Annual Budget Template - DOC by gigi12

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									       {PCN Name}
      Annual Budget
   for Next Fiscal Year

April 1, 2008 to March 31, 2009

            Version 1
PCI Annual Budget Template version 1.0

How to use this template
Instruction Boxes: For ease of reference, basic instructions are provided as part of this template rather than in
a separate information guide. Instructions are in orange boxes like this one, and sometimes in text placeholders
like this: {date} To use a placeholder, just click it once and type the requested information. To delete instruction
boxes when no longer needed, double-click where indicated.
Style Selection: This template was designed with standardized styles for the different types of text that might
be needed. Select the style to be applied to any text with one click. To change the style of any text, position the
cursor within the text and then click on the desired style type in the style listing on the toolbar above. (This
toolbar should automatically appear when this template is opened.) The style selected will apply to all the text
between the last paragraph return (¶) and the next one.
Footer: Be sure to add the date and the PCN name to the text placeholders in the footer.
To delete this instruction box, double-click [here] .

{date}                                      {PCN Name} Budget for 2008/09 FY                                 Page 2 of 6
PCI Annual Budget Template version 1.0

About the “Budget for Next Fiscal Year”
Requirement for Budget Submission: Budgets have always been part of the business plan, and were
reported retrospectively on semi-annual reports. In keeping with a best practices approach to financial
management for individual PCNs and for the Primary Care Initiative as a whole, PCNs are now required to
submit their budget for the next fiscal year (i.e., prospectively) on an annual basis.
Budget Submission Deadlines: For this introductory year only, the “Budget for the Next Fiscal Year” should
be submitted no later than July 1, 2008. Thereafter, the deadline for budget submission will be February 1, so
plan to submit the PCN’s 2009/10 budget by February 1, 2009.
Acceptance Process: Annual budgets will be reviewed and summarized by the PCI Program Office, and
approved by PCIC.
Column Headings:
 The data for the 2007/08 Forecast column should be taken from the original plan for the reporting period as
    indicated in the business plan (or subsequent amendment, if applicable). This column of data is the latest
    forecast of the revenues and costs that received PCIC approval. If necessary, estimate the allocation of
    revenues and expenses to the indicated categories.
 The 2007/08 Budget column is for the allocations used by the PCN for the previous reporting period. As
    such, it will indicate how the PCN’s budget has changed since the latest approved version (provided in first
    column). Again, use estimates, if necessary, to allocate by category. If no adjustments were made to the
    budget (as a result of physician group changes, programming realities, etc.), then the numbers in this
    column will match the numbers in the first column. Note: The numbers in this column of Tables 1 and 2
    should match those entered in the budget column of Tables 1 and 2 of the Annual Report.
 The 2008/09 Budget column is for the PCN’s budget for the upcoming fiscal year.
Rows Headings:
 Other Revenue: Billings taken into the PCN as revenue should be netted against the associated physician
    services expenses at the priority initiative level, with note disclosure of the gross amounts. If billings are
    expected to exceed associated physician services expenses, the resulting net revenue is not to be applied
    against other expenses for that priority initiative, but reported as revenue at the PCN level under “Other” and
    specified as FFSB.
    Priority Initiatives: The priority initiatives should relate to service delivery to patients, family members, and
    community members, while activities related to the PCN as a whole are central allocations. If costs are
    clearly associated with a particular initiative (i.e., if costs relate to specific service responsibility
    improvements where the patient/family is receiving care or service), include those costs with that initiative.
    Resources allocated to support the PCN as a whole in attaining overall goals and meeting reporting
    requirements are “central allocations.” Thus, education about lifestyle choices to reduce chronic disease in
    the PCN’s patient population would be part of a chronic disease priority initiative, but education for the whole
    PCN population about the range of programming available through the PCN would be a central allocation.
    Similarly, communication activities such as website development or information management improvements
    are not priority initiatives; rather they are central allocations to be listed under “Other Expenses.” (The
    breakdown by priority initiative should track the key strategies outlined in the business plan. If costs cannot
    be aggregated by priority initiative, define the priority initiatives according to a breakdown for which costs are
    available (e.g., by community, by team, etc.) or contact the PCI Program Office for assistance. If additional
    rows are needed, highlight one row, copy, and paste.
 Evaluation: PCNs are asked to provide budget information for resources devoted to evaluation.
 Other Central Administration: This category is for administration expenses that are not related to
    individual priority initiatives (i.e., not related to service delivery to patients, family members, and community
    members), and should include any activities that relate to the PCN as a whole (e.g., websites, marketing the
    PCN, IM/IT for the entire PCN). Evaluation, contingency, and unallocated accounts established to provide for
    uncertainty are central allocations, but not central administration.
Audit Requirements: This budget submission does not need to be audited.
Further Assistance: Further details are available on the PCI website (access password-protected portion,
then go to Guide & Reference > Reporting). Questions and concerns should be directed to Rita Wright,
Associate Director, PCI Program Office at
To delete this instruction box, double-click [here] .

{date}                                      {PCN Name} Budget for 2008/09 FY                                 Page 3 of 6
PCI Annual Budget Template version 1.0

                                                                   Annual Budget
                                                     April 1, 2008 to March 31, 2009
                                           for {PCN Name} initiated (go live date) {Month 1, 200#}
                                          To be submitted to PCI Program Office no later than July 1, 2008

                      Table 1: Budget in Statement of Operations Format

                                                         2007/08 Forecast
                                                          per {document}           2007/08             2008/09
                                                         dated {date} and          Budget              Budget
                                                         approved by PCIC
    Per Capita Funding Brought into Rev.
    CBG Funding Brought into Rev. 1
    Specialist Linkages Grants
    Pharmacist Project Grants
    Interest and Investment Income
    Other (specify)
Revenue Total
 {Priority Initiative name}
    {Priority Initiative name}
 {Priority Initiative name}
 {Priority Initiative name}
 {Priority Initiative name}
Expenses Subtotal for Priority Initiatives
    Evaluation Resources
    Other Central Administration
 Contingency + Other Unallocated
Expenses Subtotal for Central Allocations
Total Expenses

Revenue less Expenses for the year 2
Net Assets (Deficit) beginning of year
Net Assets (Deficit) end of year

Memo:        Per Capita Funding Receipts
Memo:        CBG Funding Receipts

    Based on “defer and match” method of revenue recognition.
    Enclose in brackets if negative.

{date}                                          {PCN Name} Budget for 2008/09 FY                             Page 4 of 6
PCI Annual Budget Template version 1.0

Table 2 presents the PCN expenses for the next fiscal year by the categories of payments to physicians, the
RHA, non-physician direct care providers, and other (including contingency).
Physician payments are broken down into the categories described in the footnotes.
The Total Expenses on this table should match the same line on Table 1.
To delete this instruction box, double-click [here] .

                        Table 2: Budget for Expenses by Payment Type

                                                        2007/08 Forecast               2007/08               2008/09
                                                           per {document}
                                                          dated {date} and
                                                                                       Budget                Budget
Expense Type (i.e., Payment To . . . )                    approved by PCIC
      Physicians: Clinical3
      Physicians: Administrative 4
      Physicians: Other
    Physicians Subtotal
    Non-Phys. Direct Care Providers
    Other Expenses + Contingency
Total Expenses

This area is for comments about the financial information presented, including:
 Significant changes in budget allocations between years.
 Any other required or helpful explanations.
Be sure to indicate if your PCN’s budget for 2008/09 includes changes in scale, scope, or both.
To delete this instruction box, double-click [here] .

{Click here to enter text}

    Clinical payments are those relating to direct patient care and interaction with team members that is related to specific
    patients/families. Payments under minimum shift guarantees (for after hours and other clinics) are considered clinical.
    Administrative payments are for governance, management, and program development activity related to the PCN, the NPC,
    and priority initiatives. Medical directorships are considered to be administrative in nature.
    Other payments are payments that are neither clinical nor administrative. Other payments include availability stipends,
    education/training, cost recovery, and other items of this nature.

{date}                                         {PCN Name} Budget for 2008/09 FY                                    Page 5 of 6
 PCI Annual Budget Template version 1.0

  zation                    PCN                        Physicians                           {RHA Name}

Name(s):     {Name}                        Dr. {Name(s)}                        {Name}
Title:       {Bus Mgr, Exec Dir, etc}      {Lead, Board, Governance, etc}       {Title}

Mailing      {Address}                     {Address}                            {Address}

Email:       {Email}                       {Email}                              {Email}
Phone(s): {(xxx) xxx-xxx}                  {(xxx) xxx-xxx}                      {(xxx) xxx-xxx}

Fax:         {(xxx) xxx-xxx}               {(xxx) xxx-xxx}                      {(xxx) xxx-xxx}

With our signatures below, we verify this is the PCN’s budget for next fiscal year as of {month day} , 2008.


 {date}                                     {PCN Name} Budget for 2008/09 FY                                   Page 6 of 6

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