Substance Abuse Prevention and Control




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FY2015-16 Annual Cost Report Forms and Instructions
Pursuant to your Agency contracts with the Department of Public Health Substance Abuse Prevention and Control (SAPC), each Provider must submit accurate and complete cost reports for the previous fiscal year by August 15 following the end of the fiscal year.
The following documents/files must be submitted by your Agency for the cost report to be considered complete:

Non-Drug Medical (NON-DMC)
  1. Original Cost Report (by SOW, Site, and Modality)
  2. Cost Certification with original signature
  3. Care Certification with original signature
Drug Medi-Cal (DMC)
  1. Original Cost Report (by Site and Modality)
  2. Cost Certification with original signature
  3. Care Certification with original signature
Drinking Driver Program (DDP)
  1. Original Cost Report (by Program)
  2. Cost Certification with original signature
  3. Care Certification with original signature
IMPORTANT:
All cost reports must be submitted by SOW, Site and Modality. No exception.

  • The annual Provider cost reports are due August 15, 2016 (45 days after end of Fiscal Year) EXCEPT DRUG MEDI-CAL WHICH IS PENDING INSTRUCTIONS FROM STATE.
  • If the cost reports are not received by the due date, your agency will be listed as a delinquent provider.
  • After August 15, 2016, a stop payment will be placed on current billings for delinquent providers.  The stop payment order will remain until such time cost reports are received.
  • Do not staple or bind cost reports.

SETTLEMENT:
  • PARTICIPANT/CLIENT FEES, THIRD PARTY REVENUE (INSURANCE PAID) COLLECTED WILL BE OFFSET FROM ALLOWABLE COST.

SUBMISSION:
Please send original cost reports with all working papers as applicable to:

County of Los Angeles Department of Public Health
Substance Abuse Prevention and Control
Cost Reporting Unit
1000 S. Fremont Ave., Bldg A-9 East
3rd Floor, North Wing, Unit 34
Alhambra, California 91803

COST REPORT FORMS/INSTRUCTION AND POWERPOINT

CARE Certification & Cost Report Certifications Forms

Must be signed and attached to ALL cost reports

Drug Medi-Cal Funded Contracts (DMC)

2016 DMC COST REPORT FORMS ARE CURRENTLY UNAVAILABLE

Non-Drug Medi-Cal funded Contracts

Provider Orientation

Mode of Service - Forms and Instructions

Non-Drug Medi-Cal Cost Report Reference

Drinking Driver Program

Provider Orientation

Forms and Instructions

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