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					The Office Of
Children, Youth and
Families (OCYF)
Contract Documentation
related to Group
Homes/Institutions
April 2009
Morning Agenda
                               8:00am-12:00pm

   Introductions

   Purpose & General Updates
       LaShanna Sloane

   Institutional Facilities/Group Homes
       Erica Nocho

   Questions

   Foster Family Contract Documentation
       Michael Laird (Afternoon Session)
                                                2
Purpose of Bulletin
   Provide documentation to support
    allowable expenses for…
     State     Act 148 and Title IV-E funded services.

    The Original Residential Service Contract
     Documentation Bulletin released in May 2008.
          Concerns expressed by Providers, Counties, and
           OCYF observation
             Not enough clarity
             No automation
             Cumbersome Submission and Review Process

                                                            3
Revised Contract
Documentation Bulletin
   Introduction
            Out of Home Placement Services
                Who is subject to complete contract documentation
            Revised the current Submission and Review Process

   Appendix B
            Electronic Submissions
                  Automation
            More that one option to report expenses
                  Multiple certificates with the same per diem
            Revised overall structure of Appendix B/Support Documentation
                Understand relationship between the forms
            Additional clarification has been added
                Indirect expenses/Cost Allocation
            Some examples have been added
                FTE calculations
            Modified forms to focus on service
                Rosters focus on job functions
            Added clear instructions from Bulletin to forms
                Reduce time/convenience

                                                                             4
Institutional Facility
Services
   The Per diems are based on licensed bed capacity.
       Exception-Office of Developmental Programs (ODP).

   Out of State Providers
       Must be licensed.
       Budget Reports/Support Documentation.

   Office of Developmental Programs (ODP)
       ODP Cost Reports-Difficult to identify State/Federal Funding

   Publicly Operated Residential Service Providers
       Must complete forms.
       Reviewed by OCYF.

                                                                       5
Initial Submission Process 08/09FY
 Separating the contracts based on per diem
       200 + OCYF
       Below 200 sent to the county agencies

            Concerns expressed by Providers, Counties, and OCYF
             observation

              • Different per diem rates for the same service.

              • Duplication of Efforts

              • Inconsistency with Implementing State Act 148 and Title
                IV-E guidelines.

              • Outstanding submissions
                                                                          6
Revised Submission Process-
FY_09/10
 Statewide Involvement
       County Review Teams
             Consists of members from the county agencies
       OCYF
             To provide Technical Assistance to the county review teams

 Review Structure
       Privately Operated Out of home service providers
             County Review Teams

       Out of home service providers licensed by the Office of
        Developmental Programs (ODP)
             County Review Teams

       Publicly Operated Out of home service providers
             Office of Children, Youth, and Families (OCYF)

                                                                           7
Public vs. Private Submissions
    Public Providers                              Private Providers
•   Institutional Residential Service         •   Institutional Residential Service
    Provider Cover Sheet                          Provider Cover Sheet
•   Rate Sheet                                •   Rate Sheet
•   Institutional Facility Staff Roster       •   Institutional Facility Staff Roster
•   Institutional Facility Staff Projection   •   Institutional Facility Staff Projection
    Sheet                                         Sheet
•   Institutional Facility Expenditure        •   Institutional Facility Expenditure
    Sheet                                         Sheet
•   Service Delivery Chart                    •   Indirect Administrative Staff Roster
•   Institutional Facility Per Diem           •   Indirect Administrative Expense
    Calculation Sheet                             Sheet
                                              •   Cost Allocation Description
                                              •   Master List of All Agency Programs
                                                  Sheet
                                              •   Service Delivery Chart
                                              •   Institutional Facility Per Diem
                                                  Calculation Sheet                       8
Documentation Submission
 Provide                                                                 County
 r                                                                       Review
 Budget                                                                   Team
 Forms
             Provide                                            County
             r                                                  Review
             Budget                                              Team
             Forms
                         Provide                       County
                         r                             Review
                         Budget                         Team
                         Forms
                                    Provide   County
                                    r         Review
                                    Budget     Team
                                    Forms




                       OCYF
                 E-mail Resource
                                                                     OCYF
                    Account                                     Secure Web Page
           Ra-ocyfcontracts@state.pa.us



                                                                  State Act 148 &
                                                                Title IV-E Per Diems
                                                                                   9
Questions

   By Email
     Please send questions regarding the Excel Workbook
      or automated process to the resource account.
          ra-ocyfcontracts@state.pa.us




                                                      10
OCYF-
Contract
Documentation
March/April 2009
Group Home/Institutional
Forms
OCYF Per Diem Contract Documentation
Flowchart




                                       12
Institutional Facility/Group Home
      Appendix B Coversheet




                                    13
Institutional Facility/Group Home- Appendix B Coversheet

    Purpose of the Sheet:
     • To identify the facility(s)/unit(s) for which the contract
     documentation is being submitted.

     • Provide the reviewer with information on who to contact
     when there are questions about the materials submitted.

     • Pertinent information listed within this cover sheet will
     populate to the forms listed within this Appendix.




                                                                    14
Institutional Facility/Group Home- Appendix B Coversheet
    When Completing This Sheet:
     • All fields listed on sheet must be completed. If a field does
     not apply, please insert N/A in that field.

     • This cover sheet must be completed for single submissions,
     multiple submissions, and/or re-submissions.

     • If completing the contract documentation packet for multiple
     certificate of compliance numbers who have the same service
     and same per diem rate, please complete the bottom of the
     coversheet.
           Note: When completing this packet for multiple facilities,
     compile all expenses and report the overall total for each area
     of the forms. The singular packet will display all expenses for
     all included certificate of compliance numbers as well as the
     total days of care for all included certificate of compliance
     numbers.
                                                                       15
Institutional Facility/Group Home Appendix B- Coversheet




                                                     16
Institutional Facility/Group Home Appendix B- Coversheet




                                                           17
                                  Summary Rate Sheet

                                                                  Summary Rate Sheet


•Complete this sheet for Child Welfare Programs Only. Please be sure to include all of the child welfare programs under your agency on this summary rate sheet.

•Report the total per diem rate along with the Title IV-E per diem rate that is being requested for services rendered for each child welfare program. Please do not
       report the calculated rate on this sheet.

•If there is no Unit ID then put N/A in this column.

•If you have multiple units/facilities that have several certificate of compliance numbers and all programs have the same per diem rate and provide the same
         service, then you do not have to list each unit/facility separately. In the column under the Certificate of Compliance Number, type in the word MULTIPLE
         and fill in one certificate of compliance number. Under the column Unit & Facility Name please fill in the name of the facilities/units that is commonly used
         to describe the programs. Then fill in rate requested for the programs.




   Certificate of Compliance                                                                                Requested Per Diem             Requested Title IV-E Per
                                            Unit ID                 Unit & Facility Name
                Number                                                                                                Rate                          Diem Rate




                                                                                                                                                                         18
               Summary Rate Sheet
   Purpose of the Sheet:
    • To be used as a quick reference sheet to identify the
    requested total per diem rate as well as Title IV-E per
    diem rate for Foster Family Home services and Group
    Home/Institutional services in the agency.

    • To have a listing of Foster Family Home services as
    well as Group Home/Institutional services and know
    what per diem rate is being requested by the provider.



                                                              19
                   Summary Rate Sheet
When Completing This Sheet:
   Complete this sheet for all Foster Family Home programs and
    Group Home/Institutional services within the agency.

   Please list the Requested per diem rate and Requested Title
    IV-E rate.

   If there is no Unit ID or Title IV-E rate then put N/A

   If there are multiple certificate of compliance numbers but all
    have the same rate and same service, type in MULTIPLE and
    then one certificate number, then under the column Unit
    Name/Facility Name please fill in the name of the
    facilities/units that is commonly used to describe the
    programs. Then fill in the requested per diem rate and
    requested Title IV-E rate for the programs.

                                                                  20
Institutional Facility Staff Roster




                                      21
         Institutional Facility Staff Roster
   The purpose of the form is:
       • Identify the baseline salary costs for staff that work
       in the institutional facility level.

       • Know what type of staff are working in the
       facility/unit and understand the variety of job
       functions that they perform at the facility.

       • The allocation of staff time to the specific facility.



                                                                  22
    Institutional Facility Staff Roster cont.
When Completing This Sheet:
   Information at the top of the page should automatically
    populate based on the proper completion of Appendix B
    coversheet.
   Click on the Pink button to insert a row for additional staff.

   Enter Staff Name/ID and Position Title.

   Is the staff hired as FT or PT for the Agency- enter the
    percentage of time they work.

   Number of weeks worked-If the employee worked less then
    52 weeks a year, please enter the number of weeks the
    employee worked.

   Enter in the Total Annual Salary paid to the employee for the
    year                                                          23
    Institutional Facility Staff Roster cont.
   Put in the allocation of staff time to the facility.

   Employee positions are divided into five (5) categories:
    - Managers/Supervisors - Direct Care
    - Support Staff           - Clinical/Treatment
    - Educational

   For each employee, place the salary amount that corresponds
    to their job functions in the appropriate column(s).

    Then enter the total salary/wage that is allocated to the
    facility.
                                                                 24
      Institutional Facility Staff Roster cont.

   An error message in Red will appear in the right
    hand column if certain costs reported on this
    sheet do not correspond with each other.


    The Error Message will appear when…….
    The salary amounts in each job category and/or
    Total Salary/Wage allocated to the facility does not
    match with the percentage that was placed in the
    “Allocation to the Facility” column.

                                                           25
Institutional Facility Staff Roster- Example 1




 In this example, the salary amounts listed in the Direct Care
 column and the Clinical/Treatment need to be been added
 together and placed in the “Total Salary/Wage allocated to this
 facility” column. This amount must be equal to the % of salary
 costs allocated to the facility. The red error message will
 automatically disappear when the correct amount is placed in the
 Total Salary/Wage allocated to facility column.                    26
 Institutional Facility Staff Roster- Example 2




In this example, the Total Salary/Wage allocated to the facility does
not equal the percentage of time that was written in the “Allocation
to Facility” column. The red error message will automatically
disappear when: 1) the % allocated to the facility is changed to
equal the total salary/wage allocated to the facility or; 2) the
amounts in the salary categories equal the % reported in the
“Allocation to Facility” column.
                                                                        27
Institutional Facility Staff Roster- Example 3




   In this example, several items could be incorrect.
   The Allocation to the facility, Total Annual
   Salary/Wage, the salary/wage amounts in the job
   categories or the Total Salary/Wage allocated to
   the facility.

                                                        28
Institutional Facility Staff Projection




                                          29
Institutional Facility Staff Projection cont.
   The purpose of this form is to:

    • Understand the number of staff (FTE) needed to run a
    facility/unit.

    • Understand how Title IV-E allowable amounts were
    developed for each job classification.

    • Understand how staff time is allocated to facility/unit.

    • Projection of staff costs over a three year period.



                                                                 30
Institutional Facility Staff Projection cont.
When Completing This Sheet:
   Totals for each job category (Managers/Supervisors,
    Direct Care Staff, Support Staff, Clinical/Treatment,
    Educational) will automatically populate (Green shaded
    cells) based on information reported on the Institutional
    Facility Staff Roster.

   Fill in job titles/positions under each job category. You
    may use the titles/positions that are on the sheet or fill in
    the title/positions that your agency uses.

   Enter in the salary/wage costs and Title IV-E allowable
    amounts for each fiscal year.
                                                                31
Institutional Facility Staff Projection cont.
   “Does the sum of job classifications equal the total of the
    institutional staff roster?” If this is true, then when the
    salary amounts are placed in the Prior Actual Audited FY
    column, a YES will appear in the cell below the Total for
    each job category.

   Fill in the FTE for each job title/position.

   Each of the columns will automatically total at the bottom
    of the sheet.



                                                             32
    Institutional Facility Staff Projection cont.
Full-time Equivalent (FTE)

   Example One: If a work year is defined as 2080 hours
    then one staff member that is employed full time for
    entire year then that staff member is considered to be
    FTE = 1.0. Two employees working 1040 hours each,
    FTE = 0.5 x 2 = 1.0.

   Example Two: 2 full-time staff (1.0 + 1.0= 2.0) and 3
    part-time staff (1 at 75%, 1 at 50% and 1 at 10%). FTE
    would equal 2.0 + 0.75 + 0.50 + 0.10 or 3.35 FTE.

                                                             33
    Institutional Facility Staff Projection cont.
   ***At Bottom of the Sheet Please Explain the Following:

    -How Institutional Facility Staff time is allocated to this
    facility

    Example1:
         ○ A time study was performed on all direct care staff
    which determined XX% percentage of their time was
    allocated to direct care job functions and XX% of their time
    was allocated to support staff job functions.

    Example 2:
        ○ For staff who work in multiple facilities- Staff time is
    based on actual time spent working in each program and is
    tracked by our payroll system.
                                                                  34
 Institutional Facility Staff Projection cont.
***At Bottom of the Sheet Please Explain the Following:

  - Any changes in staff counts (FTE) from year to year.

  - Any changes in staff salaries from year to year.

  - How Title IV-E allowable amounts were developed.

Example:
       ○ Managers/Supervisors spend 80% of their time
  overseeing the Direct Care Staff whose only responsibility is
  supervising and monitoring children. Managers/Supervisors
  spend 20% of their time supervising Clinical staff whose
  primary responsibility is mental health counseling of children.
  Therefore our agency determined Managers/Supervisors
  salaries to be 80% Title IV-E allowable.
                                                                35
Institutional Facility Expenditure Sheet




                                           36
Institutional Facility Expenditure Sheet
   The purpose of this form is to:

    • To identify all expenditures for the facility/unit.

    • Understand the reasonableness of expenditures for a
    specific facility.

    • Understand the expenditures for institutional facilities
    which encompasses three budget years.

    • Determine if line item expenses qualify for state and/or
    federal financial participation.


                                                                 37
Institutional Facility Expenditure Sheet cont.
When Completing This Sheet:
   The dates for the FY’s will automatically populate at the top of
    each column.

   Green shaded cells indicate pre-populated totals/amounts.
    Only complete the unshaded line items/cells.

   The sheet has 4 different sections to report costs.
         Personnel Expense       Facility & Operational Expense
         Direct Care Expenses    Offsetting Revenue

   Each section will automatically subtotal

   The salary/wage expenditures reported on the Institutional
    Facility Staff Projection sheet for each of the five different job
    categories will automatically transfer to the Personnel Expenses
    section of this sheet for their corresponding FY years.
                                                                     38
Institutional Facility Expenditure Sheet cont.
   Report all direct expenditures for the facility in line items
    listed on the form.

   If an expense item does not fit one of the defined line
    items, list it separately under “Other” in terms that clearly
    describe the expenditure.

        • Vague line items such as the following will be questioned:
               Miscellaneous             General Administration
               Purchased Service         Administrative Activities
               Educational Services Medical/Psychological


   Next, determine the Title IV-E allowable amount of costs
    from the total costs for each line item.
                                                                       39
Institutional Facility Expenditure Sheet cont.
   Enter costs for each FY in their respective columns along
    with their corresponding Title IV-E allowable amounts.

   For Offsetting Revenue, please list any revenues that
    offsets the costs.
        Examples:
               Fundraising                 Medical Assistance
               Foundation endorsements     Title 1
               Program Income              Clothing reimbursement

   At the bottom of the sheet, the line identified as “NET
    Facility/Direct Care Expense” will calculate and be carried
    over to the Institutional Facility Per Diem Calculation
    Sheet.

                                                              40
Institutional Facility Expenditure Sheet cont.

   Medical Assistance (county pays Room & Board only)
    • List all costs for the facility
    • List MA as an offsetting revenue

If at anytime the county is going to pay for Treatment as
    well as Room and Board then the Provider will need to
    submit forms that shows the cost for both treatment &
    room and board.




                                                            41
Institutional Facility Expenditure Sheet cont.
   Diagnostic Programs
    Forms can be completed in one of two ways….

    1) If the diagnostic cost is going to be included in the
        per diem then two sets of forms will need to be
        completed.
        - one set of forms should reflect the cost of all beds
        in the diagnostic unit
        - the other set of forms should reflect the regular
        facility/unit per diem without diagnostic

    2) Can choose to bill for diagnostic services as a
       separate service charge.

                                                                 42
Indirect Administrative Staff Roster




                                       43
           Indirect Administrative Staff Roster

   The purpose of this form is to:

    • Identify each staff member, their position title, their role
    and salary within the parent organization.

    • Understand the variation in expenditures over a three
    year period.

    • Determining which staff may be ineligible for Title IV-E.




                                                                 44
    Indirect Administrative Staff Roster cont.
When Completing This Sheet:
   Staff on this roster should be staff that are employed at
    the parent organization that indirectly oversees the
    operation of the programs within agency.

   This form is to be filled out to reflect positions and
    salaries for three fiscal year.

   Information at the top of the page should automatically
    populate based on the proper completion of Appendix B
    coversheet.

   On the form, enter Staff Name/ID and Position Title.

                                                                45
    Indirect Administrative Staff Roster cont.

   Employee positions are divided into three (3) categories
    - Administrative Staff  - Support Staff
    - Clinical/Treatment/Educational

   For each employee, place the salary amount that
    corresponds to their job functions in the appropriate
    column(s) for each FY.

   The Total Annual Salary/Wage paid to the employee for
    each FY will automatically calculate


                                                            46
Indirect Administrative Staff Roster cont.
   At bottom of the sheet please explain the following:
    - Any changes in staff from year to year
    - Any changes in staff salaries from year to year
    - If staff split their time among more than one job
    category please provide an explanation for how salary
    costs are divided

   The total costs reported for each job category (Admin
    Staff, Support Staff and Clinical/Treatment/Education
    Staff) on this sheet will automatically transfer to the
    personnel salary costs section of the Indirect
    Administrative Expense sheet.


                                                              47
Indirect Administrative Expense




                                  48
       Indirect Administrative Expense
   The purpose of this form is to:
    • To identify line item expenditures at the indirect
    administrative level and the projection of those
    expenditures over a three year period.

    • Determine if line item expenses qualify for state and/or
    federal financial participation.

    • Understand the reasonableness of expenditures for a
    parent organization.



                                                             49
Indirect Administrative Expense cont.
When Completing This Sheet:
 When the coversheet is completed, the dates for the
  FY’s will automatically populate at the top of each
  column.

   Green shaded cells indicate pre-populated
    totals/amounts. Only complete the unshaded line
    items/cells.

   The form requests a three year trend, starting with most
    recent prior year actual audited expenditures, the current
    estimated actual budget year, and projected budget year
    expenditures.

   This sheet should be filled out to reflect the Total agency
    indirect costs.                                           50
     Indirect Administrative Expense cont.
When Completing This Sheet:
   The sheet has 3 different sections to report costs.
    Personnel Expense         Facility & Operational Expense
    Offsetting Revenue


   Each section will automatically subtotal

   The salary/wage expenditures reported on the Indirect
    Administrative Staff Roster sheet for each of the three
    (3) different job categories will automatically transfer to
    the Personnel Expenses section of this sheet for their
    corresponding FY years.

                                                                  51
     Indirect Administrative Expense cont.
   If an expense item does not fit one of the defined line items,
    list it separately under “Other- please list” in terms that clearly
    describe the expenditure. For example:
           • Items such as the following will be questioned:
         Miscellaneous           General Administration
         Purchased Service       Administrative Activities
         Professional Fees       Other Admin

   ***Narrative at the bottom of the page
    -Please explain to the greatest detail possible how the Title
    IV-E allowable amounts were developed for the indirect
    administrative expenses.
         Example:
               The Indirect Administrative Expenses were determined
               to be allowable based on the same percentage of
               direct expenses that were Title IV-E allowable.
                                                                      52
    Indirect Administrative Expense cont.
   ***Narrative at the bottom of the page cont.

Items to consider when completing this section to explain
   Title IV-E allowable amounts:

    ● Personnel cost may be allocated differently then
    operational costs

    ● Personnel costs could be split based on job function(s)

    ● Some staff may be working in Title IV-E eligible
    programs but their salary costs may not be Title IV-E
    allowable


                                                            53
Cost Allocation Description




                              54
           Cost Allocation Description
   The purpose of this form is to:

    • Understand how the equitable distribution of Indirect
    Administrative Expenses are allocated by the Parent
    Organization.

    • Delineate between eligible and ineligible costs for state
    and federal financial participation.

    • Ensure that the distributed of eligible costs are
    allocated to the appropriate programs.


                                                              55
       Cost Allocation Description cont.
When Completing This Sheet:

   Summarize the methodology and procedures that is
    used to allocate costs to various programs.

   The charges are reasonable- A cost may be considered
    reasonable if the nature of the goods or services, and
    the price paid for the goods or services, reflects the
    action that a prudent person would have taken given the
    prevailing circumstances at the time the decision to incur
    the cost was made.

   Charges must benefit the program that is receiving them.


                                                             56
       Cost Allocation Description cont.

   Include all programs that fall within the organization (not
    just child welfare programs)

   The organizational chart should show the
    connection/relationship between departments which
    helps support the allocation of charges between/among
    departments/units.




                                                              57
Master List of All Agency Programs




                                     58
    Master List of All Agency Programs
   The purpose of this form is to:

    • A listing of all child welfare and non-child welfare
    programs within the agency.

    • A listing of all Title IV-E eligible foster care (residential
    and foster family home) programs within the agency.

    • Outline the fair and equitable distribution of Indirect
    Administrative Expenses to each program within the
    organization.

    • Identify the distribution of Indirect Administrative
    Expenses by reporting the percentage and dollar
    amounts assigned to each program.
                                                                  59
    Master List of All Agency Programs
When Completing This Sheet:
 When the coversheet is completed, the dates for the
  FY’s will automatically populate at the top of each
  column.

   Please report how indirect administrative costs are
    allocated to child welfare programs as well as all non-
    child welfare programs.

   Identify the licensing agency that issued the certificate of
    compliance for the services provided. This column is not
    just limited to state OCYF licensing offices but any state
    or federally licensing entity. If there is no licensing
    agency then put N/A in the box.
                                                              60
    Master List of All Agency Programs
   List the number of beds that have been licensed for the
    facility/program.
         Note: If you have multiple units or unit ID’s under
    one certificate of compliance number, please ensure that
    when the number of licensed beds are added together
    for each unit, that number of beds matches the total
    number of licensed beds assigned to that certificate of
    compliance number.

    Please list each unit on a separate line along with its’
    corresponding number of licensed beds


                                                               61
Master List of All Agency Programs
   Enter the percentage and dollar amount of the total
    indirect administrative budget that is attributed to each
    facility/program and/or unit.

   In the last column, enter the Title IV-E allowable dollar
    amount that is attributed to Title lV-E eligible programs.

     If  the program/unit is not eligible for Title IV-E funding,
        place a 0.00 in the column to signify that the
        program/unit is not eligible for Title IV-E funding.

       Since the form is for FY 2009/20010-The total
        amount of Title IV-E for all programs within your
        agency should equal the amount listed on Net Total of
        Agency Indirect Administrative Expense line for the
        Projected Budget FY Title IV-E Allowable column. 62
Service Delivery Chart




                         63
                Service Delivery Charts
   The purpose of this form is to:
    • This service delivery chart is designed to reflect the
    units/days of service delivered over a three year period-
    Prior Year Actual Audited, Current Estimated Actual and
    Projected FY.

    • To provide specific month by month projections or
    actual days of service that are delivered for group
    home/institutional programs.

    • Trends in utilization of service per certificate of
    compliance number.
                                                            64
             Service Delivery Charts
When Completing This Sheet:
 Please complete a chart for all children and youth group
  home/institutional services your agency operates.
 You may create as many charts as necessary to report
  services.
 Only one chart per certificate of compliance is necessary
  for each FY.




   Fill in the Name of the Program, Type of Program,
    Certificate of Compliance number and Total number of
    licensed beds.
                                                        65
              Service Delivery Charts
   If completing this packet for multiple certification
    numbers, combine the number of licensed beds for all
    certificates.

   If there are multiple units within one certification number,
    please use the number of licensed beds as designated
    under the certificate of compliance.

   Days in Care – Enter the total number of service days
    provided during the month.

   Final Total for Year- This should be the addition of all
    units/days of service for that year under that certificate of
    compliance number.
                                                               66
Institutional Facility Per Diem Calculation
                Worksheet




                                              67
    Institutional Facility Per Diem Calculation Worksheet

    The purpose of this form is to:

     • This form summarizes data from other supporting
     documentation to make the final purposed contracted
     per diem calculation.

     • The per diem calculation worksheet is designed to
     identify the facility’s operational and direct care
     expenditures and, if applicable, the proportional share of
     indirect administrative expenditures related to the facility.

     • Calculation of the Title IV-E allowable rate.

                                                                68
Institutional Facility Per Diem Calculation Worksheet

When Completing This Sheet:
 When the coversheet is completed, the dates for the
  FY’s will automatically populate at the top of each
  column.
 Green shaded cells indicate pre-populated
  totals/amounts. Only complete the unshaded line
  items/cells.
 The form reflects a three year trend, starting with most
  recent prior year actual audited expenditures, the current
  estimated actual budget year, and projected budget year
  expenditures.
 The Net Facility/Direct Care Expense line will
  automatically be populated based on the information
  reported on the Institutional Facility Expenditure sheet.
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    Institutional Facility Per Diem Calculation Worksheet
    The Indirect Administrative Expense line should contain only
     the amount of indirect administrative expense that is allocated
     to the facility/unit in which the forms are being completed. Do
     not put the total agency indirect administrative expense in this
     line.

        Indirect Admin Expense will need to be manually entered.

        The dollar/percentage amount of Indirect Administrative
         Expense that is listed on the Master List of All Agency
         Programs for each designated facility/unit should be the
         same as the amount listed on the Indirect Administrative
         Expense line of this sheet.

        If completing this packet for multiple certification numbers,
         enter the combined total of Indirect Administrative
         Expense for each cert number for which the packet is
         being completed.                                            70
    Institutional Facility Per Diem Calculation Worksheet
    The Grand Total line will automatically populate.

    For each FY- Enter the number of licensed beds and the
     occupancy rate.

    Number of Licensed Beds – This should be the number
     of licensed beds indicated on the Certificate of
     Compliance.
       If the Certificate of Compliance has more than one
         unit assigned to it, put the number of beds that are
         assigned to that specific unit in this line.



                                                                71
Institutional Facility Per Diem Calculation Worksheet

   Note: If provider is completing this packet for multiple
    certificate of compliance numbers in which the same
    per diem rate will be charged for several certificate of
    compliance numbers, then the number of licensed
    beds should be the total of all licensed beds for the all
    certificate of compliance numbers that are stated on
    the institutional facility coversheet.

   The Total Care Days/Units Provided and the
    Calculated Rate will automatically populate for each
    FY.




                                                            72
     Institutional Facility Per Diem Calculation Worksheet
   The Title IV-E allowable percentage for each fiscal year
    is calculated by dividing the Title IV-E allowable
    calculated rate by the Total Per Diem rate.

   For the Projected Budget FY the Title IV-E allowable
    percentage should automatically populate.

   County Contracted Rate- This is the final per diem rate
    that is negotiated between the service provider and the
    county level agency.
    Prior year actual audited- fill in the contracted rate
    Current estimated actual- fill this in if you have the info
    Projected budget year- this will not be filled in until
    negotiations are completed.
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Submitting Contract Documentation
   Only Electronic Submissions will be accepted.
   Contract Documentation must be in Excel format.
   Send the initial contract documentation forms to:
          Ra-OCYFContracts@state.pa.us

   A representative from the contract review team will be in
    touch with you to discuss the materials that were submitted
    for review and to request additional documentation such as
    audit reports & program descriptions.
   When the review is complete, the contract review team will
    submit the final contract documentation to OCYF for final
    Quality Assurance check .
   A formal letter will be mailed to the provider from OCYF
    reporting the final allowable rate.

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Questions???




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DOCUMENT INFO
Description: Home Budget Expense Sheet document sample