AnnualAuditedCostReportandTimeStudy(AACRTS.doc

KENTUCKY DEPARTMENT FOR COMMUNITY BASED SERVICES INSTRUCTIONS FOR COMPLETING THE ANNUAL COST REPORT AND TIME STUDY For Child Caring and Child Placing Programs and Facilities Send completed cost reports to: PCC REPORTS MANAGER Division of Protection Permanency Cabinet for Health and Family Services 275 E. Main Street, MS 3C-D Frankfort, KY 40621 Phone (502) 564-6852 INSTRUCTIONS FOR THE COST REPORT TIME STUDY Table of Contents I. INTRODUCTION 3 II. AGENCIES / FACILITIES REQUIRED TO REPORT 3 III. PROVIDERS WITH MULTIPLE PROGRAMS 4 IV. AGENCIES OPERATING AN ON CAMPUS SCHOOL 4 V. REPORTING PERIOD 5 VI. GENERAL GUIDELINES FOR COMPLETING THE COST REPORT 5 VII. DATA REQUIRED TO BE SUBMITTED 6 DETAILED INSTRUCTIONS FOR COMPLETING THE COST REPORT GENERAL INSTRUCTIONS 7 COST REPORT FACE SHEET 7 CERTIFICATIONS (SIGNATURES) 8 SCHEDULE 1: CAPACITY UTILIZATION 9 SCHEDULE 2: TIME STUDIED PERSONNEL (Page 1) 10 SCHEDULE 2: TIME STUDIED PERSONNEL (Page 2) 12 SCHEDULE 3: OTHER PERSONNEL 12 SCHEDULE 4: COST REVENUE SUMMARY 13 ATTACHMENT A: ALLOWABLE UNALLOWABLE COST GUIDELINES 19 ATTACHMENT B: ANNUAL TIME STUDY INSTRUCTIONS 23 ATTACHMENT C: COST REPORT TIME STUDY FORMS 27 COST REPORTING FOR CHILD CARING/CHILD PLACING AGENCIES, RESIDENTIAL FACILITIES AND OTHER CHILDREN’S SERVICE PROGRAMS I. INTRODUCTION There are three sets of information that will be used to develop a Medicaid and Title IV-E claiming factor for child caring, child placing, other childrens residential programs and family preservation/family reunification services. They are: Program Cost Report: This report will be used by the Cabinet for Health and Family Services the Department of Juvenile Justice to determine the federally reimbursable costs incurred in the provision of services to committed children. Description of Treatment Program: This narrative should describe the services and activities pr