Part A - Fee and Revenue Plan - Steuben County A - Fee and Revenue Plan ... a list of the environmental, ... Home Care Services Physically Handicapped Children's Program

Part A - Fee and Revenue Plan

FEE & REVENUE PLAN.doc 9/15/2009

Format and Guidance

General Information

For the 2010 – 2013 Municipal Public Health Services Plan cycle, the Fee and Revenue Plan will

require LHD’s to project their costs, revenues and personnel resource list over a four year period.

For a municipality to be eligible for reimbursement under the State Aid for General Public Health

Work Program, a Fee and Revenue Plan must be submitted to the NYS Department of Health for

review and approval. The Fee and Revenue Plan must include:

a list of the environmental, personal health services and other services for which fees

are charged;

a schedule of the fees charged for each service listed above;

a list of the environmental, personal health services and other services for which fees

are not charged, including a justification for not charging a fee;

a description of how fees are calculated and the relationship of the cost of providing

services to the fees;

a description of the procedures used for collecting fees; including provisions for use

of a sliding fee schedule;

an estimate of the amount of revenue from fees and charges, for each year covered by

the Fee and Revenue Plan; and

a list of the resources necessary to implement the public health programs, services

and activities outlined in the Municipal Public Health Services Plan.



Instructions

1. Listing of environmental, personal health and other services fees.

On Fee and Revenue Form A, provide a list of those environmental, personal health and

other services for which the Local Health Unit charges a fee. Additional copies of this form

may be used if necessary. For those services where the fee may vary, please footnote and

provide an explanation and/or breakdown of the variance on an attached sheet. For services

where a sliding fee schedule is used, that should be noted in the "Fee" column and a copy of

the sliding fee schedule used must accompany the Fee and Revenue Plan. Please note at the

top of each sliding fee schedule submitted the programs to which it applies. Examples of

how to complete Form A are provided below:

Form A1 - Environmental Programs:

Program: Community Sanitation and Food Protection

Service: Restaurant Inspection

Fee: $100

Form A2 - Personal Health Services Programs:

Program: Immunization

Services: Flu immunization

Fee: Sliding ($0 - $20)

2. Listing of environmental, personal health and other services for which fees are not

charged.

On Fee and Revenue Form B, provide a list of those environmental, personal health and other

services for which the Local Health Unit does not charge a fee. Additional copies of this

form may be used if necessary. An adequate justification for not charging a fee must be

provided in the "justification" column. This justification should include why the Local

Health Unit feels charging a fee will impede the delivery of service, the basis upon which

that determination was made and, where applicable, the potential impact assessing a fee

would have on program activities. For services where the State Commissioner of Health has

indicated no fees shall be charged, this should be noted in the "justification" column.

An example of how to complete Form B is provided below:

Program: STD

Service: Gonorrhea Testing

Justification: NYSDOH - no fee to be charged



3. Fee calculation and collection procedures and use of sliding fee schedule.

The Local Health Unit's written protocol for calculating, assessing and collecting fees, as

well as procedures for collecting third-party billings must be submitted on Form C. The

protocol must include, at a minimum:

a description of how the Local Health Unit calculates fees to be charged for

environmental, personal health and other services, which may include:

a. a breakdown of the estimated total costs by individual category of

expense (i.e. personal service, non-personal service, fringe benefits,

indirect costs);

b. factors used to distribute shared costs (i.e. average person-days) to

individual services;

c. criteria used to establish specific fees based on distributed costs (i.e.

number of seats in restaurant, rooms in a temporary residence, etc);

d. number of billable services (i.e. # of visits, # of permits);

e. unrecoverable costs (i.e. service to other municipal agencies);

f. if applicable, rationale for establishing separate fees for discrete

classes of recipients of services; and

g. local considerations for fee setting;

provisions for use of a sliding fee schedule, including how the sliding fee

schedule is implemented;

a description of the follow-up activities conducted by the Local Health Unit

to maximize revenue from delinquent permittee/patient accounts or rejected

Medicaid, Medicare or third-party billings.

A photocopy of Form C from your previous plan may be inserted if there have been no

changes to this procedure.



4. Projected estimate of earned revenues and costs.

Fee and Revenue - Form D-1 thru D-4 should be used to provide a projected estimate of the

earned revenues and costs for each year of the Municipal Public Health Services Plan cycle.

Projecting revenues and costs is an estimate which may be accomplished by using historical

data and applying an appropriate growth rate. The growth rate could be the current inflation

rate, consumer price index, etc. combined with known contractual agreements that may affect

your estimate (e.g., negotiated pay raises, etc). All earned revenue (i.e. Medicare, Medicaid,

third-party reimbursement, fees, fines and other income incidental to the provision of

services or sale of goods) should be included in the projected estimate. State Aid

reimbursements and revenues associated with State and Federal Grants should not be

included in the projections, as they are not considered earned revenue. All earned revenue

classified as "other" on these forms should be footnoted and the sources identified on an

attached page.

Resource list.

Fee and Revenue – Form E-1 thru E-4 should be used to provide a list of the resources

necessary to implement the public health programs, services and activities outlined in the

2010-2013 Municipal Public Health Services Plan. The resource list should include all

positions (current and proposed), services rendered under contract, clinical services provided

under contract, and other OTPS costs. These lists are similar to those provided in previous

Fee and Revenue Plans. Please provide the number of staff under the FTE column for each

item/title. Then provide the cost in dollars for each program area based on the FTEs. For

example:

Personal Services Projected Costs

Distribute FTEs as utilized in all programs/services

Item/Title Average

Salary

FTEs

Health

Assessment

($)

Family

Health

($)

Disease

Control

($)

Health

Education

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Pub Hlth Nurse $50,000 4 $25,000 $25,000 $100,000 $50,000 $0 $0

Health

Educator

$30,000 2 $0 $0 $0 $60,000 $0 $0

Home Hlth Aid $25,000 5 $0 $0 $0 $0 $0 $125,000 - CHHA



Form A

Listing of Environmental, Personal Health and Other Services Fees

Program Service Fee

Lead

Immunization

Tuberculosis

Home Care Services

Physically

Handicapped Children's Program

Early Intervention (ages 0-2)

Preschool Program (ages 3-5)

Lead Screening

Hepatitis B (adult)

Flu

Pneumovax

Adult Tetanus

Meningoccal

Zoster

Mantoux testing

Nursing, Therapy, & Home Health Aide

Service

Payment for treatment

Evaluation and Intervention Service

Preschool Special Services

$0-$25

Sliding Fee scale

(see attached)

$40.00 per dose(3

doses required)

$30.00 per dose

$45.00 per dose

$20.00 per dose

$90.00 per dose

$165.00 Per dose

$6.50 per dose

Medicaid Medicare,

Insurance, &

Private Pay based

on a sliding fee -

see attached

Parent fees

minimum

$200 per

authorization

Third Party Payors

Medicaid & State

Education



Form B

Listing of "No Fee" Services and Justification

Program Service Justification

Rabies

STD

HIV

Immunization

Tuberculosis

Animal Testing

Pet Immunization

Clinics

Post Exposure Treatment

Shots

Diagnosis Treatment

Screening

Child Immunizations

Doctor Visits

Lab Fees

Medications

Per Regulations

Free*

Third Party Payors are billed

first, then County

Free* Waiver

Free*

Free*

Per regulations, third party payors

are billed first, then County

*Free-Charging

fees would

impede poor or

near poor.


Form C

Fee Calculation and Collection Procedures Description

For the CHHA and LTC agency, rates are determined by LHU's independent auditor. These are

determined using the previous year’s cost per unit of service (hours or visits) and the estimated

cost per unit of service for the rate year. A sliding fee scale is used for patients who pay

privately based on their weekly income and the number of people in their family.

For Lead Screening the fee is based on LHU's cost for the tests. Anyone with Medicaid is billed

directly by Health Research. LHU charges others based on the sliding fee scale.

Adult immunizations Immunizations and Mantoux testing are charged based on costs per test or vaccine.

Sliding fee scales are based on the Federal Poverty Guidelines.

Refer to Fee Policy attached.


=========================================================================

TOPIC: Fees Policy (Includes self-pay, insurance, and bad debt and collections)

Approved Date: Signature of Approver:

Next Revision Due Date: 8/04 Effective Date:

Originator: Business Office: 8/03 Division Name: BO

# of pages: 2 plus 3 attachments

=========================================================================

POLICY:

To provide quality patient care to all individuals who qualify for Public Health Nursing Services without regard to patient’s ability to pay or

source of payment.

PURPOSE: To provide uniform methods for applying rates, collections and bad debt processes.

REFERENCE (S): Public Health Law 760.5(h)(4), 763.11 (11), 763.5 (f) of Title 10NYCRR regarding

provision of free care.

Department of Health and Human Services Poverty Guidelines, Research, and

Measurement website; http://aspe.os.dhhs.gov/poverty/poverty.shtml

GENERAL INFORMATION:

A patient is eligible for charity care if ALL of the following conditions are met:

o the patient is unable to pay full charges and;

is not eligible for covered benefits under Title XVIII (Medicare) or XIX

(Medicaid) of the Social Security Act and;

is not covered by any form of private insurance and whose household income

is less than 200% of the Federal Poverty levels.

Note: Charity Care is reflected on the Agency’s sliding scale based upon the most current Federal Poverty levels.

In the event that a patient refuses to complete a Financial Index Form, the SPHN and/or Administrative Assistant will be notified and a

decision may be made to either not provide services or a negotiated rate may be considered.


PROCEDURE:

Cost of services will be determined at regular intervals by a cost study. A full fee or sliding fee scale will be established on the basis of these costs.

There is a minimum charge on a sliding fee scale basis for Nursing visits, Therapy, Home Health Aide, and Personal Care Aide Services (see attached

fee schedule).

A Financial Index Form is completed by the Nurse at the first visit and is used to determine the fees and payment source. The Financial Index Form

and the Consent & Acknowledgement Form must be signed permitting authorization to release information and permitting the Agency to bill third-

party payers, when available.

All third party resources (Medicare, Medicaid, and insurance companies) will be billed and exhausted prior to billing the patient.

When third party payers cover all of the agreed cost, the service will be provided at no charge to the patient. When third party payers cover part of the

cost, the patient will be billed the deductible or coinsurance portion.

Private Pay: Families and individuals receiving services not covered by third party payers should meet the costs of service to the extent that their

resources permit.

Families who can afford to pay full fee are expected to do so. If the family does not wish to divulge financial information, full fee will be billed.

When a family is unable to pay full fee, a fee adjustment will be made. A fee adjustment is a reduction in the fee based on resources of the patient.

Resources of the family or individual will be considered as their present income out of which they meet the costs of day-to-day living, whether the

source is salary, Social Security, pensions, dividends, interest or other sources. Other resources, such as savings, property, and investments, will not

be investigated or taken into consideration in determining the extent to which income is available to meet costs of service.

Based on the families resources, as defined above, a fee will be established using the sliding fee scale. The nurse should review the last Federal Tax

Return and determine the fee based on the gross income. If the patient does not have a tax return, the nurse must review monthly statements, stubs,

etc. Indexes will be updated annually in May or upon changes in income. If the income is less than the first column of the sliding fee scale and it is

felt the patient is unable to pay anything, an exception may be made. The nurse should give all information to the Supervisor, who will make a

decision after discussing the case with the Health Care Fiscal Specialist. The patient should be assured that all information will be treated as

confidential and that whatever fee is arrived at can be adjusted as changes occur in the patient’s overall economic status. The patient should also be

advised that if necessary, someone from the agency may phone to clarify the data submitted.

If the patient dies, and it becomes known that the estate might have the resources to meet the cost of services rendered, the estate will be billed for any

unpaid balance.

Government regulations require that patients and other payors be invoiced full fee; however, the fee adjustment will also be shown on the invoice,


leaving a net amount due the agency.

In cases where a lawsuit is pending for injuries for which the agency is treating the patient, partial payment should not be accepted unless there is a

signed statement in the record that the patient and his family realize he is paying part fee and agree to full fee upon settlement of the suit. It is

preferable, in these cases to bill the client full fee, insuring that the lawyer handling the suit is aware of the full fee services.

Account Clerk and County Attorney’s Responsibilities in Declaring Bad Debts:

The same effort will be made to collect Medicare deductibles and coinsurance amounts as is to collect comparable amount from Non-Medicare

patients. The collection effort will be documented in the patient’s file by copies of bills, follow-up letters, reports of phone calls, and personal

contacts.

If a bill is unpaid after two (2) billing statements have been sent, a series of two (2) letters will be mailed monthly (the last letter should be Return

receipt requested), each followed by a phone call to see if there is any other insurance or Medicaid-if not, then to encourage payment. If no payments

are received, the debt may be deemed uncollectible and will be declared a bad debt. Any outstanding bills over $500.00 will be considered for

litigation and sent to the County Attorney. (Please refer to the sample letters attached.)

When families or patients refuse to pay and it is determined that they could make payment without endangering their future, service may be

terminated after a reasonable time has been provided for the client to make other arrangements for essential service. However, if the recipient of care

cannot control payment and would suffer for lack of service, service will not be terminated.


STEUBEN COUNTY CHILDHOOD LEAD POISONING PREVENTION PROGRAM

Sliding Fee Scale and Chart of Yearly Income and Federal Poverty Level

Family 200% 225% 250% 275% 300%

Size Yearly Income

Weekly Income

Yearly Income

Weekly Income

Yearly Income

Weekly Income

Yearly Income

Weekly Income

Yearly Income

Weekly Income

1 $21,660 $417 $24,368 $469 $27,075 $521 $29,783 $573 $32,490 $625

2 $29,140 $560 $32,783 $630 $36,425 $700 $40,068 $771 $43,710 $841

3 $36,620 $704 $41,198 $792 $45,775 $880 $50,353 $968 $54,930 $1,056

4 $44,100 $848 $49,613 $954 $55,125 $1,060 $60,638 $1,166 $66,150 $1,272

5 $51,580 $992 $58,028 $1,116 $64,475 $1,240 $70,923 $1,364 $77,370 $1,488

6 $59,060 $1,136 $66,443 $1,278 $73,825 $1,420 $81,208 $1,562 $88,590 $1,704

7 $66,540 $1,280 $74,858 $1,440 $83,175 $1,600 $91,493 $1,759 $99,810 $1,919

8 $74,020 $1,423 $83,273 $1,601 $92,525 $1,779 $101,778 $1,957 $111,030 $2,135

For each additional person add

$7,480 $144 $8,415 $162 $9,350 $180 $10,285 $198 $11,220 $216

Percent of Fee

0% 25% 50% 75% 100%

Charge $0.00 $0.00 $6.25 $6.25 $12.50 $12.50 $18.75 $18.75 $25.00 $25.00

Based on the Federal Poverty Guidelines effective January


2009

STEUBEN COUNTY PUBLIC HEALTH & NURSING SERVICES

SLIDING FEE SCALE

Determine income by looking at the previous years tax return. Choose the first column which is more than

the patients income. Their fee will be at the bottom of the column.

# 1 Step #2 Step #3 Step #4 Step # 5 Step Full Fee

FAMILY ANNUAL MONTHLY ANNUAL MONTHLY ANNUAL MONTHLY ANNUAL MONTHLY ANNUAL MONTHLY

SIZE INCOME INCOME INCOME INCOME INCOME INCOME INCOME INCOME INCOME INCOME

1 21660 1805 25271 2106 28808 2401 32490 2708 36107 3009

2 29140 2428 33998 2833 38756 3230 43710 3643 48576 4048

3 36620 3052 42725 3560 48705 4059 54930 4578 61046 5087

4 44100 3675 51451 4288 58653 4888 66150 5513 73515 6126

5 51580 4298 60178 5015 68601 5717 77370 6448 85984 7165

6 59060 4922 68905 5742 78550 6546 88590 7383 98453 8204

7 66540 5545 77632 6469 88498 7375 99810 8318 110922 9244

8 74020 6168 86359 7197 98447 8204 111030 9253 123391 10283

FEE ** **

SN-VISIT 10 38 75 113 150

PT-VISIT 10 34 68 101 135

OT-VISIT 10 34 68 101 135

ST-VISIT 10 34 68 101 135

MSW-VIS 10 34 68 101 135

NUT-VIS 10 31 63 94 125

HHA-HR 5 10 28 41 55

Effective 02/01/2009

** Persons with incomes less than the first column may be considered for free or reduced fee services.

Please refer all information to your supervisor.


Form D-1

Projected Costs and Revenues – 2010

Program

Medicare

Medicaid

3rd Party

Fees

Fines

Other

Total

Revenue

Gross

Costs

1. Health Administration __________ __________ __________ __________ __________ __________ __________ __________

Basic Services

2. Family Health Core _________ __$115,000_ __________ ___$3000__ __________ __________ _$118,000_ __________

3. Disease Control Core __$30,000 __________ __________ ___$1,500 __________ __________ __$31,500_ __________

4. Health Education __________ __________ __________ __________ __________ __________ __________ __________

5. Community Health Assessment __________ __________ __________ __________ __________ __________ __________ __________

6. Basic Laboratory __________ __________ __________ __________ __________ __________ __________ __________

7. Environmental Health Core __________ __________ __________ __________ __________ __________ __________ __________

Selected Services

8. Dental Health Services __________ __________ __________ __________ __________ __________ __________ __________

9. Home Health Services $2,800,000_ $450,000 _$444,921 $15,000 __________ _$6,000_ 3,715,921 __________

10. Radioactive Materials __________ __________ __________ __________ __________ __________ __________ __________

11. Rad Producing Materials __________ __________ __________ __________ __________ __________ __________ __________

12. Housing Hygiene __________ __________ __________ __________ __________ __________ __________ __________

13. Other Environmental Services __________ __________ __________ __________ __________ __________ __________ __________

14. Emergency Medical Services __________ __________ __________ __________ __________ __________ __________ __________

15. Long Term Home Health Care _$61,000_ _$250,000_ __________ __________ __________ _$311,000_ __________

16. Optional Laboratory __________ __________ __________ __________ __________ __________ __________

17. EI Administration __________ _$80,000_ __________ __________ __________ $80,000 __________

18. EI Service Coordination __________ _$40,000_ __________ __________ _$22,000__ $62,000 __________

19. All Others __________ __________ __________ __________ __________ __________ __________ __________

Other Services

20. Inpatient TB __________ __________ __________ __________ __________ __________ __________ __________

21. ME and ME Lab __________ __________ __________ __________ __________ __________ __________ __________

Additional Services

22. PHCP __________ __________ __________ _$8,000__ __________ __________ _$8,000_ __________

23. EI Services (0-3) __________ _$580,000_ _$60,000_ __________ __________ _$294,383 _$934,383 __________

24. 3-5 Program Services __________ _$500,000 __________ __________ __________ $2,460,325_ _$2,960,325 __________

25. General Medical Clinics __________ __________ __________ __________ __________ __________ __________ __________

26. DEC Programs __________ __________ __________ __________ __________ __________ __________ __________

TOTAL ALL PROGRAMS $2,891,000 $2,015,000 $504,921 $27,500 $2,782,708 $8,221,129 __________


Form D-2


Program

Medicare

Medicaid

3rd Party

Fees

Fines

Other

Total

Revenue

Gross

Costs


Basic Services

2. Family Health Core $117,300 $3,060 $120,360

3. Disease Control Core $30,600 $1,530 $32,130

4. Health Education

5. Community Health Assessment

6. Basic Laboratory

7. Environmental Health Core

Selected Services

8. Dental Health Services

9. Home Health Services $2,856,000 $459,000 $453,819 $15,300 $6,120 $3,790,329

10. Radioactive Materials

11. Rad Producing Materials

12. Housing Hygiene

13. Other Environmental Services

14. Emergency Medical Services

15. Long Term Home Health Care $62,220 $255,000 $317,220

16. Optional Laboratory

17. EI Administration $81,600 $81,600

18. EI Service Coordination $40,800 $22,440 $63,240

19. All Others

Other Services

20. Inpatient TB

21. ME and ME Lab

Additional Services

22. PHCP $8,160 $ 8,160

23. EI Services (0-3) $591,600 $61,200 $300,271 $953,071

24. 3-5 Program Services $510,000 $2,509,532 $3,019,532

25. General Medical Clinics

26. DEC Programs

TOTAL ALL PROGRAMS $2,948,820 $2,055,300 $515,019 $28,050 $2,838,362 $8,385,552


Form D-3


Program

Medicare

Medicaid

3rd Party

Fees

Fines

Other

Total

Revenue

Gross

Costs


Basic Services

2. Family Health Core $ 120,750 $ 3,150 $123,900

3. Disease Control Core $ 31,500 $ 1,575 $ 33,075

4. Health Education


6. Basic Laboratory


Selected Services


9. Home Health Services $ 2,940,000 $ 472,500 $467,167 $ 15,750 $6,300 $3,901,717



12. Housing Hygiene







19. All Others

Other Services

20. Inpatient TB

21. ME and ME Lab

Additional Services

22. PHCP $8,400 $8,400

23. EI Services (0-3) $609,000 $63,000 $981,102

24. 3-5 Program Services $525,000 $3,108,341


26. DEC Programs



Form D-4


Program

Medicare

Medicaid

3rd Party

Fees

Fines

Other

Total

Revenue

Gross

Costs


Basic Services

2. Family Health Core $124,200 $3,240 $127,440

3. Disease Control Core $32,400 $1,620 $34,020

4. Health Education


6. Basic Laboratory


Selected Services


9. Home Health Services $3,024,000 $486,000 $480,515 $16,200 $6,480 $4,013,195



12. Housing Hygiene







19. All Others

Other Services

20. Inpatient TB

21. ME and ME Lab

Additional Services

22. PHCP $8,640 $8,640

23. EI Services (0-3) $626,400 $64,800 $317,934 $1,009,134

24. 3-5 Program Services $540,000 $2,657,151 $3,197,151


26. DEC Programs



Form E-1

Personal Services Resource List – 2010



Item/Title Average

Salary

FTEs Health

Assessment

($)

Family Health

($)

Disease Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Administration

$70,521 2 .02 .3 .48 .2 1

Supervising Nurses

$46,453 3 .26 .19 .03 2.52

Nurses

$41,148 18 1.43 1.6 .02 14.95

HHA’s

$30,990 9.5 9.5

Public Heath Educator

$51,412 1 .39 .58 .03

Clerical

$38,348 17 3.55 1 1 11.45

Home Care Coordinator

$55,745 1 1

Public Health Coordinator

$59,011 1 .39 .58 .03

MSW

$5,000 .01 .01

Medical Director

$21,000 .13 .05 .015

.065

Administrative Officer-

SCS

$51,616 1 .15 .85

Service Coord.

$49,443 3 .2 2.8

Total Personnel Services Cost: _$2,432,390________


Form E-1

Non-Personal Services Resource List - 2010

Non-Personal Services Projected Costs

Item/Title

Health

Assessment

($)

Family Health

($)

Disease

Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Contractsfor Home Health Services

Public Health

Health Assessment

Administrative Expenses

Fringe Benefits

PHCP Medical Payments

3-5 Education

EI Services

EI Admin

EI Coordination

Basic Lab

Medical Examiner

PHCP Admin

CSHCN

3-5 Admin

Public Health Preparedness

Vector

$1.437,300

$95,000 $140,000 $7,494

$1,000

$700 $22,000 $20,000 $2,100 $220,000

$2,644 $29,314 $40,580 $6,323 $1,070,711

$100,000

4,635,000

$1,407,566

$27,000

$3,000

$16,000

$75,132

$7,000

$1,000

$43,860

$96,459

$3,000

Total Non-Personal Services Costs:__$9,507,273________ Total Projected Costs:__$11,939,663________


Form E-2




Item/Title Average

Salary

FTEs Health

Assessment

($)

Family Health

($)

Disease Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Administration

$72,919 2 .02 .3 .48 .2 1

Supervising Nurses

$48,032 3 .26 .19 .03 2.52

Nurses

$42,547 18 1.43 1.6 .02 14.95

HHA’s

$32,044 9.5 9.5


$53,160 1 .39 .58 .03

Clerical

$39,652 17 3.55 1 1 11.45


$57,640 1 1


$61,017 1 .39 .58 .03

MSW

$5,170 .01 .01

Medical Director

$21,714 .13 .05 .015

.065


SCS

$53,371 1 .15 .85

Service Coord.

51,124 3 .2 2.8



Form E-2



Item/Title

Health

Assessment

($)

Family Health

($)

Disease

Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Contracts for Home Health Services

Public Health

Health Assessment


Fringe Benefits


3-5 Education

EI Services

EI Admin

EI Coordination

Basic Lab

Medical Examiner

PHCP Admin

CSHCN

3-5 Admin


Vector

$1.466,046

$96,900 $142,800 $7,644

$1,020

$714 $22,440 $20,400 $2,142 $224,400

$2,697 $29,900 $41,391 $6,449 $1,092,126

$102,000

4,727,700

$1,435,717

$27,540

$3,060

$16,320

$76,635

$7,140

$1,020

$44,737

$98,480

$3,060



Form E-3




Item/Title Average

Salary

FTEs Health

Assessment

($)

Family Health

($)

Disease Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Administration

$74,752 2 .02 .3 .48 .2 1

Supervising Nurses

$49,240 3 .26 .19 .03 2.52

Nurses

$43,617 18 1.43 1.6 .02 14.95

HHA’s

$32,849 9.5 9.5


$54,497 1 .39 .58 .03

Clerical

$40,649 17 3.55 1 1 11.45


$59,090 1 1


$62,552 1 .39 .58 .03

MSW

$5,300 .01 .01

Medical Director

$22,260 .13 .05 .015

.065


SCS

$54,713 1 .15 .85

Service Coord.

$52,410 3 .2 2.8

Total Personnel Services Cost: __$2,578,333_______


Form E-3

Non-Personal Services Resource List – 2012


Item/Title

Health

Assessment

($)

Family Health

($)

Disease

Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Contracts for Home Health

Services

Public Health

Health Assessment


Fringe Benefits


3-5 Education

EI Services

EI Admin

EI Coordination

Basic Lab

Medical Examiner

PHCP Admin

CSHCN

3-5 Admin


Vector

$1.494,792

$98,800 $145,600 $7,794

$1,040

$728 $22,880 $20,800 $2,184 $228,800

$2,750 $30,487 $42,203 $6,576 $1,113,540

$104,000

$4,820,400

$1,463,869

$28,080

$3,120

$16,320

$78,137

$7,140

$1,020

$44,737

$98,480

$3,060

Total Non-Personal Services Costs:__$9,887,564________ Total Projected Costs:_$12,465,897_________


Form E-4




Item/Title Average

Salary

FTEs Health

Assessment

($)

Family Health

($)

Disease Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Administration

$78,868 2 .02 .3 .48 .2 1

Supervising Nurses

$50,634 3 .26 .19 .03 2.52

Nurses

$44,851 18 1.43 1.6 .02 14.95

HHA’s

$33,779 9.5 9.5


$56,039 1 .39 .58 .03

Clerical

$41,799 17 3.55 1 1 11.45


$60,762 1 1


$64,322 1 .39 .58 .03

MSW

$5,450 .01 .01

Medical Director

$22,890 .13 .05 .015

.065


SCS

$56,261 1 .15 .85

Service Coord.

$53,893 3 .2 2.8



Form E-4



Item/Title

Health

Assessment

($)

Family Health

($)

Disease

Control

($)

Health

Education

($)

Basic

Laboratory

($)

Environmental

Health

($)

Optional, Add’l &

Other Services

(Specify program)

($)

Contracts for Home Health

Services

Public Health

Health Assessment


Fringe Benefits


3-5 Education

EI Services

EI Admin

EI Coordination

Basic Lab

Medical Examiner

PHCP Admin

CSHCN

3-5 Admin


Vector

$1,523,538

$100,700 $148,400 $7,944

$1,060

$742 $23,320 $21,200 $2,226 $233,200

$2,803 $31,073 $43,015 $6,702 $1,134,954

$106,000

$4,913,100

$1,492,020

$28,620

$3,180

$16,960

$79,640

$7,420

$1,060

$46,492

$102,342

$3,180


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