Substance Abuse Prevention and Control


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FY2016-17 Annual Cost Report Forms and Instructions
Pursuant to your Agency contracts with the Department of Public Health Substance Abuse Prevention and Control (SAPC), each Provider must submit accurate and complete cost reports for the previous fiscal year by August 30 following the end of the fiscal year.

  • NEW: To assist providers in submitting cost report on time, we have extended the cost report deadline for two (2) more weeks from August 15 to August 30.  No further extensions request will be accepted.

The following documents/files must be submitted by your Agency for the cost report to be considered complete:
Non-Drug Medical (NON-DMC)
  1. Original Cost Report (by SOW, Site, and Modality)
  2. Cost Certification with original signature
Drug Medi-Cal (DMC)
  1. Original Cost Report (by Site) - E-mail completed cost report (excel file) to your assigned analyst and send original copy with signature to SAPC
  2. Cost Report must be printed in legal size paper
  3. "Provider Information and Certification" with original signature
Driving Under The Influence (DUI)
  1. Original Cost Report (by Program)
  2. Cost Certification with original signature
IMPORTANT:
All Non-DMC cost reports must be submitted by SOW, Site and Modality. No exception.

  • The annual Provider cost reports are due August 30, 2017 (60 days after end of Fiscal Year).
  • If the cost reports are not received by the due date, your agency will be listed as a delinquent provider.
  • After August 30, 2017, a stop payment will be placed on current billings for delinquent providers.  The stop payment order will remain until such time cost reports are received.
  • Do not staple or bind cost reports.

SETTLEMENT:
  • PARTICIPANT/CLIENT FEES, THIRD PARTY REVENUE (INSURANCE PAID) COLLECTED WILL BE OFFSET FROM ALLOWABLE COST.

SUBMISSION:
Please send original cost reports with all working papers as applicable to:

County of Los Angeles Department of Public Health
Substance Abuse Prevention and Control
Cost Reporting Unit
1000 S. Fremont Ave., Bldg A-9 East
3rd Floor, North Wing, Unit 34
Alhambra, California 91803
COST REPORT FORMS/INSTRUCTION AND POWERPOINT
Drug Medi-Cal Funded Contracts (DMC)
Provider Orientation

Mode of Service - Forms and Instructions
  1. Non-NTP: DMC (Perinatal and Non-Perinatal) - ODF, IOT and Residential
  2. NTP: NON-PERINATAL
  3. NTP: PERINATAL
Drug Medi-Cal Cost Report Reference
  1. Cost Allocation method - Staff Hours Cost Allocation Calculation from DMC
  2. Lower of Cost or Charges - Illustration
  3. Fee Scale
  4. NTP Cost Report - Sample
  5. DMC COST REPORT- ODF - Sample
  6. FAQ - Frequently Asked Questions
  7. Attachment 1 - Allowable Costs-Federal Register Vol 78, No 248 (P78640 to P78662)
  8. Attachment 2 - Group Session Definition
Non-Drug Medi-Cal funded Contracts
Provider Orientation

Mode of Service - Forms and Instructions
  1. Outpatient Drug Free
  2. Non-Outpatient Drug Free
  3. CalWorks-ODF
  4. CalWorks-Non-ODF
  5. MAT
  6. NPR 10% Gross Budget Adj. Worksheet
Non-Drug Medi-Cal Cost Report Reference
  1. Sample - Statement of Work (SOW) Contract Maximum Obligation
  2. Sample NPR Cost Line Item Budget
  3. Sample - Approved Budget Summary Page for NPR contract
  4. Sample - ODF Cost Report
  5. Group Session Definition
  6. Contract Performance Report
  7. EBS Detail Billing
Driving Under The Influence (DUI) Program
  • Please note - In order to meet the deadline of August 30, 2017, provider may submit the schedule of "Participant Fee" (tab # 3) separately by October 31, 2017.  All other tabs still need to be submitted by August 30, 2017.
Provider Orientation
Forms and Instructions
 
Public Health has made reasonable efforts to provide accurate translation. However, no computerized translation is perfect and is not intended to replace traditional translation methods. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version.
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