2007 best practice cost allocation plans & guidance for developing fy 2008 plans july 23, 2007...

2007 BEST PRACTICE COST ALLOCATION PLANS &

GUIDANCE FOR DEVELOPINGFY 2008 PLANS

July 23, 2007

Constitution Hall

2007 BEST PRACTICE PLANS & GUIDANCE FOR DEVELOPING

FY 2008 PLANS

• Welcome and Introductions

• Purpose of the Session

• Plan for the Day


FY 2008 PLANS

• Findings and Observations about FY 2007 Cost Allocation Plans

– Items expected and commonly found missing in original cost allocation plans

• Certification

• Description of method used to assign costs to funding sources

• Schedule of costs assigned to funding sources

• Summary of allocations of costs

• Schedule of 460 costs

• Service description

• Expense items included in the allocated cost center


FY 2008 PLANS


– Helpful items found in some of the 460 cost allocation plans and requested from all plans with June 15, 2007 addendum

• General narrative describing the entity• County Relationship• County charges (direct or indirect)• Description of accounting system• Method of Staff costing• CA relationship


FY 2008 PLANS


– Other helpful items found in some of the 460 cost allocation plans

• Table of contents

• Single document instead of Multiple files

• Excel schedules with narrative explanations

• Organizational charts that include prime subcontractors• CA Narratives with supporting schedules with financial

data


FY 2008 PLANS


– Items included in plans but not needed

• Employee job descriptions

• Employee staffing Charts

• Cost centers listing all accounts including unused accounts


FY 2008 PLANS


– Other issues found in the reviews

• Narratives indicating predetermined cost allocations between funding sources

• Inconsistent treatment of Information System costs

• Plans that appeared to follow managed care administration functions not the Section 460 cost allocation requirements and definitions for administration

• Reference to contracted cost allocation plan prepared by outside company but no detail as to compliance with the 460 cost allocation standards.


FY 2008 PLANS

• Best Practices: Three Cost Allocation Plans– All 46 plans were some what unique which was expected

– Difference approaches for addressing the needs

• Table of contents vs read me first files

• Schedule based verses narrative based

– During the development of the plans several CMHSPs requested model plans to review

– 460 cost plans are so specialized that no models existed.

– MDCH found Uniformity would be helpful to evaluate plans

– MDCH decided to select five plans to hold out as best practice models


FY 2008 PLANS

• Best Practices: Three Cost Allocation Plans

– The following criteria were used to select the models

• Plans that included most of the items expected by MDCH based on the November 6, 2006 training

• Plans that included the helpful items that were included in the addendum request but not in the original training

• The plans included other helpful items and designs that made them user friendly


FY 2008 PLANS

• Best Practices: Three Cost Allocation Plans– Specific examples of criteria include

• A general description of the organization

• Reconcilement of the 460 cost report with the FSR

• Clear identification of affiliation members and their costing methods

• Sections on direct service cost, administrative costs and allocable overhead costs.

• Clear flow of information through the plan

• Packaged as a single document


FY 2008 PLANS


– Specific examples of criteria include– Comprehensive organizational charts

– Schedules and narratives that clearly showed

» Expenses in a cost center

» Method used to assign or allocate the cost center

» Cost centers that received the cost assignment or allocation

– Descriptions of the relationship with the County and/or CA

– Descriptions of the accounting system and/or method of staff costing


FY 2008 PLANS


– Copies of 5 plans will be posted on the MDCH web site for your review

• Those five proposed best practice models are the plans submitted by

– Summit Point

– CEI

– CMHCM

– Network 180

– North Country/Northern Affiliation


FY 2008 PLANS

• Best Practices: Three Cost Allocation Plans– An overview of the plan development and underlying theory will be

presented today for three of the plans

• Network 180

• CMHCM

• North Country/Northern Affiliation

– The order was chosen to show the examples of• CMHSP/PIHP that contracts out for services

• CMHSP/PIHP with a mix of contract and direct run services

• CMHSP/PIHP affiliation with Hub and spoke model

SECTION 460 COST ALLOCATION

PLANS

Network180

CMH for Central Michigan

North Country CMH

Network180 • Who we are: including general ledger cost centers

• Review each GL cost center and allocations for Section 460 reporting

• Spread Sheet 1- Division of costs between Administrative and Direct Service

• Spread Sheet 2 – Admin and Direct Service totals by funding sources

• What I would/will do differently

Network180General Ledger Cost Centers 01 – Administration 35 – Claims 02 – Human Resources 40 - Grants 03 – Information Systems 50 – SUD (Sub Abuse) 15 – Training 53 – MI (Mental Illness 20 – Access Center Support 56 – Children/Families 23 – Access Center Services 59 - DD 29 – Med Clinic 62 – Children’s Waiver

Network180Allocation Summary for Section 460 ReportingUsing Approx FY 07 Budget

Total Cost Center

ExpensesCost Center Direct

Serv, Admin, or BothAdjustment for Section 460

ReportingAdjustmt Amount

Cost Center Adjusted Amount

Administration 01 4,705,000 100% Admin Costs none 4,705,000

Human Resources 02 288,200 100% Admin Costs none 288,200

Information Systems 03 996,200 Both ECR development 996,200

Training 15 227,300 Both Split based on staff time 227,300 spent providing training

related to direct service code

Access Center Support 20 999,900 Both Allocate occupancy expense to Access Ctr Serv (23)

(124,500) 831,300

Allocate occupancy expense to Med clinic (29)

(44,100)

Access Center Services 23 2,621,200 100% Direct Serv Allocate occupancy expense from Acc Ctr Support (20)

124,500 2,745,700

Med Clinic 29 490,200 100% Direct Serv Allocate occupancy expense from Acc Ctr Support (20)

44,100 534,300

Claims 35 566,200 100% Admin Costs none 566,200

Grants 40 1,061,300 100% Direct Serv none 1,061,300

SUD 50 6,336,000 Both Split based on review 6,336,000 MI 53 36,133,000 Both of actual expenses 36,133,000 CF 56 6,623,800 Both charge to the 6,623,800 DD 59 40,249,200 Both cost center 40,249,200 Children's Waiver 62 925,000 Both during the year 925,000

102,222,500 - 102,222,500

Network180Allocation Summary for Section 460 ReportingUsing Approx FY 07 Budget

Cost Center Adjusted Amount

Adjustment for Section 460 Reporting Admin Cost Direct Service Direct Run

Contracted Service

(Note: No Prime Sub-Contractors)

Administration 4,705,000 none 4,705,000

Human Resources 288,200 none 288,200

Information Systems 996,200 ECR development 967,100 29,100 29,100

Training 227,300 Split based on staff time 147,700 79,600 79,600 spent providing training

related to direct service code

Access Center Support 831,300

none

831,300

Access Center Services 2,745,700 none

2,745,700 2,745,700

Med Clinic534,300 none 534,300

534,300

Claims 566,200 none 566,200

Grants 1,061,300 none 1,061,300 1,061,300

SUD 6,336,000 contracted admin serv 23,000 6,313,000 6,313,000 MI 36,133,000 none 36,133,000 36,133,000 CF 6,623,800 contracted admin serv 25,000 6,598,800 6,598,800 DD 40,249,200 contracted admin serv 292,500 39,956,700 39,956,700 Children's Waiver 925,000 none 925,000 925,000

102,222,500 7,846,000 94,376,500 3,388,700 90,987,800

Direct Service Breakdown

Network180Internal work sheet ALLOCATION OF ADMIN AND DIRECT COSTS BY FUND SOURCEUSING APPROX FY 07 BUDGET

TOTAL MEDICAIDGENERAL

FUND OTHERCMHSP TOTAL

DIRECT SERVICES*1. Direct Run (Provided) Service - PIHP / CMHSA 3,388,700 2,389,034 528,637 471,029 999,667

70.5% 15.6% 13.9% 29.5%

2. Prime Sub-Contractors (none) - - - - - 70.5% 15.6% 13.9% 0%

16. Contracted Serv / Other Sub-Contractors 90,987,800 64,146,399 14,194,097 12,647,304 26,841,401 70.5% 15.6% 13.9% 29.5%

TOTAL DIRECT SERVICES BY FUNDING SOURCE 94,376,500 66,535,433 14,722,734 13,118,334 27,841,068

* Indicates the line on the 460 report

ADMINISTRATIVE COSTS

1. PIHP / CMHSA Provided: 7,846,000 Direct Assignment to Funding Source:SUD Admin/CA cost - % different than above % by rev 1,882,500 352,000 1,530,500 1,530,500

Amount to be allocated: 5,963,500 4,204,267 930,306 828,928 1,759,234 70.5% 15.6% 13.9% 30%

Sub total PIHP /CMHSP Provided: 7,846,000 4,556,267 930,306 2,359,428 3,289,734

2. Prime Sub-Contractors (none) -

Amount to be allocated: - - - - - 70.5% 15.6% 13.9% 0%

Sub total Prime Sub Contractors: - - - - -

16. Other Sub-Contractors Phase 2Direct Assignment to Funding Source:

Amount to be allocated:

TOTAL ADMIN COST BY FUNDING SOURCE 7,846,000 4,556,267 930,306 2,359,428 3,289,734

Network180 Who we are: including general ledger cost centers

Review each GL cost center and allocations for Section 460 reporting

Spread Sheet 1- Division of costs between Administrative and Direct Service

Spread Sheet 2 – Admin and Direct Service totals by funding sources

What I would/will do differently

CMHCM COST ALLOCATION

PLAN

Objectives

1. Keep it Simple

2. All in One Excel File

3. Meet the A-87 and DCH Requirements

4. Create a tool to produce the 460 Reports

Table of Contents

Item Page HyperlinkPrinting Instructions 0 PRINTING INSTRUCTIONS'!A1

Title Page 1 TITLE PAGE'!A1Table of Contents 2Certificate 3 Certificate!A1

Description of Agency 4 Agency Description'!A1

County Relationship 5 County Relationship'!A1

Accounting System 6 Accounting System'!A1

Services Description 7 Service Description'!A1

Organization Chart 8 Organizational Chart'!A1

Expenses 9 Expenses!A1

Overhead 11 Overhead!A1

Agency Vehicle Distribution 12 Vehicle Distribution'!A1

Building & Support Distribution 13 Building&Support Distribution'!A1

First Line Supervisors 20 FirstLine!A1

Contracted Services 25 Contracted Services'!A1

Prime SubContractor 26 Prime Sub-contractor'!A1

Allocation Narrative 27 allocation narititive'!A1

Overhead Allocation 28 OverheadAllocSum!A1

Service by Fund Source 29 SERVICE BY FS'!A1

Allocation by Fund Source 30 Allocation by FS'!A1

PIHP 460 Report 31 PIHP!A1

CMHSP 460 Report 32 CMHSP!A1

TABLE OF CONTENTS

Certificate

CERTIFICATE OF 460 COST ALLOCATION PLAN

This is to certify that I have reviewed the 460 cost allocation plan submitted herewith and to the best of my knowledge and belief:(1) All costs included in this proposal dated February 26, 2007 to establish cost allocations or billings for the period October 1, 2006 - September 30, 2007 are allowable in accordance with the requirements of OMB Circular A 87, "Cost Principles for Stat

(2) All costs included in this proposal are properly allocable to service or administrative costs on the basis of a beneficial or causal relationship between the expenses incurred and the categories to which they are allocated in accordance with applicabl

(3) All costs included in this proposal are allocated to service or administration and reported in compliance with the Michigan Department of Community Health Cost Allocation Requirement for the period October 1, 2006 - September 30, 2007.

I declare that the foregoing is true and correct.

Governmental Unit: Community Mental Health for Central Michigan

SignatureName of Official: James R. HouseTitle: Finance DirectorDate of Execution: May 25, 2007

Descriptions (very short)

Agency 115 words

County Relationship 63 words

Accounting System 152 words

Services 114 words

Org Chart

ADMINISTRATION

SAAdministration

DIRECT SERVICES

Program Director Program Director

Midland County

Program Director

Mecosta County

Osceola County

Medical DirectorDeputy Director of

Services

Finance - Director and all finance

functions

Clare County

Gladwin County

Isabella County

Substance Abuse

(NMSAS)

Executive Director

Program Director

RecipientRights

Administration - Deputy Director

and all Adm functions

Salaries & Wages $14,565,982Fringe Benefits $6,141,555Operating Supplies $1,514,229Staff Travel $380,052Agency Vehicles $172,659Building Costs $2,394,821Contracted Services $42,302,272Substance Abuse CA $619,188

$68,090,758

Expenses by Line Item

Expenses by Program Type

Building $2,394,821 Home Based Services $1,302,071Support Staff $2,513,382 Prevention $37,454Agency Vehicles $172,659 COPE/FIT/CPCP $237,466First Line Supervisors $1,357,717 Respite Care $64,148Executive Director $346,434 Childrens Model Waiver $71,728Medical Director $23,083 SED Waiver $239,681Special Board Expense $36,500 Wrap Around $53,700Finance $1,081,165 Juvenile Diversion $223,044Information Systems $657,895 School Program $155,596Quality Management $199,493 Family Psycho-Ed $11,876Contract Management $223,459 Health Services $967,500Human Resources $199,614 Other Emergency Service $451,255Recipient Rights $261,029 ACT Program $409,510Customer Service $94,310 Supports Coordination $4,908,672Training $220,010 Individual Supports $1,148,334Program Directors & Deputies $744,399 OBRA PASARR $331,185Clubhouse/Drop In Center $520,608 Northern Expresso $171,631Give Me Shelter $96,616 Contracted Services $42,302,272Outpatient $3,147,235 Substance Abuse C/A $619,188

Jail Diversion $68,829Perpetrators Groups $25,189 $68,090,758

Expenses by County

Clare County $8,127,052Gladwin County $4,057,636Isabella County $20,041,784Mecosta County $7,988,046Midland County $15,193,370Osceola County $7,207,539Administration $4,856,143Substance Abuse $619,188

$68,090,758

Overhead Cost Centers

BUILDINGSUPPORT

STAFF

610 Clare County Building $119,212 $132,257620 Gladwin East $41,707 $70,353621 Gladwin West $24,485 $30,948630 Isabella County Building $490,942 $329,007630 Isabella County (admin) $0 $92,281650 Midland County - Saginaw Rd $66,383 $32,879651 Midland County - Ellsworth $171,195 $105,187652 Midland County - Wackerly $77,558 $172,894654 Midland County - Jefferson $16,632 $0640 Mecosta County Building $126,616 $164,607660 Osceola County Building $113,123 $129,330

TOTAL $1,247,853 $1,259,743

DISTRIBUTIONS

Miles TotalRU # Reporting Unit Name FTE Dollars FTE Dollars 137,263 $65,886

610 Clare County Building $119,212 $132,254310 Program Director Clare/Gladwin 0.25 $3,970 0.25 $1,962

Sub Total Administration Services 0.25 $3,970 0.25 $1,962

1110 Outpatient - Clare County 4.75 $25,106 4.25 $33,511 1,346 $4681150 Jail Diversion - Clare County 0.25 $1,323 0.25 $1,4681160 Perpetrators Group - Clare County 0.03 $155 0.03 $1721205 Home Based Services - Clare County 2.25 $11,897 2.25 $13,199 4,396 $1,5291225 Respite Care - Child - Clare County 0.10 $525 0.10 $5821231 SED Waiver - Clare County 0.10 $525 0.10 $5821246 Juvenile Diversion Program - Clare County 0.25 $1,323 0.25 $1,5501305 Health Services - Nurses - Clare County 2.75 $14,544 2.75 $16,135 910 $3161323 Other Emergency - Clare County 0.45 $2,384 0.45 $2,6451362 SC/CSM DD - Clare County 5.50 $29,063 5.50 $32,244 910 $3161364 SC/CSM MI - Clare County 4.16 $21,995 4.16 $25,421 17,221 $5,9821382 Respite Care - DD - County 0.15 $799 0.15 $8861420 Indiv Support - MI - County 1.06 $5,603 1.06 $6,216

Sub Total Direct Services 21.80 $115,242 21.30 $134,611 24,782 $8,611TOTAL $119,212 $136,573 $8,611

Building Support Staff

Vehicle Cost Center

Car Phone $3,500Maintenance $66,500Fuel $65,000Depreciation $37,659Total Vehicle Costs $172,659

Vehicle Distribution

RU # Reporting Unit Name Miles Dollars101 Executive Director 6,912 $2,403211 Finance 17,424 $6,060212 Information Systems 7,435 $2,586213 Quality Management 23,190 $8,065214 Contract Management 3,650 $1,269222 Recipient Rights 2,945 $1,024300 Deputy Director - Program 9,933 $3,455433 First Line Spv Isabella 1,445 $503441 First Line Spv Mecosta 3,053 $1,0621110 Clare Outpatient 3,373 $1,1731205 Clare In Home Services 10,989 $3,8221305 Clare Health Services 2,286 $7951362 Clare Supports Coordination DD 2,283 $7941364 Clare Supports Coordination MI 42,946 $14,9362205 Gladwin In Home Services 6,103 $2,1232240 Gladwin COPE 21,609 $7,5152362 Gladwin Supports Coordination DD 1,476 $5132364 Gladwin Supports Coordination MI 2,225 $7742420 Gladwin Individual Suports 1,083 $3773051 Isabella Clubhouse 7,925 $2,7563110 Isabella Outpatient 12,763 $4,4393205 Isabella In-Home Services 21,304 $7,4093305 Isabella Health Services MI 4,422 $1,5383310 Isabella Health Services DD 2,707 $9423362 Isabella Supports Coordination DD 9,754 $3,3923364 Isabella Supports Coordination MI 27,922 $9,7113410 Isabella Individual Supports 3,582 $1,2463430 Isabella Emergency Response 33,079 $11,5053490 Isabella OBRA PASARR 10,941 $3,8054051 Mecosta Clubhouse 9,828 $3,4184205 Mecosta In-Home Services 3,157 $1,0984310 Mecosta Health Services 2,186 $7604362 Mecosta Supports Coordination DD 3,745 $1,3034364 Mecosta Supports Coordination MI 10,883 $3,7854367 Mecosta Peer Support 1,520 $5295110 Midland Outpatient 1,043 $3635205 Midland In-Home Services 33,812 $11,7605310 Midland Health Serviices 1,144 $3985362 Midland Supports Coordination DD 19,143 $6,6585364 Midland Supports Coordination MI 19,143 $6,6585430 Midland Community Support Tech 38,989 $13,5606110 Osceola Outpatient 3,244 $1,1286205 Osceola In-Home Services 8,068 $2,8066362 Osceola Supports Coordination DD 3,951 $1,3746364 Osceola Supports Coordination MI 31,827 $11,069

TOTAL 496,444 $172,659

First Line SupervisorsSPV RU County RU Account FTE AMOUNT

410 Clare 88,901

1305 70100 2.75 22,3881323 70100 0.35 2,8491362 70100 2.60 21,1671364 70100 4.16 33,8671420 70100 1.06 8,630

TOTAL 10.92 88,901

411 Clare 72,848

1110 70100 4.65 45,1661150 70100 0.25 2,4281205 70100 2.25 21,8541231 70100 0.10 9711246 70100 0.25 2,429

TOTAL 7.50 72,848

420 Gladwin 91,528

1323 70100 0.10 8331362 70100 2.90 24,1522091 70100 0.20 1,6662110 70100 0.50 4,1642150 70100 0.20 1,6662225 70100 0.05 4162240 70100 0.08 6662323 70100 0.30 2,4982362 70100 2.42 20,1542364 70100 1.34 11,1602382 70100 0.10 8332410 70100 2.26 18,8222420 70100 0.54 4,498

TOTAL 10.99 91,528

Contracted Services

Contracted Services Clare Gladwin Iabella Mecosta Midland Osceola TOTALSResidential Services $3,466,324 $615,481 $7,862,327 $2,266,230 $1,787,198 $3,599,077 $19,596,637Skill Building Services $765,777 $503,955 $1,883,809 $710,214 $1,295,283 $490,672 $5,649,710Inpatient Services - State $249,228 $75,493 $357,857 $326,120 $341,462 $52,539 $1,402,699Inpatient Services - Local $254,420 $94,700 $335,000 $330,750 $327,000 $167,000 $1,508,870Health/Clinical Services $214,094 $183,149 $695,205 $341,682 $418,038 $234,116 $2,086,284Respite $113,431 $36,851 $206,611 $74,727 $184,098 $52,320 $668,038Living Supports $625,369 $569,086 $2,980,873 $1,382,310 $4,810,653 $715,023 $11,083,314Wraparound $50,000 $50,000Juvenile Diversion $70,000 $70,000Family Psycho-Education $7,000 $7,000Safe Haven $102,220 $102,220Give Me Shelter $34,000 $34,000Clubhouse/Drop-In Ctr $43,500 $43,500

TOTALS $5,688,643 $2,078,715 $14,448,682 $5,475,533 $9,299,952 $5,310,747 $42,302,272

Prime Sub-Contractor

Substance Abuse Services In House Contractual TotalsService Service

Administrative Services $6,192 $61,720 $67,912 Direct Services $61,919 $489,357 $551,276

General Ledger Expense Items $68,111 $551,077 $619,188

Community Mental Health for Central Michigan provides Medicaid

Funding for Substance Abuse Services through its prime sub-

contractor, Northern Michigan Coordinating Agency (NMSAS). Of the

Medicaid funds received which are specifically "earmarked" for su

Allocation Summary

REPORTING UNIT Equivalents BASE COST BUILDINGSUPPORT

STAFF VEHICLESFIRST LINE

SPVIN HOUSE SERVICES

CONTRACTED SERVICES

ALLOCATED TOTAL

Building 2,394,821 (2,394,821) 0 0Support Staff 2,513,382 (2,513,382) 0 0Agency Vehicles 172,659 (172,659) 0 0First Line Supervisors 1,327,284 (1,327,284) 0 0Allocation Total 6,408,146 (2,394,821) (2,513,382) (172,659) (1,327,284) 0 0 0

Executive Director 2.1 346,434 21,668 9,633 2,403 380,138 380,138Medical Director 0.02 23,083 206 92 23,381 23,381Special Board Expense 36,500 36,500 36,500Finance 17.17 1,081,165 155,505 69,448 6,060 1,312,178 1,312,178Information Systems 6 657,895 58,582 27,749 2,586 746,812 746,812Quality Management 2 199,493 20,638 9,173 8,065 237,369 237,369Contract Management 3.5 223,459 36,116 16,053 1,269 276,897 276,897Human Resources 2.05 199,614 21,154 9,173 229,941 229,941Recipient Rights 3.72 261,029 35,055 17,291 1,024 314,399 314,399Customer Service & Public Relations 1.3 94,310 10,319 4,587 109,216 109,216Training 3.28 220,010 33,846 15,044 268,900 268,900Deputy and Program Directors 7 744,399 $70,412 $54,220 3,455 872,486 872,486Administration for SA 68,111 6,192 61,919 68,111TOTAL ADMINISTRATION 48.14 4,155,502 463,501 232,463 24,862 4,814,409 61,919 4,876,328

Clubhouse/Drop In Center 520,608 0 42,669 6,174 12,186 581,637 581,637Give Me Shelter 2.24 96,616 38,132 0 15,124 149,872 149,872Outpatient 38.96 3,177,668 408,714 653,251 8,668 284,634 4,532,935 4,532,935Jail Diversion 1 68,829 10,769 12,972 7,759 100,329 100,329Perpetrators Groups 0.16 25,189 1,284 2,814 1,047 30,334 30,334Home Based Services 17.36 1,302,071 160,765 171,954 29,018 154,838 1,818,646 1,818,646Prevention 0.41 37,454 3,277 1,894 2,531 45,156 45,156COPE/FIT/CPCP 5.33 237,466 33,231 57,823 7,515 35,722 371,757 371,757Respite Care 1.33 64,148 12,711 13,824 3,599 94,282 94,282Childrens Model Waiver 1 71,728 8,715 5,992 7,872 94,307 94,307SED Waiver 0.45 239,681 3,592 3,196 3,885 250,354 250,354Wrap Around 0.75 53,700 5,833 2,596 6,737 68,866 68,866Juvenile Diversion 1.25 223,044 10,331 6,556 11,412 251,343 251,343School Program 2 155,596 20,638 27,050 22,255 225,539 225,539Family Psycho-Ed 11,876 11,876 11,876Health Services 14.63 967,500 151,042 195,748 4,433 102,035 1,420,758 1,420,758Other Emergency Service 1.7 451,255 15,733 34,178 25,851 527,017 527,017ACT Program 5.5 409,510 38,426 26,486 35,568 509,990 509,990Supports Coordination 76.98 4,908,672 753,375 865,636 61,496 535,737 7,124,916 7,124,916Individual Supports 5.86 1,148,334 209,675 102,718 26,688 39,680 1,527,095 1,527,095OBRA PASARR 2.93 331,185 26,199 29,043 3,805 17,146 407,378 407,378Northern Expresso 4.29 171,631 18,878 24,519 1,666 216,694 216,694Contracted Services 42,302,272 42,302,272 42,302,272Substance Abuse C/A 551,077 61,919 489,357 551,276TOTAL DIRECT SERVICES 184.13 57,527,110 1,931,320 2,280,919 147,797 1,327,284 20,423,000 42,791,629 63,214,629

TOTAL EXPENSE 232.27 68,090,758 0 0 0 0 25,237,409 42,853,548 68,090,957

Allocation by Funding Source

TOTAL MEDICAIDGENERAL

FUND OTHERCMHSP TOTAL

DIRECT SERVICESDirectly Provided Services $20,423,000 $15,262,224 $2,669,677 $2,491,099 $5,160,776

Prime Sub-Contractors $489,357 $489,357 $0Sub Abuse Coordinating Agency

Other Sub-Contrators $42,302,272 $31,612,728 $5,529,717 $5,159,827 $10,689,544CMHCM COMBINED PER CENT

Total by Funding Source $63,214,629 $47,364,309 $8,199,394 $7,650,926 $15,850,320

ADMINISTRATIVE COSTSPIHP/CMHSP Administration $4,814,409

Directly Assigned to funding SourceCost of billing third parties -$55,000 $55,000 $55,000

Amount Allocated by Percentage $4,759,409 3,598,777 $629,500 $531,132 $1,160,632

Sub total PIHP /CMHSP Provided: $4,814,409

Prime Sub-Contractors $61,919 $61,919Direct Assignment to Funding Source:

Medicaid Substance Abuse -$61,919

Amount Allocated by Percentage $0

Sub total Prime Sub Contractors: $61,919

Total by Funding Source $4,876,328 $3,660,696 $629,500 $586,132 $1,215,632

TOTAL COST BY FUNDING SOURCE $68,090,957 $51,025,005 $8,828,894 $8,237,058 $17,065,952

PIHP 460 Report

PIHP: Community Mental Health for Central Michigan.

Fiscal Year: 2007

Reporting Period: X Six Month Report Annual Report

(A) (B) (C) (D) (E) (F) (G)

Contractor(s) PIHPPrime Sub-Contractors

Sub-Contract Providers PIHP

Prime Sub-Contractors

Sub-Contract Providers

1. PIHP Provided 46,874,952$ $3,598,777 -$

2. Prime Sub-Contractor(s)

3. Northern Michigan Substance Abuse CA 489,357 $61,919

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15. Sub-Total Prime Sub-Contractor(s) 489,357$ 61,919$

16. Other Sub-Contractor(s)

Included in Direct for Phase 1

17. Total without Quality Assurance Assessment Tax 46,874,952$ 489,357$ -$ 3,598,777$ 61,919$


18. Quality Assurance Assessment Tax 3,041,615$ 31,753$ 233,517$ 4,018$

19. Total with Quality Assurance Assessment Tax 49,916,567$ 521,110$ -$ 3,832,294$ 65,937$

Medicaid Direct Service Medicaid Administration

Michigan Department of Community Health

Section 460 Compliance Report

Direct Service / Administrative Cost Detail Report for the Prepaid Inpatient Health Plans

Medicaid Managed Specialty Supports and Services Concurrent 1915(b)/(c) Waiver Programs

CMHSP 460 Report

CMHSP: Community Mental Health for Central Michigan

Fiscal Year: 2007

Reporting Period: X Six Month Report Annual Report

(A) (B) (C) (D) (E) (F) (G)

Contractor(s) CMHSP Prime Sub-Contractors Sub-Contract Providers CMHSP Prime Sub-ContractorsSub-Contract

Providers

1. CMHSP PROVIDED 15,850,320$ 1,215,632$


3.

4.

5.

6.

7.

8.

.9.

10.

11.

12.

13.

14.

15. Sub-Total Prime Sub-Contractor(s) -$ -$

16. Other Sub-Contractor(s)


17. Total w ithout Local Contribution to State Medicaid Match 15,850,320$ -$ -$ 1,215,632$ -$

18. Local Contribution to State Medicaid Match 785,557$ 60,248$

19.Total w ith Local Contribution to State Medicaid Match 16,635,877$ -$ -$ 1,275,880$ -$

Non-Medicaid Direct Service Non-Medicaid Administration

Michigan Department of Community Health

Section 460 Compliance Report

Direct Service / Administrative Cost Detail Report for the Community Mental Health Service Programs

Non-Medicaid Managed Mental Health Supports and Services

NEXT . . .

North Country Community Mental Health

Section 460 Cost Allocation Plan

North Country Community Mental HealthSection 460 Cost Allocation Plan

TABLE OF CONTENTS

Certificate of 460 Cost Allocation Plan (signed) Organization Chart Total budgeted expenditures allocated between direct and administrative Program descriptions which indicate allocation between direct and

administrative Budget analysis spreadsheet, by program expenditure line item and revenue

funding stream Various expense allocation methodologies used to allocate line item costs to

programs Analysis of contracted services and how services are allocated to funding

streams Summary of direct costs by program type Detailed narrative and report of administrative costs Narrative and report on how costs are allocated to funding streams

North Country CMH-OverviewNorth Country Community Mental Health is an Authority established on April 1, 2003. The Authority covers six counties: Antrim, Charlevoix, Cheboygan, Emmet, Kalkaska, and Otsego counties. North Country Community Mental Health is a direct provider of various services throughout the six county service area. There are 12 program sites located in Petoskey, Gaylord, Walloon Lake, Charlevoix, Cheboygan, Bellaire, Kalkaska, and Rapid City. Each site operates various programs and services including administrative services, as defined and identified in the Section 460 Cost Allocation Report. As an Authority, the counties do not provide any administrative services to North Country Community Mental Health; therefore there are no indirect administrative charges. North Country holds a lease with both Antrim and Otsego Country for two service sites. The annual lease cost for the Antrim County building is $119,775 ($16.49 square foot). The lease includes all utility, janitorial, and general maintenance costs. The annual lease cost for the Otsego County building is $99,200 ($10.25 square foot). This lease does not include electric and janitorial services. North Country Community Mental Health also purchases community inpatient, residential, skill building and day services, some specialized clinical services including psychiatric services, other minor support services from various providers. During “Phase 1”, these costs are all reported as Direct Services. North Country is the PIHP and holds the contract with the Department of Community Health for Medicaid revenue for a thirteen county region. North Country Community Mental Health entered into an agreement under the Intergovernmental Transfer of Functions and Responsibilities Act (P.A. 8, 1967) with AuSable Valley Community Mental Health (covering Iosco, Ogemaw, and Oscoda counties) and Northeast Michigan Community Mental Health (covering Alcona, Alpena, Montmorency, and Presque Isle counties). AuSable Valley Community Mental Health, Northeast Michigan Community Mental Health and Northern Michigan Substance Abuse hold contracts as Medicaid service providers with North Country Community Mental Health.

A u sab le V a lleyC o m m u n ity

M e nta l He a lthS e rv ices

N o rth ea s t M ich ig anC o m m u n ity


N o rth Co u n tryC o m m u n ity


N o rth e rnM ich ig an

S u bs tan ce A bu seS e rv ices

N o rth ern A ff ilia t ion(P IH P )

Counties Served:IoscoOgemaw

Counties Served:AlconaAlpenaMontmorencyPresque Isle

Counties Served:AntrimCharlevoixCheboyganEmmetKalkaskaOtsego

The chart above depicts the flow of Medicaid funds upon receipt from MDCH. The Northern Affiliation retains a portion of the Medicaid received to pay directly for Medicaid community inpatient services and the QAAP taxes. Medicaid funds are disbursed to the three CMHs and NMSAS based on agreements with those agencies.

Organizationally, the Northern Affiliation is a department housed within the North Country Community Mental Health agency.

North Country CMH-Affiliation Overview

Organizational Chart

Director of AffiliationServices (MCO)

- Includes Network Mgmt,Access Center, and IS

Director's Office- Includes Medical Director,

Executive Assistant, andRecipient Rights

Finance Administrative Services

Program AdminDD

Program AdminCSS-MI

Program AdminCC&T

State Inpatient - MIC

Case Management - Children

Wraparound

Psychiatric Services - All

Clinical - MIA/MIC

Home Based Services

Residential/Respite - Children

Community Inpatient - MIC

State Inpatient - MIA

Older Adult Services

ACT

Case Management - Adult

PSR & Peer Operated

Residential - Adult

Community Inpatient - Adult

State Inpatient - DD

Day Services

Residential/ Respite

Case Management - DD

Clinical

Human Resources

Please note that the dotted lines indicate that Human Resources and Finance serve both the Affiliation and the Provider operation.

North Country Community Mental HealthOrganization Chart for Section 460 Cost Allocation Plan

Hospital Liaison

Program Descriptions and Allocation Costing MethodsProvider Operations Inpatient Programs

MI Adult State Inpatient. This program includes costs for all state hospitalizations of MI Adult consumers. All costs in this program are direct.

Hospital Transportation: This program includes non-Medicaid cost for transporting consumers to community hospitals. All costs in this program are direct.

MI Adult Community Inpatient. This program includes costs for non-Medicaid local hospitalization for MIA consumers. All costs in this program are direct.

MI Child State Inpatient. This program includes costs for all state hospitalizations of MI Child consumers. All costs in this program are direct.

Residential Services

DD Residential Services. This program identifies various homes that large contract provider’s operate. Also included are contracts with small AFC providers and self-determination agreements with consumers. Services provided are community living supports and personal care. All costs in this classification are direct.

DD Respite Care. This program includes non-Medicaid costs for family friends respite care. All cost in this program are direct.

MI Adult Residential and MI Adult Residential OBRA. This program includes costs for contracted community living supports and personal care for MI Adult consumers. All costs in this program are direct.

Other programs were listed under Residential Services classification in the plan.

Also listed detail under the following program classifications Skill Building & Day Support Services Clinical Services Support Services Other Support Services

Program Descriptions and Allocation Costing Methods-Administration

Administrative Services DD Day Program Supervision. Included in this program is the cost of the DD Day Program

Director. This person is a second line supervisor responsible for oversight of skill building and day services supports to the developmentally disabled population. This cost is allocated to all DD day services programs, prior to allocating costs to funding streams. Allocation of this cost to programs is based upon the total expense of each DD day service program to the total expense of all DD day services programs. All costs in this program are administrative.

DD Program Administration. This program is responsible for the oversight of DD services including; inpatient, clinical, supports coordination/case management, residential, and day services. This cost is allocated to all DD Programs prior to allocating costs to funding streams. Allocation of this cost to programs is based upon the total expense of each DD program to the total expense of all DD programs. All costs in this program are administrative.

Community Consultation and Treatment (CC&T) Program Administration. This program is responsible for the oversight of MI Adult and MI Child services including child state and community inpatient, child residential services, home based services to children, case management services to children, clinical outpatient services to both MI Adults and MI Children, psychiatric service coordination and emergency service coordination. This cost is allocated to all CC&T programs prior to allocating costs to funding streams. Allocation of this cost to programs is based upon the total expense of each CC & T program to the total expense of all CC&T programs. All costs in this program are administrative

Other types of Administration Services listed in the Plan to DCH were Community Support (CS) Program Administration Hospital Liaison Psychiatric Administration Prevention Homeless Grant Administration Board Administration

Program Descriptions and Allocation Costing Methods-Administration-Affiliation

Northern Affiliation. Inpatient Programs

Community Inpatient Services. The Northern Affiliation adjudicates all inpatient claims. Finance staff at the Affiliation level pays Medicaid claims. General Fund, MI Child, Adult Benefit Waiver, and indigent claims are forward to each contract board provider for payment. All cost of inpatient claims paid is a direct service. The cost of the employees adjudicating and paying the claims is administrative services.

Administrative Services Improving Practices Leadership Team. This coordinating grant is charged to administrative

services. Affiliation MCO Administration. This includes Access, Inpatient Claims, Information Services,

Finance, Human Resources, Member Services, Compliance, and Provider Network Management. Finance and Human Resources costs are allocated as mentioned above. Most Affiliation MCO Administration is charged to Medicaid, with the exception of some Access charges, inpatient claims adjudication, and standards setting dues. General Fund, Adult Benefit Waiver, MI Child, and indigent portions of these costs are billed back to the Contract Boards. The budgeted amount of these non-Medicaid costs is $91,682 for Ausable Valley and Northeast Michigan Community Mental Health. The non-Medicaid portion for North Country Community Mental Health is $102,508.

Prime Subcontractors The Northern Affiliation’s prime subcontractors are Northeast Michigan Community Mental

Health, Ausable Valley Community Mental Health, and Northern Michigan Substance Abuse Services. The Northern Affiliation also contracts with various community hospitals to provide inpatient services. Northeast Michigan CMH and AuSable Valley CMH submitted their own cost allocation reports to DCH and identified direct and administrative costs by revenue stream within their cost allocation plans. Northern Michigan Substance Abuse Services identified that historically 11.1% of their Medicaid disbursements are for CA Administration.

Other QAAP tax. This assessment is passed on to DCH.

Total Budgeted Expenditures-FY2007Provider MCO Total

Expenses Expenses ExpensesSalaries & Wages-Direct 7,581,146$ 859,520$ 8,440,666$ Fringe Benefits-Direct 2,718,635 306,643 3,025,278 Supplies-Direct 208,510 30,100 238,610 Supplies-Allocated 138,542 3,458 142,000 Pharmacy/Injectables-Direct 223,725 - 223,725 Communications-Direct 147,381 12,582 159,963 Communications-Allocated 87,263 418 87,681 Travel/Conference-Direct 298,527 45,319 343,846 Vehicle Gas-Direct 24,178 - 24,178 Vehicle Gas-Allocated 69,153 1,047 70,200 Transportation-Direct 35,133 35,133 Advertising-Direct 58,623 2,000 60,623 Insurance-Liability/Doctors-Direct 22,000 - 22,000 Insurance-Liability/Doctors-Allocated 115,942 8,958 124,900 Insurance-Workers Comp-Allocated 118,609 9,164 127,773 Insurance-Unemployment-Direct 74,172 6,000 80,172 **Occupancy-Rent-Direct 531,113 41,999 573,112 Occupancy-Rent-Allocated 440,821 6,001 446,822 **Prime Subcontractors-Northeast Michigan CMH 17,773,360 17,773,360 Prime Subcontractors-Ausable Valley CMH 8,966,163 8,966,163 Prime Subcontractors-Northern Mich Substance Abuse Services 691,699 691,699 Local Match Draw Down 431,035 431,035 QAAP 3,341,131 3,341,131

30,856,258$ 33,864,647$ 64,720,905$ Less Access Center/Inpatient Claims for Northeast & AV CMH* (91,682) (91,682)

30,856,258 33,772,965 64,629,223 *These are charges to Affiliates Northeast Michigan CMH and Ausable Valley CMH for the GF/MI Child/ABW portionof the access center, inpatient claims adjudication for the indigent population, and standards setting group dues.**PLEASE NOTE: in order to fit on one slide, various line items were hid on the spreadsheet.

Budgeted Expense and Revenue By Line Item(Note: spreadsheet in plan submitted to DCH contained more detail by program,

expenditure, and revenue line item)

Occupancy Total GF and AllRent Expenditures Medicaid Carry Fwd Other Total

Provider OperationsDirect Services

Inpatient Programs - 1,266,192 - 1,037,108 179,084 1,266,192 Residential Programs 416,013 12,969,183 11,320,887 1,333,151 203,145 12,969,183 Skill Building & Day Support Services 106,049 4,488,772 4,080,469 319,636 56,367 4,488,772 Clinical Services, Including Home Based 185,377 4,959,224 2,735,162 1,711,549 326,257 4,959,224 Support Services 153,138 3,244,614 2,498,981 539,500 172,533 3,244,614 Other Support Services 11,133 477,296 74,625 142,431 260,240 477,296

Subtotal-Direct Provider Services 871,710 27,405,281 20,710,124 5,083,375 1,197,626 27,405,281

Percentage-Medicaid Provider 75.57% 100.00%Percentage-All Other Provider 24.43%

Administrative Services (program admin., hospital liaison, portion of Medical Director, Bd Administration)

Subtotal-Administrative 100,224 3,019,941 2,282,169 618,431 109,880 3,019,941

Percentage-Medicaid Provider 75.57%Percentage-All Other Provider 24.43%

Subtotal-Provider Operations 971,934 30,425,222 22,992,293 5,701,806 1,307,506 30,425,222 Local Contribution to State Medicaid 431,035 431,035 431,035 Total-All Provider 971,934 30,856,257 22,992,293 5,701,806 1,738,541 30,856,257

Medicaid Direct-Provider 20,710,124 Medicaid Indirect-Provider 2,282,169 Non Medicaid Direct-Provider 6,695,157 Non Medicaid Indirect-Provider 737,772 Local Contribution to State Medicaid 431,035

Total of Above 30,856,257

Budgeted Expense and Revenue By Line Item (Continued)

Occupancy Total GF and AllRent Expenditures Medicaid Carry Fwd Other Total

Northern Affiliation (MCO)

Inpatient Programs Total-Inpatient Programs - 1,454,851 1,454,851 - - 1,454,851 Affiliates and Other Agencies

Ausable Valley Community Mental Health 8,966,163 8,966,163 8,966,163 NE Michigan Community Mental Health 17,773,360 17,773,360 17,773,360 Substance Abuse Services 691,699 691,699

Total-Affiliates and Other Agencies 27,431,222 27,431,222 27,431,222 Administrative

Improving Practices Leadership Team Grant 71,157 71,157 71,157 Affiliation-MCO Administration 48,000 1,566,287 1,372,097 70,067 115,077 1,566,287 Access Center/Inpatient Claims for Northeast and AV CMH* (2,675) (91,681) (91,682) (91,682)

Subtotal-Administrative 45,325 1,545,763 1,372,097 70,067 94,552 1,545,762 *The charges are paid by the Affiliates for GF/ABW/MI portion

OtherQAAP Tax 3,341,131 3,341,131 3,341,131

- Total-Northern Affiliation (MCO) 45,325 33,772,967 33,599,301 70,067 94,552 33,772,966

Medicaid Direct-Northern Affiliation (MCO) 28,886,073 Medicaid Indirect-Northern Affiliation (MCO) 1,372,097 Non Medicaid Direct-Northern Affiliation (MCO)Non Medicaid Indirect-Northern Affiliation (MCO) 173,665 Medicaid-QAAP Tax 3,341,131

Total Above 33,772,966

Total-All 1,017,259 64,629,224 56,591,594 5,771,873 1,833,093 64,629,223

Medicaid Direct-All 49,596,197 Medicaid Indirect-All 3,654,266 Non Medicaid Direct-All 6,695,157 Non Medicaid Indirect-All 911,437 Non-Medicaid-Local Contribution to State Medicaid 431,035 Medicaid-QAAP Tax 3,341,131

Total Above 64,629,223

North Country Community Mental Health Occupancy/Building Allocation

North Country Community Mental Health maintains 25 leases throughout the six county service area. Some leases are charged directly to reporting units if only the reporting unit benefits from the lease. Others are allocated to various reporting units on the basis of FTE’s located within the leased building. The following pages give a detail breakdown on how occupancy/building rental is allocated at each program site to reporting units.

Expense Allocations

North Country Community Mental HealthBuilding Allocation Schedule

# of Percent AnnualReporting Unit Program Code Location FTE Of Total Rent Allocated Allocated Direct

MIA/MIC Outpatient 93241/93261/93274Cheboygan 4.95 52.66% 26,213$ 13,804$ Psychiatric Services 93270 Cheboygan 0.51 5.43% 26,213$ 1,422$ MIA Case Management 93280 Cheboygan 2.54 27.02% 26,213$ 7,083$ Crisis Residential (nurse on call) 93458 Cheboygan 0.13 1.38% 26,213$ 363$ MIC Case Management 94280/94281 Cheboygan 1.27 13.51% 26,213$ 3,542$

9.40 100.00% 26,213$

MIA/MIC Outpatient 93241/93261/93274 Lockwood 10.61 23.47% 104,118$ 24,440$ Psychiatric Services 93270 Lockwood 0.56 1.24% 104,118$ 1,291$ MIA Case Management 93280 Lockwood 3.62 8.01% 104,118$ 8,345$ Crisis Residential (nurse on call) 93458 Lockwood 0.86 1.89% 104,118$ 1,971$ MIC Case Management 94280/94281 Lockwood 1.29 2.86% 104,118$ 2,974$ Board Administration 95021 Lockwood 19.39 42.91% 104,118$ 44,679$ Northern Affiliation (MCO Admin) 66661 Lockwood 2.61 5.76% 104,118$ 6,001$ DD Clinical 91241 Lockwood 0.00 0.00% 104,118$ 3$ Hospital Liaison 93160 Lockwood 1.22 2.70% 104,118$ 2,816$ Program Admin-CSS-MI 93211 Lockwood 1.22 2.70% 104,118$ 2,816$ Wrap Around 94801 Lockwood 1.29 2.86% 104,118$ 2,974$ Prevention Indirect 95821 Lockwood 0.07 0.14% 104,118$ 150$ Older Adult Services 95825/95921 Lockwood 2.46 5.44% 104,118$ 5,659$ Affiliation 66661 Lockwood 41,999$

45.20 100.00% 104,118$

MIA/MIC Outpatient 93241/93261/93274 Charlevoix 6.19 59.53% 21,000$ 12,501$ Psychiatric Services 93270 Charlevoix 0.50 4.76% 21,000$ 1,000$ MiA Case Management 93280 Charlevoix 1.24 11.90% 21,000$ 2,500$ Program Admin-CC&T 93210 Charlevoix 1.24 11.90% 21,000$ 2,500$ Decisions to Actions 96000 Charlevoix 1.24 11.90% 21,000$ 2,500$

10.40 100.00% 21,000$

MIA/MIC Outpatient 93241/93261/93274 Otsego 5.00 15.05% 99,200$ 14,926$ Psychiatric Services 93270 Otsego 0.42 1.26% 99,200$ 1,251$ MIA Case Management 93280 Otsego 1.00 3.01% 99,200$ 2,983$ DD Program Administration 91210 Otsego 2.39 7.18% 99,200$ 7,124$ DD Clinical 91241/91251 Otsego 9.12 27.41% 99,200$ 27,192$ DD Case Management 91280 Otsego 13.73 41.29% 99,200$ 40,960$ DD Day Program-Admin 91354/91356 Otsego 1.00 3.01% 99,200$ 2,983$ DD Respite Care 91701 Otsego 0.60 1.80% 99,200$ 1,781$

33.26 100.00% 99,200$

North Country Community Mental HealthBuilding Allocation Schedule

# of Percent AnnualReporting Unit Program Code Location FTE Of Total Rent Allocated Allocated DirectMIA/MIC Outpatient 93241/93261/93274 Bellaire 4.35 20.51% 116,525$ 23,900$ Psychiatric Services 93270 Bellaire 0.47 2.21% 116,525$ 2,571$ MIC Case Management 94280/94281 Bellaire 1.34 6.32% 116,525$ 7,366$ Board Administration 95021 Bellaire 4.00 18.84% 116,525$ 21,955$ DD Program Administration 91210 Bellaire 1.34 6.32% 116,525$ 7,366$ DD Clinical 91241/91251 Bellaire 3.01 14.20% 116,525$ 16,541$ DD Case Management 91280 Bellaire 5.83 27.48% 116,525$ 32,024$ DD Respite Care 91701 Bellaire 0.88 4.12% 116,525$ 4,803$

21.23 100.00% 116,525$

MIA/MIC Outpatient 93241/93261/93274 Kalkaska 5.17 80.73% 50,662$ 40,900$ Psychiatric Services 93270 Kalkaska 0.50 7.74% 50,662$ 3,920$ Program Admin-CC&T 93210 Kalkaska 0.74 11.53% 50,662$ 5,842$

6.40 100.00% 50,662$

MIA/MIC Outpatient 93241/93261/93274 Mancelona 1,641$ 1,641$

ACT-South 83290 Rapid City 4.67 34.36% 29,105$ 10,000$ PSR Clubhouse-South 83345 Rapid City 5.38 39.58% 29,105$ 11,520$ Psychiatric Services 93270 Rapid City 0.03 0.25% 29,105$ 72$ MIA Case Management 93280 Rapid City 3.51 25.81% 29,105$ 7,513$

13.59 29,105$

PSR Clubhouse-North 93345 Petoskey 61,812$ 61,812$ ACT-North 93290 Petoskey 27,850$ 27,850$ Crisis Residential 93458 Petoskey 22,666$ 22,666$ Bridge Street 93612 Petoskey 5,500$ 5,500$

DD Residenitial-Arborlight 81520 Kalkaska 25,037$ 25,037$ DD Residential-Maple 81521 Mancelona 6,000$ 6,000$ DD Residenital-Monroe 81522 Mancelona 8,400$ 8,400$ DD Residential-Rivershore 81523 Elk Rapids 20,196$ 20,196$

DD Day Program 91454/91456 Boyne City 32,717$ 32,717$ Supportive Housing Block 93611 23,000$ 23,000$ Housing Assistance Grant 93620 6,000$ 6,000$

Total 446,822$ 573,114$ Total - All 1,019,937$

North Country Community Mental HealthBuilding Allocations to Programs Crisis

Cheboygan Lockwood Charlevoix Otsego Bellaire Res TotalMIA/MIC Outpatient 13,804$ 24,440$ 12,501$ 14,926$ 23,900$ 132,111$ Psychiatric Services 1,422$ 1,291$ 1,000$ 1,251$ 2,571$ 11,527$ MIA Case Management 7,083$ 8,345$ 2,500$ 2,983$ 20,910$ MIA Case Management 7,513$ Crisis Residential 363$ 1,971$ 22,666$ 25,000$ MIC Case Management 3,542$ 2,974$ 7,366$ 13,881$ Board Administration 44,679$ 21,955$ 66,634$ Northern Affiliation (MCO Adm.) 48,000$ 48,000$ DD Clinical 3$ 27,192$ 16,541$ 43,736$ DD Case Management 40,960$ 32,024$ 72,984$ DD Respite Care 1,781$ 4,803$ 6,584$ Hospital Liaison 2,816$ 2,816$ Program Admin-DD 7,124$ 7,366$ 14,489$ Program Admin-CC&T 2,500$ 8,342$ Program Admin-CSS-MI 2,816$ 2,816$ Program Admin-DD Day Prgm 2,983$ 2,983$ DD Day Program 32,717$

26,213$ 146,117$ 21,000$ 99,200$ 116,525$ 22,666$ 524,326$ Total

PSR Clubhouse-South 11,520$ PSR Clubhouse 61,812$ 73,332$

ACT South 10,000$ ACT North 27,850$ 37,850$

Supportive Housing Block Grant 23,000$ 23,000$ Housing Assistance Grant 6,000$ 6,000$

Bridge Street 5,500$ 5,500$

DD ResidentialDD Residential-Arborlight 25,037$ DD Residential-Maple 6,000$ DD Residenital-Monroe 8,400$ DD Residential-Rivershore 20,196$ DD Residential-Winterlake 19,100$ 349,929$ 495,611$

Total-All 1,019,937$ Less: Northeast/Ausable Valley GF, ABW, and MI Child portion of the Access Center, Inpatient claims adjudication for the indigent population and stamdard setting dues(2,675)$

1,017,262$

Other Expenses Allocated(Note: Detail included in plan submitted to DCH)

Additional Expenses Allocated and Allocation Methodology

Expense Line Item Allocation Methodology

Supplies FTE Level by Location/SiteCommunications FTE Level by Location/SiteUtilities FTE Level by Location/SiteRepair & Maintenance-Building FTE Level by Location/SiteRepair & Maintenance-Equipment FTE Level by Location/SiteRepair & Maintenance-Vehicle Staff Miles by Vehicle LogVehicle Gasoline Staff Miles by Vehicle LogRent/Lease-Equipment FTE Level by Location/SiteLiability Insurance (MMRMA) FTE Level by Location/SiteDepreciation of Vehicles Staff Miles by Vehicle Log

Contracted Services NarrativeNorth Country Community Mental Health purchases the following services from various subcontractors.

Community Inpatient: North Country Community Mental Health-Northern Affiliation contracts with various local community hospitals throughout the state. The Affiliation adjudicates all claims. They pay the Medicaid claims. The indigent claims are forward to the affiliate boards for payment.

Residential: North Country Community Mental Health contracts all residential services to the DD and MIC population and most services to the MIA population. They hold contracts with four large local contract providers and many small AFC type contract providers. They also hold contracts for a few placements outside the service area. Some of these out of service area providers are small and some are large.

Skill Building & Day Services: North Country contracts five local day program providers. They also hold small contracts with other providers.

Clinical Services: North Country Community Mental Health contracts with several local psychiatrists. They also contract for many DD clinical services and some nursing. Home-based services are also contracted through Northern Family Intervention Services.

Support Services: North Country Community Mental Health contracts with other providers of case management and clinical services for individuals placed outside the service area.

Other Support Providers: North Country Community Mental Health holds small contracts with four providers to service elderly individuals. These services are billed to the Alzheimer’s grant.

North Country also contracts with other small service providers for imaging records, respite care, temporary employment services, etc. Contracted services expenditures are split between Medicaid and all other funding sources based upon a “pro rata” basis of the total. The agency bases the Medicaid /other funding spit on “net charges” for each funding stream (Medicaid/GF/ABW/MI Child/other) as a percentage of the total charges for each reporting unit. During “Phase 1” these costs are all reported as Direct Services. The following pages give a detail breakdown on direct contractual services by program type.

Contract Services SpreadsheetTotal ------Total Funding For All Line Items In This Program Grouping------

Contractual GF and Total-FundingExpense Medicaid Carry Forward All Other Sources

Provider Operations

Direct ServicesCommunity & State Inpatient 1,266,192 - 1,037,108 179,084 1,266,192

Medicaid All OtherPercent of Revenue Medicaid - 0.0% 100.0%

All Other 1,266,192

Residential Services 11,657,577 11,320,887 1,333,151 203,145 12,969,183

Medicaid All OtherPercent of Revenue Medicaid 10,175,977 87.3% 12.7%

All Other 1,481,600 -

Skill Building & Day Support Services 2,669,214 4,080,469 319,636 56,367 4,488,772

Medicaid All OtherPercent of Revenue Medicaid 2,426,420 90.9% 9.1%

All Other 242,794 -

PLEASE NOTE: in order to fit on one slide contractual and revenue columns were hidden as well as rows summarizing Clinical, Support Services and Other Support Services Expense and Revenue.

- Total-Direct Provider Services 16,565,818 20,710,124 5,083,375 1,197,626 27,405,281

Summary of AbovePrograms Medicaid All Other Total-All

Inpatient - 1,266,192 1,266,192 Residential 10,175,977 1,481,600 11,657,577 Skill Bldg & Day 2,426,420 242,794 2,669,214 Clinical inc/Home B. 460,374 374,347 834,721 Support Services 40,226 12,002 52,228 Other Support Svs. 13,428 72,458 85,886

Total-All 13,116,425 3,449,393 16,565,818

Prime Subcontractors-Affiliates

The Northeast Michigan Community Mental Health Authority serves four of the thirteen counties within the Northern Affiliation:

• Alcona• Alpena• Montmorency• Presque Isle

In fiscal year 2007, $17,773,360 in Medicaid is planned for disbursement to NEMCMHA.

• Of this, $15,745,869 is budgeted for direct services, as defined by the Section 460 Report guidelines.• $2,027,491 is budgeted for administration, as defined by the Section 460 Report guidelines. More details can be found in its Cost Allocation Report.

Prime Subcontractors-Northern Michigan SAS

The Northern Affiliation is one of four PIHPs served by the Northern Michigan Substance Abuse Services agency. All NMSAS direct services are contracted.

In fiscal year 2007, $691,699 in Medicaid is planned for disbursement to NMSAS.

• Historically, 11.1% of disbursements are used for CA administration. This would equal $76,919 in FY07.• The remainder of the funds would be used to contract direct services: $614,780.

Direct Service ExpendituresSkill-Building Other

Provider Operations (CMHSP) Inpatient Residential & Day Support Clinical Support Support Subtotal-Budgeted Expenditures Services Services Services Services Services Services ProviderSalaries & Wages -$ 535,244$ 980,889$ 2,498,927$ 1,786,070$ 203,204$ 6,004,334$ Fringe Benefits - 194,687 337,428 903,706 692,034 64,025 2,191,880 Contractual Services 1,266,192 11,657,577 2,669,214 834,721 52,228 85,886 16,565,818 Supplies - 41,422 72,395 65,548 42,100 15,368 236,833 Pharmacy/Injectables - 16,075 93,500 114,150 223,725 Rent-Building - 416,013 106,049 185,377 153,138 11,133 871,710 Utilites - 13,420 25,344 19,385 25,222 3,956 87,327 Repair & Maintenance-Building - 13,604 14,634 29,947 23,830 3,892 85,907 Repair & Maintenance-Equipment - 4,508 8,083 37,450 30,736 2,126 82,903 Repair & Maintenance-Vehicle - 7,822 28,033 5,764 44,366 993 86,978 Rent-Equipment - 1,542 3,364 22,281 19,987 1,602 48,776 Insurance-Liability/Doctors - 10,034 17,652 48,530 33,698 3,200 113,114 Insurance-Workers Comp - 10,264 18,059 34,367 30,380 3,273 96,343 Insurance-Unemployment - 9,617 22,319 16,272 14,495 2,253 64,956 Communications - 8,154 21,094 39,959 40,033 3,958 113,198 Travel/Conference - 11,421 16,756 69,757 54,712 64,747 217,393 Vehicle Gasoline - 6,619 33,194 4,391 37,571 830 82,605 Transportation - - 30,833 1,400 2,900 35,133 Advertising - 2,000 2,800 8,323 5,900 1,600 20,623 Miscellaneous - 500 22,750 13,369 2,400 1,300 40,319 Equipment - 6,127 22,907 22,834 9,009 3,253 64,130 Depreciation - 2,533 34,975 3,416 29,655 697 71,276

- Total 1,266,192$ 12,969,183$ 4,488,772$ 4,959,224$ 3,244,614$ 477,296$ 27,405,281 Less:Contractual (on separate line) 1,266,192$ 11,657,577 2,669,214 834,721 52,228 85,886 16,565,818

-$ 1,311,606$ 1,819,558$ 4,124,503$ 3,192,386$ 391,410$ 10,839,463$

Budgeted RevenueMedicaid -$ 1,144,910$ 1,654,049$ 2,274,788$ 2,458,755$ 61,197$ 7,593,699$ General Fund and All Other - 166,696 165,509 1,849,715 733,631 330,213 3,245,764

Total -$ 1,311,606$ 1,819,558$ 4,124,503$ 3,192,386$ 391,410$ 10,839,463$

Northern Affiliation (PIHP)Prime Subcontracts

Ausable Valley CMH (see cost allocation plan for Ausable Valley CMH) 7,413,974$ Northeast Michigan CMH (see cost allocation plan for Northeast Michigan CMH) 15,745,869 Northern Michigan Substance Abuse 614,780

subtotal 23,774,623$ Other Contractual-Community Inpatient 1,454,851 Total-Affiliation 25,229,474$

Administrative Services NarrativeNorth Country Community Mental Health Administrative Services for the Provider Operations of the Agency include Board Administration, Program Administration, Hospital Liaison, Psychiatric Administration, and Prevention Indirect. The following describes each type of Administration. Board Administration Board Administration includes coordination and oversight of all agency functions including Board activities, public relations and recipient rights. Board Administration also includes the following:

Administrative Services, which oversees human resources, safety, contract management, and data systems and analysis.

Finance, which is responsible for budgeting, audit, internal controls, general ledger maintenance, accounts payable, accounts receivable including reimbursement, payroll, fixed assets, and financial risk.

Both the Finance Department and the Human Resources Department provide services to both the Northern Affiliation (Medicaid Managed Care) and the Provider Operations of North Country Community Mental Health. Services provided by Human Resources are allocated to the Affiliation and Provider based on the number of employees in each Department. Services provided by Finance are allocated in the following manner:

Accounts payable is based on a one month study of the number of invoices paid for the Affiliation and Provider Operations.

Payroll is based on the number of employees in each department. Accounting Supervisor is based on the FTE levels of accounting staff supervised by the

Accounting Supervisor that are allocated to the Provider Operations and Affiliation. Finance Director is based on FTE levels of accounting staff supervised by the Finance

Director that are allocated to the Provider Operations and Affiliation. Financial Analyst is based on time study.

The Financial Analyst works primarily for the Northern Affiliation, however will provide assistance to the Provider Operations on an “as needed” basis.

Administrative Services Narrative (continued)Program Administration Program Administration is under the supervision of the Director of North Country Community Mental Health. DD Program Administration is responsible for the oversight of DD services including inpatient, clinical, supports coordination/case management, residential, and day services. The DD Day Program Supervisor directly reports to the DD Program Coordinator and is responsible for the oversight of skill building and day supports services. The DD Day Program Supervisor is a second line supervisor. Community Consultation and Treatment Program Administration is responsible for the oversight of MI Adult and MI Child services including child state and community inpatient, child residential services, home based services to children, case management services to children, clinical outpatient services to both MI Adult and MI Children, psychiatric services coordination, and emergency services coordination. Community Support Program Administration is responsible for the oversight of MI Adult services including MI Adult state inpatient and community inpatient, residential services, case management services, clubhouse services, peer directed services, assertive community treatment, older adult services, and hospital liaison. Hospital Liaison The Hospital Liaison Care Manager manages state and community hospital utilization. Psychiatric Administration The Medical Director provides Medical oversight for the Provider Operations of the Agency. The Medical Director supervises Psychiatric services, is a member of the Leadership Team, Risk Management Team, and other committees. The Medical Director is charged 30% to Administrative Services; allocated via time study. Prevention Indirect This program provides collaborative services with other coordinating agencies. The Prevention Coordinator also is responsible for the Homeless grant.

PIHP Managed Care Administration

Northern Michigan Community Mental Health is also the PIHP for Managed Care Services to the Medicaid population. North Country CMH, Northern Affiliation is responsible for managing the Medicaid dollars received from the Department of Community Health. The Affiliation provides Access, Claims Management, including adjudication of all inpatient claims, Information Services, Finance and Human Resources, Member Services, Compliance, and Provider Network Management. Finance and Human Resources costs are allocated as mentioned above. Most Affiliation MCO Administration is charged to Medicaid, with the exception of Access Center charges, claims adjudication, and standards setting dues. General Fund, Adult Benefit Waiver, MI Child, and indigent portions of these costs are billed back to Prime Sub-Contract Boards. Access Center charges are allocated to funding streams based on relative number of screens by guarantor (funding source) by Board. Claims adjudication charges are allocated to funding streams based on the relative number of claims by guarantor (funding source) by Board. Standards Setting Fees are allocated across Prime Sub-Contract Boards and guarantors (funding sources) based on expenditures reported on the FSRs of each Board. The budget amount of these non-Medicaid costs is $91,682 for subcontractors Ausable Valley and Northeast Michigan Community Mental Health. The non-Medicaid portion for North Country Community Mental Health is $102,508. The Affiliation also is also responsible for coordinating the Improving Practices Leadership Team and is responsible for managing this grant.

Access Center Costs to Funding Source

Cost# Screens % of Total Allocation

Ausable Valley CMH 1,427 30.1% 133,064 Medicaid 868 18.3% 80,953 Non-Medicaid 559 11.8% 52,112

North Country CMH 2,519 53.1% 234,806 Medicaid 1,526 32.2% 142,235 Non-Medicaid 993 20.9% 92,571

Northeast Michigan CMH 799 16.8% 74,449 Medicaid 498 10.5% 46,389 Non-Medicaid 301 6.3% 28,060

Total 4,745 100.0% 442,320 Medicaid 2,892 60.9% 269,577 Non-Medicaid 1,853 39.1% 172,743

The Access Center costs are allocated across boards and funding Source by the relative number of screens.

Total Administrative CostsMIA/MIC MIA .30 FTE Prevent

Board DD Day Prog. DD Prog. CC&T Prog. CSS-MI Prog Hospital Medical Indirect/ TotalProvider Administrative Costs Administration Admin. Admin. Admin. Admin. Liaison Director Homeless AllSalaries & Wages 1,046,205$ 44,954$ 193,830$ 114,773$ 77,115$ 52,108$ 47,827$ -$ 1,576,812$

Fringe Benefits 334,532 18,846 69,621 43,218 28,268 21,771 10,499 526,755 Contractual Services 77,485 47,848 125,333 Supplies 98,515 917 3,455 1,998 1,622 1,622 924 1,166 110,219 Rent 66,633 2,983 14,489 8,342 2,815 2,815 1,997 150 100,224 Utilites 17,021 379 905 667 1,073 1,073 183 57 21,358 Repair & Maintenance-Building 29,676 844 2,015 823 1,277 1,277 250 25 36,187 Repair & Maintenance-Equipment 22,940 1,000 3,335 1,238 531 531 366 31 29,972 Repair & Maintenance-Vehicle 9,069 2,615 - 1,193 3,066 - 23 15,966 Rent-Equipment 10,504 598 2,399 1,359 881 750 108 - 16,599 Insurance-Liability 15,404 658 2,456 1,305 805 805 3,362 33 24,828 Insurance-Workers Comp 15,758 674 2,513 1,335 823 823 306 34 22,266 Insurance-Unemployment 7,000 288 774 364 352 352 86 9,216 Communications 114,190 396 3,805 1,401 500 536 591 27 121,446 Travel/Conference 59,972 1,606 7,603 4,355 1,623 1,542 1,689 2,744 81,134 Vehicle Gasoline 5,828 1,829 995 2,055 10,726 Advertisement 38,000 38,000 Miscellaneous (dues, per diem,etc) 45,296 1,831 47,127 Equipment Purchase 67,502 184 2,315 500 110 250 287 71,148 Depreciation 28,203 1,332 687 4,390 13 34,625

Total 2,109,733$ 74,327$ 315,291$ 181,678$ 120,560$ 95,626$ 70,269$ 52,438$ 3,019,941$ RevenueMedicaid 2,282,169$ Non Medicaid-All Other 737,772$

NetManaged GF/ABW/MI Managed

Care Child Charges Care TotalAffiliation MCO Costs Admin. to Affiliates Admin. IPLT Total Medicaid All Other Revenue

Salaries & Wages 824,618$ (54,589)$ 770,029$ 34,902$ 804,931$ Fringe Benefits 281,568 (16,992) 264,576 25,075 289,651$ Contractual Services 169,539 (12,773) 156,766 2,500 159,266$ Supplies 29,458 (797) 28,661 4,100 32,761$ Rent 48,000 (2,675) 45,325 45,325$ Utilites 2,286 (105) 2,181 2,181$ Repair & Maintenance-Building 10,554 (466) 10,088 10,088$ Repair & Maintenance-Equipment 6,600 (506) 6,094 6,094$ Repair & Maintenance-Vehicle 1,256 - 1,256 1,256$ Rent-Equipment 7,500 (221) 7,279 7,279$ Insurance-Liability 8,958 (637) 8,321 8,321$ Insurance-Workers Comp 9,164 9,164 9,164$ Insurance-Unemployment 6,000 6,000 6,000$ Communications 13,000 (336) 12,664 12,664$ Travel/Conference 40,739 40,739 4,580 45,319$ Vehicle Gasoline 1,047 1,047 1,047$ Advertisement 2,000 (59) 1,941 1,941$ All Other AdministrationMiscellaneous (dues, per diem,etc) 19,000 (1,525) 17,475 17,475$ Provider 737,772$ Equipment Purchase 15,000 15,000 15,000$ PIHP 173,665 Depreciation 70,000 70,000 70,000$

911,437$ Total 1,566,287$ (91,681)$ 1,474,606$ 71,157$ 1,545,763$ 1,372,097 173,665 1,545,762

MedicaidMedicaid Administration-Subcontractors Provider 2,282,169$

Northeast Michigan CMH (see cost allocation plan submitted by Northeast Michigan CMH) 2,027,491$ 2,027,491 2,027,491 PIHP 5,028,696 Ausable Valley CMH (see cost allocation plan submitted by Ausable Valley CMH) 1,552,189 1,552,189 1,552,189 Substance Abuse Services 76,919 76,919 76,919 7,310,865$ Subtotal 3,656,599$ 3,656,599 - 3,656,599 Total 5,202,362$ 5,028,696 173,665 5,684,090

Allocation of Administrative and Direct Costs By Funding Sources

Direct Costs Administrative CostsProvider Run Other Other

Total Cost Cost Medicaid Funding Cost Medicaid FundingProgramsInpatient (all contract) 1,405,721 1,266,192 - 1,266,192 139,529 - 139,529 Residential 14,398,330 12,969,183 11,320,887 1,648,296 1,429,147 1,247,515 181,632 Skill Building & Other Day 4,983,415 4,488,772 4,080,469 408,303 494,643 449,651 44,992 Clinical Services 5,505,709 4,959,224 2,735,162 2,224,062 546,485 301,404 245,081 Support Services 3,602,156 3,244,614 2,498,981 745,633 357,542 275,377 82,165 Other Services 529,892 477,296 74,625 402,671 52,596 8,223 44,373

Subtotal-Provider Run 30,425,222 27,405,281 20,710,124 6,695,157 3,019,941 2,282,169 737,772 Less Other Subcontracts 18,391,298 16,565,818 13,116,425 3,449,393 1,825,480 1,445,372 380,108

Provider Run Net of Other Subcontracts 12,033,924 10,839,463 7,593,699 3,245,764 1,194,461 836,797 357,664 Local Match Contributin to State Medicaid 431,035 Total Costs-Provider Run (30,425,222 + 431,035) 30,856,257

Northern Affiliaiton (PIHP) Direct Costs Administrative CostsOther Other

Prime Subcontractors Total Cost Cost Medicaid Funding Cost Medicaid Funding Northeast MI CMH 17,773,360 15,745,869 15,745,869 - 2,027,491 2,027,491 - Ausable Valley CMH 8,966,163 7,413,974 7,413,974 - 1,552,189 1,552,189 - Northern MI Substance Abuse 691,699 614,780 614,780 - 76,919 76,919 - subtotal 27,431,222 23,774,623 23,774,623 - 3,656,599 3,656,599 -

Other Subcontracts 1,454,851 1,454,851 1,454,851 -

Administrative Costs-PIHP 1,545,762 1,545,762 1,372,097 173,665

Subtotall-Affiliation 30,431,835 25,229,474 25,229,474 - 5,202,361 5,028,696 173,665 QAAP 3,341,131 Total Costs-Northern Affiliation (PIHP) (30,431,835 + 3,341,131) 33,772,966

Total Costs - All (30,856,257 + 33,772,966) 64,629,223

Allocation of Administrative and Direct Costs By Funding Stream (continued)

QAAPMedicaid Direct Distribution TotalMedicaid-PIHP 7,593,699 476,457 8,070,156 Medicaid-Prime Subcontractors 23,774,623 1,491,708 25,266,331 Medicaid-Other Subcontractors 14,571,276 914,256 15,485,532 Subtotal 45,939,598 2,882,420 48,822,018

AdministrativeMedicaid-PIHP 836,797 52,504 889,301 Medicaid-Prime Subcontractors 3,656,599 229,429 3,886,028 Medicaid-Other Subcontractors 1,445,372 90,688 1,536,060 Medicaid-Administrative 1,372,097 86,090 1,458,187 Subtotal 7,310,865 458,711 7,769,576

Total-All Medicaid 53,250,463 3,341,131 56,591,594

Local Contrib.Non-Medicaid Direct State Medicaid TotalNon-Medicaid-PIHP 3,245,764 183,924 3,429,688 Non-Medicaid-Other Subcontractors 3,449,393 195,463 3,644,856 Subtotal 6,695,157 379,388 7,074,545

AdministrativeNon-Medicaid-PIHP 357,664 357,664 Non-Medicaid-Other Subcontractors 380,108 380,108 PIHP Non-Medicaid (IPLT & Access/Claims/Standards Portion) 173,665 173,665 Subtotal 911,437 51,647 963,084

Total-All Non-Medicaid 7,606,594 431,035 8,037,629

Total-All 64,629,223

Section 460 Compliance Report-Medicaid

PIHP: North Country Community Mental Health, Northern Affiliation

Fiscal Year: 2007

Reporting Period: Six Month Report Annual Report (Based on FY07 Budget)

(A) (B) (C) (D) (E) (F) (G) (H) (I)Contractor(s) PIHP Prime Sub-Contractors Sub-Contract Providers PIHP Prime Sub-Contractors Sub-Contract Providers Total Direct Services Total Administration

1. PIHP Provided 7,593,699$ 3,654,266$ 7,593,699$ 3,654,266$


3. Northeast Michigan CMH 15,745,869 2,027,491 15,745,869 2,027,491

4. Ausable Valley CMH 7,413,974 1,552,189 7,413,974 1,552,189

5. Substance Abuse Services 614,780 76,919 614,780 76,919

6. - -

7. - -

8. - -

9. - -

10. - -

11. - -

12. - -

13. - -

14. - -

15. Sub-Total Prime Sub-Contractor(s) 23,774,623$ 3,656,599$ 23,774,623$ 3,656,599$

16. Other Sub-Contractor(s) 14,571,276$ Included in Direct

for Phase 1 14,571,276$ Included in Direct

for Phase 1

17. Total without Quality Assurance Assessment Tax 7,593,699$ 23,774,623$ 14,571,276$ 3,654,266$ 3,656,599$ Included in Direct

for Phase 1 45,939,598$ 7,310,865$

18. Quality Assurance Assessment Tax 476,457$ 1,491,708$ 914,256$ 229,282$ 229,429$ 2,882,420$ 458,711$

19. Total with Quality Assurance Assessment Tax 8,070,156$ 25,266,331$ 15,485,532$ 3,883,548$ 3,886,028$ 48,822,018$ 7,769,576$

Medicaid Total CostsMedicaid Direct Service Medicaid Administration

XX

Section 460 Compliance Report-Non Medicaid

CMHSP: North Country Community Mental Health

Fiscal Year: 2007

Reporting Period: Six Month Report Annual Report (Based on FY07 Budget)

(A) (B) (C) (D) (E) (F) (G) (H)

Contractor(s) CMHSP Prime Sub-Contractors Sub-Contract Providers CMHSP Prime Sub-Contractors Sub-Contract Providers Total Direct Services

1. CMHSP PROVIDED 3,245,764$ 911,437$ 3,245,764$

2. Prime Sub-Contractor(s) -

3. -

4. -

5. -

6. -

7. -

8. -

.9. -

10. -

11. -

12. -

13. -

14. -

15. Sub-Total Prime Sub-Contractor(s) -$ -$ -$

16. Other Sub-Contractor(s) 3,449,393$ Included in Direct

for Phase 1 3,449,393$

17. Total without Local Contribution to State Medicaid Match 3,245,764$ -$ 3,449,393$ 911,437$ -$ 6,695,157$

18. Local Contribution to State Medicaid Match 183,924$ 195,463$ 51,647$ 379,388$

19.Total with Local Contribution to State Medicaid Match 3,429,688$ -$ 3,644,856$ 963,084$ -$ 7,074,545$

Non-Medicaid Total CostsNon-Medicaid Direct Service Non-Medicaid Administration

XX

Questions?

Review criteria for Cost Allocation Plans

• Single document• Table of contents• Certification form with signature (scanned into

PDF)• The organization chart must include the following

if applicable– Spoke CMHSPs– Prime subcontractors– Identify administrative and direct cost centers


• A narrative that describes the entity– The terms from the Mental Health Code such as

Authority or County Agency are adequate because they have legal definitions that define the relationship with the county.

• Narrative indicating if the costs reported include costs from the county (direct or indirect)


• Narrative that describes the accounting system used.

• Narrative that describes how the staffing costs are accounted for and assigned/allocated to cost centers

• Narrative describing the CA arrangement or a statement that there is not a CA relationship

• Narrative and schedules that identify the basis of allocations


• Either a formal budget or numbers that appear to represent the operating budget being used to begin the financial schedules of the plan

• Either a completed copy of the 460 Report form or a separate schedule of the 460 costs

• A narrative that describes the services provided


• A narrative and schedules that describe and show costs allocated to services and/or administration

• Narrative naming the cost centers, listing of cost centers or spreadsheet that identifies the cost centers

• A narrative and/or schedule that identifies the expense items in each allocated cost center

• A narrative and/or schedule that identifies the programs that receive the allocated costs


• A narrative and schedule that identifies the distribution methods used

• A schedule that summarizes all the cost centers that are allocated

• A narrative that describes the methods used for assigning costs to funding sources

• A schedule that shows the costs assigned to the funding sources using the methods described in the narrative above.

Expectations for FY 2008 Plans

• Plans are due to MDCH electronically by September 30, 2007

• Include all of the applicable items noted in review criteria noted above

• Comply with section 460 cost allocation requirements for the definition of direct services and administration

• Plans do not allocate costs to funding sources based on predetermined (budgeted) amounts


• Clear narratives regarding methods used by contracted cost allocation plans

• Narrative regarding the implementation of reporting for Phase II

• Refinement of Information systems costing in the section 460 cost allocation plans


• Review of the treatment of Information Systems (IS) costs in the 460 Cost allocation plans found a wide range of treatment– Some plans charged all the costs to administration– Some plans charged most or all the costs to direct

services– Some plans allocated costs as overhead to both direct

services and administration– Basis used for allocation of IS costs also varied across

the CMH system


• Specific examples related to these issued included– Cost plans that determined all costs within the IS

department would be charged to administration regardless of who uses the system

– IS systems held by outside vendors

– IS costs shared in affiliate PIHPs

– Different basis used for IS costs between members of an affiliation

– Contracts for IS services within Affiliations


• Issues that can result in the assignment or allocation of IS costs– Misclassification of direct services costs into

administration– Misclassification of administrative costs into direct

services– Misallocation of overhead costs based on accumulated

direct service costs– Contract terms changing classification of costs between

direct service and administration – Contract terms changing classification of costs between

funding sources such as Medicaid and General Fund


• The section 460 Cost allocation diagram gives direction as to how IS costs should be handled

• Costs are administrative unless documentation proves the costs should be allocated or direct services– Under administration the diagram shows

• Information system staff• Network management• Help desk• Security


• Under allocated overhead charged to administration (note documentation must support costs are allocable to administrative and direct services)– Equipment– Personal computer– Network management– Help desk– Securty – Hardware and software


– Under allocated overhead charged to direct services (must be supported with documentation)

• Equipment• Personal computer• Network management• Help desk• security• Hardware and software• Medical records – electronic or otherwise


– Expectations regarding IS costs• Costs that should be charged to direct services

– IS costs that can be documented as used in providing direct services should be allocated to direct services

– IS costs of using electronic medical records should be charged to direct services

– IS costs of running the IS department that can be documented as related to providing direct services


– Expectations regarding IS costs• Costs that should be charged to administration

– IS costs that relate to administrative functions should be allocated to administrative costs

– IS costs of running the IS department should be administrative costs

– Any IS costs that can not be documented as related to providing direct services


– Expectations regarding IS costs• IS costs of developing systems should be capitalized

and only expensed once they are placed in service (turned on and used)

• These costs would be allocated based on the above criteria

Questions ?

2007 best practice cost allocation plans & guidance for developing fy 2008 plans july 23, 2007...

Documents

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cost allocation standards

cost allocation plansall

cost allocation requirements

cost allocation plansthe

model plans

training plans