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quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1
1
S= UBSTANCE ABUSE PREVENTION AND CONTROL
 w= ww.publichealth.lacounty.gov/sapc
NNA
NON-DRUG MEDI-CAL FUNDED CONTRACTS
COST REPORT ORIENTATION
FISCAL YEAR 2011-12

1000 South Fremont Avenue
Building A-9 East, 3rd Flo= or, North Wing
Alhambra, CA. 91803=
7/01/2012
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•
•Welcome to &= #13;
•SAPC
•Cost Report Orientation
•For
•Fiscal Year 2011-12
2
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3
Topics of Discussion
1.Objectives
2.Important Issues
3.Source Documents
4.Type of Contracts
5.Type of Forms
6.Instructions for Completing the Forms
ØODF (Outpati= ent Drug Free) Form
ØNon ODF Form– DCR AND RESIDENTIAL
ØCal-WORKS= 3;
7.Common Errors
8.Deadline
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Objectives
A.To help you complete your cost report timely and accurately
B. =
B.To update changes for FY 2011-12 if any.
C. =
C.To answer your questions = and concerns
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7/01/2012
IMPORTANT ISSUES <= /span>
SUBMITTING YOUR COST REPORT<= /b>:
1.All  COST REPORT MUST PROVIDE UNIT OF SERVICE OR COUNSELING HOURS. THIS INCLUDES NON-PROVISIONAL RATE CONTRACT. = ;
2.FOR ODF-GROUP, YOU NEED TO INDICATE TOTAL NO. OF GROUP SESSIONS PROVIDED DURING THE YEAR.  &#= 13;
3.MAKE SURE THE UNITS OF SERVICES SUBMITTED MATCHED WITH THE PDR.  IF THERE IS ANY DISCREPANCY, PLEASE CONTACT US IMMEDIATELY.  FAILURE TO DO SO WILL IMPACT = YOUR  COST SETTLEMENT. =
4.FOR NON-PROVISIONAL RATE (NPR) CONTRACTS, PLEASE ATTACH THE LATEST COUNTY APPROVED BUDGET SUMMARY PAGE TO COST REPORT.
5.SEND SIGNED ORIGINAL COST REPORT WITH A COPY WITH THE COST REPORT CERTIFICATION  AND CARE CERTIFICATION FORMS BY MAIL FOR ALL ACTIVE AND NON-ACTIVE CONTRACTS.
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Source Documents
ØDOCUMENTS NEEDED FOR COMPLETING COST REPORT
Ø
1.THE LATEST COUNTY APPROVED BUDGET =
2.
2.PERFORMANCE DATA REPORT = (PDR) <= /span>
3.
3.FINANCIAL RECORDS
6
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7/01/2012
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Type of Contracts (FFS, PR, NPR)
1.Fee for Service (FFS)
2.
Ørendered multiplied by the contract unit rate but not to exceed the maximum contract amount.
Ø
2.Cost Reimbursement - Provisional Rate (PR)
3.
ØContracts are reimbursed based on the lesser amount of actual cost or contract amount. The = negotiated provisional ra= te is an approximation provided for processing provider’s monthly clai= ms for reimbursement.=
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Type of Contract (cont.)
3.Cost Reimbursement - Non-Provisional Rate (NPR) Line Item
1)Costs are reimbursed for actual costs in accordance w= ith the line Ø =
2)The contract provision= allows providers to revi= se a total amount of all existing line item(s) by a maximum of 10% of t= he gross provided that any increas= e in any line item(s) is offset by a corresponding decrease in the other line item(s) of t= he budget or Ø =
3)TEN PERCENT (10%) GROSS BUDGET ADJUSTMENT <= /b>WORKSHEET. =
      The NPR contract <= u>MUST provide this worksheet a= nd document submitting cost report.
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charset="us-ascii" Slide 1
Type of Forms
1.2. Non-ODF (DCH and Residential) =
3.
4.
5.6.Ø* Note – The JAG and Cal-WORKS has its own form.   For ØAll forms are similar exc= ept for reporting “Units of Service” on  Line 13 in the Summary Page.
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Type of Forms (Cont.)
For = ODF form, the Expenditures must be allocated into:
ØIndividual (IND) and
ØGroup (GRP)
Units of service should be reported as follows:
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UNITS OF SERVICE REVIEW
1= .ONTPDTX:  Reported as “Slot Day.”  Whereas, slot da= y is one to prescribe and administ= er medication.
2.  This is the direct service staff = hours (Counseling Hours). <= /span>
3. =
Ø= Group Counseling  – 90 minutes per session
Ø= Individu= al Counseling – 50 minutes per session
3= .Individual Face to Face Visits:  The number of individuals = attending individual counseling sessions.
4. =
4.  The total number of individuals i= n the group attending group sessions.
5= .Group Sessions:  The total number of sessions held = for providing group counseling during the year.
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ODF Form Instructions
SUMMARY P= AGE =
1.HEADING : Enter all Information listed in this section. The provider name and
m= ode of service will be posted to all schedules automatically.
1. =
2.TOTAL EXPENSES (Line 1 to 5): No entry required. All Information are linked
f= rom Schedule P1 to P5.
l
3.REVENUE (Line 7 to 10):
        = ;   Line 7. : &= #13;
        = ;            &n= bsp;  Enter fees collected from clients during the Fiscal Year. This excludes
        = ;            &n= bsp; County Reimbursement.
        = ;   Line 8.        = ;            &n= bsp; Client fees collected during last Fiscal Year 2010-11 in excess of
        = ;            &n= bsp; budgeted projection, but were not spent during the same Fiscal Year
        = ;            &n= bsp; and therefore, carried over to this Fiscal Year 2011-12. =
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ODF Form Instructions
<= u>SUMMARY P= AGE (cont.)
  REVENUE (cont.) =
Ø
Line 9. Excess Fees to be Carr= ied Forward to next Fiscal Year 2012-13:
        = ;   Client fees collected during the Fiscal Year 2011-12 in excess of  
        = ;   budgeted projection,   theref= ore
        = ;   are carried forward .
         = Please note, Any Fees Carried forward        = ;   the County Program Advisory Board and the approval of both the = ;
        = ;   County Board of Supervisors and the State Department of Alcohol and
        = ;   Drug Program. This amount should be included in the budget for = ;
        = ;   FY 2012-13 excess fees carryover calculation. 
Line= 10. Private Funding/Public Assistance/Other Provider Revenue:
        = ;     Enter the total amount of each of these funding sources, such as= 3;
        = ;     fund raising, donation, interest and others if applicable.
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ODF Form Instructions
SUMMARY PAGE (cont.)
&#= 13;
UNITS OF SERVICE (Line 13a to 13e)
&#= 13;
ØMANDATORY, DO NOT LEAVE BLANK.
Ø =
ØDETAILED INSTRUCTIONS = ARE ATTACHED TO THE COST REPORT FORM.
 
ØTHE UNITS OF SERVICE SHOULD AGREE WITH PDR.  MAKE = SURE THE UNITS REPORTED ARE ACCURATE.  IF THERE IS ANY VARIANCE, PLEASE<= span style=3D'mso-spacerun:yes'>  CONTACT US IMMEDIATELY.       = 3;
Ø <= /u>
Line 13a. &n= bsp; Total Staff Hours  The available staff hours spent providing services.  Please  
        = ;            see detailed instructions attached to the cost report forms.
Line 13b.    Total Service Staff H= ours (Counseling Hours) 
        = ;             staff hours (counseling hours)&nbs= p; for Individual and Group.
Line 13c. &n= bsp; Total Individual Face-to-Face Visits: Total number of&nb= sp; I= ndividual
        = ;            participants. 
Line 13d. &n= bsp; Total Group VisitsLine 13e. &n= bsp; Total Group Sessions: Total number of&nb= sp; G= roup Sessions provided during the
        = ;            year.
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JAG ODF - Units of Services Instructions
SUMMARY PAGE
UNITS OF SERVICE (Line 13a to 13e)&= #13;
      =
L= ine 13a. Total Staff Hours  If counseling services were provided and the Contract
        = ;         rate is for ent= er the  number of staff hours he= re and continue filling
        = ;         information on lines 13b-13e.  If no participants and only Outreach Services
        = ;         were provided enter staff hours and leave lines 13b-13e blank. =
Line 13b. Total Service Staff Hours:  Total direct service staff hours (Counseling Hrs).= 3;
Line 13c. Total Individual Face-to-Face Visits= :  Total number of Individual participant= s. 
  Total number of participants in Group Sessions.
Line 13e.  Total Group Sessions: Total number of Group Sessions provided for the year.
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Cal-Works ODF – Units of Services Instruction
SUMMARY PAGE
UNITS OF SERVICE (Line 13a to 13e)&= #13;
13a. Total Service Hours for Orientation & Outreach and Case Management:  Total hours for providing O&O and Case Management services.
Ø
  Total Service Staff Hours (Counse= ling Hours): To= tal direct 
         treatment service staff hours.
Ø
  Total Individual Face-to-Face Vis= its:  Total number of Individual
         participants. 
Ø
13d.  Total Group Visits  Total number of participants in <= /span>Group Sessions.
Ø
  Total Group Sessions:  Total number of Group Sessions provided
         for the year.
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Non-ODF - Units of Service Instructions
SUMMARY PAGE
UNITS OF SERVICE (Line13) <= /b>
1.Staff Hours: Total staff hours for providing services.
2. Bed Days:   Total number of bed days = for services. 
3. Visit Days:  Total number of days the clients     &#= 13;
        = ;            &n= bsp;      received Day Care Habilitative Services.
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Cal-Works = ;
SUMMARY PAGE
UNITS OF SERVICE (Line 13a to 13b)&= #13;
13a. Total Service Hour:  The hour worked where Orientation & Outreach and Case Management activities were provided directly to Cal-WORKS and recipients.
1= 3b. Total Units of Service (Staff Hours, Resident Day, DayCare Day): <= /span>
         Indi= cate the actual units of service provided e.g. Staff Hour, Day Care Day, <= /span>
         Resident Day.
Ø<= /span>Please note,  if there are units that were not disclosed on your monthly claim for reimbursement but should be charged to this contract, include these units in the cost report and submit supplemental claims to Cost Reimbursement Unit.
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JAG Non-ODF Units of Services Instructions
SUMMARY PAGE= 3;
&#= 13;
UNITS OF SERVICE (Line 13a to13e)
=
Line 13a.  SACPA Hours:  Enter total number of sta= ff hours provided during the
f= iscal year.   
Line 13b.  Clients Served (# of SA= CPA Clients) :  MANDATORY.
Total number of SACPA client served.  Do not count the same client more= than once. (Substance Abuse and Crime Prevention  Act of 2000 (SACPA).
Line 13c.   SACPA Visits : For DCH services, enter total number of visit days  &= #13;
p= rovided during the fiscal year.
Line 13d.   Slots Days:  For Outpatient Narcotic Treatment Program, enter the total licensed to prescribe and administer medication. =
Line 13e.    SACPA Bed Days: For Residential services, enter total number of bed days provided during the fiscal year.
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ODF Form Instructions
SCHEDULE = P1 – SALARIES AND EMPLOYEE BENEFITS
HEADING:  Infor= mation is automatically linked from Summary Page.
Column (A) to (J)
(A)TITLE OF POSITION : 
        Employee with taxes and benefits paid - L= ist each non-consultant
        position working on the contract by title.
        Employee without taxes and bene= fits paid - Report on Schedule P4,
        page 1 of 2, on the line for Consultants.
Ø
  MONTHLY SALARY:  For each position listed in (A) indicate the monthly salary based on a 40 hours work-week as if the indivi= dual had worked for the company 100% of the time.
Ø
   %  OF TIME EMPLOYED BY AGENCY :<= /b>  Indicate the % of time an = employee worked for the organization.  Full time =3D = 100%, half time =3D 50%, quarter time =3D 25% (number of hours per week divide= d by 40).  This percentage should not exc= eed 100% or 40 hours per week.
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ODF Form Instructions
SCHEDULE = P1 – SALARIES AND EMPLOYEE BENEFITS (continued)
(D)  % OF TIME SPENT ON CONTRACT SERVICES % of time spent on this = contract.
(E) :  Perce= ntage of time charged to
       this contract for providing direct services. Direct services are those that dea= l directly with clients.= 3;
Ø= ; =
(F)   Enter amounts from financial reco= rds of this position.= 3;
Ø= ; =
(G)  ACTUAL EXPENDITURES OD= F - IND:  Actual cost from payroll or gener= al
      ledger  charged to ODF Individual Service= s.
Ø= ; =
(H)  ACTUAL EXPENDITUES ODF= - GRP:  Actual cost from payroll or gener= al ledger
        = ;            &n= bsp;            = ;            &n= bsp;            = ;          charged to ODF Group Services.
(I)   = COUNTY APPROVED BUDGET= :  Enter the amount for each position from the latest= 3;
        = ;            &n= bsp;            = ;            &n= bsp;       County Approved Budget for the specific contract.
(J) VARIANCE: Formulated. No entry required.
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ODF Form Instructions
SCHEDULE = P2 – FACILITY RENT/LEASE OR DEPRECIATION
I.  &nb= sp; <= u>RENT/LEASE
FACILITY ADDRESS:  Mandatory. Please enter complete facility address.
(= A ) T= OTAL ANNUAL RENT/LEASE  Enter actual rent/lease from financial records for &#= 13;
        = ;            &n= bsp;            = ;            &n= bsp;       the contract period.
Ø
( B )   Enter actual square footage of the facility.
( C )  COST PER SQUARE FOOT:  Formulated.  No entry required.
(= D ) & ( E )   <= /span>
        = ;        Enter square footage charged to Individual and Group Services. =
Ø
( F) & ( G ) ACTUAL EXPENDITURES FOR INDIVIDUAL AND GROUP:  Formulated.  No entry required.
        = ;        This amount should agree with your financial records.
( H )   Amount from the latest County Approved Budget.
( I ) VARIANCE: Formulated. No entry required.
(J)  EXPLANATION= : Use this box to explain= the variance, if any.
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ODF Form Instructions
SCHEDULE = P2 – FACILITY RENT/LEASE OR DEPRECIAT= ION (cont.)
=
 II. = FACILITY OWNED =
     (A,B,C,D,F,G) – Fill-out informa= tion in appropriate boxes.   Do
        = ;            &n= bsp;        not include land cost in facility cost (box B)
   &n= bsp; (= E) DEPRECIABLE COST: =
        = ;    Facility cost (B)+ Facility improvement (C)-Salvage value (D). =
     (H)<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bidi-font-famil= y: Arial;mso-hansi-font-family:Arial;font-size:57%'> ANNUAL DEPRECIATION EXPENSE CHARGED TO AGENCY   (I & J)=   ACTUAL ANNUAL DEPRECIATION CHARGED TO PROGRAM= :    
        = ;         Enter amount of actual depreciation charged to Individual and Group&#= 13;
        = ;         Services.
   = (K)  COUNTY APPROVED BUDGET: Post the amount from the latest County
        = ;    Approved Budget.
   &n= bsp; (L= ) VARIANCE: <= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bidi-font-famil= y: Arial;mso-hansi-font-family:Arial;font-size:57%'>Formulated. No entry required.
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ODF Form Instructions
SCHEDULE P3 = 211; EQUIPMENT AND OTHER ASSET LEASES
  <= /span>
        = ;       ( A )  DESCRIPTION OF LEASES<= /u>:  The Los Angeles County, Departmen= t of Public Health 
        = ;            &n= bsp;     encourages the leasing of items classified as Fixed Assets Equipmen= t.  For this
        = ;            &n= bsp;     column,  itemize those assets classified as fixed assets, equipment or any asset 
        = ;            &n= bsp;     regardless of classification costing over $5,000 and $500 (Perinatal and Drug
        = ;            &n= bsp;     Medi-Cal) per leased unit and has an expected service life of more = than three years. = 3;
        = ;            &n= bsp;     Leased items costing less than the above must be itemized in the &#= 8220;Miscellaneous
        = ;            &n= bsp;     Services and Supply Items” section of Schedule P4, page 2 of 2.
        ( B )  VALUE OF EQUIPMENT:  Enter= the lesser of the purchase price or 
        = ;            &n= bsp;            = ;            &n= bsp;             market value of the leased assets/equipment.
        ( C )  NUMBER OF ITEMS: Enter the number of leased items from column (A).&#= 13;
        (D & E)  ACTUAL EXPENDITURES CHARGED TO ODF IND AND GRP:  =
        = ;      Enter the actual cost for leased equipment and/or other assets char= ged to this
        = ;      contract for Individual and Group services.
(F)   Enter the amount from the latest = County
       App= roved Budget.
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ODF Form Instructions
SCHEDULE = P4 – SERVICE, SUPPLIES & EQUIPMENT DEPRECIATION =
      PAGE 1 OF 2
(A)<= span style=3D'mso-spacerun:yes'>  ITEM:  Revie= w this column for appropriateness and accuracy in terms of service and
        = ;          supplies used by your agency.  If items cannot be found, use page 2 of 2 under
        = ;          “Miscellaneous Services and Supply Items” to report cost.  Please note that space is
        = ;           provided for bookkeeping fees which is separate from consultant services.
(B &= amp; C) A= CTUAL EXPENDITURES-ODF INDIVIDUAL AND GROUP:  Alloc= ate the actual cost for     
        = ;     Individual and Group services.
Ø
(D)   Enter the amount from the latest = County Approved Budget.
      PAGE 2 OF 2
      (A). MISCELLANEOUS SERVICE AND SUPPLY ITEMS<= span style=3D'font-family:Arial;mso-ascii-font-family:Arial;mso-bidi-font-famil= y: Arial;mso-hansi-font-family:Arial;font-size:44%'>:  In this column,  itemize
        = ;           expenditures not found under column (A), page 1, including leased equipment not i= ncluded in Schedule P3 because of the program cost limitations.
      (B & C) ACTUAL EXPENDITURES-ODF IND & GRP  Enter the actual cost of miscellaneous
        = ;            services and supply items listed in column (A) for Individual and G= roup services.
      (D) COUNTY APPROVED BUDGET= :  Enter the amount from the latest = County Approved Budget.
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ODF Form Instructions
SCHEDULE = P4, PAGE 2 of 2 (cont.= )
        (A) DEPRECIATION FOR EQUIPMENT/FIXED ASSETS 
        = ;      In accordance with the “Fixed Assets Classification Guidelines developed by the
        = ;      County Auditor-Controller Accounting Division,” the County of= Los Angeles,
        = ;      Department of Public Health, Substance Abuse Prevention and Control will not 
        = ;      pay for the initial outlay of funds for items classified as fixed assets and     &= nbsp;   
        = ;      equipment.   Howe= ver, agencies may depreciate such fixed assets, and  
        = ;      equipment over a period of not less than three years from the date = of purchase
        = ;      and charge depreciation expense to the contract for the appropriate amount.
        = ;      Depreciation is limited to cover those periods the contract is in effect and over the
        = ;      periods benefited.
A. =
(B) : En= ter the cost of the items listed in column (A).
A. =
(C) : En= ter the number of items identified in column (A).
A. =
(D&E) ACTUAL EXPENDITURES-ODF INDIVIDUAL AND GROUP SERV= ICES:
        = ;   Enter the actual depreciation cost charged to Individual and Group Services.
A. =
(F)   Enter the amount from the latest County Approved = ;
        = ;     Budget.
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ODF Form Instructions
SCHEDULE P5 = 211; ADMINISTRATIVE OVERHEAD
Administrative Overhead, = as defined in the “State Department of Alcohol & Drug Progra= ms Audit Assistance Guide” are indirect costs that were incurred for a common or joint purpose benefiting more than one cost objective, = and not readily assignable to a specific cost objective.
These Costs involve:
A= .Salaries, wages, and empl= oyee benefits of administrative personnel whose effort benefits more than one cost objective.&#= 13;
=
B.= Operational costs and maintenance costs which benefit more than one cost objective.
=
Ø3 SUGGESTED METHODS TO CALCULATE THE PROGRAM’S
        = ;   ADMINISTRATIVE OVERHEAD EXPENSE.  CHOOSE ONE OF
        = ;   THE FOLLOWING:
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ODF Form Instructions
SCHEDULE = P5 (cont.= ) = ;
I.     ADMIN. O.H. EXPENSE AS A PERCENTAGE OF TOTAL AGENCY EXPENSES <= /div>
1.= 1.TOTAL ADMINISTRATIVE EXPENSE POOL:  Enter total administrative expenses.
        = ;         of the agency.
= 2.TOTAL  AGENCY EXPENSES:  Enter the total agency expenses.&= #13;
3. =
= 3.ADMINISTRATIVE OVERHEAD RATE: Formulated. No entry required.
4. =
= 4.PROGRAM EXPENSES (A1) = and (A2):  Formulated. No entry required. Da= ta is
        = ;         automatically linked from the Cost Report Summary Page line 1 throu= gh 4.
2. =
= 5.TOTAL PROGRAM EXPENSES= :  Add lines 1 through 4. Formulated.
6. =
6= .ACTUAL EXPENDITURES-ODF IND (B): Formulated.  No entry require= d. Multiply Total Program Expenses ( I ), col. (A1) by the Administrati= ve Overhead Rate. This amount will automatically post to line 5, column (1),  on the Summary Page. <= /span>
7= .ACTUAL EXPENDITURES ODF GRP (C):  Formulated.  No entry required. Multiply Total= Program Expenses ( G ), c= ol. (A2) by the Administrative Overhead Rate.=   This amount will automatically post to line 5, column (2), on the Summ= ary Page.
1. =
8.  Enter the amount from the latest = County Approved
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ODF Form Instructions
SCHEDULE = P5 (cont.= )
II.     ADMIN. O.H. EXPENSE AS A PERCENTAGE OF TOTAL DIRECT AGENCY SALARIES <= /span>
&#= 13;
1.  Post Total Direct Salary from col= . (G) plus 2.
2.  Enter the total direct salaries p= aid by the 3. =
3.  Formulated. Total Direct Program = Salaries divided by Total Direct Agency Salaries.
4. Enter total administrative expenses by Individual and Group Counseling Services for the agency.
Ø
5.ACTUAL EXPENDITURES-ODF IND (B) AND ODF GRP (C):  Formulated.
       Administrative Expense Pool for ODF Individual and ODF Group multip= lied by Administrative Overhead Rate (A) respectively.
5. =
6= .COUNTY APPROVED BUDGET (D):  Enter the latest County Approved Budget.
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ODF Form Instructions
<= p:onmouseclick hyperlinktype=3D"otherFile" href=3D"../../Users/vpham/Documents/SAPC/WEB/CR0405/Orientation/Non-DMC/L= inks%20for%20Orientation/schedule%20P5.xls"/>SCHEDULE = P5 (cont.= )
III.   &= nbsp; OTHER METHOD USED TO CALCULATE THE ADMIN O.H. EXPENSES
If you use other method, explain the method worksheets used to calculate Administrative Overhead Expense. &nb= sp; Please note that:
Actual Admin. O. H. expendit= ures must be identified separately between Individual and Group Services.
Ø
Must Manually Post Total to line 5, column (1) and (2), on the = Summary Page.
Ø
Also post the amount from the latest County Approved Budget to line 5, columns (3) on the Summary Page.
Ø
(Please read detailed instructions attached to Forms).
6. =
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Common Errors:
6. =
• =
•
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1.Summary Page
2. = ;
ØIncorrect contract number.
ØProvider Number does not match with facility address
ØMissing Authorized Signature
ØMissing Contact Information
ØMissing County Approved Budget Information
ü<= /span>The signature confirms = that all information is correct and corresponds to the Agency’s fina= ncial records.  Please make sure th= at the Certification Page is signed by the authorized person and completely fill= ed out with contact person’s name, email address and phone/fax number in ca= se we need to call for questions concerning your cost report.
Ø
2.Schedule P2 - Fa= cility Rent/Lease or Depreciation
ØMissing Facility Addres= s
ü<= /span>Please fill out the ser= vice facility address where the services were provided. If multiple facilities,  use additional schedules for each facility.
------=_NextPart_01CD5A87.87853030 Content-Location: file:///C:/9F293A52/Non-DrugMedi-CalOrientation11-12_files/slide0041.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1
Common Errors, cont.
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• =
•
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3.Revenue
ØCounty reimbursement are being reported under revenue.
üPlease do not include County Reimbursement as Revenue.
Ø
4.Units of Service Information
ØMissing units of service information. <= /span>
ØUnits do not match with billing.
üPlease always provide the unit information. The un= it information on the Summar= y Page can be obtained from the Performance Data Report.
üIf there are = units that were not disclosed on your monthly claim for = reimbursement but should be charged to this contra= ct, include these units in the cost report and submit supplemental claims to CRU.
üNPR contract = (Cost Line-Item Non-Provisional rate) - actual units of service/staff hours in accordance to the contract modality is required for reporting purposes.
üSupplemental = claims will be reimbursed on the cost report settlement.
Ø
vPlease note, incorrect units reported on the cost report will impact your cost settlement, therefore, always make sure the reported units is acc= urate.
------=_NextPart_01CD5A87.87853030 Content-Location: file:///C:/9F293A52/Non-DrugMedi-CalOrientation11-12_files/slide0042.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" Slide 1
Mandatory
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A.Units of Servi= ces - All cost reports, including cost reimbursement line item contracts (NPR) must have the units of service reported before submission. 
B.&= #13;
B.PLEASE DO NOT LEAVE THIS INFORMATION BLANK<= /u>.
C.
C.Fill in the lat= est County Approved Budget on Summary Page.
D.&= #13;
D.All issues or changes pertaining to this fiscal year cost report should be submitted to County by
      September= 15, 2012. 
       = 3;
      There will be no concession after the final= submission to the State.
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DEADLINE
6. =
• =
•
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SUBMIT FY 2011-12 COST REPORT BY
AUGUST 15, 2012
  PLEASE SUBMIT:
 
ü1) ORIGINAL COST REPORT AND ONE (1) CO= PY,
ü2) MOST CURRENT COUNTY APPROVED BUDGET= FOR
       NON-PROVISIONAL RATE CONTRACT (SUMMARY PAGE ONLY).
ü3) CARE CERTIFICATION 
ü4) COST REPORT CERTIFICATION= 3;
MAIL TO:
<= b>COUNTY OF LOS ANGELES
DEPARTMENT OF P= UBLIC HEALTH
SUBSTANCE ABUSE PREVENTION AND CONTROL
1000 SOUTH FREMONT AVENUE
BUILDING A-9 EAST, 3rd FLOOR, NORTH WING, UNIT 34 =
ALHAMBRA, CA   91803
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COST REPORTING UNIT
6. =
• =
•
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7/01/2012
Alex Domond         (626) 299-4156<= span style=3D'mso-spacerun:yes'>        = ;   adomond@ph.lacounty.gov
Hanna Battung      (626) 299-4179          hbattung@ph.lacounty.gov
Lisa Lee (626) 299-4165        = ;   Lislee@ph.lacounty.gov
Zenaida Arenas (626) 299-4584        = ;   zarenas@ph.lacounty.gov
Winnie Su (626) 299-4146        = ;   zsu@ph.lacounty.gov
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