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UNIT COST REIMBURSEMENT (UCR) - CHILD AND ADULT

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UNIT COST REIMBURSEMENT (UCR) - CHILD AND ADULT ...

     APRIL 2003

    93.959 BLOCK GRANTS FOR PREVENTION AND TREATMENT OF

    SUBSTANCE ABUSE

    STATE-TREATMENT ALTERNATIVES FOR WOMEN FUNDS

    State Project/Program PERINATAL AND MATERNAL SUBSTANCE ABUSE

    INITIATIVE

    U. S. Department of Health and Human Services

    Federal Authorization: Public Health Service Act, Title XIX, Part B, Subpart II, as amended,

    Public Law 102-321; 42 U.S.C. 300x and 45 CFR Part 96.

    State Authorization: General Statutes 122C-117; 122C-141, 122C-143.2, and NCAC

    T10.1159

    N. C. Department of Health and Human Services

    Division of Mental Health, Developmental Disabilities, and Substance Abuse Services

    Agency Contact Person Program N.C. DHHS Confirmation Reports: Flo Stein, Chief SFY 2003 audit confirmation reports for payments made to

    Substance Abuse Services Section Counties, Area Programs, Councils of Government and

    NC Division of MH/DD/SAS District Health Departments will be available by around 3007 Mail Service Center late August to early September at the following web

    Raleigh, NC 27699-3007 address: http://www.dhhs.state.nc.us/control/ (919) 733-4670 At this site, page down to “Letters/reports/forms for ALL flo.stein@ncmail.net Agencies” and click on “Audit Confirmation Reports (State

    Fiscal Year 2002-2003)”.

The auditor should not consider the Supplement to be “safe harbor” for identifying audit

    procedures to apply in a particular engagement, but the auditor should be prepared to justify

    departures from the suggested procedures. The auditor can consider the supplement a “safe harbor” for identification of compliance requirements to be tested if the auditor performs

    reasonable procedures to ensure that the requirements in the Supplement are current. The

    grantor agency may elect to review audit working papers to determine that audit tests are

    adequate.

    I. PROGRAM OBJECTIVES

    The overall objective of the Substance Abuse Prevention and Treatment Block Grant is to provide

    funds to States, territories and eligible Indian tribes for use in providing certain types of substance

    abuse prevention and treatment services as specified in the statutes. The North Carolina Perinatal

    and Maternal Substance Abuse Initiative is supported both by State-Treatment Alternatives for

    Women funds appropriated by the N.C. General Assembly and Substance Abuse Prevention and

    Treatment Block Grant Funds. The Perinatal and Maternal Substance Abuse Initiative program

    objective is to provide specialized substance abuse treatment to pregnant women and women with

    dependent children.

    II. PROGRAM PROCEDURES

    There are twenty-two programs in the Perinatal and Maternal Substance Abuse Initiative statewide.

    The programs supported by these funds are as follows:

    ? Edgecombe-Nash MH/DD/SAS Program/Brighter Day Program

    ? Sandhills Area MH/DD/SAS/ Clean Start Program

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    PERINATAL AND MATERNAL SUBSTANCE ABUSE INITIATIVE

    ? Smoky Mountain Area Program/Community Outreach for Perinatal Enhancement Program (adult,

    adolescent and residential)

    ? Mecklenburg Health, Mental health, and Community Services/CASCADE Program ? Cumberland County Area Program/Day By Day Treatment Center Perinatal Program ? Durham Area Program/New Leaf and Duke University-Family Care Program ? OPC Area Program/Family Wellness and Recovery Services-Hope Meadow Program ? OPC Area Program/UNC-Chapel Hill-Horizons Program

    ? Southeastern Center MH/DD/SAS/New Visions and EastCoast Solutions-Kelly House ? Lenoir County Area Program/Adolescent Case Management Program ? Southeastern Regional Area Program/Robeson Health Care Corporation-Perinatal Program ? Blue Ridge Area Program/Mary Benson House and Mountain Area Substance Abuse Program

    (adult and adolescent)

    ? Pitt Area Program/Robeson Health Care Corporation-Maria’s House

    ? Roanoke-Chowan Area Program/Adolescent Case Management Program ? Wake Area Program/Step By Step

    ? CenterPoint Area Program/Women’s and Infant’s Services for Health

    These programs participated in a competitive “Request for Proposals” (RFP) process and were awarded grants based on their approved grant proposals. The RFP process was opened to any area program and public or private non-profit agency interested in applying. Proposals were submitted to the Division and grants awarded based on the RFP criteria. Each program has different levels of care (i.e. case management, intensive out-patient, residential, etc.) relative to the services that were approved as a part of the grant award.

    Funds shall be paid to area programs based on a Request for Funds. Unit cost will be determined using a consistently applied methodology approved by the Division. Funds paid shall be settled based on earnings computed through the unit cost reimbursement (UCR). This methodology includes the identification of service cost centers, the allocation of allowable costs, the determination of expected units of service and the calculation of a unit cost reimbursement rate.

    In some cases, funds are on an expenditure basis due to the limitations of the unit cost reimbursement system relative to the unique services offered by a particular program. The amount of these funds would be found in the Division of MH/DD/SAS Final Allocation Letter under Treatment

    Alternatives for Women fund number 536766-1490 or 1491. All other funds allocated inside the UCR system can be found under Treatment Alternatives for Women fund number 536976-1490 or

    1491.

    For the Substance Abuse Prevention and Treatment Block Grant, funds are allocated by the Division Director.

    III. COMPLIANCE REQUIREMENTS

    Crosscutting Requirements

    The DHHS/Division of Mental Health, Developmental Disabilities and Substance Abuse

    Services (DMHDDSAS) mandates that all the testing included within the crosscutting section be performed by the local auditors. Please refer to that section, which is identified as “DMH-

    0” for those mandated requirements.

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    PERINATAL AND MATERNAL SUBSTANCE ABUSE INITIATIVE

    A. Activities Allowed and Unallowed

    In accordance with Section 1924 of P.L. 102-321, any program receiving SAPTBG set-aside

    funds for operating a program of treatment for substance abusing pregnant women and women

    with dependent children shall:

    1. Treat the family as a unit, admitting both women and their children into treatment services,

    as appropriate; and

2. Provide or arrange for the provision of the following services to pregnant women and women

    with dependent children, including women who are attempting to regain custody of their

    children:

    a. Primary medical care for women, including referral for prenatal care and, while the

    women are receiving such services, child care;

    b. Primary pediatric care, including immunization, for their children;

    c. Gender specific substance abuse treatment and other therapeutic interventions for women

    which may address issues of relationships, sexual and physical abuse and parenting, and

    child care while the women are receiving these services;

    d. Therapeutic interventions for children in custody of women in treatment which may,

    among other things, address their developmental needs, their issues of sexual and

    physical abuse, and neglect; and

    e. Sufficient case management and transportation to ensure that women and their children

    have access to services provided to them as listed in items a.-d. above.

Allowable activities would also include:

    a. Residential services for women and their children

    b. Services listed in Section I. of Allowable Activities for pregnant and parenting

    adolescents when the approved grant proposal is for this population

    c. Incentive programming i.e. a voucher for a meal for attending group.

    d. Purchase of supplies for children i.e. diapers, bottles, formula, etc.

    e. Funds may be used to pay rent or lease payments for facility

    f. Program evaluation

    g. Training and education

    h. All services approved on the Women’s Special Categorical Funds Pioneer Funding

    System Circle Chart.

    Unallowed Activities

    1. Provide inpatient hospital services except under the following conditions.

    In order to comply with the Federal restriction that SAPTBG funds are not used for inpatient

    services except for medical necessity, the Division will not reimburse area programs for

    earnings through the provision of substance abuse inpatient services except as follows. If an

    area program wishes to earn SAPTBG funds through the provision of substance abuse

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    PERINATAL AND MATERNAL SUBSTANCE ABUSE INITIATIVE

    inpatient services, the area program must contact the Division’s Substance Abuse Section to

    confirm this arrangement prior to implementation and comply with the following Federal

    requirements:

    a. the primary diagnosis of the individual is substance abuse and the physician certifies this

    fact;

    b. the individual cannot be safely treated in a community-based non-hospital, residential

    treatment program;

    c. the service can reasonably be expected to improve an individual’s condition or level of

    functioning;

    d. the hospital-based substance abuse program follows national standards of substance

    abuse professional practice;

    e. the daily rate of payment provided to the hospital for providing the services to the

    individual will not exceed the comparable daily rate provided for community-based, non-

    hospital, residential programs of treatment for substance abuse; and

    f. funds may be expended for such services only to the extent that it is medically necessary,

    i.e., only for those days that the patient cannot be safely treated in a residential,

    community-based program.

    2. Make cash payments to intended recipients of health services.

    3. Purchase or improve land, purchase, construct or permanently improve any building or other

    facility, or purchase major medical equipment--unless the State has obtained a waiver from the

    Secretary of Health and Human Services.

    4. Satisfy any requirement for the expenditure of non-Federal funds as a condition for the receipt

    of Federal funds.

    5. Provide financial assistance to any entity other than a public or nonprofit entity, or to support

    any individual salary in excess of $125,000.00.

    6. All programs funded in whole or in part with SAPTBG funds shall certify they have not and will

    not use Federal funds to pay for lobbying activities.

    7. All programs funded in whole or in part with SAPTBG funds shall use such funds as a

    “payment of last resort” for services but, per North Carolina General Statute 122C-146, no

    individual may be refused services because of an inability to pay

    If expenditures are made for these purposes, funds in excess of federal block grant funds must be available.

    B. Allowable Cost/Cost Principles

    Certain expenditures are considered non-allowable and are not included in the cost allocation.

    These expenditures are shown in the Pioneer Funding System Operating Manual Volume IV:

    Fiscal Manual, Section 20.

    Funds must be expended or earned in accordance with the Performance Agreement between the

    Division of MH/DD/SAS and the Area Authority, including amendments via individual

    allocation letters.

    Guidelines can be found under the DMH/DD/SAS Crosscutting Requirements Supplement.

    C. Cash Management

    These funds are reimbursed based on the allocation of funds:

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    PERINATAL AND MATERNAL SUBSTANCE ABUSE INITIATIVE

    1- Funds are earned through Unit Cost Reimbursement via the Pioneer Funding System and/or

    Integrated Payment and Reporting System (IPRS) based on allowable activities provided by

    the entity receiving the funds; and/or

    2- Funds are settled on a reimbursement basis per cost of the allowable activities rendered. E. Eligibility

    Each program has admission requirements that can be verified by review of the approved grant proposal. In general, the following apply to most programs:

    1. These service are available to the following population in priority preference order

    a. Pregnant IV Drug User

    b. Pregnant Drug User

    c. All other women with dependent children 2. All of the programs in the Perinatal and Maternal Substance Abuse Initiative are Cross Area

    Service Programs that admit clients statewide. F. Equipment & Real Property Management

    Equipment Management

    Area programs should follow the state’s guidelines for Equipment Management when allocated one-time funds outside of the Unit Cost Reimbursement (UCR) System. Guidelines can be found under the DMHDDSAS Crosscutting Requirements Supplement.

    Real Property Management

    Not applicable at the local level.

    G. Matching, Level of Effort, Earmarking

    Matching

    There is no required match.

    Level of Effort Block grant funds allocated shall be used to supplement and increase the level of State, local and other non-federal funds and shall, in no event, supplant such State, local and other non-federal funds. This information is included in the Performance Agreement between the Division of MH/DD/SAS and each area programs and all subsequent allocation letters sent to the area programs.

    Earmarking These services are available to the following population in priority preference order: 1. Pregnant IV Drug User

    2. Pregnant Drug User

    3. All other women with dependent children

    This can be found in the Department of Health and Human Services,45 CFR Part 96, Interim Final Rule, 45 CFR 95.131.

    H. Period of Availability of Federal Funds

    Funds are available to Area Programs on a state fiscal year of July 1 through June 30.

    I. Procurement & Suspension & Debarment

    Follow procedures in DMH crosscutting supplement.

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    PERINATAL AND MATERNAL SUBSTANCE ABUSE INITIATIVE

    L. Reporting

    These funds are allocated as Special Categorical. Each area program is required to submit

    pioneer units of service and meet the special categorical funding requirements per the Pioneer

    Funding System Operating Manual Volume V: Reporting Requirements which includes a

    requirement for targeting of dollars to clients or services at a level of specificity which cannot be

    tracked by regular reporting through the Pioneer Funding System and/or IPRS system. Area

    Programs which receive Special Categorical Funds are required to submit additional reports to

    meet the special requirements as stated in the Pioneer Funding System Operating Manual

    Volume V: Reporting Requirements.

    M. Subrecipient Monitoring

    Monitoring is required if the agency disburses or transfers any State funds to other organizations,

    except for the purchase of goods or services, the grantee shall require such organizations to file

    with it similar reports and statements as required by G.S. 143-6.1 and the applicable prescribed

    requirements of the Office of the State Auditor’s Audit Advisory #2 (as revised October 1997)

    including its attachments. If the agency disburses or transfers any pass-through federal funds

    received from the State to other organizations, the agency shall require such organizations to

    comply with the applicable requirements of OMB Circular A-133.

    N. Special Test & Provisions

    Guidelines can be found under the DMH/DD/SAS Crosscutting Requirements Supplement.

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