{"text_format":"1","workbook":"xlsx","n_sheets":25,"sheets":["Lists","Instructions","Provider Data","Questions","Services","Units&Revenues","Direct Support Employee","Direct Support Contracted","Program Staff","Productivity & Transportation","Expenses","Assisted Living","Adult Day Health","Personal Care","Respite","Chore Historical","Chore","Companion","Extra Care for Children","Home Again Services","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","PAS","Workbook Config"],"not_rendered":{"charts":0,"images":0,"macros":1,"external_links":0,"defined_names":52,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Lists","index":0,"n_rows":80,"n_cols":36,"rows_kept":80,"cut":false,"hidden":true,"merged":[]}
["Employee","Exempt","Supervisor","Direct","Education","Experience","Benefits","AlocationBasis",null,"Program Staff","Admin Staff","Staffing",null,null,"Yes","Yes","Yes","Yes","No","Yes","Yes","Yes","Yes","No","No","No",null,null,null,"ALF",null,"Units of Service",null,null,"Yes","X"]
["Employee","Exempt","Yes","Direct","High School","0-2","No Waiting Period","Direct Salaries",null,"Assistant Director","Executive Director","Caregiver",null,null,"Home","Day","Employment","Behavioral","Nursing","Financial","CaseMgmt","Residential","Meals","Interpreter","PERS","Driving",null,null,null,"Waiver",null,"15 Minute",null,null,"No"]
["Contractor","Nonexempt","No","Program","Associate's","3-6","1-2 Months","PRE Salaries",null,"Child Care Supervisor","Assistant Director","Certified Nurse Assistant",null,null,"Respite Care Provider","Center Director","Job Coach","Cognitive Behaviorist","RN","Financial Manager","Case Manager","Residential Counselor","Delivery Driver","Interpreter","Installer","Occupational Therapist",null,null,null,"State Plan",null,"30 Minute"]
[null,null,null,null,"Bachelor's","7-10","3-5 Months","Direct and PRE Salaries",null,"Dietician/Nutritionist","Admin Assistant","Chore Worker",null,null,"Homemaker","Nurse Manager","Supported Employment Specialist","Community Support Person","LPN",null,"Manager of Clinical Operations","House Manager","Kitchen Staff",null,"Call Center","Driver Rehabilitation Specialist",null,null,null,"Both",null,"Hourly"]
[null,null,null,null,"Master's","10+","6-11 Months","Direct Hours",null,"Director of Nursing","Business Mgr/Financial Director","Community Support Person",null,null,"Companion","RN",null,"Peer Support Specialist",null,null,"Access Coordiantor","Nurse Manager","Dietician",null,null,null,null,null,null,null,null,"Daily"]
[null,null,null,null,"M. & Credential",null,"12+ Months","PRE Hours",null,"Interpreter","Accountants","Companion",null,null,"ILST","LPN",null,"Recovery Assistant",null,null,"Interpreter","SALSA",null,null,null,null,null,null,null,null,null,"Meal"]
[null,null,null,null,"PhD",null,null,"Direct and PRE Hours",null,"Nurse Staff - Not Billable Under Other Programs","Payroll Coordinator","Dietary Aide",null,null,"Recovery Assistant","CNA",null,null,null,null,"Program Support Assistant","RN Designee",null,null,null,null,null,null,null,null,null,"Other"]
[null,null,null,null,null,null,null,"Mileage",null,"Program Manager/Director","Public Relations","Driver",null,null,"Caregiver","Program Assistant",null,null,null,null,"Quality Improvement","LPN"]
[null,null,null,null,null,null,null,"Sq Footage",null,"Program Support Assistant","Marketing","Housekeeping",null,null,null,"Van Driver",null,null,null,null,"Education Services","HHA"]
[null,null,null,null,null,null,null,"Cost",null,"Quality Improvement","Admissions","Kitchen Staff",null,null,null,"Recreation Therapist/Activity Coordinator",null,null,null,null,"Billing","RSC"]
[null,null,null,null,null,null,null,{"$error":"#REF!"},null,null,"MIS Director","Licensed Practical Nurse",null,null,null,"Kitchen/Dietary Aide",null,null,null,null,"Recruiter","Billing Staff"]
[null,null,null,null,null,null,null,{"$error":"#REF!"},null,null,"IT Programmers/Analysts","Recreation/Activity Coordinator",null,null,null,"Assistant Director",null,null,null,null,"PC Support/Help Desk","Administrator of Nursing Services"]
[null,null,null,null,null,null,null,{"$error":"#REF!"},null,null,"PC Support / Help Desk","Registered Nurse",null,null,null,"Social Worker",null,null,null,null,"Transitional Case Manager","Housekeeping"]
[null,null,null,null,null,null,null,{"$error":"#REF!"},null,null,"Billing Staff","Respite Care Provider",null,null,null,null,null,null,null,null,"Human Resources","Security"]
[null,null,null,null,null,null,null,null,null,null,"Receptionist","Universal Worker",null,null,null,null,null,null,null,null,"Receptionists","Recreation Coordinator"]
[null,null,null,null,null,null,null,null,null,null,"Human Resources"]
[null,null,null,null,null,null,null,null,null,null,"Development"]
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[{"$f":"'Provider Data'!$A$3","v":"2021 Cost Survey Form - Aged and Disabled (A&D) Waiver and PAS Rate Study"}]
[]
["Instructions"]
[{"$f":"\"Provider Name - \" & 'Provider Data'!$C$10","v":"Provider Name - "}]
["I.  Working with the Survey, Training Information, and Survey Submission"]
[]
[null,"Note:  This cost survey is intended to be completed by agencies who provide services under the Aged and Disabled Waiver and PAS services.  This is NOT intended to be completed by independent providers.  A separate request will be made of the independent providers outside of this cost survey."]
[]
["1.","Completion of this electronic Microsoft Excel form is the required method of filing.  If your system is not compatible with Excel, please contact Myers and Stauffer as stated in step 6 below."]
[]
["2.","The Cost Survey Form is set up as an Excel workbook.  There are 11 standard worksheets within the workbook.  The required schedules are Provider Data, Questions, Services, Units&Revenues, Direct Support Employee, Direct Support Contracted, Program Staff, Productivity & Transportation and Expenses.  \n\nThere are also service specific tabs that will be required to complete, based on the services you select on the Services tab.  If a tab appears, please complete the information requested for that service."]
[]
["3.","Every schedule, except for the instructions tab, asks you to key information.  \n\nThe file is password protected, as no text, formatting, or other changes are allowed.  For this reason, information can only be keyed into the light blue/gray shaded cells.   \n\nUser Tip:  Using the \"Tab\" and \"Shift Tab\" keys during data entry will move you quickly between valid data cells.  This will help to avoid navigating through locked cells (and thereby reduce the number of pop-up messages you receive).  If you need assistance in using the electronic form, you may contact Myers and Stauffer directly as stated in step 7 below."]
[]
["4.","If your business operates in multiple locations, you may either submit a separate survey for each location OR submit a single combined survey. You may choose the option that is easier for you.\n\nFor organizations whose accounting records comingle costs of multiple businesses, operations, or services, it is required to report the expenses for every service included in your financial records. Although we are only interested in determining a cost of providing A&D Wavier services and PAS, if your financial records include other services, we will require you to report them in the \"Other\" column of the survey. You will be submitting your financial support and we need a check figure to know that all expenses are accounted for."]
[]
["5.","Recorded training modules are available at the same location you were able to download the cost survey.  In addition to the recoded modules, additional in-person Webinar trainings will be held during the following times:"]
[]
[null,"Assisted Living Agency Providers:","Wednesday, May 18, 2022 from 10:00 am - 11:00 am Central Time"]
[null,null,"Webinar Instructions:"]
[null,null,"1. Click on the link below or copy and paste the following into your web browser:  "]
[null,null,"https://sonvideo.webex.com/sonvideo/j.php?MTID=m6f66fc53bdba379e6151c2b7815c16f8"]
[null,null,"2. Join by Phone:  1-408-418-9388"]
[null,null,"3. Enter Meeting Number:  2488 080 5637 "]
[null,null,"4. If prompted, enter meeting password:  KdXW2SfWF36"]
[]
[null,"Other Waiver Service Agency Providers:","Wednesday, May 18, 2022 from 12:00 pm - 1:00 pm Central Time"]
[null,null,"Webinar Instructions:"]
[null,null,"1. Click on the link below or copy and paste the following into your web browser:  "]
[null,null,"https://sonvideo.webex.com/sonvideo/j.php?MTID=m85b9df51f4cae28aa565935ec2adf707"]
[null,null,"2. Join by Phone:  1-408-418-9388"]
[null,null,"3. Enter Meeting Number:  2489 918 9089"]
[null,null,"4. If prompted, enter meeting password:  hfJwVN5VK25"]
[]
[null,"If you have other questions while completing this cost survey, please email NECostSurvey@mslc.com and someone will contact you with a response or will follow up with a phone call."]
[]
["6.","After all schedules have been completed, the file should be transferred electronically to Myers and Stauffer. Do not include any protected employee wage or protected health information.  You must submit the survey by e-mailing the completed survey and supporting documents to NECostSurvey@mslc.com.  Once received, a confirmation e-mail will be sent.  If you do not receive a confirmation e-mail within 48 hours of submission, please reach out to NECostSurvey@mslc.com in a separate email."]
[]
["7.","Once your completed survey and other required documents are received, Myers and Stauffer LC may contact you in order to address any questions related to this information."]
[]
["8.","Completed surveys and supporting documentation are due to Myers and Stauffer LC by Friday, June 24, 2022."]

{"sheet":"Provider Data","index":2,"n_rows":46,"n_cols":5,"rows_kept":46,"cut":false,"hidden":false,"merged":[[0,5,4,14],[39,2,39,4],[40,2,40,4],[43,2,43,4],[9,2,9,4],[11,2,11,4],[20,2,20,4],[23,2,23,4],[33,1,37,4]]}
["STATE OF NEBRASKA"]
["Department of Health and Human Services (DHHS)"]
["2021 Cost Survey Form - Aged and Disabled (A&D) Waiver and PAS Rate Study"]
[]
["Click i for additional directions."]
[]
[1,"Fiscal Year Start Date",null,"i"]
[2,"Fiscal Year End Date"]
[]
[3,"Provider Name"]
[]
[4,"Address"]
[5,"City"]
[6,"State"]
[7,"Zip"]
[8,"County"]
[]
[{"$f":"A16+1","v":9},"Medicaid Provider Number"]
[{"$f":"A18+1","v":10},"National Provider Identifier (NPI)"]
[]
[{"$f":"A19+1","v":11},"Contact Person"]
[{"$f":"A21+1","v":12},"Title"]
[{"$f":"A22+1","v":13},"Phone"]
[{"$f":"A23+1","v":14},"Email"]
[]
[]
[null,"Source Document(s) Used to Complete the Cost Survey"]
[null,null,null,"Select \"X\" if Document was Used for Cost Survey Completion","Copy Enclosed?"]
[{"$f":"A24+1","v":15},"Income Statement (Profit & Loss Statement)"]
[{"$f":"A29+1","v":16},"Trial Balance"]
[{"$f":"A30+1","v":17},"Latest Filed Income Tax Return"]
[{"$f":"A31+1","v":18},"Other (Describe)"]
[]
[null,"Declaration by owner and preparer: I declare that I have examined this financial report, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. I understand this information is being submitted for the purpose of reviewing costs per unit of the services identified in this cost report for the State of Nebraska.  "]
[]
[]
[]
[]
[]
[{"$f":"A32+1","v":19},"Authorized Representative"]
[{"$f":"A40+1","v":20},"Signature"]
[{"$f":"A41+1","v":21},"Title"]
[22,"Phone"]
[23,"Email"]
[24,"Date"]
[null,"* Electronic Signatures are accepted."]

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["Questions"]
["Provider Name: ",null,null,{"$f":"'Provider Data'!$C$10","v":0}]
["Instructions:  Please complete the questionnaire below. This information provides us with a general overview of your organization's operations."]
[]
["I. General Questions"]
["Line","Requirement / Question",null,null,"Response"]
["1.","Please identify the nature of your agency. Select \"X\" in the box to the right of each applicable qualification."]
[null,"Owner is also the administrator"]
[null,"Expenses are recorded on a cash basis"]
[null,"Expenses are recorded on an accrual basis"]
[null,"Other info you want to share. Type in the shaded box below. Use \"ALT Enter\" if you want to start a new row."]
[]
["2.","Please identify any services other than the services identified on the \"Services\" tab that your business operates. This is unique to each agency. Any non-A&D waiver services or PAS operations should be identified below."]
[]
[]
[null,"a)"]
[]
[null,"b)"]
[]
[null,"c)"]
[]
[null,"d)"]
["3.","If your agency has multiple offices or sites, you have the option to submit a cost survey for the operations in each of these locations or you may combine the information into a single cost survey IF THAT IS EASIER FOR YOU. Locations do not refer to services provided in the participant's homes.  Please select one of the following with an \"X\" next to the option selected: "]
[null,"This cost survey is prepared for a single location. "]
[null,"This cost survey is prepared for all agency offices/sites and are combined onto one report. If yes, please list the agency office/site location in the shaded boxes below and to the right.  Note: Locations do not refer to services provided in a participant's home."]
[null,"Location 1"]
[null,"Location 2"]
[null,"Location 3"]
[null,"Location 4"]
[null,"Location 5"]
[null,"Location 6"]
[null,"Location 7"]
[null,"Location 8"]
[null,"Location 9"]
[null,"Location 10"]
[null,"Location 11"]
[null,"Location 12"]
[null,"Location 13"]
[null,"Location 14"]
[null,"Location 15"]
[null,"Location 16"]
[null,"Location 17"]
[null,"Location 18"]
[null,"Location 19"]
[null,"Location 20"]
[null,"Location 21"]
[null,"Location 22"]
[null,"Location 23"]
[null,"Location 24"]
[null,"Location 25"]
["4.","Anything else you want to share?  If you have anything else you would like to explain or share, please use the shaded box below. (Note: To start a new line or row within the box, use ALT-Enter)"]

{"sheet":"Services","index":4,"n_rows":18,"n_cols":3,"rows_kept":18,"cut":false,"hidden":false,"merged":[[2,0,2,2]]}
["Summary of Services Provided"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Select \"X\" box for each service provided by your organization. This workbook will customize based on the services selected. "]
["Click i for service codes related to each service."]
["Service","Select \"X\" for Services Provided"]
["Assisted Living",null,"i"]
["Adult Day Health",null,"i"]
["Personal Care",null,"i"]
["Respite Care",null,"i"]
["Chore Historical",null,"i"]
["Chore",null,"i"]
["Companion",null,"i"]
["Extra Care for Children With Disabilities (Disability Related Child Care)",null,"i"]
["Home Again Service",null,"i"]
["Independence Skills Building",null,"i"]
["Non-Medical Transportation",null,"i"]
["Home Delivered Meals",null,"i"]
["Personal Assistance Services (Medicaid State Plan)",null,"i"]

{"sheet":"Units&Revenues","index":5,"n_rows":62,"n_cols":7,"rows_kept":62,"cut":false,"hidden":false,"merged":[[0,3,0,7],[2,0,2,6]]}
["Summary of Service Units and Revenue"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please populate the \"Waiver Service & PAS Revenues\" section of this schedule with the number of units billed and the associated billed revenue for that service. Billed units are being requested to capture all services provided. This may differ from paid units and revenue, but we want to capture all services that were provided during the cost survey period, whether they were paid or not.\n\nPlease populate the \"Non-Waiver Service Revenues\" section with units, if applicable, and revenues related to other services your organization provides. This may include services similar to the services in the \"Wavier Service & PAS Revenues\" section, but paid by a non-Medicaid source. You will also report any revenues related to services your organization provides that are not included in this cost survey. \n"]
[]
["Line","Service Code","Service","Procedure Code Description","Unit of Service","Billed Units","Billed Revenue"]
["Waiver Service & PAS Revenues"]
[1,"N/A","Assisted Living Rates - A&D","Multiple Occupancy","Monthly"]
[{"$f":"A7+1","v":2},"N/A","Assisted Living Rates - A&D","Multiple Occupancy","Daily"]
[{"$f":"A8+1","v":3},"N/A","Assisted Living Rates - A&D","Level 40 Rural Single Occupancy","Monthly"]
[4,"N/A","Assisted Living Rates - A&D","Level 40 Rural Single Occupancy","Daily"]
[5,"N/A","Assisted Living Rates - A&D","Level 41 Rural Multiple Occupancy","Monthly"]
[6,"N/A","Assisted Living Rates - A&D","Level 41 Rural Multiple Occupancy","Daily"]
[7,"N/A","Assisted Living Rates - A&D","Level 42 Urban Single Occupancy","Monthly"]
[8,"N/A","Assisted Living Rates - A&D","Level 42 Urban Single Occupancy","Daily"]
[9,"N/A","Assisted Living Rates - A&D","Level 43 Urban Multiple Occupancy","Monthly"]
[10,"N/A","Assisted Living Rates - A&D","Level 43 Urban Multiple Occupancy","Daily"]
[11,"N/A","Assisted Living Rates - TBI Waiver","TBI Waiver","Monthly"]
[12,"N/A","Assisted Living Rates - TBI Waiver","TBI Waiver","Daily"]
[13,9245,"Adult Day Health",null,"Daily"]
[14,5761,"Personal Care","Personal Care Hourly","Hourly"]
[15,5761,"Personal Care","Personal Care Daily","Daily"]
[16,1113,"Respite In Home","Respite Care Hourly","Hourly"]
[17,1113,"Respite In Home","Respite Care Daily","Daily"]
[18,7395,"Respite Care","Respite Care Hourly","Hourly"]
[19,7395,"Respite Care","Respite Care Daily","Daily"]
[20,1691,"Chore Historical","Chore Hourly","Hourly"]
[21,1691,"Chore Historical","Chore Daily","Daily"]
[22,6496,"Chore","Chore Hourly","Hourly"]
[23,6496,"Chore","Chore Daily","Daily"]
[24,9510,"Companion","Companion Hourly","Hourly"]
[25,9510,"Companion","Companion Daily","Daily"]
[26,2500,"Extra Care for Children with Disabilities In Home","Child / Youth Care Hourly","Hourly"]
[{"$f":"A32+1","v":27},9704,"Extra Care for Children with Disabilities","Child / Youth Care Day","Daily"]
[{"$f":"A33+1","v":28},9704,"Extra Care for Children with Disabilities","Child / Youth Care Hourly","Hourly"]
[{"$f":"A34+1","v":29},8234,"Home Again Service",null,"Occurrence"]
[30,8382,"Independence Skills Building",null,"Hourly"]
[{"$f":"A36+1","v":31},9233,"Independence Skills Building In Home",null,"Hourly"]
[{"$f":"A37+1","v":32},2556,"Transportation Within Omaha/Lincoln by a Commercial Provider","Non-Medical Transportation Flat Rate","Occurrence"]
[33,2772,"Transportation Base Rate by a Commercial Provider","Non-Medical Transportation by Base Rate","Occurrence"]
[34,4592,"Escort Services by an Agency Provider","Non-Medical Transportation by Hour","Hourly"]
[35,4677,"Transportation Mileage by a Commercial Provider","Non-Medical Transportation by Mile","Miles"]
[36,6579,"Transportation by Individual Provider","Non-Medical Transportation by Mile","MIles"]
[37,7122,"Transportation Base Rate by a Commercial Wheelchair Van Provider","Non-Medical Transportation by Base Rate","Occurrence"]
[38,7272,"Escort Services by an Individual Provider","Non-Medical Transportation by Hour","Hourly"]
[39,7593,"Transportation Mileage by a Commercial Wheelchair Van Provider","Non-Medical Transportation by Mile","Miles"]
[40,9660,"Transportation Provided by an Exempt Public Transportation Provider","Non-Medical Transportation by One Way Trip","Occurrence"]
[41,9040,"Home Delivered Meal",null,"Occurrence"]
[42,4475,"Personal Assistance Services (Medicaid State Plan)",null,"Occurrence"]
["Non-Waiver Service & Non-PAS Revenues"]
[1,null,"Assisted Living Services","Non-Medicaid Services, Including Room and Board"]
[{"$f":"A50+1","v":2},null,"Assisted Living Services ","Room and Board Associated with Medicaid Residents"]
[{"$f":"A51+1","v":3},null,"Other Revenue","Please Define"]
[4,null,"Other Revenue","Please Define"]
[5,null,"Other Revenue","Please Define"]
[6,null,"Other Revenue","Please Define"]
[7,null,"Other Revenue","Please Define"]
[8,null,"Other Revenue","Please Define"]
[9,null,"Other Revenue","Please Define"]
[10,null,"Other Revenue","Please Define"]
[11,null,"Other Revenue","Please Define"]
[12,null,"Other Revenue","Please Define"]
["Total Revenue",null,null,null,null,null,{"$f":"SUM(G7:G61)","v":0}]

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["Direct Support Professional  Wages and Hours "]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  This schedule is used to identify the salaries and wages paid to the direct support professionals who provide services under the A&D Waiver and PAS. This schedule will collect information related to the workers who are employees of your organization. Please select an appropriate position for the employees providing the service in the table below. At the bottom of the worksheet, there is guidance for each position. If there is a position that does not fall into one of the pre-populated positons, you may type your own description. If your organization provides multiple services, please assign the estimated percentage of time that the position worked for each service. Based on that percentage, total direct support professional wages will calculate for the service. These totals will automatically populate on the \"Expenses\" tab.\n\nA couple of suggestions to determine the percentage of time each position performs, you may ask the employee if they have an estimate of the amount of time they spend performing each service, or you may be able to use billing records to assist with this calculation.\n\nClick i for additional directions."]
[]
["Direct Support Professional Employee Wages and Hours"]
["Line","Employee Position","Education","Experience","Salaries and Wages Paid","Regular Hours Paid",null,"Overtime Paid","Overtime Hours Paid",null,null,null,"Total Weighted Average Hourly Rate","% of Time Related to Applicable Services"]
[null,null,null,null,null,null,"Weighted Average Pay Rate",null,null,"Weighted Average Overtime Pay Rate","Total Salaries and Wages Paid","Total Hours Paid",null,"Assisted Living","Adult Day Health","Personal Care","Respite Care","Chore Historical","Chore","Companion","Extra Care for Children with Disabilities","Home Again Service","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","Personal Assistance Services ","Other Non-Waiver Services"]
[null,"i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i"]
["Ex.","Caregiver","Bachelor's","3-6",75000,2080,{"$f":"E9/F9","v":36.057692307692307},10000,200,{"$f":"H9/I9","v":50},{"$f":"E9+H9","v":85000},{"$f":"F9+I9","v":2280},{"$f":"(E9+H9)/(F9+I9)","v":37.280701754385966},0.2,0.1,0.1,null,null,null,null,null,null,null,null,null,null,0.6]
[1,null,null,null,null,null,{"$f":"IFERROR((E10/F10),0)","v":0},null,null,{"$f":"IFERROR((H10/I10),0)","v":0},{"$f":"E10+H10","v":0},{"$f":"F10+I10","v":0},{"$f":"IFERROR(((E10+H10)/(F10+I10)),0)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(SUM(N10:AA10)=1,SUM(N10:AA10)=0),\"\",\"Total of the percentages does not equal 100%. Please review and update.\")","v":""}]
[2,null,null,null,null,null,0,null,null,{"$f":"IFERROR((H11/I11),0)","v":0},{"$f":"E11+H11","v":0},{"$f":"F11+I11","v":0},{"$f":"IFERROR(((E11+H11)/(F11+I11)),0)","v":0},null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[3,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[4,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[5,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[6,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[7,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[8,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[9,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[10,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[11,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[12,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[13,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[14,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[15,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[16,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[17,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[24,null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[{"$f":"A27+1","v":25},null,null,null,null,null,0,null,null,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"Totals",null,null,{"$f":"SUM(E10:E28)","v":0},{"$f":"SUM(F10:F28)","v":0},null,{"$f":"SUM(H10:H28)","v":0},{"$f":"SUM(I10:I28)","v":0},null,{"$f":"SUM(K10:K28)","v":0},{"$f":"SUM(L10:L28)","v":0},null,{"$f":"SUMPRODUCT(N10:N28,$K$10:$K$28)","v":0},{"$f":"SUMPRODUCT(O10:O28,$K$10:$K$28)","v":0},0,0,{"$f":"SUMPRODUCT(R10:R28,$K$10:$K$28)","v":0},0,0,0,0,0,0,0,0,0]
[null,null,null,null,null,null,null,null,null,null,null,null,"Calculated Total Hours/Service",{"$f":"SUMPRODUCT(N10:N28,$L$10:$L$28)","v":0},{"$f":"SUMPRODUCT(O10:O28,$L$10:$L$28)","v":0},0,0,{"$f":"SUMPRODUCT(R10:R28,$L$10:$L$28)","v":0},0,0,0,0,0,0,0,0,0]
[null,"This table provides some additional guidance for identifying an appropriate job title for each positon. Note that this is a guide and is not all inclusive."]
[null,"Title","Additional Information"]
[null,"Caregiver","This position provides general care and support for an individual. This title may apply to multiple services included on the cost survey."]
[null,"Certified Nurse Assistant","This position may provide general care and support for an individual. This title may apply to multiple services included on the cost survey. "]
[null,"Chore Worker ","This position performs general household tasks to maintain the home in a clean, sanitary and safe environment. This title may apply to Chore Historical, Chore or Assisted Living services."]
[null,"Community Support Person","This position may create an provide programs for individuals in a community setting. This title may apply to Adult Day Health, Extra Care for Children with Disabilities, Home Again Service, or Independence Skills Building."]
[null,"Companion","This position provides supervision and/or social supports in an individual's home and possibly other community settings. This position may provide light housekeeping tasks, assist with bill paying, errand services, essential shopping, food preparation, and laundry service. This position does not provide any hands-on nursing care. This title may apply to Chore Historical or Companion services."]
[null,"Dietary Aide","This position assists with meal preparation and dining assistance. They may also assist in dishwashing and cleaning the kitchen. This position may apply to Assisted Living services or Home Delivered Meals."]
[null,"Driver","This position includes driving a delivery vehicle to provide goods to individuals. This position may provider services under Home Delivered Meals."]
[null,"Housekeeping","This position may provide assistance to individuals such as in-home cleaning and care of household equipment, appliances or furnishings. These workers may also perform minor repairs around the household and provide landscaping services such as snow removal, mowing, raking and removing trash. This service does not duplicate the light housekeeping provided under Companion services. This title may apply to Chore Historical, Chore or Assisted Living services."]
[null,"Kitchen Staff","This position provides assistance with meal preparation and maintaining the cleanliness of the kitchen area and dining utensils. This position may apply to Assisted Living facilities or Home Delivered Meals."]
[null,"Licensed Practical Nurse","This position may provide general care and support for an individual. This title may apply to multiple services included on the cost survey. "]
[null,"Recreation/Activity Coordinator","This position is in charge of planning, directing and coordinating events in a social environment. This position may apply to Assisted Living facilities or Adult Day Health services."]
[null,"Registered Nurse","This position may provide general care and support for an individual. This title may apply to multiple services included on the cost survey. "]
[null,"Respite Care Provider","This position provides relief for a primary caregiver over a period of time. This position may apply to Respite Care."]
[null,"Universal Worker","This position may provide multiple functions, such as caregiver, chore or housekeeping services. The duties of this position are not easily separated into one particular service. This position may apply to Assisted Living facilities."]

{"sheet":"Direct Support Contracted","index":7,"n_rows":30,"n_cols":19,"rows_kept":30,"cut":false,"hidden":false,"merged":[[2,0,2,3],[5,2,6,2],[5,3,6,3],[5,4,5,17],[5,1,6,1],[5,0,6,0]]}
["Direct Support Professional  Contracted Services"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  This schedule is used to identify the amounts paid to contracted direct support professionals who provide services under the A&D Waiver and PAS. Please select an appropriate position for the contractor providing the service in the table below. At the bottom of the worksheet, there is guidance for each position. If there is a position that does not fall into one of the pre-populated positons, you may type your own description. If the contractor provides multiple services, please assign the estimated percentage of time that the contractor worked for each service. Based on that percentage, total direct support professional contracted expense will calculate for the service. These totals will automatically populate on the \"Expenses\" tab.\n\nA couple of suggestions to determine the percentage of time each position performs, you may ask the contractor if they have an estimate of the amount of time they spend performing each service, or you may be able to use billing records to assist with this calculation.\n\nClick i for additional directions."]
[]
["Direct Support Professional Contracted Expenses and Hours"]
["Line","Contracted Position\n(see guidance for each postion on the \"Direct Support Employee\" tab)","Total Contracted Expense","Total Contracted Hours","% of Time Related to Applicable Services"]
[null,null,null,null,"Assisted Living","Adult Day Health","Personal Care","Respite Care","Chore Historical","Chore","Companion","Extra Care for Children with Disabilities","Home Again Service","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","Personal Assistance Services ","Other Non-Waiver Services"]
[null,"i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i","i"]
["Ex.","Caregiver ",75000,2080,0.2,0.1,0.1,null,null,null,null,null,null,null,null,null,null,0.6]
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[2,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[3,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[4,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[5,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[6,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[7,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[8,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[9,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[10,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[11,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[12,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[13,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[14,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[15,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[16,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[17,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[24,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[{"$f":"A27+1","v":25},null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,""]
[null,"Totals",{"$f":"SUM(C10:C28)","v":0},{"$f":"SUM(D10:D28)","v":0},{"$f":"SUMPRODUCT(E10:E28,$C$10:$C$28)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0]
[null,null,null,"Total Hours/Service",{"$f":"SUMPRODUCT(E10:E28,$D$10:$D$28)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0]

{"sheet":"Program Staff","index":8,"n_rows":48,"n_cols":58,"rows_kept":48,"cut":false,"hidden":false,"merged":[[47,2,47,11],[2,0,2,11],[38,2,38,11],[39,2,39,11],[40,2,40,11],[41,2,41,11],[43,2,43,11],[44,2,44,11],[45,2,45,11],[46,2,46,11],[5,4,6,4],[5,0,6,0],[5,1,6,1],[5,2,6,2],[5,3,6,3],[42,2,42,11],[5,12,5,25],[5,5,6,5],[5,6,6,6],[5,8,6,8],[5,7,6,7],[5,9,6,9]]}
["Program Related Staff Wages and Hours"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  This schedule is used to identify the amounts paid to program related professionals who provide support to the Direct Support Professional staff for the services covered under the A&D Waiver and PAS. The program related professionals are positions that are required in order to provide services under the waiver program, but who are not providing the direct \"hands-on\" service. These positions do not include positions that are administrative in nature and would be part of normal operational duties any business would need to support general business operations. \n\nPlease select an appropriate position for the program related employees in the table below. At the bottom of the worksheet, there is guidance for each position. If there is a position that does not fall into one of the pre-populated positons, you may type your own description. If your organization provides multiple services, please select an \"X\" under the service the position supports. The salary expenses will automatically allocate to each service based on the total direct support professional employee and contractor hours calculated on the \"Direct Support Employee\" and \"Direct Support Contracted\" tabs. The costs will only allocate to the services the positions support. The total calculated program related wages will automatically populate on the \"Expenses\" tab.\n\nClick i for additional directions."]
[]
[]
["Line","Employee Position","Exempt/ Nonexempt","Number of Employees","Education","Experience","\nSalaries and Wages Paid","Regular Hours Paid","Overtime Paid","Overtime Hours Paid",null,null,"Applicable Services\nNote Applicable Services with \"X\". Expense will Allocate to Each Service Based on Direct Support Employee and Contracted Hours.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,"DSP Hours",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Allocated Cost"]
[null,null,null,null,null,null,null,null,null,null,"Total Salaries and Wages Paid","Total Hours Paid","Assisted Living","Adult Day Health","Personal Care","Respite Care","Chore Historical","Chore","Companion","Extra Care for Children with Disabilities","Home Again Service","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","Personal Assistance Services ","Other Non-Waiver Services",null,"Assisted Living","Adult Day Health","Personal Care","Respite Care","Chore Historical","Chore","Companion","Extra Care for Children with Disabilities","Home Again Service","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","Personal Assistance Services ","Other","Total",null,"Assisted Living","Adult Day Health","Personal Care","Respite Care","Chore Historical","Chore","Companion","Extra Care for Children with Disabilities","Home Again Service","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","Personal Assistance Services ","Other","Total"]
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["Ex.","Program Supervisor","Exempt",1,"Bachelor's","3-6",75000,2080,0,0]
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[null,"Totals",null,null,null,null,{"$f":"SUM(G10:G34)","v":0},0,0,0,0,0,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(AR10:AR34)","v":0},{"$f":"SUM(AS10:AS34)","v":0},0,0,0,0,0,0,0,0,0,0,0,{"$f":"SUM(BE10:BE34)","v":0},{"$f":"SUM(BF10:BF34)","v":0}]
[]
[null,null,null,null,null,null,null,null,null,null,null,"Allocated Program Wages",{"$f":"AR35","v":0},{"$f":"AS35","v":0},{"$f":"AT35","v":0},{"$f":"AU35","v":0},{"$f":"AV35","v":0},{"$f":"AW35","v":0},0,0,0,0,0,0,0,0]
[null,"This table provides some additional guidance for identifying an appropriate job title for each positon. Note that this is a guide and is not all inclusive."]
[null,"Title","Additional Information"]
[null,"Assistant Director","This position assists the program director with managing the service programs. This title may apply to multiple services included on the cost survey."]
[null,"Child Care Supervisor","This position trains and supervises child care staff, monitor's interactions with children, provides training and schedules the direct support staff. This title may apply to Extra Care for Children with Disabilities services."]
[null,"Dietician/Nutritionist","This position is in charge of ensuring meals meet the nutritional needs of individuals. They plan meals and supervise other dietary staff. This position may apply to Assisted Living services or Home Delivered Meals."]
[null,"Director of Nursing","This position is responsible for supervising the nursing staff employed by an organization and provides overall monitoring of the care individuals receive. This position may apply to Assisted Living services."]
[null,"Interpreter","This position may provide assistance to individuals to enable communication with the organization's staff. This title may apply to multiple services included on the cost survey."]
[null,"Nurse Staff - Not Billable Under Other Programs","This position is a licensed nurse that is employed to provide health assessments and nursing service components of the service and supervise activities of daily living, as well as associated training components. This service may apply to Adult Day Health, Assisted Living, and Extra Care for Children with Disabilities."]
[null,"Program Manager/Director","This position is responsible for the overall service operations of an organization. This position may apply to multiple services included on the cost survey."]
[null,"Program Support Assistant","This position provides administrative support, as it relates to service planning and implementing a service plan. This position may apply to multiple services included on the cost survey."]
[null,"Quality Improvement","This position focuses on maintaining and improving the quality of services provided to individuals. This position may apply to multiple services included on the cost survey."]

{"sheet":"Productivity & Transportation","index":9,"n_rows":55,"n_cols":17,"rows_kept":55,"cut":false,"hidden":false,"merged":[[2,0,2,1],[5,2,5,15],[8,0,9,0],[20,0,21,0],[20,1,21,1],[8,1,9,1]]}
["Direct Support Staff Productivity, Supervision, Training, Paid Time Off and Transportation Services"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please complete the information requested below. This worksheet provides us with information related to the service delivery."]
[]
[]
[null,null,"Applicable Services"]
[null,"Information Requested","Assisted Living","Adult Day Health","Personal Care","Respite Care","Chore Historical","Chore","Companion","Extra Care for Children with Disabilities","Home Again Service","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","Personal Assistance Services ","Other Non-Waiver Services"]
["I.","Productivity - Non-Billable Time in an Average Work Week"]
["Line","Complete this section for Direct Support Professional Staff included on the \"Direct Support Employee\" tab. Estimate total hours direct care staff dedicates to non-billable tasks per 40 hour work week. In general, this includes time spent performing tasks that the direct support professionals perform that do not involve direct interaction with the individual."]
[]
[1,"Average total hours worked in a week, including both direct service delivery and non-billable tasks."]
[{"$f":"A11+1","v":2},"Travel time between individuals receiving service, included in Line 1 above"]
[{"$f":"A12+1","v":3},"Recordkeeping and office time (do not include documentation during the course of service provision), Included in Line 1 above"]
[4,"Employer time' (e.g. receiving one-on-one supervision, staff meetings, etc.), Included in Line 1 above"]
[5,"Other, Included in Line 1 above - Please Describe"]
[6,"Other, Included in Line 1 above - Please Describe"]
[7,"Other, Included in Line 1 above - Please Describe"]
[null,"Total Non-Productive Time",{"$f":"SUM(C12:C17)","v":0},{"$f":"SUM(D12:D17)","v":0},0,0,0,0,0,0,0,0,0,0,0,0]
[]
["II.","On-Site Supervision of Direct Care Staff"]
["Line","Complete this section for On-Site Supervision of the Direct Care Staff. This time should include time in which the supervisors are directly supervising the direct support professionals while performing the service. "]
[]
[1,"Does your organization provide on-site supervision of staff for services performed?"]
[2,"If yes, how many direct care workers are supervised by 1 supervisor"]
[3,"If yes, average number of hours of on-site supervision provided per staff during a typical week"]
[]
["III.","Training Hours"]
["Line","Complete this section for Direct Support Professional Staff included on the \"Direct Support Employee\" tab. Estimate total hours of training in the cost survey period."]
[1,"Training hours in first year of employment, including time spent \"job shadowing\""]
[2,"Training Hours in subsequent years of employment"]
[]
["IV.","Paid Time Off"]
["Line","Complete this section for Direct Support Professional Staff included on the \"Direct Support Employee\" tab. Estimate total days (8 hour equivalent) of paid time off during the cost survey period."]
[1,"Average Number of Vacation Days"]
[2,"Average Number of Sick Days"]
[3,"Average Number of Paid Holidays"]
[]
["V.","Employee Turnover Information - Direct Support Professional Staff"]
["Line","Complete this section for Direct Support Professional Staff included on the \"Direct Support Employee\" tab."]
[1,"Total Direct Support Professional Staff at Beginning of the Year"]
[2,"Total Direct Support Professional Staff at End of the Year"]
[3,"Average # of Staff",{"$f":"IFERROR(AVERAGE(C40:C41),0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0]
[4,"Number of Direct Support Professional Staff Voluntary/Involuntary Terminations During the Year"]
[5,"Average Turnover Rate for Direct Support Professional Staff",{"$f":"IFERROR((C43/C42),\"\")","v":""},"","","","","","","","","","","","",""]
[]
["VI.","Transportation Expenses Included in Direct Service"]
["Line","Complete this section if transportation expenses included on the \"Expenses\" tab, Lines 16 - 18, are related to the service being provided."]
[1,"Percent of the total expense related to transportation expenses for the applicable service.",null,null,null,null,null,null,null,null,null,null,null,null,null,null,{"$f":"IF(OR(SUM(C48:P48)=1,SUM(C48:P48)=0),\"\",\"Total of the percentages does not equal 100%. Please review and update.\")","v":""}]
[{"$f":"A48+1","v":2},"Total number of trips provided"]
[{"$f":"A49+1","v":3},"Percent of total trips related to #2 provided using company vehicles"]
[{"$f":"A50+1","v":4},"Percent of total trips related to #2 provided using vehicles owned by employees"]
[5,"For Assisted Living:  Total # of medical trips "]
[6,"For Assisted Living:  % of medical trips exceeding 50 miles"]
[7,"For Assisted Living:  % of medical trips exceeding 5 per month"]
[8,"For Assisted Living:  Total # of non-medical trips"]

{"sheet":"Expenses","index":10,"n_rows":114,"n_cols":18,"rows_kept":114,"cut":false,"hidden":false,"merged":[[2,0,2,3],[26,0,26,3]]}
["Expenses Related to Service Delivery"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  To complete this schedule, you will gather your financial records that include the expenses related to providing A&D Waiver services and PAS.  \n\nIf your financial records separate these services from all other operations at your organization, then only report the expenses related to A&D Wavier services and PAS. You will also be required to provide the financial support for those expenses with the cost survey.  \n\nFor organizations whose accounting records comingle costs of multiple businesses, operations, or services, it is required to report the expenses for every service included in your financial records. Although we are only interested in determining a cost of providing A&D Wavier services and PAS, if your financial records include other services, we will require you to report them in the \"Other\" column of the survey. You will be submitting your financial support and we need a check figure to know that all expenses are accounted for.\n\nEnter information requested in the lighter blue/gray shaded cells below.  The darker blue/gray shaded cells are calculations built into the survey and do not require data entry. Click i for additional directions."]
[]
["Line","Expense Classification",null,"Total Expenses per General Ledger","Assisted Living","Adult Day Health","Personal Care","Respite Care","Chore Historical","Chore","Companion","Extra Care for Children with Disabilities","Home Again Service","Independence Skills Building","Non-Medical Transportation","Home Delivered Meals","Personal Assistance Services ","Other Non-Waiver Services"]
["Payroll Taxes and Employee Benefits"]
[1,"Bonus Pay","i"]
[{"$f":"A7+1","v":2},"Payroll Taxes","i"]
[3,"Workers' Compensation","i"]
[4,"Health Insurance","i"]
[5,"Retirement / 401k","i"]
[6,"Other Benefits (type description in cell)","i"]
[{"$f":"A12+1","v":7},"Total Employee Taxes and Benefits",null,{"$f":"SUM(D7:D12)","v":0}]
[{"$f":"A13+1","v":8},"Total Salaries and Wages",null,{"$f":"D17+D23+D50+D66+D99","v":0}]
[]
["Direct Support Professional Wages, Salaries, Benefits and Contracted Services"]
[{"$f":"A14+1","v":9},"Direct Support Professional Employee Salaries","i",{"$f":"'Direct Support Employee'!K29","v":0},{"$f":"'Direct Support Employee'!N29","v":0},{"$f":"'Direct Support Employee'!O29","v":0},{"$f":"'Direct Support Employee'!P29","v":0},{"$f":"'Direct Support Employee'!Q29","v":0},{"$f":"'Direct Support Employee'!R29","v":0},{"$f":"'Direct Support Employee'!S29","v":0},{"$f":"'Direct Support Employee'!T29","v":0},{"$f":"'Direct Support Employee'!U29","v":0},{"$f":"'Direct Support Employee'!V29","v":0},{"$f":"'Direct Support Employee'!W29","v":0},{"$f":"'Direct Support Employee'!X29","v":0},{"$f":"'Direct Support Employee'!Y29","v":0},{"$f":"'Direct Support Employee'!Z29","v":0},{"$f":"'Direct Support Employee'!AA29","v":0}]
[{"$f":"A17+1","v":10},"Direct Support Professional Employee Benefits","i",{"$f":"IFERROR(((D17/$D$14)*$D$13),0)","v":0},{"$f":"IFERROR(((E17/$D$14)*$D$13),0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0,0]
[{"$f":"A18+1","v":11},"Direct Support Professional Contracted Staff","i",{"$f":"'Direct Support Contracted'!C29","v":0},{"$f":"'Direct Support Contracted'!E29","v":0},{"$f":"'Direct Support Contracted'!F29","v":0},{"$f":"'Direct Support Contracted'!G29","v":0},{"$f":"'Direct Support Contracted'!H29","v":0},{"$f":"'Direct Support Contracted'!I29","v":0},{"$f":"'Direct Support Contracted'!J29","v":0},{"$f":"'Direct Support Contracted'!K29","v":0},{"$f":"'Direct Support Contracted'!L29","v":0},{"$f":"'Direct Support Contracted'!M29","v":0},{"$f":"'Direct Support Contracted'!N29","v":0},{"$f":"'Direct Support Contracted'!O29","v":0},{"$f":"'Direct Support Contracted'!P29","v":0},{"$f":"'Direct Support Contracted'!Q29","v":0},{"$f":"'Direct Support Contracted'!R29","v":0}]
[{"$f":"A19+1","v":12},"Total Direct Support Professional Wages, Salaries, Benefits and Contracted Services",null,{"$f":"SUM(D17:D19)","v":0},{"$f":"SUM(E17:E19)","v":0},{"$f":"SUM(F17:F19)","v":0},0,0,{"$f":"SUM(I17:I19)","v":0},0,0,0,0,0,0,0,0,0]
[]
["Program Related Employee Salaries"]
[{"$f":"A20+1","v":13},"Program Related Employee Salaries and Wages","i",{"$f":"'Program Staff'!K35","v":0},{"$f":"'Program Staff'!M37","v":0},{"$f":"'Program Staff'!N37","v":0},{"$f":"'Program Staff'!O37","v":0},{"$f":"'Program Staff'!P37","v":0},{"$f":"'Program Staff'!Q37","v":0},{"$f":"'Program Staff'!R37","v":0},{"$f":"'Program Staff'!S37","v":0},{"$f":"'Program Staff'!T37","v":0},{"$f":"'Program Staff'!U37","v":0},{"$f":"'Program Staff'!V37","v":0},{"$f":"'Program Staff'!W37","v":0},{"$f":"'Program Staff'!X37","v":0},{"$f":"'Program Staff'!Y37","v":0},{"$f":"'Program Staff'!Z37","v":0}]
[{"$f":"A23+1","v":14},"Program Related Employee Benefits","i",{"$f":"IFERROR(((D23/$D$14)*D13),0)","v":0},{"$f":"IFERROR(((E23/$D$14)*$D$13),0)","v":0},{"$f":"IFERROR(((F23/$D$14)*$D$13),0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0]
[{"$f":"A24+1","v":15},"Total Program Related Employee Salaries and Benefits",null,{"$f":"SUM(D23:D24)","v":0},{"$f":"SUM(E23:E24)","v":0},{"$f":"SUM(F23:F24)","v":0},0,0,{"$f":"SUM(I23:I24)","v":0},0,0,0,0,0,0,{"$f":"SUM(P23:P24)","v":0},0,0]
[]
["Non-Payroll Program Related Expenses (PRE) - Will Allocate to Each Service Based on Program Related Employee Salaries and Wages"]
[{"$f":"A25+1","v":16},"Company Vehicle Expense","i"]
[{"$f":"A28+1","v":17},"Public Transportation and Parking Expense","i"]
[{"$f":"A29+1","v":18},"Mileage Expense","i"]
[19,"Depreciation","i"]
[{"$f":"A31+1","v":20},"Contracted Program Related Staff","i"]
[{"$f":"A32+1","v":21},"Equipment/Devices/Technology (direct care related)","i"]
[22,"Occupancy Expense","i"]
[23,"Insurance","i"]
[24,"Telephone/Communications","i"]
[25,"Dues, Licenses & Subscriptions","i"]
[26,"Postage","i"]
[27,"Food Expenses (direct care related, not part of room & board)","i"]
[28,"Program/Medical Supplies","i"]
[29,"Employee Recruitment","i"]
[30,"Training and Development (direct care related)","i"]
[31,"Other Program Related expense (type description)","i"]
[32,"Other Program Related expense (type description)","i"]
[33,"Other Program Related expense (type description)","i"]
[34,"Total Non-Payroll Program Related Expenses (PRE)",null,{"$f":"SUM(D28:D45)","v":0},{"$f":"IFERROR(($D$46*(E23/$D$23)),0)","v":0},{"$f":"IFERROR(($D$46*(F23/$D$23)),0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0]
[{"$f":"A46+1","v":35},"Total Direct & Program Related Expense (Accumulated Cost)",null,{"$f":"IFERROR((D46+D25+D20),0)","v":0},{"$f":"IFERROR((E46+E25+E20),0)","v":0},{"$f":"IFERROR((F46+F25+F20),0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0]
[]
["Room and Board Expenses "]
[{"$f":"A47+1","v":36},"General Facility Maintenance Salaries and Wages - Assisted Living Facilities","i"]
[{"$f":"A50+1","v":37},"General Facility Maintenance Benefits - Assisted Living Facilities","i",{"$f":"IFERROR(((D50/$D$14)*$D$13),0)","v":0}]
[{"$f":"A51+1","v":38},"Depreciation - ALF Building, Leasehold Improvements, Fixed Equipment, MME)","i"]
[{"$f":"A52+1","v":39},"Equipment/Devices/Technology (room and board related)","i"]
[{"$f":"A53+1","v":40},"Occupancy Expense","i"]
[41,"Telephone/Communications","i"]
[{"$f":"A55+1","v":42},"General Facility Repairs and Maintenance","i"]
[{"$f":"A56+1","v":43},"Food Expenses (room and board related)","i"]
[44,"Other Room and Board expense (type description)","i"]
[45,"Other Room and Board expense (type description)","i"]
[46,"Other Room and Board expense (type description)","i"]
[47,"Total Room and Board Expenses",null,{"$f":"SUM(D50:D60)","v":0}]
[{"$f":"A61+1","v":48},"Allowable Administrative % of Square Footage - From Assisted Living Tab",null,{"$f":"'Assisted Living'!D66","v":""}]
[{"$f":"A62+1","v":49},"Allowable Room & Board Expense, Excluding Food",null,{"$f":"IFERROR(((D61-D57)*D62),0)","v":0},{"$f":"D63","v":0}]
[]
["Administrative Employee Salaries"]
[{"$f":"A63+1","v":50},"Administrative Salaries and Wages (Report Marketing/Fundraising on Line 80)","i"]
[{"$f":"A66+1","v":51},"Administrative Benefits","i",{"$f":"IFERROR(((D66/$D$14)*$D$13),0)","v":0}]
[{"$f":"A67+1","v":52},"Total Administrative Employee Salaries & Benefits",null,{"$f":"IFERROR((D66+D67),0)","v":0}]
["Non-Payroll Administrative Expenses"]
[{"$f":"A68+1","v":53},"Accounts Collection","i"]
[{"$f":"A70+1","v":54},"Accounting","i"]
[{"$f":"A71+1","v":55},"Auto and Travel, not related to PRE above","i"]
[56,"Bank and Finance Charges","i"]
[{"$f":"A73+1","v":57},"Contracted Administrative Staff","i"]
[{"$f":"A74+1","v":58},"Depreciation, not related to PRE above","i"]
[59,"Dues, Licenses & Subscriptions, Not related to PRE above","i"]
[60,"Employee Recruitment, not related to PRE above","i"]
[61,"Equipment Expense, not related to PRE above","i"]
[62,"Home Office Costs -  If part of a chain, this is an allocation of any expenses related to a central office, not the management fee charged to the facility","i"]
[63,"Interest, Working Capital","i"]
[64,"Legal and Other","i"]
[65,"Occupancy Expense, Not related to PRE above","i"]
[66,"Office Supplies","i"]
[67,"Postage, Not related to PRE above","i"]
[68,"Malpractice/Liability Insurance","i"]
[69,"Telephone/Communications, not related to PRE above","i"]
[70,"Training and Development, Not related to PRE above","i"]
[71,"Other Administrative & General Expense (type description)","i"]
[72,"Other Administrative & General Expense (type description)","i"]
[73,"Other Administrative & General Expense (type description)","i"]
[74,"Other Administrative & General Expense (type description)","i"]
[75,"Other Administrative & General Expense (type description)","i"]
[76,"Total Non-Payroll Administrative Expenses",null,{"$f":"SUM(D70:D92)","v":0}]
[{"$f":"A93+1","v":77},"Total Administrative Salaries, Benefits & Non-Payroll Expense",null,{"$f":"D93+D68","v":0},{"$f":"IFERROR(($D$94*(E47/$D$47)),0)","v":0},{"$f":"IFERROR(($D$94*(F47/$D$47)),0)","v":0},0,0,0,0,0,0,0,0,0,0,0,0]
[{"$f":"A94+1","v":78},"Add In Allowable Administrative Occupancy Expense for Assisted Living",null,{"$f":"D63","v":0},{"$f":"E63","v":0}]
[{"$f":"A95+1","v":79},"Total Allowable Administrative Expense",null,{"$f":"D94+D95","v":0},{"$f":"E94+E95","v":0},{"$f":"F94+F95","v":0},0,0,0,0,0,0,0,0,0,0,0,0]
[]
["Non-Reimbursable Expenses"]
[{"$f":"A96+1","v":80},"Fundraising/Marketing Wages","i"]
[{"$f":"A99+1","v":81},"Fundraising/Marketing Benefits","i",{"$f":"IFERROR(((D99/$D$14)*$D$13),0)","v":0}]
[{"$f":"A100+1","v":82},"Bad Debts, Lobbying, Penalties, etc.","i"]
[{"$f":"A101+1","v":83},"Promotional Advertising, Including Fundraising ","i"]
[{"$f":"A102+1","v":84},"Contributions/Donations","i"]
[{"$f":"A103+1","v":85},"Other Non-Reimbursable Expense (type description in cell)","i"]
[86,"Other Non-Reimbursable Expense (type description in cell)","i"]
[87,"Other Non-Reimbursable Expense (type description in cell)","i"]
[88,"Other Non-Reimbursable Expense (type description in cell)","i"]
[89,"Total Non-Reimbursable Expenses",null,{"$f":"SUM(D99:D107)","v":0}]
[]
["Total Expenses"]
[{"$f":"A108+1","v":90},"Total Expenses",null,{"$f":"D108+D94+D61+D47","v":0}]
[{"$f":"A111+1","v":91},"Total Expenses per G/L"]
[{"$f":"A112+1","v":92},"Percent Difference",null,{"$f":"IFERROR(((D112-D111)/D112),\"\")","v":""}]
[null,null,null,{"$f":"IF(D113>0.05,\"% Variance is not within tolerable levels, review entries above for proper reporting and correct before survey submission otherwise it may be rejected.\",IF(D113<-0.05,\"% Variance is not within tolerable levels, review entries above for proper reporting and correct before survey submission otherwise it may be rejected.\",IF(AND(D113<=0.05,D113>=-0.05),\"% Variance is tolerable and does not need to be reviewed before submitting survey.\")))","v":"% Variance is not within tolerable levels, review entries above for proper reporting and correct before survey submission otherwise it may be rejected."}]

{"sheet":"Assisted Living","index":11,"n_rows":66,"n_cols":13,"rows_kept":66,"cut":false,"hidden":true,"merged":[[38,9,39,9],[38,10,39,10],[5,10,6,10],[38,0,39,0],[38,1,39,1],[38,2,39,2],[38,3,39,3],[38,4,39,4],[34,0,35,11],[0,2,0,12],[5,0,6,0],[5,1,6,1],[5,3,6,3],[5,4,6,4],[5,9,6,9],[5,2,6,2],[5,7,6,7],[5,8,6,8],[5,11,6,11],[5,5,6,5],[5,6,6,6],[2,0,2,11]]}
["Assisted Living"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  If your organization operates an assisted living facility, please complete the requested information related to licensed beds and occupied days.  This schedule will also identify any square footage associated with the room and board and administrative areas.  The square footage related to administrative areas, as a percentage of the total square footage, will be used to calculate an allowable portion of expenses associated with the building."]
[]
["Licensed Beds and Census Information"]
["Location","Number of Licensed Beds","Calculated Available Bed Days","Total Medicaid Days - Non-Memory Care","Total Non-Medicaid Days - Non-Memory Care","Total Medicaid Days - TBI1.","Total Non-Medicaid Days - TBI1.","Total Medicaid Days - Memory Care","Total Non-Medicaid Days -Memory Care","Total Days","Occupancy %","Medicaid Occupancy %"]
[]
[1,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B8","v":0},null,null,null,null,null,null,{"$f":"SUM(D8:I8)","v":0},{"$f":"IFERROR((J8/C8),\"\")","v":""},{"$f":"IFERROR(((H8+D8+F8)/J8),\"\")","v":""},{"$f":"IF(K8=\"\",\"\",(IF(K8>1,\"Occupancy percentage is greater than 100%.  Please review total days and licensed beds.\",\"\")))","v":""}]
[2,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B9","v":0},null,null,null,null,null,null,{"$f":"SUM(D9:I9)","v":0},{"$f":"IFERROR((J9/C9),\"\")","v":""},{"$f":"IFERROR(((H9+D9+F9)/J9),\"\")","v":""},{"$f":"IF(K9=\"\",\"\",(IF(K9>1,\"Occupancy percentage is greater than 100%.  Please review total days and licensed beds.\",\"\")))","v":""}]
[3,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B10","v":0},null,null,null,null,null,null,0,"","",{"$f":"IF(K10=\"\",\"\",(IF(K10>1,\"Occupancy percentage is greater than 100%.  Please review total days and licensed beds.\",\"\")))","v":""}]
[4,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B11","v":0},null,null,null,null,null,null,0,"","",""]
[5,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B12","v":0},null,null,null,null,null,null,0,"","",""]
[6,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B13","v":0},null,null,null,null,null,null,0,"","",""]
[7,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B14","v":0},null,null,null,null,null,null,0,"","",""]
[8,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B15","v":0},null,null,null,null,null,null,0,"","",""]
[9,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B16","v":0},null,null,null,null,null,null,0,"","",""]
[10,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B17","v":0},null,null,null,null,null,null,0,"","",""]
[11,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B18","v":0},null,null,null,null,null,null,0,"","",""]
[12,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B19","v":0},null,null,null,null,null,null,0,"","",""]
[13,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B20","v":0},null,null,null,null,null,null,0,"","",""]
[14,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B21","v":0},null,null,null,null,null,null,0,"","",""]
[15,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B22","v":0},null,null,null,null,null,null,0,"","",""]
[16,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B23","v":0},null,null,null,null,null,null,0,"","",""]
[17,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B24","v":0},null,null,null,null,null,null,0,"","",""]
[18,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B25","v":0},null,null,null,null,null,null,0,"","",""]
[19,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B26","v":0},null,null,null,null,null,null,0,"","",""]
[20,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B27","v":0},null,null,null,null,null,null,0,"","",""]
[21,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B28","v":0},null,null,null,null,null,null,0,"","",""]
[22,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B29","v":0},null,null,null,null,null,null,0,"","",""]
[23,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B30","v":0},null,null,null,null,null,null,0,"","",""]
[24,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B31","v":0},null,null,null,null,null,null,0,"","",""]
[25,null,{"$f":"(('Provider Data'!$C$8-'Provider Data'!$C$7)+1)*B32","v":0},null,null,null,null,null,null,0,"","",""]
["Totals",{"$f":"SUM(B8:B32)","v":0},{"$f":"SUM(C8:C32)","v":0},{"$f":"SUM(D8:D32)","v":0},0,{"$f":"SUM(F8:F32)","v":0},0,0,0,0,{"$f":"IFERROR((J33/C33),\"\")","v":""},{"$f":"IFERROR(((H33+D33+F33)/J33),\"\")","v":""}]
[]
["1 Days reported in this column should reflect days associated with individuals diagnosed with a Traumatic Brain Injury (TBI).   A TBI is defined as, \"a nondegenerative, noncongenital insult to the brain from an external mechanical force, possibly leading to permanent or temporary impairment of cognitive, physical, and psychosocial functions, with an associated diminished or altered state of consciousness.\"  Days reported here should not be related to individuals diagnosed with an acquired brain disorder."]
[]
[]
["Allowable Square Footage Calculation"]
["Location","Total Building Square Footage\ni","Total Administrative Square Footage\ni","Allowable Administrative Square Footage"]
[]
[1,null,null,{"$f":"IFERROR((C41/B41),\"\")","v":""},{"$f":"IF(D41=\"\",\"\",(IF(D41>1,\"Administrative square footage is greater than 100%.  Please review.\",\"\")))","v":""}]
[2,null,null,{"$f":"IFERROR((C42/B42),\"\")","v":""},{"$f":"IF(D42=\"\",\"\",(IF(D42>1,\"Administrative square footage is greater than 100%.  Please review.\",\"\")))","v":""}]
[3,null,null,"",""]
[4,null,null,"",""]
[5,null,null,"",""]
[6,null,null,"",""]
[7,null,null,"",""]
[8,null,null,"",""]
[9,null,null,"",""]
[10,null,null,"",""]
[11,null,null,"",""]
[12,null,null,"",""]
[13,null,null,"",""]
[14,null,null,"",""]
[15,null,null,"",""]
[16,null,null,"",""]
[17,null,null,"",""]
[18,null,null,"",""]
[19,null,null,"",""]
[20,null,null,"",""]
[21,null,null,"",""]
[22,null,null,"",""]
[23,null,null,"",""]
[24,null,null,"",""]
[25,null,null,"",""]
["Totals",{"$f":"SUM(B41:B65)","v":0},{"$f":"SUM(C41:C65)","v":0},{"$f":"IFERROR((C66/B66),\"\")","v":""}]

{"sheet":"Adult Day Health","index":12,"n_rows":34,"n_cols":5,"rows_kept":34,"cut":false,"hidden":true,"merged":[[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Adult Day Health"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Adult Day Health services."]
[]
["Line","Information Requested","Example","Adult Day Health"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per year services are provided",250]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per year a typical individual participates in the service",235]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Caseload and Service Design - Pre-COVID 19 Pandemic (Fiscal Year Ended 2019, if available)"]
[{"$f":"A14+1","v":8},"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"Number of days per year services are provided",250]
[10,"Average number of days per year a typical individual participates in the service",235]
[11,"Average number of hours per day services are provided",8]
[12,"Average number of hours per day a typical individual receives services",6.5]
[13,"Percentage of individuals receiving less than four hours of service per day",0.4]
[14,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D21:D22)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A22+1","v":15},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A24=\"\",A23+1,A24+1)","v":16},"If Line 15 is Yes, what is the typical group size?",2]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A26=\"\",A25+1,A26+1)","v":17},"2:1 staff-to-individual ratio",0.1]
[18,"1:1 staff-to-individual ratio",0.7]
[19,"1:2 staff-to-individual ratio",0.2]
[20,"1:3 staff-to-individual ratio",0]
[21,"Other staff-to-individual ratio (type ratio here)",0]
[22,"Other staff-to-individual ratio (type ratio here)",0]
[23,"Other staff-to-individual ratio (type ratio here)",0]
[24,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D27:D34)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Personal Care","index":13,"n_rows":26,"n_cols":5,"rows_kept":26,"cut":false,"hidden":true,"merged":[[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Personal Care"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Personal Care services."]
[]
["Line","Information Requested","Example","Personal Care Services"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per week services are provided",5]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per week a typical individual participates in the service",3]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A14+1","v":8},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"If Line 8 is Yes, what is the typical group size?",2.5]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A18=\"\",A17+1,A18+1)","v":10},"2:1 staff-to-individual ratio",0.1]
[11,"1:1 staff-to-individual ratio",0.7]
[12,"1:2 staff-to-individual ratio",0.2]
[13,"1:3 staff-to-individual ratio",0]
[14,"Other staff-to-individual ratio (type ratio here)",0]
[15,"Other staff-to-individual ratio (type ratio here)",0]
[16,"Other staff-to-individual ratio (type ratio here)",0]
[17,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D19:D26)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Respite","index":14,"n_rows":42,"n_cols":5,"rows_kept":42,"cut":false,"hidden":true,"merged":[[1,0,1,1],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3],[2,0,2,3]]}
["Respite Care"]
["Provider Name: abc"]
["Instructions:  Please report the requested information for Respite Services."]
["Click i for additional directions."]
["Line","Information Requested","Example","Respite"]
[]
[null,"Agency Caseload"]
[1,"Number of individuals receiving service from your organization",100]
[2,"Average number of hours of service per year per individual",260]
[3,"Average service length in hours",2]
[null,"Location of Services (consider all hours of service, total should equal 100%)",null,0]
[4,"Percentage of hours provided in the individual's home",0.2]
[{"$f":"A12+1","v":5},"Percentage of hours provided in the respite provider's home",0.1]
[{"$f":"A13+1","v":6},"Percentage of hours provided in an assisted living facility",0]
[7,"Percentage of hours provided in a licensed respite facility",0.1]
[8,"Perdentage of hours provided in a licensed or approved child care home or center",0.3]
[9,"Percentage of hours provided in an other community setting",0.3,null,{"$f":"IF(SUM(D12:D17)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Length of Non-Daily Services (consider services of less than 24 hours, total should equal 100%)",null,0,"i"]
[{"$f":"A17+1","v":10},"For services less than 24 hours, percentage that are fewer than 4 hours",0.4]
[{"$f":"A19+1","v":11},"For services less than 24 hours, percentage that are 4 or more hours, but less than 8 hours",0.2]
[{"$f":"A20+1","v":12},"For services less than 24 hours, percentage that are 8 or more hours, but less than 16 hours",0.2]
[13,"For services less than 24 hours, percentage that are 16 or more hours, but less than 24 hours",0.2,null,{"$f":"IF(SUM(D19:D22)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Length of Daily Services (consider services provided on a daily basis, total should equal 100%)",null,0]
[{"$f":"A22+1","v":14},"For services provided over 24 hours, percentage that are only for 1 day.",0.3]
[{"$f":"A24+1","v":15},"For services provided over 24 hours, percentage that are only for 2 consecutive days.",0.2]
[{"$f":"A25+1","v":16},"For services provided over 24 hours, percentage that are only for 3 consecutive days.",0.25]
[17,"For services provided over 24 hours, percentage that are only for 4 consecutive days.",0.1]
[{"$f":"A27+1","v":18},"For services provided over 24 hours, percentage that are only for 5 or more consecutive days.",0.15,null,{"$f":"IF(SUM(D24:D28)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"A28+1","v":19},"1:1 staff-to-individual ratio",0.7]
[{"$f":"A30+1","v":20},"1:2 staff-to-individual ratio",0.2]
[{"$f":"A31+1","v":21},"1:3 staff-to-individual ratio",0.1]
[22,"Other staff-to-individual ratio (type ratio here)",0]
[23,"Other staff-to-individual ratio (type ratio here)",0]
[24,"Other staff-to-individual ratio (type ratio here)",0]
[25,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D30:D36)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Overnight Services"]
[{"$f":"A36+1","v":26},"Are staff working overnight shifts permitted to sleep?","Yes"]
[{"$f":"A38+1","v":27},"If yes, are overnight hours treated as 'regular' work hours subject to minimum wage and overtime requirements?","No"]
[null,"Service Delivery, Groups"]
[{"$f":"A39+1","v":28},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"A41+1","v":29},"If Line 28 is Yes, what is the typical group size?",2]

{"sheet":"Chore Historical","index":15,"n_rows":34,"n_cols":5,"rows_kept":34,"cut":false,"hidden":true,"merged":[[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Chore Historical"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Chore Historical services."]
[]
["Line","Information Requested","Example","Chore Historical Services"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per week services are provided",5]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per week a typical individual participates in the service",3]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Caseload and Service Design - Pre-COVID 19 Pandemic (Fiscal Year Ended 2019, if available)"]
[{"$f":"A14+1","v":8},"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"Number of days per year services are provided",250]
[10,"Average number of days per year a typical individual participates in the service",235]
[11,"Average number of hours per day services are provided",8]
[12,"Average number of hours per day a typical individual receives services",6.5]
[13,"Percentage of individuals receiving less than four hours of service per day",0.4]
[14,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D21:D22)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A22+1","v":15},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A24=\"\",A23+1,A24+1)","v":16},"If Line 15 is Yes, what is the typical group size?",2.5]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A26=\"\",A25+1,A26+1)","v":17},"2:1 staff-to-individual ratio",0.1]
[18,"1:1 staff-to-individual ratio",0.7]
[19,"1:2 staff-to-individual ratio",0.2]
[20,"1:3 staff-to-individual ratio",0]
[21,"Other staff-to-individual ratio (type ratio here)",0]
[22,"Other staff-to-individual ratio (type ratio here)",0]
[23,"Other staff-to-individual ratio (type ratio here)",0]
[24,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D27:D34)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Chore","index":16,"n_rows":26,"n_cols":5,"rows_kept":26,"cut":false,"hidden":true,"merged":[[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Chore"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Chore services."]
[]
["Line","Information Requested","Example","Chore Services"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per week services are provided",5]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per week a typical individual participates in the service",3]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A14+1","v":8},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"If Line 8 is Yes, what is the typical group size?",2.5]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A18=\"\",A17+1,A18+1)","v":10},"2:1 staff-to-individual ratio",0.1]
[11,"1:1 staff-to-individual ratio",0.7]
[12,"1:2 staff-to-individual ratio",0.2]
[13,"1:3 staff-to-individual ratio",0]
[14,"Other staff-to-individual ratio (type ratio here)",0]
[15,"Other staff-to-individual ratio (type ratio here)",0]
[16,"Other staff-to-individual ratio (type ratio here)",0]
[17,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D19:D26)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Companion","index":17,"n_rows":26,"n_cols":5,"rows_kept":26,"cut":false,"hidden":true,"merged":[[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Companion"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Companion services."]
[]
["Line","Information Requested","Example","Companion Services"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per week services are provided",5]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per week a typical individual participates in the service",3]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A14+1","v":8},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"If Line 8 is Yes, what is the typical group size?",2.5]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A18=\"\",A17+1,A18+1)","v":10},"2:1 staff-to-individual ratio",0.1]
[11,"1:1 staff-to-individual ratio",0.7]
[12,"1:2 staff-to-individual ratio",0.2]
[13,"1:3 staff-to-individual ratio",0]
[14,"Other staff-to-individual ratio (type ratio here)",0]
[15,"Other staff-to-individual ratio (type ratio here)",0]
[16,"Other staff-to-individual ratio (type ratio here)",0]
[17,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D19:D26)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Extra Care for Children","index":18,"n_rows":34,"n_cols":5,"rows_kept":34,"cut":false,"hidden":true,"merged":[[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3],[2,0,2,3]]}
["Extra Care for Children with Disabilities (Disability Related Child Care)"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Extra Care for Children (Disability Related Child Care)."]
[]
["Line","Information Requested","Example","Extra Care for Children"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per year services are provided",250]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per year a typical individual participates in the service",235]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Caseload and Service Design - Pre-COVID 19 Pandemic (Fiscal Year Ended 2019, if available)"]
[{"$f":"A14+1","v":8},"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"Number of days per year services are provided",250]
[10,"Average number of days per year a typical individual participates in the service",235]
[11,"Average number of hours per day services are provided",8]
[12,"Average number of hours per day a typical individual receives services",6.5]
[13,"Percentage of individuals receiving less than four hours of service per day",0.4]
[14,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D21:D22)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A22+1","v":15},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A24=\"\",A23+1,A24+1)","v":16},"If Line 16 is Yes, what is the typical group size?",2.5]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A26=\"\",A25+1,A26+1)","v":17},"2:1 staff-to-individual ratio",0.1]
[18,"1:1 staff-to-individual ratio",0.7]
[19,"1:2 staff-to-individual ratio",0.2]
[20,"1:3 staff-to-individual ratio",0]
[21,"Other staff-to-individual ratio (type ratio here)",0]
[22,"Other staff-to-individual ratio (type ratio here)",0]
[23,"Other staff-to-individual ratio (type ratio here)",0]
[24,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D27:D34)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Home Again Services","index":19,"n_rows":13,"n_cols":4,"rows_kept":13,"cut":false,"hidden":true,"merged":[[1,0,1,1],[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Home Again Service"]
["Provider Name: abc"]
["Instructions:  Please report the requested information for Home Again Service."]
[]
["Line","Information Requested","Example","Home Again Service"]
[]
[null,"Service Design"]
[1,"Number of individuals who received home again services from your organization",100]
[2,"Average number of direct service hours per individual to provide home again services",40]
[3,"Average cost of essential furniture purchased per individual",1000]
[4,"Average cost of security deposits per individual",750]
[{"$f":"A11+1","v":5},"Average cost of set-up fees or utility deposits per individual",500]
[6,"Average cost of necessary home accessibility adaptations",1500]

{"sheet":"Independence Skills Building","index":20,"n_rows":34,"n_cols":5,"rows_kept":34,"cut":false,"hidden":true,"merged":[[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3],[2,0,2,3]]}
["Independence Skills Building"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Independence Skills Building."]
[]
["Line","Information Requested","Example","Independence Skills Building"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per year services are provided",250]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per year a typical individual participates in the service",235]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Caseload and Service Design - Pre-COVID 19 Pandemic (Fiscal Year Ended 2019, if available)"]
[{"$f":"A14+1","v":8},"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"Number of days per year services are provided",250]
[10,"Average number of days per year a typical individual participates in the service",235]
[11,"Average number of hours per day services are provided",8]
[12,"Average number of hours per day a typical individual receives services",6.5]
[13,"Percentage of individuals receiving less than four hours of service per day",0.4]
[14,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D21:D22)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A22+1","v":15},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A24=\"\",A23+1,A24+1)","v":16},"If Line 22 is Yes, what is the typical group size?",2.5]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A26=\"\",A25+1,A26+1)","v":17},"2:1 staff-to-individual ratio",0.1]
[18,"1:1 staff-to-individual ratio",0.7]
[19,"1:2 staff-to-individual ratio",0.2]
[20,"1:3 staff-to-individual ratio",0]
[21,"Other staff-to-individual ratio (type ratio here)",0]
[22,"Other staff-to-individual ratio (type ratio here)",0]
[23,"Other staff-to-individual ratio (type ratio here)",0]
[24,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D27:D34)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Non-Medical Transportation","index":21,"n_rows":17,"n_cols":5,"rows_kept":17,"cut":false,"hidden":true,"merged":[[1,0,1,1],[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Non-Medical Transportation"]
["Provider Name: abc"]
["Instructions:  Please report the requested information for Non-Medical Transportation."]
[]
["Line","Information Requested","Example","Non-Medical Transportation"]
[]
[null,"Service Design"]
[1,"Total number of non-medical trips provided to individuals during the cost survey period (from \"Productivity & Transportation\" tab)",500,{"$f":"'Productivity & Transportation'!M49","v":0}]
[2,"Percent of total trips related to #1 provided using company vehicles (from \"Productivity & Transportation\" tab)",0.8,{"$f":"'Productivity & Transportation'!M50","v":0}]
[3,"Percent of total trips related to #1 provided using vehicles owned by employees (from \"Productivity & Transportation\" tab)",0.2,{"$f":"'Productivity & Transportation'!M51","v":0},{"$f":"IF(SUM(C9:C10)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":""}]
[4,"Total mileage driven during the cost survey period.",20000]
[{"$f":"A11+1","v":5},"Average mileage driven per trip per individual",{"$f":"C11/C8","v":40}]
[6,"Do you provide transportation to more than one individual at the same time?","Yes"]
[{"$f":"A13+1","v":7},"If 6 is yes, % of trips with one individual in the vehicle",0.8]
[{"$f":"A14+1","v":8},"If 6 is yes, % of total trips with two individuals in the vehicle",0.1]
[{"$f":"A15+1","v":9},"If 6 is yes, % of total trips with three individuals in the vehicle",0.05]
[{"$f":"A16+1","v":10},"If 6 is yes, % of total trips with four or more individuals in the vehicle",0.05,null,{"$f":"IF(SUM(D14:D17)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Home Delivered Meals","index":22,"n_rows":13,"n_cols":4,"rows_kept":13,"cut":false,"hidden":true,"merged":[[1,0,1,1],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3],[2,0,2,3]]}
["Home Delivered Meals"]
["Provider Name: abc"]
["Instructions:  Please report the requested information for Home Delivered Meals."]
[]
["Line","Information Requested","Example","Home Delivered Meals"]
[]
[null,"Service Design"]
[1,"Number of individuals receiving home delivered meals from your organization",100]
[2,"Number of delivered meals during the cost survey period",30000]
[3,"Average number of meals delivered per week",900]
[4,"Is food contracted from a caterer for delivery?","No"]
[5,"If food is contracted, total annual cost for contracted services"]
[6,"Average number of volunteer staff, based on a full time equivalent (i.e., 2,080 annual hours worked)",5]

{"sheet":"PAS","index":23,"n_rows":34,"n_cols":5,"rows_kept":34,"cut":false,"hidden":true,"merged":[[2,0,2,3],[4,0,5,0],[4,1,5,1],[4,2,5,2],[4,3,5,3]]}
["Personal Assistance Services (PAS)"]
[{"$f":"\"Provider Name: \"& 'Provider Data'!$C$10","v":"Provider Name: "}]
["Instructions:  Please report the requested information for Personal Assistance Services."]
[]
["Line","Information Requested","Example","Personal Assistance Services (PAS)"]
[]
[null,"Caseload and Service Design - Current Services"]
[1,"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A8=\"\",A7+1,A8+1)","v":2},"Number of days per year services are provided",250]
[{"$f":"IF(A9=\"\",A8+1,A9+1)","v":3},"Average number of days per year a typical individual participates in the service",235]
[4,"Average number of hours per day services are provided",6]
[5,"Average number of hours per day a typical individual receives services",4.75]
[6,"Percentage of individuals receiving less than four hours of service per day",0.4]
[7,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D13:D14)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Caseload and Service Design - Pre-COVID 19 Pandemic (Fiscal Year Ended 2019, if available)"]
[{"$f":"A14+1","v":8},"Number of individuals receiving services from your organization",50]
[{"$f":"IF(A16=\"\",A15+1,A16+1)","v":9},"Number of days per year services are provided",250]
[10,"Average number of days per year a typical individual participates in the service",235]
[11,"Average number of hours per day services are provided",8]
[12,"Average number of hours per day a typical individual receives services",6.5]
[13,"Percentage of individuals receiving less than four hours of service per day",0.4]
[14,"Percentage of individuals receiving four or more hours of service per day",0.6,null,{"$f":"IF(SUM(D21:D22)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]
[null,"Service Delivery, Groups"]
[{"$f":"A22+1","v":15},"Does your organization deliver this service to groups?","Yes"]
[{"$f":"IF(A24=\"\",A23+1,A24+1)","v":16},"If Line 22 is Yes, what is the typical group size?",2.5]
[null,"Staffing Ratios. Input the percentage of face-to-face direct service time provided at each of the following ratios:"]
[{"$f":"IF(A26=\"\",A25+1,A26+1)","v":17},"2:1 staff-to-individual ratio",0.1]
[18,"1:1 staff-to-individual ratio",0.7]
[19,"1:2 staff-to-individual ratio",0.2]
[20,"1:3 staff-to-individual ratio",0]
[21,"Other staff-to-individual ratio (type ratio here)",0]
[22,"Other staff-to-individual ratio (type ratio here)",0]
[23,"Other staff-to-individual ratio (type ratio here)",0]
[24,"Other staff-to-individual ratio (type ratio here)",0,null,{"$f":"IF(SUM(D27:D34)=1,\"\",\"Total of the percentages does not equal 100%.  Please review and update.\")","v":"Total of the percentages does not equal 100%.  Please review and update."}]

{"sheet":"Workbook Config","index":24,"n_rows":30,"n_cols":15,"rows_kept":30,"cut":false,"hidden":true,"merged":[]}
[]
[]
["Workbook/Worksheet",null,"Is TRUE/FALSE",null,"Visible: -1/Hidden: 0/VeryHidden: 2","TRUE/FALSE","TRUE/FALSE","TRUE/FALSE",null,"TRUE/FALSE","Range","R1C1","Row# List","Col# List","Protection Schemes"]
["ObjectType","ObjectName","Protection","Password","Visibility","FormulaBar","Gridlines","Headings","CodeName","SelectedSheet","SelectedCell","ReferenceStyle","HiddenRows","HiddenColumns","Protections"]
["Workbook","NE AD Waiver Cost Survey -Final.xlsm",false,null,null,true,null,null,null,null,null,1]
["Worksheet","Lists",false,null,0,null,true,true,"Sheet7",false,"$I$19",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Instructions",true,"NEhcbs2022",-1,null,false,true,"Sheet8",false,"$1:$1048576",null,null,null,"EnableSelection:= 1, DrawingObjects:= True, Contents:= True, Scenarios:= True, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Provider Data",true,"NEhcbs2022",-1,null,false,true,"Sheet1",false,"$H$17",null,null,null,"EnableSelection:= 0, DrawingObjects:= True, Contents:= True, Scenarios:= True, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Questions",true,"NEhcbs2022",-1,null,false,true,"Sheet2",false,"$D$10",null,null,null,"EnableSelection:= 0, DrawingObjects:= True, Contents:= True, Scenarios:= True, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Services",true,"NEhcbs2022",-1,null,false,true,"Sheet3",false,"$D$19",null,null,null,"EnableSelection:= 0, DrawingObjects:= True, Contents:= True, Scenarios:= True, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Units&Revenues",true,"NEhcbs2022",-1,null,false,true,"Sheet4",false,"$C$28",null,null,null,"EnableSelection:= 0, DrawingObjects:= True, Contents:= True, Scenarios:= True, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Direct Support Employee",false,null,-1,null,true,true,"Sheet5",true,"$D$8:$D$9",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Direct Support Contracted",false,null,-1,null,false,true,"Sheet9",false,"$J$29",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Program Staff",false,null,-1,null,true,true,"Sheet10",false,"$BF$15:$BF$16",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Productivity & Transportation",false,null,-1,null,false,true,"Sheet6",false,"$B$50:$B$52",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Expenses",false,null,-1,null,false,true,"Sheet11",false,"$D$113",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Workbook Config",false,null,0,null,true,true,"Sheet12",false,"$1:$1048576",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Assisted Living",false,null,-1,null,false,true,"Sheet13",false,"$M$10",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Adult Day Health",false,null,-1,null,false,true,"Sheet14",false,"$E$23",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Personal Care",false,null,-1,null,true,true,"Sheet15",false,"$I$44",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Respite",false,null,-1,null,false,true,"Sheet16",false,"$H$25",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Chore Historical",false,null,-1,null,true,true,"Sheet17",false,"$E$15,$E$23",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Chore",false,null,-1,null,true,true,"Sheet18",false,"$E$23",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Companion",false,null,-1,null,true,true,"Sheet19",false,"$E$23",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Extra Care for Children",false,null,-1,null,true,true,"Sheet20",false,"$E$15:$E$23",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Home Again Services",false,null,-1,null,true,true,"Sheet21",false,"$1:$1048576",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Independence Skills Building",false,null,-1,null,true,true,"Sheet22",false,"$E$15",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Non-Medical Transportation",false,null,-1,null,true,true,"Sheet23",false,"$E$19",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","Home Delivered Meals",false,null,-1,null,true,true,"Sheet24",false,"$1:$1048576",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]
["Worksheet","PAS",false,null,-1,null,true,true,"Sheet25",false,"$I$19",null,null,null,"EnableSelection:= 0, DrawingObjects:= False, Contents:= False, Scenarios:= False, UserInterfaceOnly:= False, AllowFormattingCells:= False, AllowFormattingColumns:= False, AllowFormattingRows:= False, AllowInsertingColumns:= False, AllowInsertingRows:= False, AllowInsertingHyperlinks:= False, AllowDeletingColumns:= False, AllowDeletingRows:= False, AllowSorting:= False, AllowFiltering:= False, AllowUsingPivotTables:= False"]