecipients that commit to having direct service staff who both live and work in their communities. 

Task 2.a. Performance Measure 

1. Submit a Program Organizational Chart detailing assigned staff (or designated to-be-hired), their roles, and matrixed supports within fifteen (15) days from the beginning of the period of performance. This organizational chart should include a list of names and emails of all individuals assigned to work on the design, implementation, and monitoring of the program. 

Task 3: Plan Telehealth Implementation 

Subrecipients must provide the following deliverables:  

Task 3.a. Conduct Telehealth Planning Assessment  

The subrecipient must assess the acceptability, feasibility, and effectiveness of telehealth for increasing access to prevention, treatment, harm reduction, and recovery support services among people with or at risk for OUD and other co-occurring SUDs. The assessment should evaluate health disparities and the related social and economic inequities that impact access to and need for services, as well as technology infrastructure.  

Task 3.a. Performance Measure  

1. Submit the planning assessment report within sixty (60) days from the beginning of the period of performance. It should include:   

• • A Position Statement, explaining the reason for, end goal of, and features of the new telehealth service.  

• • A User Profile, indicating the proposed end users and their intended use of the new telehealth service. The user profile(s) should specifically address priority populations. 

• • A comprehensive written report detailing the results of a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis of implementing new telehealth services in the catchment area. The SWOT should specifically address opportunities to outreach to priority populations. 

For tips on developing the above, go to The National Telehealth Technology Assessment Resource Center’s Technology Assessment 101. 

Task 3.b. Design Telehealth Services 

The subrecipient must identify specific telehealth services to be provided, based on the above Telehealth Planning Assessment. Services shall include but are not limited to: 

• Synchronous activities: Interaction between provider and recipient occurring in real time, such as through videoconferencing or audio only (via landline or wireless connection).  

• Asynchronous (store-and-forward) activities: Sharing of information between provider and recipient that does not require real-time interaction, such as: 

• Texting health care questions and updates. 

• Uploading medical reports, lab results, digital medical imaging, or health histories into a portal. 

• Remote patient monitoring. 

Services are to focus on prevention, treatment, harm reduction, and recovery support for individuals with or at risk for OUD and other co-occurring SUDs, particularly in communities and populations disproportionally impacted by the opioid/overdose crisis 

Task 3.b. Performance Measure 

1. Submit, within one hundred and twenty (120) days from the beginning of the period of performance, a Telehealth Implementation Plan that details the telehealth services to be provided in terms of meeting the needs of the community within its telecommunication parameters. Include what the services will include, when and how they will be rolled out, and how and which staff will be trained on telehealth provision.  

Task 4. Build Systems Infrastructure  

The subrecipient must identify and acquire the services, healthcare devices, and functionality support necessary for the operation of the services proposed in accordance with legal and regulatory requirements. At a minimum, this must include the following functionality: 

• Patient consultation portal with texting and video communication capabilities, 

• Mobile medical devices that gather, analyze, and transmit data, and 

• Internet and device support for providers and patients 

• HIPAA compliance assessments, policy development, and implementation 

 Technology components considerations include the following:  

• Computers, webcams, microphones, and other optional hardware (e.g., digital telescope, examination camera, endoscope) 

• Platform and/or software licensing  

• Networks, data centers, cloud services 

• Reliable internet services/hotspots for providers and patients 

• Loaner tablets for patients lacking reliable internet connections or devices suitable for video consultations 

• Mobile device support 

• A patient portal  

• Electronic health record interoperability 

• Security systems 

Task 4.a. Performance Measure 

1. Submit, within 180 days from the beginning of the period of performance, evidence of acquisition of all technology infrastructure components, as well as evidence of relevant licensing.  

Task 5. Establish Processes and Procedures  

The subrecipient must develop processes and procedures to ensure user-friendly, effective, and reliable telehealth services. Such documentation must be provided for at least the following:  

• Preferred telehealth platform or software. 

• Internet connectivity standards. 

• Compliance with all federal and State licensing, privacy, security, and confidentiality laws, rules, or regulations, including the Health Insurance Portability and Accountability Act (HIPAA). 

• Informed consent process for telehealth services. 

• Technical issue resolution during telehealth sessions. 

• Patient concerns or complaints related to telehealth services. 

• Reporting mechanisms for quality assurance and data analysis. 

• Quality assurance and quality control procedures that include annual reviews of program policies and procedures and ongoing assessment of patient outcomes. 

Task .5a. Performance Measure 

1. Submit, within 240 days from the beginning of the period of performance, policies and procedures documentation related to telehealth operations.  

Task 6: Provide Training and Technical Support  

The subrecipient must provide training and technical support to patient-facing staff (e.g., physician, physician’s assistant, registered nurse, care manager, scheduler) on the use of telehealth for prevention, treatment, harm reduction, and recovery support services to assist and meet the needs of people who have an OUD or other co-occurring SUD.  

Task 6.a. Performance Measures 

1. Submit, within 240 days from the beginning of the period of performance, an education plan for training staff, including content, intended audience, and expected frequency of training sessions.  
2. Submit a Training Log (staff name, staff role, training subject, name and credentials of the training provider, delivery mode, and date of completion) within twelve (12) months of the beginning of the period of performance for initial training and every six (6) months thereafter as needed for new-staff, follow-up, and refresher training sessions. 

Task 6.b. Performance Measures 

1. Submit a Technical Support Log (date, nature of technical support, and job title of recipient) at 12, 18, 24, 30, and 36 months from the beginning of the period of performance.  

Task 7: Provide and Monitor Telehealth Services  

The subrecipient must launch and maintain the proposed telehealth services in accordance with program requirements as well as all federal and State licensing, privacy, security, and confidentiality laws, rules, or regulations. The subrecipient must participate in monitoring and evaluation of services. At minimum, aggregate data on individuals served and specific services provided should be collected for all service provision included in the scope of services. For example, the number and nature of telehealth interventions provided, number of unique users, and patient and provider satisfaction with access to and operation of telehealth services. Data on the reach of subrecipient services must also be collected to ensure services reach priority communities and populations with the highest needs. The subrecipient will work with the Opioid Abatement Settlements Effectiveness Evaluator external evaluator to identify additional outcome indicators for subrecipient’s scope of services.  

Task 7.a. Performance Measures 

1. Submit required information in a Monthly Report within 45 days of the completion of any month in which the subrecipient provides telehealth services.  

The following table details (a) the deliverables required according to the scope of services and (b) associated performance measures, standards, and potential metrics (subject to change) to be collected by task. Time periods refer to the days from the beginning of the period of performance, unless otherwise specified. Standards for activities refer to percentages of those described in the ISP. 

The following sections discuss allowable and unallowable costs for this funding opportunity. 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 

Allowable costs are those that are necessary and reasonable based on the activity contained in the statement of work (SOW), are justified in the budget narrative, and are allowable under 2 CFR §§ 200.400-476. 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 

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: 

• 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) 

• Capital expenditures for general purpose equipment, including any vehicle regardless of cost, buildings, and land (2 CFR § 200.439) 

• Capital expenditures for improvements to land, buildings, or equipment that materially increase their value or useful life (2 CFR § 200.439) 

• Food and other goods or services for personal use of the grantee’s employees, contractors, or consultants unless authorized as per diem under the Illinois Governor’s Travel Control Board (2 CFR § 200.445) 

• Deposits for items, services, or space 

• Dues to societies, organizations, or federations 

• Meetings or conventions, unless directly related to the program and approved in advance by the RCCA 

• Alcoholic beverages 

• Cash payments to intended recipients of services 

• Purchase or repair of vehicles 

• Lobbying, political contributions, or compensation of a government body 

• Fundraising 

• Bad debt, fines, or penalties 

• Personal-use items, including expenses related to personal use of vehicles 

• Unallowable relocation expenses 

• Related-party transactions 

• Any other costs not approved in the plan and budget 

Indirect Cost Rate 

To charge indirect costs to this grant, the applicant organization must: (1) have a federal annually negotiated indirect cost rate agreement (NICRA), or (2) elect to use the de minimis rate and specify what percentage (up to fifteen percent [15%] of modified total direct costs) the applicant chooses. See 2 CFR § 200.414. 

Indirect Cost Rate Election 

• Federally Negotiated Rate: Organizations that receive direct federal funding may have an indirect cost rate that was negotiated with a federal cognizant agency. The organization must provide a copy of the federal NICRA. Organizations must notify the RCCA of any changes to their previously established NICRA no later than six (6) months after the close of the organization’s fiscal year. 

• de minimis Rate: An organization may elect a de minimis rate of up to fifteen percent (15%)  of modified total direct cost (MTDC).** Once established, the de minimis rate may be used indefinitely. If programs elect to use the de minimis rate, it is critical that program budgets accurately calculate the MTDC base. 

Please see regulation 2 CFR § 200.1 below and note the exclusions to MTDC. 

**2 CFR § 200.1, Modified Total Direct Costs, means “all direct salaries and wages, applicable fringe benefits, materials and supplies, services, travel, and up to the first $50,000 of each subaward (regardless of the period of performance of the subawards under the award). MTDC excludes equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs, and the portion of each subaward in excess of $50,000. Other items may only be excluded when necessary to avoid a serious inequity in the distribution of indirect costs and with the approval of the cognizant agency for indirect costs.” 

“No Rate” 

Subrecipients have discretion not to request payment for indirect costs. Subrecipients that elect not to claim indirect costs cannot be reimbursed for indirect costs. The organization must record an election of “No Indirect Costs” in the Budget Workbook linked in Section J. Mandatory Forms

Subrecipients are required to adhere to the requirements outlined in the following: 

• Grant Accountability and Transparency Act (GATA), 30 ILCS 708 

• Illinois Administrative Code, Government Contracts, Title 44, Part 7000 

• Grantmaking, Procurement, and Property Management, and federal regulations under Grants and Agreements, 2 CFR § 200, et al. 

• The requirements and policies outlined in the IDHS Substance Use Prevention and Recovery Contractual Policy Manual 

• Any other federal or state statutues, regulations or policies specified in the subaward agreement or its attachments.