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{"sheet":"Overview","index":1,"n_rows":24,"n_cols":2,"rows_kept":24,"cut":false,"hidden":false,"merged":[[2,0,2,1],[3,0,3,1],[4,0,4,1],[7,0,7,1],[14,0,14,1],[5,0,5,1]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["COST AND WAGE PROVIDER SURVEY - GENERAL INSTRUCTIONS OVERVIEW"]
["1. General Instructions"]
["This Cost and Wage Provider Survey (\"survey\") should be completed by Montana DPHHS providers who deliver services as part of Adult Behavioral Health, Child Mental Health, Substance Use Disorder, Developmental Disabilities, Senior and Long Term Care, and Case Management programs. \n\nThe survey includes six Worksheets, and each Worksheet includes questions that require responses from the providers and/or provider organizations (\"agency\", \"organization\").\n- Survey respondents should populate each yellow box, or response box, with an appropriate response. For descriptive or alternative responses in addition to selecting predetermined options, please enter information in the blue boxes marked \"(Specify)\".\n- The top section of each Worksheet highlights specific instructions for responses to the questions in the corresponding Worksheet.\n- Individual questions include in-line notes for clarity, and response boxes display notes to guide the survey respondent.\n- If a question is not applicable or information is not available, please respond with \"N/A\" or leave the response box blank, depending on the Worksheet instructions.\n\nProviders should use data from the time period noted in the individual worksheet instructions (e.g., Provider organization's fiscal year 2019, January 2022).\n\nSurvey template and instructions are available on https://clientsurvey.guidehouse.com/jfe/form/SV_enRYuZBkQXxlbsq. The Montana DPHHS Provider Cost and Wage Survey Instruction Manual provides instructions to assist with completion of the survey. Questions and requests for clarification may be sent to MT-DPHHS-Rates@guidehouse.com. Responses to inquiries will be sent within 1 business day."]
["2. Survey Submission"]
["Submit completed survey through the Guidehouse File Transfer system at https://share.guidehouse.com by Friday, March 4, 2022."]
["3. Survey Color Legend"]
["Color","Description"]
["Blue or White Cell","Cell or response box should be populated by provider organization."]
["Blue - \"(Specify)\"","Cell or response box should be populated by provider organization with descriptive or alternative responses."]
["Gray","Cell is autopopulated based on calculations or responses in other cells; cell should not be populated by provider organization."]
["Orange","Example data for illustrative and clarification purposes."]
["Green Text","Dates marked in green text specify the time period for the data requested in each Worksheet."]
["4. Survey Overview"]
["Worksheet","Sections & Topics"]
["Worksheet 1: Organization Information","Provider identification, contact information, organizational details, and organizational revenues"]
["Worksheet 2: Total Costs","Employee salaries, taxes and benefits, non-payroll administrative costs and program support costs, and facility, vehicle and equipment costs "]
["Worksheet 3: Program Area","Geographic areas where services are delivered"]
["Worksheet 4: Programs & Services","Programs operated and services delivered"]
["Worksheet 4a: Staffing Time & Wages","Staff types, hourly wages, supplemental pay, bonuses, rate increase, and training time"]
["Worksheet 4b: Staffing Patterns & Service Design","Billable vs Non-Billable, supervisor and staffing patterns, delivery time and frequency, training requirements, and other service design and delivery specifications"]
["Worksheet 5: Benefits","Benefits that organizations offer full-time and part-time employees who deliver services – health, vision and dental insurance, retirement, unemployment benefits and workers’ compensation, holiday, sick time, and paid time off"]
["Worksheet 6: Additional Information","Clarifying comments in addition to the information covered in other worksheets or sections"]

{"sheet":"1. Organizational Information","index":2,"n_rows":66,"n_cols":3,"rows_kept":66,"cut":false,"hidden":false,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 1: ORGANIZATIONAL INFORMATION"]
[{"$f":"\"Provider Name: \"&IF($C$10=\"\",\"\",$C$10)","v":"Provider Name: "}]
["Time Period for Data Requested: \nLines 1-29, 31-32: Provider organization's fiscal year 2019; \nLine 30: Provider Organization's fiscal year 2021"]
["Instruction Manual Pages: 10-12"]
["Enter your organizational information"]
["1. PROVIDER IDENTIFICATION"]
["Question Number","Question","Response"]
["1","Provider Corporate Name:"]
["2","Medicaid Provider ID (PID):"]
["3","National Provider Identifier (NPI):"]
["4","Additional Identification:"]
["5","Additional Identification:"]
["6","Additional Identification:"]
["7","Additional Identification:"]
["8","Are you owned by a larger organization or umbrella company?"]
["8a ","If yes, what is the name of that organization?"]
["9","City:"]
["10","County:"]
["11","Provider Fiscal Year (FY) beginning (MM/DD/YYYY):"]
["12","Provider Fiscal Year (FY) ending (MM/DD/YYYY):"]
["2. CONTACT INFORMATION"]
["13","Contact Name:"]
["14","Title: "]
["15","Phone Number:"]
["16","Email Address: "]
["3. ORGANIZATIONAL DETAILS"]
["17","Is this survey for Psychiatric Residential Treatment Facility (PRTF) services?"]
["18","Is this survey for all sites operated by your organization? (Only agencies offering Psychiatric Residential Treatment Facility (PRTF) services should submit a separate survey for each site. Additionally, agencies offering other services in addition to PRTF services should submit two separate surveys – one for the PRTF and a second for the other services. All other agencies should submit one survey for all sites.)"]
["19","Are you completing this survey for a particular site? (Applicable to PRTF providers only)"]
["19a","Please indicate the relevant site. (Applicable to PRTF providers only)"]
["20","How many residential sites does your organization operate?"]
["21","How many day program sites does your organization operate?"]
["22","Number of unduplicated active clients at end of fiscal year:"]
["23","Total number of employees",{"$f":"IF(SUM($C$37:$C$39)=0,\"\",SUM($C$37:$C$39))","v":""}]
["23a","Number of full-time employees at end of fiscal year:\n(30 or more hours per week or 130 or more hours per month)"]
["23b","Number of part-time employees at end of fiscal year:\n(Less than 30 hours/week or 130 hours/month)"]
["23c","Number of contracted employees at end of fiscal year:"]
["24","Are your employees covered by a union contract?"]
["25","Is your organization a Financial Management Agency?"]
["26","Do you provide self-directed services only?"]
["26a","If line 26 is 'Yes', please identify the number of individuals that receive self-directed services"]
["27","Where do you provide most of your services (rural/urban/suburban/all)?"]
["28","Do you serve in Montana's Tribal areas/jurisdictions? (Note: Tribal areas are defined as geographic areas; this question is not asking about serving clients of Tribal backgrounds)"]
["4. ORGANIZATIONAL REVENUES"]
["29","Report revenues from your agency's fiscal year 2019."]
["29a","Medicaid Waiver Program revenues"]
["29b","Medicaid State Plan revenues"]
["29c","Fundraising/Grants"]
["29d","National School Lunch revenue"]
["29e","Other revenues (private pay / SSI / other funding sources)"]
[null,"Total Revenues in 2019",{"$f":"SUM(C48:C52)","v":0}]
["30","Report revenues from your agency's fiscal year 2021."]
["30a","Medicaid Waiver Program revenues"]
["30b","Medicaid State Plan revenues"]
["30c","Fundraising/Grants"]
["30d","National School Lunch revenue"]
["30e","Other revenues (private pay / SSI / other funding sources)"]
[null,"Total Revenues ",{"$f":"SUM(C55:C59)","v":0}]
["31","Indicate with an \"X\" the type of entity which best describes your organization."]
["31a"," For-Profit"]
["31b"," Non-Profit"]
["31c"," Governmental"]
["NOTES OR CLARIFYING COMMENTS"]
["32"]

{"sheet":"2. Total Costs","index":3,"n_rows":75,"n_cols":11,"rows_kept":75,"cut":false,"hidden":false,"merged":[[5,0,5,10]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 2: TOTAL COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
["Time Period for Data Requested: Provider organization's fiscal year 2019"]
["Instruction Manual Pages: 12-19"]
["Report costs from your organization's fiscal year 2019"]
["DESCRIPTION",null,null,"Total Expenses Per General Ledger","Expenses Allocated to State Plan Program","Expenses Allocated to Waiver Program","Expenses for Room and Board","Expenses Allocated to Education","Expenses Allocated to Other Programs","Total Expenses Allocated to Medicaid","Total Expenses Allocated to Non-Medicaid"]
["1. EMPLOYEE SALARIES"]
["#","1. EMPLOYEE SALARIES","Optional/Other","Total Expenses Per General Ledger","Expenses Allocated to State Plan Program","Expenses Allocated to Waiver Program","Expenses for Room and Board","Expenses Allocated to Education","Expenses Allocated to Other Programs","Expenses Allocated to Medicaid","Expenses Allocated to Non-Medicaid"]
[1,"Total Direct Care Employee Salaries and Wages",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[2,"Total Direct Care Supervisor Salaries and Wages",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[3,"Total Maintenance Employee Salaries and Wages",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[4,"Total Administrative Employee Salaries and Wages",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[5,"Total Program Support Employee Salaries and Wages",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[6,"Total Salaries and Wages for Contracted Direct Care Staff",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[7,"Total Salaries and Wages for Contracted Program Support Staff",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[8,"Total Salaries and Wages for Contracted Administrative Staff",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[null,"Total Employee Salaries and Wages",null,{"$f":"SUM(D11:D18)","v":0},{"$f":"SUM(E11:E18)","v":0},0,0,0,0,0,0]
["2. EMPLOYEE TAXES AND BENEFITS"]
[9,"Total Employee Payroll Taxes",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[10,"Total Employee Health Insurance",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[11,"Total Other Insurance",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[12,"Total Employee Other Benefits",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[null,"Total Employee Taxes and Benefits",null,{"$f":"SUM(D21:D24)","v":0},{"$f":"SUM(E21:E24)","v":0},0,0,0,0,0,0]
["3. NON-PAYROLL ADMINISTRATIVE COSTS"]
[13,"Office Equipment and Furniture (not for direct care)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[14,"Interest Expense (report mortgage on Line 41)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[15,"Non-payroll Taxes",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[16,"Licensing/ Certification/ Accreditation Fees",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[17,"Hiring Expenses",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[18,"Staff Training and Development (administrative related)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[19,"Insurance (excluding benefits and auto insurance)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[20,"Information Technology Expense (e.g., computers and software)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[21,"Office Supplies",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[22,"Postage",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[23,"Advertising/Marketing",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[24,"Dues and Subscriptions",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[25,"Consulting - Training / Legal / Accounting/ Etc.",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[26,"Travel (excluding client transportation and direct care vehicles)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[27,"Cost for Translating Materials",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[28,"Bad Debt",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[29,"Corporate Office Overhead",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
["29a","If Overhead is reported, describe allocation methodology here","(Specify)"]
[30,"Other Administrative Costs","(Specify)",null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[31,"Other Administrative Costs","(Specify)",null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[32,"Other Administrative Costs","(Specify)",null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[null,"Total Non-Payroll Administrative Costs",null,{"$f":"SUM(D27:D43, D45:D47)","v":0},{"$f":"SUM(E27:E43, E45:E47)","v":0},0,0,0,0,0,0]
["4. NON-PAYROLL PROGRAM SUPPORT EXPENSES"]
[33,"Program Supplies",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[34,"Devices / Technology (direct care related)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[35,"Activity Costs (for direct care staff)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[36,"Staff Training and Development (direct care related)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[37,"Transportation Costs - Client related",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[38,"Other Program Support Costs","(Specify)",null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[39,"Other Program Support Costs","(Specify)",null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[40,"Other Program Support Costs","(Specify)",null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[null,"Total Non-Payroll Program Support Expenses",null,{"$f":"SUM(D50:D57)","v":0},0,0,0,0,0,0,0]
["5. FACILITY, VEHICLE, AND EQUIPMENT RELATED EXPENSES"]
[41,"Facility Rent / Mortgage",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[42,"Total Sq. Ft. of Facility","(Specify)",null,null,null,null,null,null,"-","-"]
[43,"Sq. Ft. of Admin Space","(Specify)",null,null,null,null,null,null,"-","-"]
[44,"Utilities / Telecommunications / Etc. (administrative)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[45,"Utilities / Telecommunications / Etc. (direct care facilities)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[46,"Building Maintenance and Repairs",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[47,"Facility Janitorial/ Landscaping/ Repairs/ Etc. (not part of rent)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[48,"Vehicle Licensing/ Acquisition/ Registration/ Lease Costs",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[49,"Vehicle Maintenance/ Repair Costs",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[50,"Vehicle Insurance",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[51,"Vehicle Depreciation",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[52,"Equipment Costs (non-administrative)",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[53,"Equipment Depreciation",null,null,null,null,null,null,null,{"$f":"IF('1. Organizational Information'!$C$29=\"Yes\",Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]]+Total_Costs_2[[#This Row],[Expenses for Room and Board]],Total_Costs_2[[#This Row],[Expenses Allocated to State Plan Program]]+Total_Costs_2[[#This Row],[Expenses Allocated to Waiver Program]])","v":0},{"$f":"Total_Costs_2[[#This Row],[Total Expenses Per General Ledger]]-Total_Costs_2[[#This Row],[Expenses Allocated to Medicaid]]","v":0}]
[null,"Total Facility, Vehicle and Equipment Related Expenses",null,{"$f":"SUM(D60:D72)","v":0},{"$f":"SUM(E60:E72)","v":0},0,0,0,0,0,0]
["6. TOTAL COSTS"]
[54,"Total Cost",null,{"$f":"SUM(D19,D25,D48,D58,D73)","v":0},{"$f":"SUM(E19,E25,E48,E58,E73)","v":0},0,0,0,0,0,0]

{"sheet":"3. Program Area","index":4,"n_rows":67,"n_cols":36,"rows_kept":67,"cut":false,"hidden":false,"merged":[[7,0,9,0],[7,1,9,1],[7,2,7,35],[8,2,9,2],[8,3,9,3],[8,4,8,18],[8,20,8,21],[8,28,8,34],[8,22,8,27]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 3: PROGRAM AREAS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
["Time Period for Data Requested: October 2021 - December 2021"]
["Instruction Manual Page: 19"]
["Indicate the counties where services under the following programs are provided by your organization."]
["Question","County","Programs (select applicable programs)"]
[null,null,"All Programs","All Program Checks","Adult Behavioral Health",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Children's Mental Health ",null,"Developmental Services",null,null,null,null,null,"Senior and Long Term Care"]
[null,null,null,null,"HCBS for Adults with Severe Disabling Mental Illness (SDMI)","HCBS for Adults with Severe Disabling Mental Illness (SDMI)","Medicaid Behavioral Health Targeted Case Management (MBH-TCM)","Medicaid Behavioral Health Targeted Case Management (MBH-TCM)","Medicaid Mental Health Services Individuals 18 years of age and older (MMHS)","Medicaid Mental Health Services Individuals 18 years of age and older (MMHS)","Non-Medicaid for Crisis Stabilization & Crisis Intervention and Response (NM-CSCI)","Non-Medicaid for Crisis Stabilization & Crisis Intervention and Response (MN-CSCI)","Substance Use Disorder (SUD) Medicaid Provider","Substance Use Disorder (SUD) Medicaid Provider","Substance Use Disorder (SUD) Non-Medicaid Provider","Substance Use Disorder (SUD) Non-Medicaid Provider","Substance Use Disorder (SUD) State Plan","Substance Use Disorder (SUD) State Plan","Other Targeted Case Management (Non Mental Health)","Targeted Case Management (Non Mental Health)","Medicaid Youth Mental Health","Medicaid Youth Mental Health","Developmental Disabilities Program (DDP) Waiver","Developmental Disabilities Program (DDP) Waiver","Medicaid Autism Treatment Services or Applied Behavioral Analysis Services (M-ATS)","Medicaid Autism Treatment Services (M-ATS)","Targeted Case Management (TCM-DD)","Targeted Case Management (TCM-DD)","Community First Choice (CFC) Services","Community First Choice (CFC/PAS) Services","Elderly and Physically Disabled - Big Sky Waiver (EPD - BSW)","Elderly and Physically Disabled - Big Sky Waiver","Personal Assistance Services (PAS)","Home Health Services (HHS)","Home Health Services (HHS)","Personal Assistance Services (PAS)"]
["Question","County","True Across All Programs","FALSE","HCBS for Adults with Severe Disabling Mental Illness (SDMI)","HCBS for Adults with Severe Disabling Mental Illness (SDMI)2","Medicaid Behavioral Health Targeted Case Management (MBH-TCM)","Medicaid Behavioral Health Targeted Case Management (MBH-TCM)3","Medicaid Mental Health Services Individuals 18 years of age and older (MMHS)","Medicaid Mental Health Services Individuals 18 years of age and older (MMHS)4","Non-Medicaid for Crisis Stabilization & Crisis Intervention and Response (MN-CSCI)","Non-Medicaid for Crisis Stabilization & Crisis Intervention and Response (MN-CSCI)5","Substance Use Disorder (SUD) Medicaid Provider","Substance Use Disorder (SUD) Medicaid Provider6","Substance Use Disorder (SUD) Non-Medicaid Provider","Substance Use Disorder (SUD) Non-Medicaid Provider7","Substance Use Disorder (SUD) State Plan","Substance Use Disorder (SUD) State Plan8","Targeted Case Management (Non Mental Health)","Targeted Case Management (Non Mental Health)9","Medicaid Youth Mental Health","Medicaid Youth Mental Health10","Developmental Disabilities Program (DDP) Waiver","Developmental Disabilities Program (DDP) Waiver11","Medicaid Autism Treatment Services or Applied Behavioral Analysis Services (M-ATS)","Medicaid Autism Treatment Services (M-ATS)","Targeted Case Management (TCM-DD)","Targeted Case Management (TCM-DD)12","Community First Choice (CFC) Services","Community First Choice (CFC/PAS) Services","Elderly and Physically Disabled - Big Sky Waiver (EPD - BSW)","Elderly and Physically Disabled - Big Sky Waiver","Personal Assistance Services (PAS)","Home Health Services (HHS)","Home Health Services (HHS)13","FALSE17"]
[1,"Beaverhead",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[2,"Big Horn",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[3,"Blaine",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[4,"Broadwater",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[5,"Carbon",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[6,"Carter",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[7,"Cascade",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[8,"Chouteau",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[9,"Custer",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[10,"Daniels",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[11,"Dawson",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[12,"Deer Lodge",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[13,"Fallon",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[14,"Fergus",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[15,"Flathead",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[16,"Gallatin",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[17,"Garfield",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[18,"Glacier",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[19,"Golden Valley",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[20,"Granite",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[21,"Hill",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[22,"Jefferson",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[23,"Judith Basin",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[24,"Lake County",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[25,"Lewis and Clark",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[26,"Liberty",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[27,"Lincoln",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[28,"Madison",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[29,"McCone",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[30,"Meagher",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[31,"Mineral",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[32,"Missoula",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[33,"Musselshell",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[34,"Park",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[35,"Petroleum",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[36,"Phillips",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[37,"Pondera",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[38,"Powell ",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[39,"Powder River",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[40,"Prairie",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[41,"Ravalli",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[42,"Richland",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[43,"Roosevvelt",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[44,"Rosebud",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[45,"Sanders",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[46,"Sheridan",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[47,"Silver Bow",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[48,"Stillwater",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[49,"Sweet Grass",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[50,"Teton",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[51,"Toole",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[52,"Treasure",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[53,"Valley",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[54,"Wheatland",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[55,"Wibaux",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]
[56,"Yellowstone",null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false,null,false]

{"sheet":"4. Programs & Services","index":5,"n_rows":107,"n_cols":24,"rows_kept":107,"cut":false,"hidden":false,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4: PROGRAMS AND SERVICES"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 20-21, 77-85"]
["Indicate the services provided by your organization (check all appropriate boxes). Organizations may need to complete additional service-specific Worksheets based on services selected below."]
["Adult Behavioral Health",null,null,null,null,null,"Children's Mental Health (CMH)"]
["HCBS for Adults with Severe Disabling Mental Illness (HCBS-SDMI)",null,null,null,null,null,"Community-based Psychiatric Rehabilitation & Support (CBPRS)",null,false,"mental_health","CMH)"]
["Adult Day Care",null,false,"day_service","HCBS-SDMI)",null,"Comprehensive School and Community Treatment (CSCT)",null,false,"mental_health","CMH)"]
["Behavioral Intervention Assistant ",null,false,"mental_health","HCBS-SDMI)",null,"Extraordinary Needs Aide Services",null,false,"hcbs","CMH)"]
["Case Management",null,false,"case_mgmt","HCBS-SDMI)",null,"Home Support Services",null,false,"home_based","CMH)"]
["Consultative Clinical and Therapeutic Services",null,false,"therapy","HCBS-SDMI)",null,"Partial Hospitalization",null,false,"sud_hosp","CMH)"]
["Homemaker Chores",null,false,"home_based","HCBS-SDMI)",null,"Permanency Therapeutic Foster Care",null,false,"therapy","CMH)"]
["Life Coach",null,false,"supported_employment","HCBS-SDMI)",null,"Psychiatric Residential Treatment Facility (PRTF)",null,false,"prtf","CMH)"]
["Meal Services (Nutrition)",null,false,"meals","HCBS-SDMI)",null,"Respite Care",null,false,"respite","CMH)"]
["Pain and Symptom Management",null,false,"therapy","HCBS-SDMI)",null,"Shelter Care",null,false,"hcbs","CMH)"]
["Personal Assistance Attendant Agency",null,false,"home_based","HCBS-SDMI)",null,"Therapeutic Foster Care",null,false,"hcbs","CMH)"]
["Personal Assistance Attendant/Oversight Self-directed",null,false,"home_based","HCBS-SDMI)",null,"Therapeutic Group Home",null,false,"hcbs","CMH)"]
["Private Duty Nursing ",null,false,"nursing","HCBS-SDMI)",null,"Targeted Case Management - SED",null,false,"case_mgmt","CMH)"]
["Residential Habilitation – Adult Group Home",null,false,"hcbs","HCBS-SDMI)",null,"Youth Day Treatment",null,false,"mental_health","CMH)"]
["Residential Habilitation – Mental Health Group Home",null,false,"hcbs","HCBS-SDMI)",null,null,null,null,null,""]
["Residential Habilitation – Intensive Mental Health Group Home",null,false,"hcbs","HCBS-SDMI)",null,"Senior and Long Term Care",null,null,null,""]
["Residential Habilitation – Assisted Living Facilities and Adult Foster Homes",null,false,"hcbs","HCBS-SDMI)",null,"Community First Choices / Personal Attendant Services (CFC/PAS)",null,null,null,""]
["Respite Care",null,false,"respite","HCBS-SDMI)",null,"Community Supports",null,false,"home_based","CFC/PAS)"]
["Specialized Nursing Services",null,false,"nursing","HCBS-SDMI)",null,"Personal Assistance Services Agency",null,false,"home_based","CFC/PAS)"]
["Supported Employment (all SE services)",null,false,"supported_employment","HCBS-SDMI)",null,"Personal Assistance Services Self-Directed",null,false,"home_based","CFC/PAS)"]
["Transportation",null,false,"transport","HCBS-SDMI)",null,"Medical Escorts",null,false,"home_based","CFC/PAS)"]
[null,null,null,null,null,null,"Specially Trained Attendant",null,false,"home_based","CFC/PAS)"]
["Medicaid Behavioral Health Targeted Case Management (MBH-TCM)",null,null,null,null,null,"Transportation",null,false,"transport","CFC/PAS)"]
["Targeted Case Management",null,false,"case_mgmt","MBH-TCM)",null,null,null,null,null,""]
[null,null,null,null,null,null,"Home Health Services (HHS)",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," "]
["Medicaid Mental Health Services Individuals 18 years of age and older (MMHS)",null,null,null,null,null,"Physical Therapy",null,false,"therapy","HHS)"]
["Adult Foster Care",null,false,"hcbs","MMHS)",null,"Occupational Therapy",null,false,"therapy","HHS)"]
["Behavioral Group Home",null,false,"hcbs","MMHS)",null,"Speech Therapy",null,false,"therapy","HHS)"]
["Community-based Psychiatric Rehabilitation & Support",null,false,"mental_health","MMHS)",null,"Skilled Nursing",null,false,"nursing","HHS)"]
["Crisis Stabilization",null,false,"mental_health","MMHS)",null,"Home Health Aide",null,false,"home_based","HHS)"]
["Day Treatment",null,false,"day_service","MMHS)"]
["Dialectical Behavior Therapy",null,false,"therapy","MMHS)",null,"Elderly and Physically Disabled - Big Sky Waiver (EPD-BSW)",null,null,null,""]
["Illness Management",null,false,"therapy","MMHS)",null,"Adult Day Care",null,false,"day_service","EPD-BSW)"]
["Intensive Psychotherapy Services",null,false,"mental_health","MMHS)",null,"Community Residential Rehabilitation",null,false,"hcbs","EPD-BSW)"]
["MACT",null,false,"mental_health","MMHS)",null,"Community Supports Services",null,false,"home_based","EPD-BSW)"]
["InPACT",null,false,"sud_hosp","MMHS)",null,"Comprehensive Day Treatment",null,false,"therapy","EPD-BSW)"]
["PACT",null,false,"sud_hosp","MMHS)",null,"Day Habilitation",null,false,"day_service","EPD-BSW)"]
["PACT Community Maintenance Program",null,false,"sud_hosp","MMHS)",null,"Special Child Care for Children",null,false,"day_service","EPD-BSW)"]
["Partial Hospitalization",null,false,"sud_hosp","MMHS)",null,"Consultative Clinic and Therapeutic Services",null,false,"therapy","EPD-BSW)"]
["Peer Supports",null,false,"mental_health","MMHS)",null,"Family Training and Support",null,false,"training","EPD-BSW)"]
[null,null,null,null,null,null,"Financial Manager for Self-Directed",null,false,"self_direct","EPD-BSW)"]
["Non-Medicaid 72 Hour Presumptive Eligibility Program for Crisis Stabilization &",null,null,null,null,null,"Homemaker",null,false,"home_based","EPD-BSW)"]
["Crisis Intervention and Response Individuals 18 years of age and older (NM-CSCI)",null,null,null,null,null,"Homemaker Chores",null,false,"home_based","EPD-BSW)"]
["Care Coordination",null,false,"case_mgmt","NM-CSCI)",null,"Nutrition Classes (Nutritionalist)",null,false,"therapy","EPD-BSW)"]
["Crisis Management",null,false,"mental_health","NM-CSCI)",null,"Nutritional Counseling (Dietician)",null,false,"therapy","EPD-BSW)"]
["Community-based Psychiatric Rehabilitation & Support",null,false,"mental_health","NM-CSCI)",null,"Prevocational Services",null,false,"supported_employment","EPD-BSW)"]
[null,null,null,null,null,null,"Residential Habilitation – Assisted Living Facilities and Adult Foster Homes             ",null,false,"hcbs","EPD-BSW)"]
["Substance Use Disorder Medicaid Provider (SUD-M)",null,null,null,null,null,"Residential Habilitation – Group Home (for Adults with Physical Disabilities)           ",null,false,"hcbs","EPD-BSW)"]
["Medication-Assisted Treatment",null,false,"mental_health","SUD-M)",null,"Residential Habilitation – Specialized Assisted Living Facilities (TBI/AR) ",null,false,"hcbs","EPD-BSW)"]
["Intensive Outpatient",null,false,"sud_hosp","SUD-M)",null,"Respite Care",null,false,"respite","EPD-BSW)"]
["Partial Hospitalization (ASAM 2.5)",null,false,"sud_hosp","SUD-M)",null,"Supported Employment (all SE services and Prevocational)",null,false,"supported_employment","EPD-BSW)"]
["Clinically Managed High-Intensity Adult/ Medium-Intensity Adolescent (ASAM 3.5)",null,false,"sud_hosp","SUD-M)",null,"Independence Advisor for Self-Directed",null,false,"self_direct","EPD-BSW)"]
["Medically Monitored Intensive Inpatient (ASAM 3.7)",null,false,"sud_hosp","SUD-M)",null,"Meal Services (Nutrition)",null,false,"meals","EPD-BSW)"]
["Peer Support",null,false,"mental_health","SUD-M)",null,"Pain and Symptom Management",null,false,"therapy","EPD-BSW)"]
[null,null,null,null,null,null,"Personal Assistance Services Agency",null,false,"home_based","EPD-BSW)"]
["Substance Use Disorder Non-Medicaid Provider (SUD-NM)",null,null,null,null,null,"Personal Assistance Services Self-Directed",null,false,"home_based","EPD-BSW)"]
["Case Consultation",null,false,"mental_health","SUD-NM)",null,"Private Duty Nursing",null,false,"nursing","EPD-BSW)"]
["Clinically Managed High-Intensity Adult/ Medium-Intensity Adolescent (ASAM 3.5)",null,false,"sud_hosp","SUD-NM)",null,"Registered Nurse Supervision",null,null,"nursing","EPD-BSW)"]
["Clinically Managed Low Intensity Room and Board (ASAM 3.1)",null,false,"sud_hosp","SUD-NM)",null,"Specialized Nursing Services",null,false,"nursing","EPD-BSW)"]
["Clinically Managed Low Intensity Women/Children Room and Board (ASAM 3.1) ",null,false,"sud_hosp","SUD-NM)",null,"Specially Trained Attendant - LPN/RN",null,false,"nursing","EPD-BSW)"]
["Medically Monitored Intensive Inpatient (ASAM 3.7)",null,false,"sud_hosp","SUD-NM)",null,"Senior Companion",null,false,"home_based","EPD-BSW)"]
["Partial Hospitalization (ASAM 2.5)",null,false,"sud_hosp","SUD-NM)",null,"Supported Living",null,false,"hcbs","EPD-BSW)"]
["Medication Assisted Therapy / Treatment",null,false,"mental_health","SUD-NM)",null,"Case Management",null,false,"case_mgmt","EPD-BSW)"]
["Intensive Outpatient",null,false,"sud_hosp","SUD-NM)",null,"Transportation",null,false,"transport","EPD-BSW)"]
["Peer Support",null,false,"mental_health","SUD-NM)",null,null,null,null,null,""]
["Psychosocial Rehabilitation",null,false,"mental_health","SUD-NM)",null,"Developmental Services",null,null,null,""]
["School Based Services",null,false,"day_service","SUD-NM)",null,"Developmental Disabilities Program (DD)",null,null,null,""]
[null,null,null,null,null,null,"Adult Foster Support",null,false,"hcbs","DD)"]
["Other Targeted Case Management (TCM-OTHER)",null,null,null,null,null,"Assisted Living",null,false,"hcbs","DD)"]
["Case Management for High Risk Pregnant Women",null,false,"case_mgmt","TCM-OTHER)",null,"Behavioral Support Services",null,false,"mental_health","DD)"]
["Case Management for Children and Youth with Special Health Needs",null,false,"case_mgmt","TCM-OTHER)",null,"Caregiver Training and Support",null,false,"training","DD)"]
[null,null,null,null,null,null,"Companion",null,false,"home_based","DD)"]
[null,null,null,null,null,null,"Congregate Living",null,false,"hcbs","DD)"]
[null,null,null,null,null,null,"Day Supports",null,false,"day_service","DD)"]
[null,null,null,null,null,null,"Fiscal Agent Admin for Self-Directed",null,false,"self_direct","DD)"]
[null,null,null,null,null,null,"Homemaker",null,false,"home_based","DD)"]
[null,null,null,null,null,null,"Meal Services (Home Delivered Meals)",null,false,"meals","DD)"]
[null,null,null,null,null,null,"Nutritionist Services ",null,false,"therapy","DD)"]
[null,null,null,null,null,null,"Personal Care",null,false,"home_based","DD)"]
[null,null,null,null,null,null,"Private Duty Nursing",null,false,"nursing","DD)"]
[null,null,null,null,null,null,"Psychological Services",null,false,"mental_health","DD)"]
[null,null,null,null,null,null,"Supported Living",null,false,"hcbs","DD)"]
[null,null,null,null,null,null,"Residential Training Support",null,false,"hcbs","DD)"]
[null,null,null,null,null,null,"Respite Care",null,false,"respite","DD)"]
[null,null,null,null,null,null,"Retirement Services",null,false,"day_service","DD)"]
[null,null,null,null,null,null,"Remote Monitoring",null,false,"hcbs","DD)"]
[null,null,null,null,null,null,"Supported Employment (all SE services)",null,false,"supported_employment","DD)"]
[null,null,null,null,null,null,"Supports Broker for Self-Directed",null,false,"self_direct","DD)"]
[null,null,null,null,null,null,"Transportation",null,false,"transport","DD)"]
[null,null,null,null,null,null,"Medicaid Autism Treatment Services or Applied Behavioral Analysis Services (M-ATS)",null,null,null,""]
[null,null,null,null,null,null,"Adaptive Behavior Treatment",null,false,"mental_health","M-ATS)"]
[null,null,null,null,null,null,"Behavior Identification Assessment / Supporting Assessment",null,false,"mental_health","M-ATS)"]
[null,null,null,null,null,null,"Group Intensive Treatment",null,false,"mental_health","M-ATS)"]
[null,null,null,null,null,null,"Parent / Guardian Training",null,false,"training","M-ATS)"]
[null,null,null,null,null,null,"Targeted Case Management (TCM-DD)",null,null,null,""]
[null,null,null,null,null,null,"Targeted Case Management",null,false,"case_mgmt","TCM-DD)"]
[]
[]
[]
["x","x","x","x","x","x","x","x","x","x","x","x"]

{"sheet":"4a. Respite & Support - Time","index":6,"n_rows":62,"n_cols":31,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,22,8,30],[8,15,8,17],[8,21,9,21],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,18,8,20],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: RESPITE & CAREGIVER SUPPORT - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Non Medicaid Respite Care - Youth \n(CMH)","Respite \n(DD)","Respite Care \n(EPD-BSW)","Respite Care \n(HCBS-SDMI)","Respite Care - Assisted Living \n(HCBS-SDMI)","Respite Care - Assisted Living and Adult Foster Care \n(EPD-BSW)","Respite Care - Hospital \n(EPD-BSW)","Respite Care - Nursing Facility \n(EPD-BSW)","Respite Care - Nursing Facility \n(HCBS-SDMI)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor? (Employee, Contractor, N/A)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Non Medicaid Respite Care - Youth \n(CMH)","Respite \n(DD)","Respite Care \n(EPD-BSW)","Respite Care \n(HCBS-SDMI)","Respite Care - Assisted Living \n(HCBS-SDMI)","Respite Care - Assisted Living and Adult Foster Care \n(EPD-BSW)","Respite Care - Hospital \n(EPD-BSW)","Respite Care - Nursing Facility \n(EPD-BSW)","Respite Care - Nursing Facility \n(HCBS-SDMI)"]
["Example","Direct Service Professional - Daytime",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.01,0.01,1.4999999999999999E-2,10,"x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Respite_4a[[#This Row],[Total Regular Hours Paid]]+Respite_4a[[#This Row],[Total Overtime Hours Paid]]+Respite_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Respite & Support - Pattern","index":7,"n_rows":41,"n_cols":12,"rows_kept":41,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: RESPITE & CAREGIVER SUPPORT - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 32-34"]
["Line","Factor","Example","Non Medicaid Respite Care - Youth \n(CMH)","Respite \n(DD)","Respite Care \n(EPD-BSW)","Respite Care \n(HCBS-SDMI)","Respite Care - Assisted Living \n(HCBS-SDMI)","Respite Care - Assisted Living and Adult Foster Care \n(EPD-BSW)","Respite Care - Hospital \n(EPD-BSW)","Respite Care - Nursing Facility \n(EPD-BSW)","Respite Care - Nursing Facility \n(HCBS-SDMI)"]
["1. AGENCY CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Question","Example","Non Medicaid Respite Care - Youth \n(CMH)","Respite \n(DD)","Respite Care \n(EPD-BSW)","Respite Care \n(HCBS-SDMI)","Respite Care - Assisted Living \n(HCBS-SDMI)","Respite Care - Assisted Living and Adult Foster Care \n(EPD-BSW)","Respite Care - Hospital \n(EPD-BSW)","Respite Care - Nursing Facility \n(EPD-BSW)","Respite Care - Nursing Facility \n(HCBS-SDMI)"]
[1,"Number of individuals receiving each service from your organization",20]
[2,"Average number of visits per week per direct service staff worker",10]
[3,"Average visit length in hours",3]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[4,"Total cost of capital equipment purchased to perform services",500]
[5,"Average life (in years) of equipment purchased",2]
[6,"If costs are listed in Line 4, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[7,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[8,"If costs are listed in Line 7, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[9,"Client-facing service delivery",30]
[10,"Recordkeeping and documentation for services",1]
[11,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",2]
[12,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",3]
[13,"Travel time to/from and between client residences/locations",4]
[14,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[15,"Other activities",0]
[16,"Total hours worked and paid for in a week",40]
[17,"Autopopulated: Has all time been allocated? (Total in Line 16 should equal sum of Lines 9-15)",{"$f":"IF(SUM(C21:C27)=C28,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D21:D27)=40,\"Yes\",\"No\")","v":"No"},"No","No","No","No","No","No","No","No"]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[18,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[19,"How many individuals on average are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[20,"Number of training hours received by staff in their first year of employment",40]
[21,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[22,"Is non-medical transportation required for this service?","Yes"]
["22a","Is client transportation bundled into the service? [Respond if Line 22 is marked as 'Yes]","Yes"]
[23,"Is non-medical staff transportation required for this service?","Yes"]
["23a","Is staff client transportation bundled into the service? [Respond if Line 23 is marked as 'Yes]","Yes"]

{"sheet":"4a. Case Management - Time","index":8,"n_rows":62,"n_cols":36,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,22,8,35],[8,12,9,12],[8,13,9,13],[8,14,9,14],[8,15,8,17],[8,21,9,21],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,18,8,20],[8,10,9,10],[8,11,9,11]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: CASE MANAGEMENT - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 34-35"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Care Coordination (NM-CSCI)","Case Management (HCBS-SDMI)","Case Management (EPD-BSW)","Case Management plus Supported Living Coordination \n(EPD-BSW)","Targeted Case Management for Children and Youth with Special Health Care Needs \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nurse \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nutritionist \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Social Worker \n(TCM-OTHER)","Targeted Case Management -Adult \n(MBH-TCM)","Targeted Case Management - Substance Use Disorders \n(MBH-TCM)","Targeted Case Management - Youth \n(MBH-TCM)","Targeted Case Management - Youth Frontier Differential \n(MBH-TCM)","Targeted Case Management - SED (CMH)","Targeted Case Management\n (TCM-DD)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Column6","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Care Coordination (NM-CSCI)","Case Management (HCBS-SDMI)","Case Management (EPD-BSW)","Case Management plus Supported Living Coordination \n(EPD-BSW)","Targeted Case Management for Children and Youth with Special Health Care Needs \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nurse \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nutritionist \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Social Worker \n(TCM-OTHER)","Targeted Case Management -Adult \n(MBH-TCM)","Targeted Case Management - Substance Use Disorders \n(MBH-TCM)","Targeted Case Management - Youth \n(MBH-TCM)","Targeted Case Management - Youth Frontier Differential \n(MBH-TCM)","Targeted Case Management - SED (CMH)","Targeted Case Management\n (TCM-DD)"]
["Example","Case Manager",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.01,0.01,0.01,10,"x","x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Case_Management_4a[[#This Row],[Total Regular Hours Paid]]+Case_Management_4a[[#This Row],[Total Overtime Hours Paid]]+Case_Management_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Case Management - Patterns","index":9,"n_rows":41,"n_cols":17,"rows_kept":41,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: CASE MANAGEMENT - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 35-37"]
["Line","Factor","Example","Care Coordination (NM-CSCI)","Case Management (HCBS-SDMI)","Case Management (EPD-BSW)","Case Management plus Supported Living Coordination \n(EPD-BSW)","Targeted Case Management for Children and Youth with Special Health Care Needs \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nurse \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nutritionist \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Social Worker \n(TCM-OTHER)","Targeted Case Management -Adult \n(MBH-TCM)","Targeted Case Management - Substance Use Disorders \n(MBH-TCM)","Targeted Case Management - Youth \n(MBH-TCM)","Targeted Case Management - Youth Frontier Differential \n(MBH-TCM)","Targeted Case Management - SED (CMH)","Targeted Case Management\n (TCM-DD)"]
["1. AGENCY CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Factor","Example","Care Coordination (NM-CSCI)","Case Management (HCBS-SDMI)","Case Management (EPD-BSW)","Case Management plus Supported Living Coordination \n(EPD-BSW)","Targeted Case Management for Children and Youth with Special Health Care Needs \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nurse \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Nutritionist \n(TCM-OTHER)","Targeted Case Management for High Risk Pregnant Women - Services provided by the Social Worker \n(TCM-OTHER)","Targeted Case Management -Adult \n(MBH-TCM)","Targeted Case Management - Substance Use Disorders \n(MBH-TCM)","Targeted Case Management - Youth \n(MBH-TCM)","Targeted Case Management - Youth Frontier Differential \n(MBH-TCM)","Targeted Case Management - SED (CMH)","Targeted Case Management\n (TCM-DD)"]
[1,"Number of individuals receiving each service from your organization",20]
[2,"Average caseload per case manager",35]
[3,"Average number of hours spent with each client per day",2]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[4,"Total cost of capital equipment purchased to perform services",500]
[5,"Average life (in years) of equipment purchased",2]
[6,"If costs are listed in Line 4, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[7,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[8,"If costs are listed in Line 7, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[9,"Client-facing service delivery",30]
[10,"Recordkeeping and documentation for services",1]
[11,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",2]
[12,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",3]
[13,"Travel time to/from and between client residences/locations",4]
[14,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[15,"Other activities",0]
[16,"Total hours worked for in a week",40]
[17,"Autopopulated: Has all time been allocated? (Total in Line 16 should equal sum of Lines 9-15)",{"$f":"IF(C28<>\"\",IF(SUM(C21:C27)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D28<>\"\",IF(SUM(D21:D27)=40,\"Yes\",\"No\"),\"\")","v":""},{"$f":"IF(E28<>\"\",IF(SUM(E21:E27)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","","","","","","","","",""]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[18,"How many case managers or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[19,"How many individuals on average are typically served by one case manager or practitioner?",1]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[20,"Number of training hours received by case managers in their first year of employment",40]
[21,"Number of training hours received annually by case managers after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[22,"Is client transportation required for this service?","Yes"]
["22a","Is client transportation bundled into the service? [Respond if Line 22 is marked as 'Yes]","Yes"]
[23,"Is staff transportation required for this service?","Yes"]
["23a","Is staff client transportation bundled into the service? [Respond if Line 23 is marked as 'Yes]","Yes"]

{"sheet":"4a. Day - Time","index":10,"n_rows":62,"n_cols":30,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,18,8,20],[8,21,9,21],[8,22,8,29],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14],[8,15,8,17]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: DAY SERVICES - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: Lines October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 37"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Adult Day Care \n(EPD-BSW)","Adult Day Care \n(HCBS-SDMI)","Day Habilitation \n(EPD-BSW)","Day Supports and Activities \n(DD)","Day Treatment - \nAdult Half Day \n(MMHS)","Retirement Services \n(DD)","School Based Services \n(SUD-NM)","Special Child Care \nfor Children \n(EPD-BSW)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Column6","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Adult Day Care \n(EPD-BSW)","Adult Day Care \n(HCBS-SDMI)","Day Habilitation \n(EPD-BSW)","Day Supports and Activities \n(DD)","Day Treatment - \nAdult Half Day \n(MMHS)","Retirement Services \n(DD)","School Based Services \n(SUD-NM)","Special Child Care \nfor Children \n(EPD-BSW)"]
["Example","Internal Service Coordinators",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.02,0.02,0.02,20,"x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Day_4a[[#This Row],[Total Regular Hours Paid]]+Day_4a[[#This Row],[Total Overtime Hours Paid]]+Day_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Day - Patterns","index":11,"n_rows":42,"n_cols":11,"rows_kept":42,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: DAY SERVICES - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 37-40"]
["Line","Factor","Example","Adult Day Care \n(EPD-BSW)","Adult Day Care \n(HCBS-SDMI)","Day Habilitation \n(EPD-BSW)","Day Supports and Activities \n(DD)","Day Treatment - \nAdult Half Day \n(MMHS)","Retirement Services \n(DD)","School Based Services \n(SUD-NM)","Special Child Care \nfor Children \n(EPD-BSW)"]
["1. SERVICE CHARACTERISTICS"]
["Line","Question","Example","Adult Day Care \n(EPD-BSW)","Adult Day Care \n(HCBS-SDMI)","Community Supports Services \n(EPD-BSW)","Community Supports Services \n(PAS)","Comprehensive Day Treatment \n(EPD-BSW)","Day Habilitation \n(EPD-BSW)","Day Supports and Activities \n(DD)","Day Treatment - Adult Half Day \n(MMHS)"]
[1,"Number of individuals receiving day services from your organization",20]
[2,"Are services offered in individual and/or group settings?","Group"]
[3,"Site for delivering day services (Facility, Community, Both)","Facility"]
[4,"Average number of zero occupancy days per year",3.75]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[5,"Total cost of capital equipment purchased to perform services",500]
[6,"Average life (in years) of equipment purchased",2]
[7,"If costs are listed in Line 5, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[8,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[9,"If costs are listed in Line 8, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[10,"Client-facing service delivery",30]
[11,"Recordkeeping and documentation for services",4]
[12,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[13,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[14,"Travel time to/from and between client residences/locations",0]
[15,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[16,"Other activities",0]
[17,"Total hours worked for in a week",40]
[18,"Autopopulated: Has all time been allocated? (Total in Line 17 should equal sum of Lines 10-16)",{"$f":"IF(C29<>\"\",IF(SUM(C22:C28)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D29<>\"\",IF(SUM(D22:D28)=40,\"Yes\",\"No\"),\"\")","v":""},"",{"$f":"IF(F29<>\"\",IF(SUM(F22:F28)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","",""]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[19,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[20,"How many individuals on average are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[21,"Number of training hours received by staff in their first year of employment",40]
[22,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[23,"Is client non-medical transportation required for this service?","Yes"]
["23a","Is client transportation bundled into the service? [Respond if Line 23 is marked as 'Yes]","Yes"]
[24,"Is staff non-medical transportation required for this service?","Yes"]
["24a","Is staff client transportation bundled into the service? [Respond if Line 24 is marked as 'Yes]","Yes"]

{"sheet":"4a. Home-Based - Time","index":12,"n_rows":62,"n_cols":45,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,14,9,14],[8,15,8,17],[8,21,9,21],[8,22,8,44],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,18,8,20],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: HOME-BASED SERVICES - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 40"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Companion \n(DD)","Community Supports Services \n(CFC/PAS)","Community Supports Services \n(EPD-BSW)","Homemaker \n(DD)","Homemaker \n(EPD-BSW)","Homemaker Chores (EPD-BSW)","Homemaker Chores (HCBS-SDMI)","Homemaker Other (DD)","Medical Escort \n(CFC/PAS)","Personal Assistance Attendant \n(HCBS-SDMI)","Personal Assistance Attendant - Agency-Based \n(EPD-BSW)","Personal Assistance Attendant - Per Day (EPD-BSW)","Personal Assistance Attendant - Self-Directed\n (HCBS-SDMI)","Personal Assistance Attendant - Self-Directed \n(EPD-BSW)","Personal Assistance Nurse Supervision - Agency-Based \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(HCBS-SDMI)","Personal Assistance Services \n(CFC/PAS)","Personal Care \n(DD)","Self-Directed Personal Assistance Services \n(CFC/PAS)","Senior Companion (EPD-BSW)","Specially Trained Attendant \n(CFC/PAS)","Home Health Aide  (HHS)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Companion \n(DD)","Community Supports Services \n(CFC/PAS)","Community Supports Services \n(EPD-BSW)","Homemaker \n(DD)","Homemaker \n(EPD-BSW)","Homemaker Chores (EPD-BSW)","Homemaker Chores (HCBS-SDMI)","Homemaker Other (DD)","Medical Escort \n(CFC/PAS)","Personal Assistance Attendant \n(HCBS-SDMI)","Personal Assistance Attendant - Agency-Based \n(EPD-BSW)","Personal Assistance Attendant - Per Day (EPD-BSW)","Personal Assistance Attendant - Self-Directed\n (HCBS-SDMI)","Personal Assistance Attendant - Self-Directed \n(EPD-BSW)","Personal Assistance Nurse Supervision - Agency-Based \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(HCBS-SDMI)","Personal Assistance Services \n(CFC/PAS)","Personal Care \n(DD)","Self-Directed Personal Assistance Services \n(CFC/PAS)","Senior Companion (EPD-BSW)","Specially Trained Attendant \n(CFC/PAS)","Column1"]
["Example","Direct Service Professional - Daytime",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.01,0.01,0.04,5,"x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Home_Based_4a[[#This Row],[Total Regular Hours Paid]]+Home_Based_4a[[#This Row],[Total Overtime Hours Paid]]+Home_Based_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Home-Based - Patterns","index":13,"n_rows":42,"n_cols":26,"rows_kept":42,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: HOME-BASED SERVICES - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 41-43"]
["Line","Factor","Example","Companion (DD)","Community Supports Services (CFC/PAS)","Community Supports Services (EPD-BSW)","Homemaker \n(DD)","Homemaker \n(EPD-BSW)","Homemaker Chores (EPD-BSW)","Homemaker Chores (HCBS-SDMI)","Homemaker Other (DD)","Medical Escort \n(CFC/PAS)","Personal Assistance Attendant \n(HCBS-SDMI)","Personal Assistance Attendant - Agency-Based \n(EPD-BSW)","Personal Assistance Attendant - Per Day (EPD-BSW)","Personal Assistance Attendant - Self-Directed\n (HCBS-SDMI)","Personal Assistance Attendant - Self-Directed \n(EPD-BSW)","Personal Assistance Nurse Supervision - Agency-Based \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(HCBS-SDMI)","Personal Assistance Services \n(CFC/PAS)","Personal Care \n(DD)","Self-Directed Personal Assistance Services \n(CFC/PAS)","Senior Companion (EPD-BSW)","Specially Trained Attendant \n(CFC/PAS)","Home Health Aide (HHS)"]
["1. AGENCY CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Question","Example","Companion (DD)","Community Supports Services (CFC/PAS)","Community Supports Services (EPD-BSW)","Homemaker \n(DD)","Homemaker \n(EPD-BSW)","Homemaker Chores (EPD-BSW)","Homemaker Chores (HCBS-SDMI)","Homemaker Other (DD)","Medical Escort \n(CFC/PAS)","Personal Assistance Attendant \n(HCBS-SDMI)","Personal Assistance Attendant - Agency-Based \n(EPD-BSW)","Personal Assistance Attendant - Per Day (EPD-BSW)","Personal Assistance Attendant - Self-Directed\n (HCBS-SDMI)","Personal Assistance Attendant - Self-Directed \n(EPD-BSW)","Personal Assistance Nurse Supervision - Agency-Based \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(EPD-BSW)","Personal Assistance Oversight - Self-Directed \n(HCBS-SDMI)","Personal Assistance Services \n(CFC/PAS)","Personal Care \n(DD)","Self-Directed Personal Assistance Services \n(CFC/PAS)","Senior Companion (EPD-BSW)","Specially Trained Attendant \n(CFC/PAS)","Specially Trained Attendant \n(EPD-BSW)2"]
[1,"Number of individuals receiving each service from your organization",20]
[2,"Are services offered in an individual or group setting?","Individual"]
[3,"Average number of visits per week per direct service staff worker",35]
[4,"Average visit length in hours",3.75]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[5,"Total cost of capital equipment purchased to perform services",500]
[6,"Average life (in years) of equipment purchased",2]
[7,"If costs are listed in Line 5, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[8,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[9,"If costs are listed in Line 8, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[10,"Client-facing service delivery",30]
[11,"Recordkeeping and documentation for services",4]
[12,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[13,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[14,"Travel time to/from and between client residences/locations",0]
[15,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[16,"Other activities",0]
[17,"Total hours worked for in a week",40]
[18,"Autopopulated: Has all time been allocated? (Total in Line 17 should equal sum of Lines 10-16)",{"$f":"IF(C29<>\"\",IF(SUM(C22:C28)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D29<>\"\",IF(SUM(D22:D28)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","","","","","","","","","","","","","","","","","","",{"$f":"IF(Z29<>\"\",IF(SUM(Z22:Z28)=40,\"Yes\",\"No\"),\"\")","v":""}]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[19,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[20,"How many individuals on average are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[21,"Number of training hours received by staff in their first year of employment",40]
[22,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[23,"Is client non-medical transportation required for this service?","Yes"]
["23a","Is client transportation bundled into the service? [Respond if Line 23 is marked as 'Yes]","Yes"]
[24,"Is staff non-medical transportation required for this service?","Yes"]
["24a","Is staff client transportation bundled into the service? [Respond if Line 24 is marked as 'Yes]","Yes"]

{"sheet":"4a. Meals - Time","index":14,"n_rows":62,"n_cols":25,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,18,8,20],[8,21,9,21],[8,22,8,24],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14],[8,15,8,17]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: MEAL SERVICES - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 43"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Meal Services (DD)","Nutrition - Meals \n(EPD-BSW)","Nutrition - Meals (HCBS-SDMI)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Meal Services (DD)","Nutrition - Meals \n(EPD-BSW)","Nutrition - Meals (HCBS-SDMI)"]
["Example","Dietician",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.02,0.02,0.02,25,"x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Meals_4a[[#This Row],[Total Regular Hours Paid]]+Meals_4a[[#This Row],[Total Overtime Hours Paid]]+Meals_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Meals - Pattern","index":15,"n_rows":52,"n_cols":5,"rows_kept":52,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: MEAL SERVICES - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 43-46"]
["Line","Factor","Meal Services\n (DD)","Nutrition - Meals \n(EPD-BSW)","Nutrition - Meals \n(HCBS-SDMI)"]
["1. AGENCY CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Question","Meal Services\n (DD)","Nutrition - Meals \n(EPD-BSW)","Nutrition - Meals \n(HCBS-SDMI)"]
[1,"Total number of active unduplicated home-delivered meal clients (all funding sources) ",{"$f":"SUM(C12:C13)","v":0},{"$f":"SUM(D12:D13)","v":0},{"$f":"SUM(E12:E13)","v":0}]
[2,"Number of active non-Medicaid unduplicated home-delivered meal clients"]
[3,"Number of active Medicaid unduplicated home-delivered meal clients"]
[4,"Number of kitchens operated"]
[5,"Total number of meals prepared per kitchen per day"]
[6,"Total cost per meal"]
[7,"Number of cooks per kitchen"]
[8,"Total square feet per kitchen"]
["2. TOTAL COSTS FOR MEAL SERVICES (INPUT THE COST OF THE FOLLOWING ITEMS TO DELIVER THE SERVICE)"]
[9,"Personnel - Salaries (line 9 is sum of lines 10-12)",{"$f":"SUM(C21:C23)","v":0},{"$f":"SUM(D21:D23)","v":0},{"$f":"SUM(E21:E23)","v":0}]
[10,"Project Management (Directly Employed)"]
[11,"Meals (Site Staff-Directly Employed)"]
[12,"Administrative Personnel"]
[13,"Fringe Benefits"]
[14,"Bulk Meal Transport Cost"]
[15,"Home Meal Delivery Costs (for transportation of meals)"]
[16,"Meal Packaging Costs"]
[17,"Supplies"]
[18,"Utilities"]
[19,"Communications"]
[20,"Building Costs"]
[21,"Building Space Square Footage"]
[22,"Professional Services"]
[23,"Raw Food"]
[24,"Caterer (Sub-contract)"]
["24a","Select 'Yes' if costs in line 24 include delivery costs. Otherwise, select 'No'"]
[25,"Equipment"]
[26,"Insurance"]
[27,"Mileage Reimbursement"]
[28,"Agency Sponsored Volunteer Recognition"]
[29,"Other"]
["29a","Specify the types of other costs identified in line 29","(Specify)","(Specify)","(Specify)"]
[30,"Total (line 30 is sum of lines 10-29)",{"$f":"SUM($C$21:$C$31,$C$33:$C$35,$C$37:$C$41)","v":0},{"$f":"SUM(D20:D41)","v":0},{"$f":"SUM(E20:E41)","v":0}]
["3. DONATED SERVICES AND VOLUNTEER HOURS (IF ANY)"]
[31,"Volunteer Miles (only include if currently tracked)"]
[32,"Volunteer Recognition"]
[33,"Volunteer Hours"]
[34,"Building/Facility Square Footage"]
[35,"Other (In Kind) - Specify the types of other donations in kind","(Specify)","(Specify)","(Specify)"]
["4. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[36,"Number of training hours received by staff in their first year of employment"]
[37,"Number of training hours received annually by staff after their first year of employment"]

{"sheet":"4a. Nursing - Time","index":16,"n_rows":62,"n_cols":35,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,14,9,14],[8,15,8,17],[8,21,9,21],[8,22,8,34],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,18,8,20],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: NURSING SERVICES - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 46"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Private Duty Nursing (EPD-BSW)","Private Duty Nursing - LPN \n(EPD-BSW)","Private Duty Nursing - LPN \n(HCBS-SDMI)","Private Duty Nursing - RN \n(EPD-BSW)","Private Duty Nursing - RN \n(HCBS-SDMI)","Private Duty Nursing (Medicaid State Plan) - LPN \n(DD)","Private Duty Nursing (Medicaid State Plan) - RN \n(DD)","Registered Nurse Supervision \n(EPD-BSW)","Specialized Nursing Services \n(EPD-BSW)","Specialized Nursing Services \n(HCBS-SDMI)","Specially Trained Attendant - LPN \n(EPD-BSW)","Specially Trained Attendant - RN \n(EPD-BSW)","Skilled Nursing (HHS)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Direct Care or Supervisor? (Direct Care, Supervisor","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Private Duty Nursing (EPD-BSW)","Private Duty Nursing - LPN \n(EPD-BSW)","Private Duty Nursing - LPN \n(HCBS-SDMI)","Private Duty Nursing - RN \n(EPD-BSW)","Private Duty Nursing - RN \n(HCBS-SDMI)","Private Duty Nursing (Medicaid State Plan) - LPN \n(DD)","Private Duty Nursing (Medicaid State Plan) - RN \n(DD)","Registered Nurse Supervision \n(EPD-BSW)","Specialized Nursing Services \n(EPD-BSW)","Specialized Nursing Services \n(HCBS-SDMI)","Specially Trained Attendant - LPN \n(EPD-BSW)","Specially Trained Attendant - RN \n(EPD-BSW)","Skilled Nursing - Visit Charge (HHS)"]
["Example","Licensed Practical Nurse (LPN)",null,"Employee","Direct Care","Both",10,1500,200,30,2200,30000,4000,1000,1500,14,12,16.5,0.02,0.02,0.02,30,"x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Nursing_4a[[#This Row],[Total Regular Hours Paid]]+Nursing_4a[[#This Row],[Total Overtime Hours Paid]]+Nursing_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Nursing - Patterns","index":17,"n_rows":41,"n_cols":16,"rows_kept":41,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: NURSING SERVICES - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 46-48"]
["Line","Factor","Example","Private Duty Nursing (EPD-BSW)","Private Duty Nursing - LPN \n(EPD-BSW)","Private Duty Nursing - LPN \n(HCBS-SDMI)","Private Duty Nursing - RN \n(EPD-BSW)","Private Duty Nursing - RN \n(HCBS-SDMI)","Private Duty Nursing (Medicaid State Plan) - LPN \n(DD)","Private Duty Nursing (Medicaid State Plan) - RN \n(DD)","Registered Nurse Supervision \n(EPD-BSW)","Specialized Nursing Services \n(EPD-BSW)","Specialized Nursing Services \n(HCBS-SDMI)","Specially Trained Attendant - LPN \n(EPD-BSW)","Specially Trained Attendant - RN \n(EPD-BSW)","Skilled Nursing (HHS)"]
["1. CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Question","Example","Private Duty Nursing (EPD-BSW)","Private Duty Nursing - LPN \n(EPD-BSW)","Private Duty Nursing - LPN \n(HCBS-SDMI)","Private Duty Nursing - RN \n(EPD-BSW)","Private Duty Nursing - RN \n(HCBS-SDMI)","Private Duty Nursing (Medicaid State Plan) - LPN \n(DD)","Private Duty Nursing (Medicaid State Plan) - RN \n(DD)","Registered Nurse Supervision \n(EPD-BSW)","Specialized Nursing Services \n(EPD-BSW)","Specialized Nursing Services \n(HCBS-SDMI)","Specially Trained Attendant - LPN \n(EPD-BSW)","Specially Trained Attendant - RN \n(EPD-BSW)","Skilled Nursing - Visit Charge"]
[1,"Number of individuals receiving each service from your organization",20]
[2,"Average number of visits or sessions per week per direct service staff worker",10]
[3,"Average visit or session length in hours",0.5]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[4,"Total cost of capital equipment purchased to perform services",500]
[5,"Average life (in years) of equipment purchased",2]
[6,"If costs are listed in Line 4, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[7,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[8,"If costs are listed in Line 7, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[9,"Client-facing service delivery",30]
[10,"Recordkeeping and documentation for services",4]
[11,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[12,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[13,"Travel time to/from and between client residences/locations",0]
[14,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[15,"Other activities",0]
[16,"Total hours worked for in a week",40]
[17,"Autopopulated: Has all time been allocated? (Total in Line 16 should equal sum of Lines 9-15)",{"$f":"IF(C28<>\"\",IF(SUM(C21:C27)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D28<>\"\",IF(SUM(D21:D27)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","","","","","","","",{"$f":"IF(O28<>\"\",IF(SUM(O21:O27)=40,\"Yes\",\"No\"),\"\")","v":""},""]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[18,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[19,"How many individuals on average are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[20,"Number of training hours received by staff in their first year of employment",40]
[21,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[22,"Is client transportation required for this service?","Yes"]
["22a","Is client transportation bundled into the service? [Respond if Line 22 is marked as 'Yes]","Yes"]
[23,"Is staff transportation required for this service?","Yes"]
["23a","Is staff client transportation bundled into the service? [Respond if Line 23 is marked as 'Yes]","Yes"]

{"sheet":"4a. Training - Time","index":18,"n_rows":62,"n_cols":26,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,7,9,7],[8,8,9,8],[8,15,8,17],[8,22,8,25],[8,18,8,20],[8,21,9,21],[8,9,9,9],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14],[8,6,9,6],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: TRAINING SERVICES - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 49"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Family Training and Support \n(EPD-BSW)","Group Parent/Guardian Training by BCBA or BCaBA with or without members present\n(M-ATS)","Parent/Guardian Taining by BCBA or BCaBA with or without Member Present\n(M-ATS) ","Caregiver Training and Support \n(DD)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Column6","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Family Training and Support \n(EPD-BSW)","Group Parent/Guardian Training by BCBA or BCaBA with or without members present\n(M-ATS)","Parent/Guardian Taining by BCBA or BCaBA with or without Member Present\n(M-ATS) ","Caregiver Training and Support \n(DD)"]
["Example","Employment Specialist/Job Coach",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,1.4999999999999999E-2,0.01,0.02,30,"x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Training_4a[[#This Row],[Total Regular Hours Paid]]+Training_4a[[#This Row],[Total Overtime Hours Paid]]+Training_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Training - Patterns","index":19,"n_rows":41,"n_cols":7,"rows_kept":41,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: TRAINING SERVICES - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 49-51"]
["Line","Factor","Example","Family Training and Support \n(EPD-BSW)","Group Parent/Guardian Training by BCBA or BCaBA with or without members present\n(M-ATS)","Parent/Guardian Taining by BCBA or BCaBA with or without Member Present\n(M-ATS) ","Caregiver Training and Support \n(DD)"]
["1. AGENCY CASELOAD AND SERVICE CHARACTERISTICS"]
["Line","Question","Example","Family Training and Support \n(EPD-BSW)","Group Parent/Guardian Training by BCBA or BCaBA with or without members present\n(M-ATS)","Parent/Guardian Taining by BCBA or BCaBA with or without Member Present\n(M-ATS) ","Caregiver Training and Support \n(DD)"]
[1,"Number of individuals receiving each service from your organization",20]
[2,"Average number of training sessions per week per direct service worker",15]
[3,"Average length of session in hours",0.5]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[4,"Total cost of capital equipment purchased to perform services",500]
[5,"Average life (in years) of equipment purchased",2]
[6,"If costs are listed in Line 4, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)"]
[7,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[8,"If costs are listed in Line 7, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[9,"Client-facing service delivery",30]
[10,"Recordkeeping and documentation for services",4]
[11,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[12,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[13,"Travel time to/from and between client residences/locations",0]
[14,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[15,"Other activities",0]
[16,"Total hours worked for in a week",40]
[17,"Autopopulated: Has all time been allocated? (Total in Line 16 should equal sum of Lines 9-15)",{"$f":"IF(C28<>\"\",IF(SUM(C21:C27)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D28<>\"\",IF(SUM(D21:D27)=40,\"Yes\",\"No\"),\"\")","v":""},{"$f":"IF(E28<>\"\",IF(SUM(E21:E27)=40,\"Yes\",\"No\"),\"\")","v":""},{"$f":"IF(F28<>\"\",IF(SUM(F21:F27)=40,\"Yes\",\"No\"),\"\")","v":""},{"$f":"IF(G28<>\"\",IF(SUM(G21:G27)=40,\"Yes\",\"No\"),\"\")","v":""}]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[18,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[19,"How many individuals on average are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[20,"Number of training hours received by staff in their first year of employment",40]
[21,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[22,"Is client transportation required for this service?","Yes"]
["22a","Is client transportation bundled into the service? [Respond if Line 22 is marked as 'Yes]","Yes"]
[23,"Is staff transportation required for this service?","Yes"]
["23a","Is staff client transportation bundled into the service? [Respond if Line 23 is marked as 'Yes]","Yes"]

{"sheet":"4a. Therapy - Time","index":20,"n_rows":62,"n_cols":53,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,18,8,20],[8,10,9,10],[8,11,9,11],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,12,9,12],[8,13,9,13],[8,14,9,14],[8,15,8,17],[8,22,8,52],[8,21,9,21]]}
["Provider Cost and Wage Survey","Provider Cost and Wage Survey","Provider Cost and Wage Survey","Provider Cost and Wage Survey","Provider Cost and Wage Survey","Provider Cost and Wage Survey","Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: THERAPEUTIC SERVICES - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 51"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Acupuncture \n(EPD-BSW)","Acupuncture \n(HCBS-SDMI)","Chiropractic \n(EPD-BSW)","Chiropractic \n(HCBS-SDMI)","Consultative Clinic and Therapeutic Services \n(EPD-BSW)","Consultative Clinic and Therapeutic Services \n(HCBS-SDMI)","CranioSacral Therapy \n(EPD-BSW)","CranioSacral Therapy \n(HCBS-SDMI)","Dialectical Behavior Therapy – Skill Development - Group \n(MMHS)","Dialectical Behavior Therapy – Skill Development - Individual \n(MMHS)","Hyperbaric Oxygen Therapy \n(EPD-BSW)","Hyperbaric Oxygen Therapy \n(HCBS-SDMI)","Illness Management and Recovery - Group \n(MMHS)","Illness Management and Recovery - Individual \n(MMHS)","Massage Therapy \n(EPD-BSW)","Massage Therapy \n(HCBS-SDMI)","Mind-Body Therapies (EPD-BSW)","Mind-Body Therapies (HCBS-SDMI)","Pain and Symptom Management\n(EPD-BSW)","Pain and Symptom Management \n(HCBS-SDMI)","Pain Mitigation Counseling/Coaching \n(EPD-BSW)","Pain Mitigation Counseling/Coaching \n(HCBS-SDMI)","Reflexology \n(EPD-BSW)","Reflexology \n(HCBS-SDMI)","Physical Therapy (HHS)","Occupational Therapy (HHS)","Speech Therapy (HHS)","Nutritionist Services - Medicaid State Plan (DD)","Nutrition Classes, Nutritionalist (EPD-BSW)","Nutritional Counseling, Dietician (EPD-BSW)","Comprehensive Day Treatment (EPD-BSW)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Acupuncture \n(EPD-BSW)","Acupuncture \n(HCBS-SDMI)","Chiropractic \n(EPD-BSW)","Chiropractic \n(HCBS-SDMI)","Consultative Clinic and Therapeutic Services \n(EPD-BSW)","Consultative Clinic and Therapeutic Services \n(HCBS-SDMI)","CranioSacral Therapy \n(EPD-BSW)","CranioSacral Therapy \n(HCBS-SDMI)","Dialectical Behavior Therapy – Skill Development - Group \n(MMHS)","Dialectical Behavior Therapy – Skill Development - Individual \n(MMHS)","Hyperbaric Oxygen Therapy \n(EPD-BSW)","Hyperbaric Oxygen Therapy \n(HCBS-SDMI)","Illness Management and Recovery - Group \n(MMHS)","Illness Management and Recovery - Individual \n(MMHS)","Massage Therapy \n(EPD-BSW)","Massage Therapy \n(HCBS-SDMI)","Mind-Body Therapies (EPD-BSW)","Mind-Body Therapies (HCBS-SDMI)","Pain and Symptom Management - Negotiated with Upper Limit \n(EPD-BSW)","Pain and Symptom Management \n(HCBS-SDMI)","Pain Mitigation Counseling/Coaching \n(EPD-BSW)","Pain Mitigation Counseling/Coaching \n(HCBS-SDMI)","Reflexology \n(EPD-BSW)","Reflexology \n(HCBS-SDMI)","Physical Therapy (HHS)","Occupational Therapy (HHS)","Speech Therapy (HHS)","Nutritionist Services - Medicaid State Plan (DD)","Nutrition Classes, Nutritionalist (EPD-BSW)","Nutritional Counseling, Dietician (EPD-BSW)","Comprehensive Day Treatment (EPD-BSW)"]
["Example","Occupational Therapist",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.02,0.02,0.02,10,"x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Therapy_4a[[#This Row],[Total Regular Hours Paid]]+Therapy_4a[[#This Row],[Total Overtime Hours Paid]]+Therapy_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Therapy - Patterns","index":21,"n_rows":46,"n_cols":34,"rows_kept":46,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: THERAPEUTIC SERVICES - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 51-54"]
["Line","Factor","Example","Acupuncture \n(EPD-BSW)","Acupuncture \n(HCBS-SDMI)","Chiropractic \n(EPD-BSW)","Chiropractic \n(HCBS-SDMI)","Consultative Clinic and Therapeutic Services \n(EPD-BSW)","Consultative Clinic and Therapeutic Services \n(HCBS-SDMI)","CranioSacral Therapy \n(EPD-BSW)","CranioSacral Therapy \n(HCBS-SDMI)","Dialectical Behavior Therapy – Skill Development - Group \n(MMHS)","Dialectical Behavior Therapy – Skill Development - Individual \n(MMHS)","Hyperbaric Oxygen Therapy \n(EPD-BSW)","Hyperbaric Oxygen Therapy \n(HCBS-SDMI)","Illness Management and Recovery - Group \n(MMHS)","Illness Management and Recovery - Individual \n(MMHS)","Massage Therapy \n(EPD-BSW)","Massage Therapy \n(HCBS-SDMI)","Mind-Body Therapies (EPD-BSW)","Mind-Body Therapies (HCBS-SDMI)","Pain and Symptom Management\n(EPD-BSW)","Pain and Symptom Management \n(HCBS-SDMI)","Pain Mitigation Counseling/Coaching \n(EPD-BSW)","Pain Mitigation Counseling/Coaching \n(HCBS-SDMI)","Reflexology \n(EPD-BSW)","Reflexology \n(HCBS-SDMI)","Physical Therapy (HHS)","Occupational Therapy (HHS)","Speech Therapy (HHS)","Nutritionist Services - Medicaid State Plan (DD)","Nutrition Classes, Nutritionalist (EPD-BSW)","Nutritional Counseling, Dietician (EPD-BSW)","Comprehensive Day Treatment (EPD-BSW)"]
["1. AGENCY CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Question","Example","Acupuncture \n(EPD-BSW)","Acupuncture \n(HCBS-SDMI)","Chiropractic \n(EPD-BSW)","Chiropractic \n(HCBS-SDMI)","Consultative Clinic and Therapeutic Services \n(EPD-BSW)","Consultative Clinic and Therapeutic Services \n(HCBS-SDMI)","CranioSacral Therapy \n(EPD-BSW)","CranioSacral Therapy \n(HCBS-SDMI)","Dialectical Behavior Therapy – Skill Development - Group \n(MMHS)","Dialectical Behavior Therapy – Skill Development - Individual \n(MMHS)","Hyperbaric Oxygen Therapy \n(EPD-BSW)","Hyperbaric Oxygen Therapy \n(HCBS-SDMI)","Illness Management and Recovery - Group \n(MMHS)","Illness Management and Recovery - Individual \n(MMHS)","Massage Therapy \n(EPD-BSW)","Massage Therapy \n(HCBS-SDMI)","Mind-Body Therapies (EPD-BSW)","Mind-Body Therapies (HCBS-SDMI)","Pain and Symptom Management - Negotiated with Upper Limit \n(EPD-BSW)","Pain and Symptom Management \n(HCBS-SDMI)","Pain Mitigation Counseling/Coaching \n(EPD-BSW)","Pain Mitigation Counseling/Coaching \n(HCBS-SDMI)","Reflexology \n(EPD-BSW)","Reflexology \n(HCBS-SDMI)","Physical Therapy (HHS)","Occupational Therapy (HHS)","Speech Therapy (HHS)","Nutritionist Services - Medicaid State Plan (DD)","Nutrition Classes, Nutritionalist (EPD-BSW)","Nutrition Classes, Nutritionalist (EPD-BSW)2","Nutrition Classes, Nutritionalist (EPD-BSW)3"]
[1,"Number of individuals receiving services from your organization",20]
[2,"Are services offered in individual and/or group settings?","Group"]
[3,"Average number of clients (or groups) seen per week per direct service staff worker",100]
[4,"Average number of sessions seen per week per staff",15]
[5,"Average length of session in hours",2]
[6,"Average Square footage of program space per staff",150]
[7,"Operating cost per square foot of program space",12.5]
[8,"Length of time to complete an evaluation in hours",2.5]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[9,"Total cost of capital equipment purchased to perform services",500]
[10,"Average life (in years) of equipment purchased",2]
[11,"If costs are listed in Line 9, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[12,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[13,"If costs are listed in Line 12, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[14,"Client-facing service delivery",30]
[15,"Recordkeeping and documentation for services",4]
[16,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[17,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[18,"Travel time to/from and between client residences/locations",0]
[19,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[20,"Other activities",0]
[21,"Total hours worked for in a week",40]
[22,"Autopopulated: Has all time been allocated? (Total in Line 21 should equal sum of Lines 14-20)",{"$f":"IF(C33<>\"\",IF(SUM(C26:C32)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D33<>\"\",IF(SUM(D26:D32)=40,\"Yes\",\"No\"),\"\")","v":""},{"$f":"IF(E33<>\"\",IF(SUM(E26:E32)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[23,"How many therapists or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[24,"How many individuals on average are typically served by one therapist or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[25,"Number of training hours received by staff in their first year of employment",40]
[26,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[27,"Is client non-medical transportation required for this service?","Yes"]
["27a","Is client transportation bundled into the service? [Respond if Line 27 is marked as 'Yes]","Yes"]
[28,"Is staff non-medical transportation required for this service?","Yes"]
["28a","Is staff client transportation bundled into the service? [Respond if Line 28 is marked as 'Yes]","Yes"]

{"sheet":"4a. Amb. Behavioral - Time","index":22,"n_rows":62,"n_cols":56,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,13,9,13],[8,14,9,14],[8,22,8,55],[8,18,8,20],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,15,8,17],[8,21,9,21],[8,9,9,9],[8,10,9,10],[8,11,9,11],[8,12,9,12]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: AMBULATORY BEHAVIORAL HEALTH INTERVENTIONS - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 55-56"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Adaptive Behavior Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Adaptive Behavioral Treatment with Protocol Modification by BCBA or BCaBA\n(M-ATS)","Behavior Identification Assessment by \nBCBA or BCaBA\n(M-ATS)","Behavior Identification Supporting Assessment, One Technician\n(M-ATS)","Behavioral Intervention Assistant\n (HCBS-SDMI)","Behavioral Support Services\n (DD)","Community-Based Psychiatric Rehabilitation and Support - Group\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Group\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (NM-CSCI)","Comprehensive School and Community Treatment\n (CMH)","CSCT Intervention, Assessment and Referral\n (CMH)","Group Intensice Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Group Intensive Treatment by BCBA or BCaBA\n(M-ATS)","Home Support Services Frontier Differential\n (CMH)","Home Support Services\n (CMH)","Intensive Individual DBT Psychotherapy Services\n (MMHS)","Medication-Assisted Therapy - Intake\n (SUD-M)","Medication-Assisted Therapy - Intake\n (SUD-NM)","Medication-Assisted Therapy\n (SUD-M)","Medication-Assisted Therapy\n (SUD-NM)","Montana Assertive Community Treatment - MACT\n (MMHS)","Out of State Therapeutic Home Visit\n (CMH)","Peer Support (Certified) - Group\n (SUD-NM)","Peer Support (Certified) - Individual\n (MMHS)","Peer Support (Certified) - Individual\n (SUD-M)","Peer Support (Certified) - Individual\n (SUD-NM)","Peer Support (Certified) Co Occurring - Individual \n (MMHS)","Peer Support (Certified) Co Occurring - Individual\n (SUD-NM)","Peer Support (Certified) Co-Occurring - Individual\n (SUD-M)","Psychological Services\n (DD)","Psychosocial Rehabilitation\n (SUD-NM)","Youth Day Treatment\n (CMH)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Adaptive Behavior Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Adaptive Behavioral Treatment with Protocol Modification by BCBA or BCaBA\n(M-ATS)","Behavior Identification Assessment by \nBCBA or BCaBA\n(M-ATS)","Behavior Identification Supporting Assessment, One Technician\n(M-ATS)","Behavioral Intervention Assistant\n (HCBS-SDMI)","Behavioral Support Services\n (DD)","Community-Based Psychiatric Rehabilitation and Support - Group\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Group\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (NM-CSCI)","Comprehensive School and Community Treatment\n (CMH)","CSCT Intervention, Assessment and Referral\n (CMH)","Group Intensice Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Group Intensive Treatment by BCBA or BCaBA\n(M-ATS)","Home Support Services Frontier Differential\n (CMH)","Home Support Services\n (CMH)","Intensive Individual DBT Psychotherapy Services\n (MMHS)","Medication-Assisted Therapy - Intake\n (SUD-M)","Medication-Assisted Therapy - Intake\n (SUD-NM)","Medication-Assisted Therapy\n (SUD-M)","Medication-Assisted Therapy\n (SUD-NM)","Montana Assertive Community Treatment - MACT\n (MMHS)","Out of State Therapeutic Home Visit\n (CMH)","Peer Support (Certified) - Group\n (SUD-NM)","Peer Support (Certified) - Individual\n (MMHS)","Peer Support (Certified) - Individual\n (SUD-M)","Peer Support (Certified) - Individual\n (SUD-NM)","Peer Support (Certified) Co Occurring - Individual \n (MMHS)","Peer Support (Certified) Co Occurring - Individual\n (SUD-NM)","Peer Support (Certified) Co-Occurring - Individual\n (SUD-M)","Psychological Services\n (DD)","Psychosocial Rehabilitation\n (SUD-NM)","Youth Day Treatment\n (CMH)"]
["Example","Psychiatrist",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.03,0.04,0.06,15,"x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Amb_Behavior_4a[[#This Row],[Total Regular Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Overtime Hours Paid]]+Amb_Behavior_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Amb. Behavioral - Patterns","index":23,"n_rows":42,"n_cols":37,"rows_kept":42,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: AMBULATORY BEHAVIORAL HEALTH INTERVENTIONS - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 56-61"]
["Line","Factor","Example","Adaptive Behavior Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Adaptive Behavioral Treatment with Protocol Modification by BCBA or BCaBA\n(M-ATS)","Behavior Identification Assessment by \nBCBA or BCaBA\n(M-ATS)","Behavior Identification Supporting Assessment, One Technician\n(M-ATS)","Behavioral Intervention Assistant\n (HCBS-SDMI)","Behavioral Support Services\n (DD)","Community-Based Psychiatric Rehabilitation and Support - Group\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Group\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (NM-CSCI)","Comprehensive School and Community Treatment\n (CMH)","CSCT Intervention, Assessment and Referral\n (CMH)","Group Intensice Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Group Intensive Treatment by BCBA or BCaBA\n(M-ATS)","Home Support Services Frontier Differential\n (CMH)","Home Support Services\n (CMH)","Intensive Individual DBT Psychotherapy Services\n (MMHS)","Medication-Assisted Therapy - Intake\n (SUD-M)","Medication-Assisted Therapy - Intake\n (SUD-NM)","Medication-Assisted Therapy\n (SUD-M)","Medication-Assisted Therapy\n (SUD-NM)","Montana Assertive Community Treatment - MACT\n (MMHS)","Out of State Therapeutic Home Visit\n (CMH)","Peer Support (Certified) - Group\n (SUD-NM)","Peer Support (Certified) - Individual\n (MMHS)","Peer Support (Certified) - Individual\n (SUD-M)","Peer Support (Certified) - Individual\n (SUD-NM)","Peer Support (Certified) Co Occurring - Individual \n (MMHS)","Peer Support (Certified) Co Occurring - Individual\n (SUD-NM)","Peer Support (Certified) Co-Occurring - Individual\n (SUD-M)","Psychological Services\n (DD)","Psychosocial Rehabilitation\n (SUD-NM)","Youth Day Treatment\n (CMH)"]
["1. AGENCY CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Question","Example","Adaptive Behavior Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Adaptive Behavioral Treatment with Protocol Modification by BCBA or BCaBA\n(M-ATS)","Behavior Identification Assessment by \nBCBA or BCaBA\n(M-ATS)","Behavior Identification Supporting Assessment, One Technician\n(M-ATS)","Behavioral Intervention Assistant\n (HCBS-SDMI)","Behavioral Support Services\n (DD)","Community-Based Psychiatric Rehabilitation and Support - Group\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Group\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (CMH)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (MMHS)","Community-Based Psychiatric Rehabilitation and Support - Individual\n (NM-CSCI)","Comprehensive School and Community Treatment\n (CMH)","CSCT Intervention, Assessment and Referral\n (CMH)","Group Intensice Treatment by Technician under Direction of BCBA or BCaBA \n(M-ATS)","Group Intensive Treatment by BCBA or BCaBA\n(M-ATS)","Home Support Services Frontier Differential\n (CMH)","Home Support Services\n (CMH)","Intensive Individual DBT Psychotherapy Services\n (MMHS)","Medication-Assisted Therapy - Intake\n (SUD-M)","Medication-Assisted Therapy - Intake\n (SUD-NM)","Medication-Assisted Therapy\n (SUD-M)","Medication-Assisted Therapy\n (SUD-NM)","Montana Assertive Community Treatment - MACT\n (MMHS)","Out of State Therapeutic Home Visit\n (CMH)","Peer Support (Certified) - Group\n (SUD-NM)","Peer Support (Certified) - Individual\n (MMHS)","Peer Support (Certified) - Individual\n (SUD-M)","Peer Support (Certified) - Individual\n (SUD-NM)","Peer Support (Certified) Co Occurring - Individual \n (MMHS)","Peer Support (Certified) Co Occurring - Individual\n (SUD-NM)","Peer Support (Certified) Co-Occurring - Individual\n (SUD-M)","Psychological Services\n (DD)","Psychosocial Rehabilitation\n (SUD-NM)","Youth Day Treatment\n (CMH)"]
[1,"Number of individuals receiving services from your organization",20]
[2,"Are services offered in an individual or group setting?","Group"]
[3,"Average number of visits per week per direct service worker",3]
[4,"Average visit length in hours",2]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[5,"Total cost of capital equipment purchased to perform services",500]
[6,"Average life (in years) of equipment purchased",2]
[7,"If costs are listed in Line 5, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[8,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[9,"If costs are listed in Line 8, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[10,"Client-facing service delivery",30]
[11,"Recordkeeping and documentation for services",4]
[12,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[13,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[14,"Travel time to/from and between client residences/locations",0]
[15,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[16,"Other activities",0]
[17,"Total hours worked for in a week",40]
[18,"Autopopulated: Has all time been allocated? (Total in Line 17 should equal sum of Lines 10-16)",{"$f":"IF(C29<>\"\",IF(SUM(C22:C28)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},null,null,null,null,{"$f":"IF(H29<>\"\",IF(SUM(H22:H28)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","","","","","","","","","","","","","","","","","","","","","","","","","",""]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[19,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[20,"How many individuals on average are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[21,"Number of training hours received by staff in their first year of employment",40]
[22,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[23,"Is client non-medical transportation required for this service?","Yes"]
["23a","Is client transportation bundled into the service? [Respond if Line 23 is marked as 'Yes]","Yes"]
[24,"Is staff non-medical transportation required for this service?","Yes"]
["24a","Is staff client transportation bundled into the service? [Respond if Line 24 is marked as 'Yes]","Yes"]

{"sheet":"4a. Hosp. & Intensive - Time","index":24,"n_rows":62,"n_cols":52,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,18,8,20],[8,21,9,21],[8,22,8,51],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14],[8,15,8,17]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: HOSPITALIZATION SERVICES AND INTENSIVE INTERVENTIONS - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 58-59"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Acute Partial Hospitalization - Full Day\n (CMH)","Acute Partial Hospitalization - Half Day\n (CMH)","Acute Partial Hospitalization - Full Day (MMHS)","Acute Partial Hospitalization - Half Day (MMHS)","Adolescent SUD Intensive Outpatient (SUD-NM)","Adolescent SUD Intesive Outpatient (SUD-M)","Adult High Tier SUD Intensive Outpatient (SUD-M)","Adult High Tier SUD Intensive Outpatient (SUD-NM)","Adult Low Tier SUD Intensive Outpatient (SUD-M)","Adult Low Tier SUD Intensive Outpatient (SUD-NM)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-M)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Room & Board \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Women/Children Room & Board \n(SUD-NM)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-M)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-NM)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-M)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-NM)","Crisis Management Inpatient Hospital - Day One\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Three\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Two\n (NM-CSCI)","Crisis Management Mental Health Center - Day One\n (NM-CSCI)","Crisis Management Mental Health Center - Day Three\n (NM-CSCI)","Crisis Management Mental Health Center - Day Two\n (NM-CSCI)","Crisis Stabilization Program\n (MMHS)","InPACT (MMHS)","PACT Community Maintenance Program\n (MMHS)","PACT\n (MMHS)","Sub-acute Partial Hospitalization - Full Day\n (CMH)","Sub-acute Partial Hospitalization - Half Day\n (CMH)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Acute Partial Hospitalization - Full Day\n (CMH)","Acute Partial Hospitalization - Half Day\n (CMH)","Acute Partial Hospitalization - Full Day (MMHS)","Acute Partial Hospitalization - Half Day (MMHS)","Adolescent SUD Intensive Outpatient (SUD-NM)","Adolescent SUD Intesive Outpatient (SUD-M)","Adult High Tier SUD Intensive Outpatient (SUD-M)","Adult High Tier SUD Intensive Outpatient (SUD-NM)","Adult Low Tier SUD Intensive Outpatient (SUD-M)","Adult Low Tier SUD Intensive Outpatient (SUD-NM)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-M)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Room & Board \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Women/Children Room & Board \n(SUD-NM)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-M)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-NM)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-M)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-NM)","Crisis Management Inpatient Hospital - Day One\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Three\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Two\n (NM-CSCI)","Crisis Management Mental Health Center - Day One\n (NM-CSCI)","Crisis Management Mental Health Center - Day Three\n (NM-CSCI)","Crisis Management Mental Health Center - Day Two\n (NM-CSCI)","Crisis Stabilization Program\n (MMHS)","InPACT (MMHS)","PACT Community Maintenance Program\n (MMHS)","PACT\n (MMHS)","Sub-acute Partial Hospitalization - Full Day\n (CMH)","Sub-acute Partial Hospitalization - Half Day\n (CMH)"]
["Example","Direct Service Professional - Daytime",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.03,0.04,0.06,10,"x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Hosp_4a[[#This Row],[Total Regular Hours Paid]]+Hosp_4a[[#This Row],[Total Overtime Hours Paid]]+Hosp_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Hosp. & Intensive - Pattern","index":25,"n_rows":44,"n_cols":33,"rows_kept":44,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: HOSPITALIZATION SERVICES AND INTENSIVE INTERVENTIONS - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 59-61"]
["Line","Factor","Example","Acute Partial Hospitalization - Full Day\n (CMH)","Acute Partial Hospitalization - Half Day\n (CMH)","Acute Partial Hospitalization - Full Day (MMHS)","Acute Partial Hospitalization - Half Day (MMHS)","Adolescent SUD Intensive Outpatient (SUD-M)","Adolescent SUD Intensive Outpatient (SUD-NM)","Adult High Tier SUD Intensive Outpatient (SUD-M)","Adult High Tier SUD Intensive Outpatient (SUD-NM)","Adult Low Tier SUD Intensive Outpatient (SUD-M)","Adult Low Tier SUD Intensive Outpatient (SUD-NM)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-M)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Room & Board \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Women/Children Room & Board \n(SUD-NM)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-M)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-NM)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-M)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-NM)","Crisis Management Inpatient Hospital - Day One\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Three\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Two\n (NM-CSCI)","Crisis Management Mental Health Center - Day One\n (NM-CSCI)","Crisis Management Mental Health Center - Day Three\n (NM-CSCI)","Crisis Management Mental Health Center - Day Two\n (NM-CSCI)","Crisis Stabilization Program\n (MMHS)","InPACT\n (MMHS)","PACT Community Maintenance Program\n (MMHS)","PACT\n (MMHS)","Sub-acute Partial Hospitalization - Full Day\n (CMH)","Sub-acute Partial Hospitalization - Half Day\n (CMH)"]
["1. AGENCY CASELOAD AND SERVICE CHARACTERISTICS"]
["Line","Question","Example","Acute Partial Hospitalization - Full Day\n (CMH)","Acute Partial Hospitalization - Half Day\n (CMH)","Acute Partial Hospitalization - Full Day (MMHS)","Acute Partial Hospitalization - Half Day (MMHS)","Adolescent SUD Intensive Outpatient (SUD-M)","Adolescent SUD Intensive Outpatient (SUD-NM)","Adult High Tier SUD Intensive Outpatient (SUD-M)","Adult High Tier SUD Intensive Outpatient (SUD-NM)","Adult Low Tier SUD Intensive Outpatient (SUD-M)","Adult Low Tier SUD Intensive Outpatient (SUD-NM)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-M)","ASAM 2.5 SUD Partial Hospitalization \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Room & Board \n(SUD-NM)","ASAM 3.1 SUD Clinically Managed Low Intensity - Women/Children Room & Board \n(SUD-NM)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-M)","ASAM 3.5 SUD Clinically Managed High-Intensity (Adult)/Medium-Intensity (Adolescent) Residential \n(SUD-NM)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-M)","ASAM 3.7 SUD Medically Monitored Intensive Inpatient \n(SUD-NM)","Crisis Management Inpatient Hospital - Day One\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Three\n (NM-CSCI)","Crisis Management Inpatient Hospital - Day Two\n (NM-CSCI)","Crisis Management Mental Health Center - Day One\n (NM-CSCI)","Crisis Management Mental Health Center - Day Three\n (NM-CSCI)","Crisis Management Mental Health Center - Day Two\n (NM-CSCI)","Crisis Stabilization Program\n (MMHS)","InPACT\n (MMHS)","PACT Community Maintenance Program\n (MMHS)","PACT\n (MMHS)","Sub-acute Partial Hospitalization - Full Day\n (CMH)","Sub-acute Partial Hospitalization - Half Day\n (CMH)"]
[1,"Number of individuals receiving services from your organization",20]
[2,"Are services offered in an individual or group setting?","Group"]
[3,"Average number of visits per week per direct service worker",3]
[4,"Average visit length in hours",2]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[5,"Total cost of capital equipment purchased to perform services",500]
[6,"Average life (in years) of equipment purchased",2]
[7,"If costs are listed in Line 5, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[8,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[9,"If costs are listed in Line 8, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[10,"Client-facing service delivery",30]
[11,"Recordkeeping and documentation for services",4]
[12,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[13,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[14,"Travel time to/from and between client residences/locations",0]
[15,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[16,"Other activities",0]
[17,"Total hours worked for in a week",40]
[18,"Autopopulated: Has all time been allocated? (Total in Line 17 should equal sum of Lines 10-16)",{"$f":"IF(C29<>\"\",IF(SUM(C22:C28)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D29<>\"\",IF(SUM(D22:D28)=40,\"Yes\",\"No\"),\"\")","v":""},{"$f":"IF(E29<>\"\",IF(SUM(E22:E28)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","","","","","","","","","","","","","","","","","","","","","","","","",""]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[19,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[20,"On average, how many individuals are typically served by one staff or practitioner?",10]
[21,"At most, how many individuals are typically served by one staff or practitioner?",10]
[22,"At least, how many individuals are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[23,"Number of training hours received by staff in their first year of employment",40]
[24,"Number of training hours received annually by staff after their first year of employment",15]
["7. NON-MEDICAL TRANSPORTATION"]
[25,"Is client non-medical transportation required for this service?","Yes"]
["25a","Is client transportation bundled into the service? [Respond if Line 28 is marked as 'Yes]","Yes"]
[26,"Is staff non-medical transportation required for this service?","Yes"]
["26a","Is staff client transportation bundled into the service? [Respond if Line 29 is marked as 'Yes]","Yes"]

{"sheet":"4a. Residential - Time","index":26,"n_rows":62,"n_cols":65,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,13,9,13],[8,14,9,14],[8,22,8,64],[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,15,8,17],[8,18,8,20],[8,21,9,21],[8,9,9,9],[8,10,9,10],[8,11,9,11],[8,12,9,12]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: RESIDENTIAL SERVICES - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 62-63"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Adult Foster Care - Therapeutic Leave \n(MMHS)","Adult Foster Care \n(MMHS)","Adult Foster Support - Enhanced Supervision \n(DD)","Adult Foster Support - Intensive Supervision (DD)","Adult Foster Support - Low Supervision \n(DD)","Adult Foster Support - Moderate Supervision \n(DD)","Assisted Living - Enhanced \n(DD)","Assisted Living - Moderate \n(DD)","Behavioral Health Group Home \n(MMHS)","Community Residential Rehabilitation \n(EPD-BSW)","Congregate Living - Children's \n(DD)","Congregate Living - Hourly \n(DD)","Congregate Living - Medical \n(DD)","Extraordinary Needs Aide Services\n (CMH)","Permanency Therapeutic Foster Care \n(CMH)","Res. Hab. - Adult Group Home \n(HCBS-SDMI)","Residential Habilitation - Assisted Living Facilities and Adult Foster Homes \n(EPD-BSW)","Res. Hab. - Assisted Living Facilities and Adult Foster Homes \n(HCBS-SDMI)","Residential Habilitation - Group Home (for Adults with Physical Disabilities)           \n(EPD-BSW)","Res. Hab. - Intensive Mental Health Group Home \n(HCBS-SDMI)","Res. Hab. - Mental Health Group Home (HCBS-SDMI)","Res. Hab. Supported Living - Base \n(DD)","Res. Hab. Supported Living - Flex \n(DD)","Res. Hab. Supported Living - High Geo. Factor \n(DD)","Res. Hab. Supported Living - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living - No Geo. Factor \n(DD)","Res. Hab. Supported Living - Rural Remote \n(DD)","Res. Hab. Supported Living (Small agency) - High Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - No Geo. Factor \n(DD)","Residential Habilitation - Specialized Assisted Living Facilities (TBI/AR) \n(EPD-BSW)","Residential Training Support - High Geo. Factor \n(DD)","Residential Training Support - Medium Geo. Factor \n(DD)","Residential Training Support - No Geo. Factor \n(DD)","Residential Training Support (Small Agency) - High Geo. Factor \n(DD)","Residential Training Support (Small Agency) - Medium Geo. Factor \n(DD)","Residential Training Support (Small Agency) - No Geo. Factor \n(DD)","Supported Living (EPD-BSW)","Therapeutic Foster Care \n(CMH)","Therapeutic Youth Group Home - Therapeutic Home Leave \n(CMH)","Therapeutic Youth Group Home \n(CMH)","Remote Monitoring (DD)","Shelter Care (CMH)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Adult Foster Care - Therapeutic Leave \n(MMHS)","Adult Foster Care \n(MMHS)","Adult Foster Support - Enhanced Supervision \n(DD)","Adult Foster Support - Intensive Supervision (DD)","Adult Foster Support - Low Supervision \n(DD)","Adult Foster Support - Moderate Supervision \n(DD)","Assisted Living - Enhanced \n(DD)","Assisted Living - Moderate \n(DD)","Behavioral Health Group Home \n(MMHS)","Community Residential Rehabilitation \n(EPD-BSW)","Congregate Living - Children's \n(DD)","Congregate Living - Hourly \n(DD)","Congregate Living - Medical \n(DD)","Extraordinary Needs Aide Services\n (CMH)","Permanency Therapeutic Foster Care \n(CMH)","Res. Hab. - Adult Group Home \n(HCBS-SDMI)","Residential Habilitation - Assisted Living Facilities and Adult Foster Homes \n(EPD-BSW)","Res. Hab. - Assisted Living Facilities and Adult Foster Homes \n(HCBS-SDMI)","Residential Habilitation - Group Home (for Adults with Physical Disabilities)           \n(EPD-BSW)","Res. Hab. - Intensive Mental Health Group Home \n(HCBS-SDMI)","Res. Hab. - Mental Health Group Home (HCBS-SDMI)","Res. Hab. Supported Living - Base \n(DD)","Res. Hab. Supported Living - Flex \n(DD)","Res. Hab. Supported Living - High Geo. Factor \n(DD)","Res. Hab. Supported Living - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living - No Geo. Factor \n(DD)","Res. Hab. Supported Living - Rural Remote \n(DD)","Res. Hab. Supported Living (Small agency) - High Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - No Geo. Factor \n(DD)","Residential Habilitation - Specialized Assisted Living Facilities (TBI/AR) \n(EPD-BSW)","Residential Training Support - High Geo. Factor \n(DD)","Residential Training Support - Medium Geo. Factor \n(DD)","Residential Training Support - No Geo. Factor \n(DD)","Residential Training Support (Small Agency) - High Geo. Factor \n(DD)","Residential Training Support (Small Agency) - Medium Geo. Factor \n(DD)","Residential Training Support (Small Agency) - No Geo. Factor \n(DD)","Supported Living (EPD-BSW)","Therapeutic Foster Care \n(CMH)","Therapeutic Youth Group Home - Therapeutic Home Leave \n(CMH)","Therapeutic Youth Group Home \n(CMH)","Remote Monitoring (DD)","Shelter Care (CMH)"]
["Example","Direct Service Professional - Daytime",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.03,0.04,0.06,20,"x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Residential_4a[[#This Row],[Total Regular Hours Paid]]+Residential_4a[[#This Row],[Total Overtime Hours Paid]]+Residential_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Residential - Patterns","index":27,"n_rows":39,"n_cols":46,"rows_kept":39,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: RESIDENTIAL SERVICES - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 63-65"]
["Line","Factor","Example","Adult Foster Care - Therapeutic Leave \n(MMHS)","Adult Foster Care \n(MMHS)","Adult Foster Support - Enhanced Supervision \n(DD)","Adult Foster Support - Intensive Supervision (DD)","Adult Foster Support - Low Supervision \n(DD)","Adult Foster Support - Moderate Supervision \n(DD)","Assisted Living - Enhanced \n(DD)","Assisted Living - Moderate \n(DD)","Behavioral Health Group Home \n(MMHS)","Community Residential Rehabilitation \n(EPD-BSW)","Congregate Living - Children's \n(DD)","Congregate Living - Hourly \n(DD)","Congregate Living - Medical \n(DD)","Extraordinary Needs Aide Services\n (CMH)","Permanency Therapeutic Foster Care \n(CMH)","Res. Hab. - Adult Group Home \n(HCBS-SDMI)","Residential Habilitation - Assisted Living Facilities and Adult Foster Homes \n(EPD-BSW)","Res. Hab. - Assisted Living Facilities and Adult Foster Homes \n(HCBS-SDMI)","Residential Habilitation - Group Home (for Adults with Physical Disabilities)            \n(EPD-BSW)","Res. Hab. - Intensive Mental Health Group Home \n(HCBS-SDMI)","Res. Hab. - Mental Health Group Home (HCBS-SDMI)","Res. Hab. Supported Living - Base \n(DD)","Res. Hab. Supported Living - Flex \n(DD)","Res. Hab. Supported Living - High Geo. Factor \n(DD)","Res. Hab. Supported Living - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living - No Geo. Factor \n(DD)","Res. Hab. Supported Living - Rural Remote \n(DD)","Res. Hab. Supported Living (Small agency) - High Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - No Geo. Factor \n(DD)","Residential Habilitation - Specialized Assisted Living Facilities (TBI/AR) \n(EPD-BSW)","Residential Training Support - High Geo. Factor \n(DD)","Residential Training Support - Medium Geo. Factor \n(DD)","Residential Training Support - No Geo. Factor \n(DD)","Residential Training Support (Small Agency) - High Geo. Factor \n(DD)","Residential Training Support (Small Agency) - Medium Geo. Factor \n(DD)","Residential Training Support (Small Agency) - No Geo. Factor \n(DD)","Supported Living (EPD-BSW)","Therapeutic Foster Care \n(CMH)","Therapeutic Youth Group Home - Therapeutic Home Leave \n(CMH)","Therapeutic Youth Group Home \n(CMH)","Remote Monitoring (DD)","Shelter Care (CMH)"]
["1. HOME AND SERVICE CHARACTERISTICS"]
["Line","Question","Example","Adult Foster Care - Therapeutic Leave \n(MMHS)","Adult Foster Care \n(MMHS)","Adult Foster Support - Enhanced Supervision \n(DD)","Adult Foster Support - Intensive Supervision (DD)","Adult Foster Support - Low Supervision \n(DD)","Adult Foster Support - Moderate Supervision \n(DD)","Assisted Living - Enhanced \n(DD)","Assisted Living - Moderate \n(DD)","Behavioral Health Group Home \n(MMHS)","Community Residential Rehabilitation \n(EPD-BSW)","Congregate Living - Children's \n(DD)","Congregate Living - Hourly \n(DD)","Congregate Living - Medical \n(DD)","Extraordinary Needs Aide Services\n (CMH)","Permanency Therapeutic Foster Care \n(CMH)","Res. Hab. - Adult Group Home \n(HCBS-SDMI)","Residential Habilitation - Assisted Living Facilities and Adult Foster Homes \n(EPD-BSW)","Res. Hab. - Assisted Living Facilities and Adult Foster Homes \n(HCBS-SDMI)","Residential Habilitation - Group Home (for Adults with Physical Disabilities)            \n(EPD-BSW)","Res. Hab. - Intensive Mental Health Group Home \n(HCBS-SDMI)","Res. Hab. - Mental Health Group Home (HCBS-SDMI)","Res. Hab. Supported Living - Base \n(DD)","Res. Hab. Supported Living - Flex \n(DD)","Res. Hab. Supported Living - High Geo. Factor \n(DD)","Res. Hab. Supported Living - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living - No Geo. Factor \n(DD)","Res. Hab. Supported Living - Rural Remote \n(DD)","Res. Hab. Supported Living (Small agency) - High Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - Medium Geo. Factor \n(DD)","Res. Hab. Supported Living (Small agency) - No Geo. Factor \n(DD)","Residential Habilitation - Specialized Assisted Living Facilities (TBI/AR) \n(EPD-BSW)","Residential Training Support - High Geo. Factor \n(DD)","Residential Training Support - Medium Geo. Factor \n(DD)","Residential Training Support - No Geo. Factor \n(DD)","Residential Training Support (Small Agency) - High Geo. Factor \n(DD)","Residential Training Support (Small Agency) - Medium Geo. Factor \n(DD)","Residential Training Support (Small Agency) - No Geo. Factor \n(DD)","Supported Living (EPD-BSW)","Therapeutic Foster Care \n(CMH)","Therapeutic Youth Group Home - Therapeutic Home Leave \n(CMH)","Therapeutic Youth Group Home \n(CMH)","Remote Monitoring (DD)","Shelter Care (CMH)"]
[1,"Number of residences or homes operated by your organization",20]
[2,"Number of residential coordinators employed by your organization",35]
[3,"How many homes, on average, is a coordinator responsible for?",3.75]
[4,"Average number of clients per home operated by your organization",8]
[5,"Average absence days per consumer per month (due to hospitalization, vacation, etc.)",8]
[6,"Average number of zero occupancy days, per home, per year",16]
[7,"Identify the types of residences or homes for delivering the service (e.g., group home, foster home, family home, participant's home, etc.)","Group Home"]
[8,"Do services and service rates vary based on an identified characteristic? (e.g., geography, level or intensity of client support, provider type, poverty line, etc.)","Yes"]
["8a","If line 8 is 'Yes', specify the characteristic here","Level of Client Support"]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[9,"Total cost of capital equipment purchased to perform services",500]
[10,"Average life (in years) of equipment purchased",2]
[11,"If costs are listed in Line 9, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[12,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[13,"If costs are listed in Line 12, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[14,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["4. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[15,"On average, how many individuals are typically served by one staff or practitioner?",10]
[16,"At most, how many individuals are typically served by one staff or practitioner?",15]
[17,"At least, how many individuals are typically served by one staff or practitioner?",5]
["5. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[18,"Number of training hours received by staff in their first year of employment",40]
[19,"Number of training hours received annually by staff after their first year of employment",15]
["6. TRANSPORTATION"]
[20,"Is client non-medical transportation required for this service?","Yes"]
["20a","Is client transportation bundled into the service? [Respond if Line 20 is marked as 'Yes]","Yes"]
[21,"Is staff non-medical transportation required for this service?","Yes"]
["21a","Is staff client transportation bundled into the service? [Respond if Line 21 is marked as 'Yes]","Yes"]

{"sheet":"4a. PRTF - Time","index":28,"n_rows":62,"n_cols":25,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,15,8,17],[8,18,8,20],[8,21,9,21],[8,22,8,24],[8,9,9,9],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 65"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,23,24]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"In-State PRTF (CMH)","In-State PRTF Therapeutic Home Visit (CMH)","In-State PRTF Assessment Services (CMH)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Supervisor?","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","In-State PRTF (CMH)","In-State PRTF Therapeutic Home Visit (CMH)","In-State PRTF Assessment Services (CMH)"]
["Example","Teacher",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.03,0.04,0.02,20,"x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"PRTF_4a[[#This Row],[Total Regular Hours Paid]]+PRTF_4a[[#This Row],[Total Overtime Hours Paid]]+PRTF_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. PRTF - Patterns","index":29,"n_rows":62,"n_cols":6,"rows_kept":62,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: PSYCHIATRIC RESIDENTIAL TREATMENT FACILITY (PRTF) - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 66-68"]
["Line","Factor","Example","In-State PRTF (CMH)","In-State PRTF Therapeutic Home Visit (CMH)","In-State PRTF Assessment Services (CMH)"]
["1. FACILITY DETAILS"]
["Line","Question","Example","In-State PRTF (CMH)","Out of State PRTF Services (CMH)","In-State PRTF Therapeutic Home Visit (CMH)"]
[1,"Total number of licensed facility beds",50]
[2,"Maximum number of facility beds utilized (should be les than or equal to number of licensed facility beds)",20]
[3,"Maximum number of PRTF beds utilized (should be les than or equal to number of licensed facility beds)",35]
[4,"Total number of days the facility was open and operational",365]
[5,"Total PRTF facility resident days",8]
[6,"Total number of admissions including readmissions",8]
[7,"Annual count of unduplicated residents",200]
["2. TYPES OF SPECIALIZED TREATMENTS OFFERED"]
[8,"Total treatments included in PRTFs",{"$f":"15-COUNTIF(C20:C34,\"No\")-COUNTIF(C20:C34,\"(Specify)\")-COUNTIF(C20:C34,\"\")","v":12},{"$f":"15-COUNTIF(D20:D34,\"No\")-COUNTIF(D20:D34,\"(Specify)\")-COUNTIF(D20:D34,\"\")","v":0},{"$f":"15-COUNTIF(E20:E34,\"No\")-COUNTIF(E20:E34,\"(Specify)\")-COUNTIF(E20:E34,\"\")","v":0},{"$f":"15-COUNTIF(F20:F34,\"No\")-COUNTIF(F20:F34,\"(Specify)\")-COUNTIF(F20:F34,\"\")","v":0}]
["8a","Autism Spectrum Disorders (high functioning)","Yes"]
["8b","Autism Spectrum Disorders (low functioning)","Yes"]
["8c","Severe Emotional Disturbance","Yes"]
["8d","Conduct Disorder","Yes"]
["8e","Substance Abuse","Yes"]
["8f","Sexualized Behaviors","Yes"]
["8g","Specialized Eating Disorder","Yes"]
["8h","Developmentally Disabled","Yes"]
["8i","Physical Aggression","Yes"]
["8j","Mental Illness","Yes"]
["8k","Parent-Youth Conflict","Yes"]
["8l","Issues of Abuse and Neglect","Yes"]
["8m","Emotional and Behavioral Problems","No"]
["8n","Other Medical (i.e. Diabetic, ect)","No"]
["8o","Other (specify)",null,"(Specify)","(Specify)","(Specify)"]
["3. EQUIPMENT AND SUPPLIES"]
[9,"Total cost of capital equipment purchased to perform services",500]
[10,"Average life (in years) of equipment purchased",2]
[11,"If costs are listed in Line 10, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)"]
[12,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[13,"If costs are listed in Line 13, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)"]
["4. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[14,"Client-facing service delivery",30]
[15,"Recordkeeping and documentation for services",4]
[16,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[17,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[18,"Travel time to/from and between client residences/locations",0]
[19,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[20,"Other activities",0]
[21,"Total hours worked and paid for in a week",40]
[22,"Autopopulated: Has all time been allocated? (Total in Line 21 should equal sum of Lines 14-20)",{"$f":"IF(SUM(C42:C48)=40,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D42:D48)=1,\"Yes\",\"No\")","v":"No"},{"$f":"IF(SUM(E42:E48)=1,\"Yes\",\"No\")","v":"No"},{"$f":"IF(SUM(F42:F48)=1,\"Yes\",\"No\")","v":"No"}]
["5. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[23,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["6. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[24,"How many individuals on average are typically served by one staff or practitioner?",10]
["7. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[25,"Number of training hours received by staff in their first year of employment",40]
[26,"Number of training hours received annually by staff after their first year of employment",15]
["8. TRANSPORTATION"]
[27,"Is client non-medical transportation required for this service?","Yes"]
["27a","Is client transportation bundled into the service? [Respond if Line 27 is marked as 'Yes]","Yes"]
[28,"Is staff non-medical transportation required for this service?","Yes"]
["28a","Is staff client transportation bundled into the service? [Respond if Line 28 is marked as 'Yes]","Yes"]

{"sheet":"4a. Self-Directed Supp. - Time","index":30,"n_rows":62,"n_cols":26,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,22,8,25],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14],[8,15,8,17],[8,21,9,21],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,18,8,20]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: SUPPORTS FOR SELF-DIRECTION - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 69"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Financial Manager \n(EPD-BSW)","Fiscal Agent Admin Fee \n(DD)","Independence Advisor \n(EPD-BSW)","Supports Broker - Self-Direction \n (DD)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Financial Manager \n(EPD-BSW)","Fiscal Agent Admin Fee \n(DD)","Independence Advisor \n(EPD-BSW)","Supports Broker - Self-Direction \n (DD)"]
["Example","Internal Service Coordinators",null,"Employee","Supervisor","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.03,0.04,0.06,6,"x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Self_Directed_4a[[#This Row],[Total Regular Hours Paid]]+Self_Directed_4a[[#This Row],[Total Overtime Hours Paid]]+Self_Directed_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Self-Directed Supp. - Patt.","index":31,"n_rows":32,"n_cols":7,"rows_kept":32,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: SUPPORTS FOR SELF-DIRECTION - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 69-70"]
["Line","Factor","Example","Financial Manager \n(EPD-BSW)","Fiscal Agent Admin Fee \n(DD)","Independence Advisor \n(EPD-BSW)","Supports Broker - Self-Direction \n (DD)"]
["1. AGENCY CASELOAD AND SERVICE SPECIFICATIONS"]
["Line","Question","Example","Financial Manager \n(EPD-BSW)","Fiscal Agent Admin Fee \n(DD)","Independence Advisor \n(EPD-BSW)","Supports Broker - Self-Direction \n (DD)"]
[1,"Number of individuals receiving transition services from your organization",20]
[2,"Average number of clients per staff",35]
[3,"Average number of hours spent with each client per day",2]
["2. TRANSITION, EQUIPMENT & SUPPLY COSTS (INPUT THE COST TO DELIVER THE SERVICE)"]
[4,"Total cost per member per month",1000]
[5,"Total cost of capital equipment purchased to perform services",500]
[6,"Average life (in years) of equipment purchased",2]
[7,"If costs are listed in Line 5, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)"]
[8,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[9,"If costs are listed in Line 8, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)"]
["3. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[10,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["4. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[11,"How many individuals on average are typically served by one staff or practitioner?",10]
["5. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[12,"Number of training hours received by staff in their first year of employment",40]
[13,"Number of training hours received annually by staff after their first year of employment",15]
["6. NON-MEDICAL TRANSPORTATION"]
[14,"Is client transportation required for this service?","Yes"]
["14a","Is client transportation bundled into the service? [Respond if Line 14 is marked as 'Yes]","Yes"]
[15,"Is staff transportation required for this service?","Yes"]
["15a","Is staff client transportation bundled into the service? [Respond if Line 15 is marked as 'Yes]","Yes"]

{"sheet":"4a. Supported Employment - Time","index":32,"n_rows":62,"n_cols":31,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,6,9,6],[8,7,9,7],[8,8,9,8],[8,15,8,17],[8,18,8,20],[8,0,9,0],[8,22,8,30],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,21,9,21],[8,9,9,9],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: SUPPORTED EMPLOYMENT - STAFF TIME AND COSTS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 70-71"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Life Coach \n(HCBS-SDMI)","Prevocational Services \n(EPD-BSW)","Supported Employment \n(EPD-BSW)","Supported Employment \n(HCBS-SDMI)","Supported Employment - Co Worker Support \n(DD)","Supported Employment - Individual Employment Support \n(DD)","Supported Employment Follow Along \n(DD)","Supported Employment Small Group Hourly \n(DD)","Supported Employment Small Group \n(DD)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus","Average Hourly Wage","Lowest Hourly Wage","Highest Hourly Wage","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Life Coach \n(HCBS-SDMI)","Prevocational Services \n(EPD-BSW)","Supported Employment \n(EPD-BSW)","Supported Employment \n(HCBS-SDMI)","Supported Employment - Co Worker Support \n(DD)","Supported Employment - Individual Employment Support \n(DD)","Supported Employment Follow Along \n(DD)","Supported Employment Small Group Hourly \n(DD)","Supported Employment Small Group \n(DD)"]
["Example","Employment Specialist/Job Coach",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,14,12,16.5,0.03,0.04,0.06,20,"x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Supported_Employ_4a[[#This Row],[Total Regular Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Overtime Hours Paid]]+Supported_Employ_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Supported Employ. - Pattern","index":33,"n_rows":43,"n_cols":12,"rows_kept":43,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: SUPPORTED EMPLOYMENT - STAFFING PATTERNS AND SERVICE DESIGN"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 71-73"]
["Line","Factor","Example","Life Coach \n(HCBS-SDMI)","Prevocational Services \n(EPD-BSW)","Supported Employment \n(EPD-BSW)","Supported Employment \n(HCBS-SDMI)","Supported Employment - Co Worker Support \n(DD)","Supported Employment - Individual Employment Support (DD)","Supported Employment Follow Along \n(DD)","Supported Employment Small Group Hourly \n(DD)","Supported Employment Small Group \n(DD)"]
["1. AGENCY CASELOAD AND SERVICE DESIGN"]
["Line","Question","Example","Life Coach \n(HCBS-SDMI)","Prevocational Services \n(EPD-BSW)","Supported Employment \n(EPD-BSW)","Supported Employment \n(HCBS-SDMI)","Supported Employment - Co Worker Support \n(DD)","Supported Employment - Individual Employment Support (DD)","Supported Employment Follow Along \n(DD)","Supported Employment Small Group Hourly \n(DD)","Supported Employment Small Group \n(DD)"]
[1,"Number of individuals receiving supported employment from your organization",20]
[2,"Are services offered in an individual or group setting?","Individual"]
[3,"Average number of clients (or groups) seen per week per direct service staff worker",35]
[4,"Average visit length in hours",3.75]
["2. EQUIPMENT AND SUPPLIES"]
[5,"Total cost of capital equipment purchased to perform services",500]
[6,"Average life (in years) of equipment purchased",2]
[7,"If costs are listed in Line 5, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[8,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[9,"If costs are listed in Line 8, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE NUMBER OF HOURS PER WEEK FOR THE FOLLOWING:"]
[10,"Client-facing service delivery",30]
[11,"Recordkeeping and documentation for services",4]
[12,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",5]
[13,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",1]
[14,"Travel time to/from and between client residences/locations",0]
[15,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, etc.)",0]
[16,"Other activities",0]
[17,"Total hours worked for in a week",{"$f":"SUM(C22:C28)","v":40}]
[18,"Autopopulated: Has all time been allocated? (Total in Line 17 should equal sum of Lines 10-16)",{"$f":"IF(C29<>\"\",IF(SUM(C22:C28)=40,\"Yes\",\"No\"),\"\")","v":"Yes"},{"$f":"IF(D29<>\"\",IF(SUM(D22:D28)=40,\"Yes\",\"No\"),\"\")","v":""},{"$f":"IF(E29<>\"\",IF(SUM(E22:E28)=40,\"Yes\",\"No\"),\"\")","v":""},"","","","","","",""]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[19,"How many staff or practitioners on average are typically supervised by one supervisor?",5]
["5. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[20,"How many individuals on average are typically served by one staff or practitioner?",10]
["6. STAFF TRAINING - INPUT THE NUMBER OF HOURS OF TRAINING RECEIVED BY DIRECT SERVICE STAFF"]
[21,"Number of training hours received by staff in their first year of employment",40]
[22,"Number of training hours received annually by staff after their first year of employment",15]
[23,"Number of training hours received by staff at client work sites per year. Please report training time only when client is not present. ",15]
["7. NON-MEDICAL TRANSPORTATION"]
[24,"Is client non-medical transportation required for this service?","Yes"]
["24a","Is client transportation bundled into the service? [Respond if Line 24 is marked as 'Yes]","Yes"]
[25,"Is staff non-medical transportation required for this service?","Yes"]
["25a","Is staff client transportation bundled into the service? [Respond if Line 25 is marked as 'Yes]","Yes"]

{"sheet":"4a. Transportation Time & Wage","index":34,"n_rows":62,"n_cols":37,"rows_kept":62,"cut":false,"hidden":true,"merged":[[8,6,9,6],[8,0,9,0],[8,1,9,1],[8,3,9,3],[8,4,9,4],[8,5,9,5],[8,15,8,17],[8,22,8,36],[8,18,8,20],[8,21,9,21],[8,7,9,7],[8,8,9,8],[8,9,9,9],[8,10,9,10],[8,11,9,11],[8,12,9,12],[8,13,9,13],[8,14,9,14]]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4A: TRANSPORTATION - STAFF TIME AND WAGES"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
[{"$f":"\"Medicaid ID: \"&IF('1. Organizational Information'!$C$11=\"\",\"\",'1. Organizational Information'!$C$11)","v":"Medicaid ID: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 25-31, 73-74"]
[null,1,null,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35]
["Line","Job Titles",null,"Employee/ Contractor? (Employee, Contractor)","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Hourly Wage",null,null,"Annual Average Percent Change in Wages",null,null,"Average Annual Paid Training \nHours per Staff","Services (select applicable services)"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021",null,"Non-Emergency Transportation - Mile \n(CFC/PAS)","Transportation OTHER - taxi, bus pass, misc -  \n(DD)","Transportation - Mile \n(DD)","Transportation - Commute Individual - Month \n(DD)","Transportation - Commute Individual Wheelchair Van - Month \n(DD)","Transportation - Commute Shared - Month \n(DD)","Transportation - Commute Shared Wheelchair Van - Month \n(DD)","Transportation - Work/Day Integration (12 max/yr) - Ride or Trip \n(DD)","Transportation - Work/Day Integration Wheelchair Van (regular unit rate times 20%) 12 max/yr - Ride or Trip \n(DD)","Transportation - Residential Integration -  \n(DD)","Transportation - Residential Integration Wheelchair Van -  (DD)","Transportation - Mile \n(EPD-BSW)","Transportation - Trip \n(EPD-BSW)","Transportation - Mile \n(HCBS-SDMI)","Transportation - Trip \n(HCBS-SDMI)"]
["Line","Job Titles","Optional (Please Specify)","Employee/ Contractor?","Direct Care or Supervisor? (Direct Care, Supervisor)","Medicaid/Non-Medicaid? (Medicaid, Non-Medicaid, Both)","Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)","Total Hours Paid","Total Regular Wages Paid (does not include bonuses)","Total Overtime Wages Paid","Total Supplemental Pay (premium, shift differentials, and nonproduction bonuses)","Bonus Amount","Average","Lowest","Highest","2018 to 2019","2019 to 2020","2020 to 2021","Average Annual Paid Training \nHours per Staff","Non-Emergency Transportation - Mile \n(CFC/PAS)","Transportation OTHER - taxi, bus pass, misc -  \n(DD)","Transportation - Mile \n(DD)","Transportation - Commute Individual - Month \n(DD)","Transportation - Commute Individual Wheelchair Van - Month \n(DD)","Transportation - Commute Shared - Month \n(DD)","Transportation - Commute Shared Wheelchair Van - Month \n(DD)","Transportation - Work/Day Integration (12 max/yr) - Ride or Trip \n(DD)","Transportation - Work/Day Integration Wheelchair Van (regular unit rate times 20%) 12 max/yr - Ride or Trip \n(DD)","Transportation - Residential Integration -  \n(DD)","Transportation - Residential Integration Wheelchair Van -  (DD)","Transportation - Mile \n(EPD-BSW)","Transportation - Trip \n(EPD-BSW)","Transportation - Mile \n(HCBS-SDMI)","Transportation - Trip \n(HCBS-SDMI)"]
["Example","Driver (Note: Driver's primary responsibility should be driving.)",null,"Employee","Direct Care","Both",10,1500,200,500,2200,30000,4000,6000,1500,15,12,16,0.01,0.01,0.01,15,"x","x","x","x","x","x","x","x","x","x","x","x","x","x","x"]
[1,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[2,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[3,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0},null,null,null,null,""]
[4,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[5,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[6,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[7,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[8,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[9,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[10,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[11,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[12,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[13,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[14,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[15,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[16,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[17,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[18,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[19,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[20,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[21,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[22,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[23,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[24,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[25,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[26,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[27,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[28,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[29,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[30,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[31,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[32,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[33,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[34,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[35,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[36,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[37,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[38,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[39,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[40,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[41,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[42,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[43,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[44,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[45,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[46,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[47,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[48,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[49,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]
[50,null,"(Specify)",null,null,null,null,null,null,null,{"$f":"Transportation_4a[[#This Row],[Total Regular Hours Paid]]+Transportation_4a[[#This Row],[Total Overtime Hours Paid]]+Transportation_4a[[#This Row],[Total Supplemental Pay Hours (e.g., premium, shift differentials, nonproduction bonuses)]]","v":0}]

{"sheet":"4b. Transp. Costs & Vehicles","index":35,"n_rows":74,"n_cols":4,"rows_kept":74,"cut":false,"hidden":true,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 4B: TRANSPORTATION COSTS AND VEHICLES"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 71-74, 74-76"]
["1. ORGANIZATIONAL DETAILS"]
["Questions 1 through 4 pertain only to unbundled transportation trips, i.e., those not provided with other services, if the transportation service is folded into the rates for these services. This includes"]
["services on tab '4a. Transportation Time & Wage'."]
["Question Number","Question","Additional Information","Response "]
["1","Number of one-way passenger trips your organization provided directly in the time period:"]
["2","Number of one-way passenger trips outsourced to a third party personal transportation provider in the time period:"]
["3","Number of one-way passenger trips outsourced to a third party commercial transportation provider in time period:"]
["4","Number of one-way passenger trips outsourced to public transit in the time period:"]
["Questions 5 though 8 pertain only to bundlied transportation trips, i.e., those provided with other services, if the transportation service is folded into the rates for these services."]
["5","Number of one-way passenger trips your organization provided directly in the time period:"]
["6","Number of one-way passenger trips outsourced to a third party personal transportation provider in the time period:"]
["7","Number of one-way passenger trips outsourced to a third party commercial transportation provider in time period:"]
["8","Number of one-way passenger trips outsourced to public transit in the time period:"]
["2. COST INFORMATION"]
["Report total costs by the provider."]
[null,"Transportation-Related Salaries and Wages (9-15)",null,{"$f":"SUM(D23:D29)","v":0}]
["9","Driver's Salaries and Wages"]
["10","Transportation Aide (Direct Service Support) Salaries & Wages"]
["11","Vehicle Maintenance Workers Salaries and Wages"]
["12","Transportation Supervisor/Coordinator Salaries and Wages"]
["13","Administrative Employees Salaries and Wages"]
["14","Volunteer Reimbursement (e.g., stipends, mileage)"]
["15","Other Salaries and Wages (specify):","(Specify)"]
[null,"Purchased Transportation Services (16)",null,{"$f":"SUM(D31)","v":0}]
["16","Purchased Transportation Services"]
[null,"Facility and Equipment-Related Expenses (17-30)",null,{"$f":"SUM(D33:D46)","v":0}]
["17","Operator Training and Licensure"]
["18","Automobile Insurance"]
["19","Registration"]
["20","Materials and Supplies (e.g. Fuel, Tires, Other)"]
["21","Utilities"]
["22","Technology and Communication Related to Transportation"]
["23","Passenger Revenue Vehicles"]
["24","Service Vehicles"]
["25","General Administration Facilities"]
["26","Vehicle Depreciation"]
["27","Property Depreciation "]
["28","Capital Leases Amortization"]
["29","Land Improvements Amortization"]
["30","Purchase Lease Payments"]
[null,"Contracted Services (31-33)",null,{"$f":"SUM(D48:D50)","v":0}]
["31","Contracted Transportation Services"]
["32","Contract Maintenance Services"]
["33","Other Contracted Services "]
[null,"Total Transportation-Related Expenses (34)",null,{"$f":"SUM(D22,D30,D32,D47)","v":0}]
["34","Confirm that the expenses and costs above were included, in aggregate, in Worksheet 2: Total Costs."]
["3. VEHICLE TYPES"]
["35","Does your organization own the following vehicle types? Enter the total number of vehicles owned.",null,{"$f":"SUM(D55:D59)","v":0}]
["35a","Sedans/Station Wagons"]
["35b","Minivans"]
["35c","Small Bus/Van"]
["35d","Medium Bus (11-20 passengers)"]
["35e","Large Bus (20+ passengers)"]
["36","Does your organization lease the following vehicle types? Enter the total number of vehicles owned.",null,{"$f":"SUM(D61:D65)","v":0}]
["36a","Sedans/Station Wagons"]
["36b","Minivans"]
["36c","Small Bus/Van"]
["36d","Medium Bus (11-20 passengers)"]
["36e","Large Bus (20+ passengers)"]
[null,"Total Number of Vehicles Leased or Owned by Organization",null,{"$f":"SUM(D61:D65)","v":0}]
["37","Average number of trips / day by each vehicle:"]
["38","Average minutes each vehicle is in use per day:"]
["39","Average loaded minutes per day for each vehicle:"]
["40","Average empty minutes per day for each vehicle:"]
["41","Average loaded miles per day for each vehicle:"]
["42","Average empty miles per day for each vehicle:"]
["NOTES OR CLARIFYING COMMENTS"]
["43"]

{"sheet":"5. Benefits","index":36,"n_rows":48,"n_cols":5,"rows_kept":48,"cut":false,"hidden":false,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 5: BENEFITS"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
["Time Period for Data Requested: October 1, 2021 - December 31, 2021"]
["Instruction Manual Pages: 21-24"]
["Identify the benefits that your organization offers their full-time staff and part-time staff that deliver services to clients."]
["I. STAFFING AND HEALTH, VISION, & DENTAL INSURANCE",null,null,"FULL-TIME","PART-TIME"]
["Question Number","Question","Optional","Response 1: Full-Time","Response 2: Part-Time"]
[1,"How many employees who provide direct services to clients does your organization currently employ?"]
[2,"Are direct service staff eligible to receive health insurance through your organization?"]
[3,"How many direct service staff are currently eligible for health insurance from your organization?"]
[4,"Does your organization contribute towards health insurance premiums?"]
[5,"How many direct service staff currently receive individual coverage health insurance from your organization?"]
[6,"On average, how much does a typical employee with individual coverage contribute towards his/her own monthly premium?"]
[7,"On average, how much does your organization (the employer) contribute towards the monthly plan premium of one typical employee with individual coverage? If your organization self-insures any portion of the health insurance, report the premium equivalent of self-insured costs plus any other premiums paid (e.g. stop-loss premiums, ACO fees)."]
[8,"On average, how much is the total monthly premium for a typical employee with individual coverage? (Note: this number should equal the sum of the responses to Questions 6 and 7)"]
[9,"What is the average annual deductible for the health insurance offered for individual coverage?"]
[10,"How many direct service staff currently receive family coverage health insurance from your organization?"]
[11,"On average, how much does a typical employee with family coverage contribute towards his/her own monthly premium?"]
[12,"On average, how much does your organization (the employer) contribute towards the monthly plan premium of one typical employee with family coverage? If your organization self-insures any portion of the health insurance, report the premium equivalent of self-insured costs plus any other premiums paid (e.g. stop-loss premiums, ACO fees)."]
[13,"On average, how much is the total monthly premium for a typical employee with family coverage? (Note: this number should equal the sum of the responses to Questions 11 and 12)"]
[14,"What is the average annual deductible for the health insurance offered for family coverage?"]
[15,"Are direct service staff eligible to receive vision insurance through your organization?"]
[16,"How many direct service staff currently receive vision insurance from your organization?"]
[17,"What was your organization's total contribution to vision insurance costs for direct service staff last year?"]
[18,"Are direct service staff eligible to receive dental insurance through your organization?"]
[19,"How many direct service staff currently receive dental insurance from your organization?"]
[20,"What was your organization's total contribution to dental insurance costs for direct service staff last year?"]
[21,"Does your organization participate in the Health Care for Health Care Workers program?"]
["II. RETIREMENT",null,null,"FULL-TIME","PART-TIME"]
[22,"Does your organization contribute to a 401k, 403b or other retirement plan for your direct service staff?"]
[23,"How many direct service staff currently receive retirement contributions from your organization?"]
[24,"What is your organization's average retirement contribution for participating direct service staff as a percent of wages?"]
["III. OTHER BENEFITS",null,null,"FULL-TIME","PART-TIME"]
[25,"Does your organization contribute to any other benefits for staff? (please specify)","(Specify)"]
[26,"How many direct service staff currently receive these benefits from your organization?"]
[27,"What was your organization's cost for providing these benefits?"]
["IV. UNEMPLOYMENT INSURANCE AND WORKERS' COMPENSATION",null,null,"FULL-TIME","PART-TIME"]
[28,"If your organization makes unemployment insurance payments based on a percentage of wages, what is your organization's state unemployment insurance tax rate?"]
[29,"What is your average workers' compensation cost for direct service staff (per $100 in wages paid)?"]
["V. HOLIDAYS, VACATION, SICK TIME, AND PERSONAL DAYS",null,null,"FULL-TIME","PART-TIME"]
[30,"Are direct service staff eligible for holiday pay?"]
[31,"How many paid holidays are direct care service staff eligible to receive per year?"]
[32,"Are direct service staff eligible to receive paid time off (vacation), in addition to holidays?"]
[33,"How many paid time off (vacation) days are direct care service staff eligible to receive per year?"]
[34,"How many sick days are direct care service staff eligible to receive per year?"]
[35,"How many personal days are direct care service staff eligible to receive per year?"]

{"sheet":"6. Additional Information","index":37,"n_rows":8,"n_cols":1,"rows_kept":8,"cut":false,"hidden":false,"merged":[]}
["Provider Cost and Wage Survey"]
["Montana Department of Public Health and Human Services (MT DPHHS)"]
["WORKSHEET 6: ADDITIONAL INFORMATION"]
[{"$f":"\"Provider Name: \"&IF('1. Organizational Information'!$C$10=\"\",\"\",'1. Organizational Information'!$C$10)","v":"Provider Name: "}]
["Enter any clarifying comments in addition to the information covered in previous worksheets or sections. Please specify the data period for the additional information. If there is no additional information, please mark as \"N/A\"."]
["Instruction Manual Page: 24"]
["ADDITIONAL INFORMATION"]
["Question #"]

{"sheet":"Job Types","index":38,"n_rows":49,"n_cols":1,"rows_kept":49,"cut":false,"hidden":true,"merged":[]}
["Addiction Counselor"]
["Audiologist"]
["Behavioral Specialist/Technician"]
["Board Certified Assistant Behavior Analysts"]
["Board Certified Behavior Analyst"]
["Case Manager"]
["Certified Nursing Assistant"]
["Certified Peer Support Specialist"]
["Dietician"]
["Direct Service Professional - Daytime"]
["Direct Service Professional - Overnight Workers Allowed to Sleep (if different)"]
["Direct Service Professional - Swing Shift/Overnight"]
["Driver (Note: Driver's primary responsibility should be driving.)"]
["Employment Specialist/Job Coach"]
["Housekeeper"]
["Internal Service Coordinators"]
["Licensed Clinical Professional Counselor (LCPC)"]
["Licensed Nurse Practitioner (NP)"]
["Licensed Practical Nurse (LPN)"]
["Licensed Clinical Social Worker (LCSW)"]
["Life Skills/Personal Support Coach"]
["Medical Assistant"]
["Midwife"]
["Occupational Therapist"]
["Occupational Therapy Assistant"]
["Physical Therapist"]
["Physical Therapist Assistant"]
["Professional Counselor"]
["Psychologist"]
["Psychiatrist"]
["Recreational Therapists"]
["Registered Nurse (RN)"]
["Shift and Unit Supervisor (if primarily delivering services)"]
["Social Worker"]
["Speech Therapist"]
["Speech Therapist Assistant"]
["Teacher"]
["Transportation Aide"]
["Client Benefits Manager"]
["Direct Support Supervisor"]
["Residential Director"]
["Shift and Unit Supervisor"]
["Executive Director/Assistant Director"]
["Clinical Director"]
["Professional Administrative Staff"]
["Occupancy and Maintenance staff"]
["Food Service Staff"]
["Other Administative Staff (clerical, IT, central office)"]
["Other Staff"]