Cattaraugus County Community Services Board

Cattaraugus County Community Services Board Part 599 Outpatient Mental Health Treatment Program Second Round Questions and Answers

STAFFING 1. Please provide additional detail related to clinical staffing. What are the job titles, professional disciplines/licensure, length of service and salaries of employees currently in place? Can you provide detail on the staff positions that are classified as County Staff vs. Contracted Staff?  See Appendix A, Clinical Staffing. Length of service can not be disclosed.

2. Can you please provide an organizational chart identifying direct care staff, administrative, billing and support staff?  See Appendix B, Clinic Organizational Chart.

3. Will the new provider have access to the last two years performance appraisals and staff development plans for each staff member that they are seeking to retain?  No. The County will supply job descriptions / title, dates of employment, and salary history for reference purposes. Upon an employee’s request, the County will also supply to the employee any additional information from his/her personnel file.

4. Are there anticipated staffing changes or planned staff realignment prior to the new provider transition on October 1, 2012?  No

5. What are the productivity standards in the clinic by position and what level of productivity was achieved by staff last year?

Staff Position Hours/Wk Standard Clinician (10 staff) 35 1170/yr Clinician (7 staff) 40 1300/yr RN (2 staff) 35 360/yr RN (1 staff) 40 408/yr

 The total weighted productivity for 2011 for the entire clinic, including clinicians, RNs and doctors was 20,479 units. o 76% of staff achieved 70% or greater of their productivity standard: . 29% achieved 90% or greater, . 23.5% achieved 80%-90%, and . 23.5% achieved 70%-80%. o 24% of staff achieved less than 70%.

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 6. Does the current CBA contain a Successor clause? If yes, may we have a copy of the Successor Language? If yes, please describe. If yes, does the Successor clause establish a requirement/contractual obligation for a Successor organization? Do you have a written legal opinion regarding the Successor clause? If yes, may we have a copy? What positions are covered by the CBA? Does the CBA cover Full Time, Part Time and Per Diem staff.  Nothing in the Collective Bargaining Agreement guarantees employment upon abolishment of the position. Any future rights of employment of laid off employees are in accordance with the civil service law.

SERVICES 7. Please provide a breakdown on the units of services by type of visit generated at each program location, including schools, as well as how many of those units are provided to adults versus children at each location. What is the payer mix? (Medicaid Managed Care, straight Medicaid, Medicare, Third Party, and self pay)  See Appendix C, Units of Service Billed.

8. Of the 1500 clients identified in the RFP, what is the total number of clients that are seen in the medication clinic only?

Number of Med Clinic Clients By Site: LCC (Linwood Counseling Center) 6 NCC (North County Counseling Center) 15 OCC (Olean Counseling Center) 212 SCC (Salamanca Counseling Center) 85

9. Of the 1500 clients identified in the RFP, what is the total number of clients that are active and have been seen in the past 30 days?

Total Number Clients Seen since 1/1/12 CAC (Child Advocacy Center) 33 FCS (Franklinville Central School) 5 FES (Franklinville Elementary School) 13 GCS (Gowanda Central School) 7 In Home 1 Jail (Forensic Service at Little Valley) 8 LCC (Linwood Counseling Center) 3 NCC (North County Counseling Center) 98 OCC (Olean Counseling Center) 589 PCS (Pioneer Central School) 34 PES (Prospect Elementary, Salamanca) 7 SCC (Salamanca Counseling Center) 222 SES (Seneca Elementary, Salamanca) 12 SMS (Salamanca Middle School) 8

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 10. Can you provide units of service detail by location and by type of visit so we can better understand staffing configurations? (We are requesting the type of visit data so we can be more precise in our revenue projections.) (By type of visit we mean assessment, individual, group, medication management, medication evaluation, psych evaluation, etc.)  See Appendix C, Units of Service Billed.

11. Has Cattaraugus County’s clinic been designated as a “specialty children’s clinic” by the NYSOMH?  Yes

12. How many units of services are billed to Medicaid versus Medicaid managed care for children?  See Appendix D, Units of Service billed for Children with Medicaid, Medicaid Managed Care, and Third Party Insurance for 2011.

FINANCIAL 13. Both the 2011 results of operations and the 2012 budget include an expense entitled “other.” Please provide a breakdown of the expenses included under “other,” including detail of general operating expenses (OTPS) particularly as it relates to facilities management and general operations? If available, please show the breakdown by location.  See Appendix E, Financial Data. Specific location data, with the exception of rent and utilities, is not available.

14. Provide detail on what the sources of payments and amounts are that you have classified in the financials as “Medicaid Supplements”? Please provide a breakdown of the reported COPS revenue? How much of it is straight Medicaid and how much is Medicaid managed care?  See Appendix E, Financial Data.

15. Is there any CSP revenue in your financial report and if so, where?  See Appendix E, Financial Data.

16. Can you provide the program CFRs for the past 3 years?  See Appendix E, Financial Data. The most recent CFRs available are 2008-2010. Since there have been significant changes in operations since 2009 due to OMH Clinic Restructuring, data for 2008 and 2009 has not been included. The information in Appendix E more accurately reflects current operations from 2010-2012.

17. Reimbursement in 2012 will be a “blend” of current APG rates and legacy rates. A new provider coming into Cattaraugus County would not have a legacy rate. Would reimbursement be made at the 100% of APG rates or through a “blend” using the provider’s own legacy rate or the legacy rate of Cattaraugus County?

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12  According to guidance from New York State Office of Mental Health, the APG rate for new clinics is at the lowest value for their peer group. Thus, Cattaraugus County’s legacy rate will not be factored into the rate for a new clinic.

18. May any surplus earned by the Provider be retained by the Provider to be used for future operations or in other areas of the Provider’s organization?  If the provider does not receive state aid, any program surplus may be retained. If the provider receives state aid, the surplus will reduce the amount of the state aid awarded.

PHYSICAL SPACE 19. Please provide additional detail on the space used for the various programs, leasing expenses by location and what locations will continue to be available under similar lease arrangements? Are the school and jail locations leased? Please explain the type of space arrangement at the Child Advocacy Center? How many square feet are leased at what annual rent cost? Do any leases include utilities? Is there any County leased space and what is that expense expected to be for the RFP recipient?  Olean Counseling Center occupies 5,859 sq. ft. at an expense of $80,331 annually. Since this is a County-owned building, this expense is covered under shared services, which includes phones, information services, insurance, records management, maintenance, and utilities. The county is willing to consider lease options for this site, especially to ease the transition period.  North County Counseling Center occupies 2,678 sq. ft. at an expense of $36,770 annually. This is a County-owned building, similar to Olean Counseling Center above. This site will be available for lease with the terms to be negotiated with the County.  Salamanca Counseling Center occupies 3,000 sq. ft. at an annual expense of $32,130 for rent and $16,380 annually for utilities. This space may be available for lease through Community Bank, NA.  Schools, jail, Child Advocacy Center, and Linwood locations are not leased. These sites provide an office for the clinicians to see clients at no cost to the county. It is anticipated that these agreements would continue.

20. Would it be possible to visit the Cattaraugus County mental health program locations?  Cattaraugus County will host a tour of the Olean Counseling Center on Tuesday, February 21, 2012, at 5 p.m. Those agencies interested in the tour should make reservations with Becky Dash, Administrative Coordinator, by calling 716-701-3304 or via e-mail at [email protected]. Photos and floor plans of the Salamanca and North County Counseling Centers will be provided at the time of the Olean tour.

ELECTRONIC MEDICAL RECORD 21. Are the clinics using an electronic medical record (EMR)? If not, has any planning or preparation for use of an EMR taken place? If an EMR is being used, is it fully implemented or is the implementation still under way?

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12  The clinics are using QuicDoc from DocuTrac, Inc., which is an Electronic Medical Record (EMR) system that comes fully equipped with assessment, treatment planning, progress notes, discharge summaries, as well as the capabilities to build documentation according to clinic specifications. The Department is still in the implementation stage, as the documentation is completed in the EMR but is still printed, signed and kept in a paper chart. Electronic signature pads have been installed but not turned on at this point.

22. Can you describe the current IT capabilities of the programs: a. IT infrastructure, communications, networking, etc.?  Staff communicates via email and instant messaging. All clinicians have access to view the scheduler and electronic health record. Support staff has access to view the scheduler. Networking is maintained by County domain. b. Automated billing process?  The Department’s scheduler software initiates the billing process. Clinic support staff tags the encounters for billing, while claims, authorizations and collections are processed by a contracted billing agency (Healthcare Solutions of WNY, LLC.). c. Are all clinicians familiar with a desktop environment to conduct their daily duties, scheduling, inter/intra-office communication, and record-keeping?  Yes d. Are all support staff familiar with a desktop environment to conduct their daily duties, scheduling, billing, other record-keeping?  Yes

OTHER 23. Will the Community Services Board entertain a proposal from a joint venture (two separate nonprofits that plan to collaborate in fulfilling the requirements of the RFP)?  Yes. The Board is open to considering this as long as there is one lead administrative oversight body that will be licensed by the Office of Mental Health.

24. What are the clinics’ top five sources of referrals?  Hospital Inpatient Units / ER  Probation / Jails  Social Services  Schools  Primary Care Physicians

25. What will be the duration of the contract the County intends to sign with a provider?  The LGU will engage in an annual contract with the agency for the pass-through of state aid. The County will be giving up its license to provide mental health clinic services. If the awarded agency decides to not continue mental health clinic services, the County would then plan for that service to continue under another agency’s auspice. The Community Services Board will monitor quality of services.

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 26. Can you provide detail of the contracted service? What services are provided by contracted providers? What level of service and in what locations? Are the contracts assignable?  Cattaraugus County Department of Community Services sub-contracts for some therapist positions, a nursing position, an Intake Coordinator and a Quality Assurance Advisor at various sites for clinical and on-call services. All services, including clinical supervision, are managed by the County clinic under the OMH license. These contracts expire September 30, 2012.  The Department contracts with Healthcare Solutions WNY, LLC, to provide billing and accounts receivable management services for the clinic operations, including obtaining authorizations for services from various insurers, claims submission (EDI and Paper), payment posting and error/denial/appeal and follow-up management. This contract with the County will expire at the end of 2012.  The Department contracts with Jamestown Psychiatric, P.C., for psychiatric services, which includes a Medical Director, a Psychiatric Nurse Practitioner, a Psychiatrist, and a Child Psychiatrist.  None of these contracts are assignable.

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 Appendix A

Clinical Staffing

Annual COUNTY EMPLOYEE TITLE LICENSURE Salary A Clinical Supervisor LCSW $67,526.00 B Community Mental Health Nurse RN $49,914.00 C Community Mental Health Nurse RN $49,914.00 D Licensed Practical Nurse LPN $45,017.00 E Program Director LMHC $66,416.00 F Program Director LMSW $70,157.00 G Mental Health Therapist LMSW $57,203.00 H Mental Health Therapist LMHC $56,321.00 I Mental Health Therapist LMHC $61,479.00 J Mental Health Therapist LMHC $61,479.00 K Staff Social Worker LCSW $61,241.00 L Staff Social Worker LCSW $57,203.00 M Staff Social Worker LMSW $57,203.00 N Staff Social Worker LCSW $57,203.00 O Staff Social Worker LCSW $57,203.00 P Staff Social Worker LMSW $60,985.00 CONTRACTED EMPLOYEE A Staff Soc. Wrkr/MH Therapist LMSW $44,824.00 B Staff Soc. Wrkr/MH Therapist MSW $43,950.00 C RN RN $38,501.00 D Staff Soc. Wrkr/MH Therapist LMSW $40,581.00 E Staff Soc. Wrkr/MH Therapist LMSW $40,581.00 F Staff Soc. Wrkr/MH Therapist MSEd $49,000.00 G Staff Soc. Wrkr/MH Therapist MSEd $43,098.00 H Intake Coordinator BA $34,632.00

* There is no difference in duties between the Staff Social Worker and Mental Health Therapist positions.

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 Appendix B

Clinic Organizational Chart

Cattaraugus County Community Legislature Services Board

DCS Director County Administrator CSB Subcommittees & Contract Agencies

Administrative Team

Adult Program Clinical Supervisor: Child Program Senior Administrative Office Quality Director: Adult Clinic Services Director: Accountant Coordinator Manager Assurance Adult Clinic Services Child Clinic Services Child Clinic Services Coordinator

General Accounting & Adult Clinic Staff: Child Clinic Staff: Billing Staff OCC/NCC/SCC OCC/NCC/SCC/4 School 1 Staff 7 Clinicians Sites/CAC 9 Clinicians 1 Early Identification Specialist

Clinic Support Staff: Community MH OCC 5 Staff Nursing Staff NCC 1 Staff OCC/NCC/SCC SCC 2 Staff 3 RN 1 LPN Page 8 of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 Page 9 of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 Appendix C

Units of Service Billed

CAC 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 1 1 1 90804 Ind. 30 Min 90806 Ind 45 Min 3 1 4 1 3 90846 Fam w/o Client 90847 Fam with Client 1 1 1 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

FCS 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 2 9 11 1 4 6 90804 Ind. 30 Min 11 127 138 1 31 63 43 90806 Ind 45 Min 36 124 160 11 21 96 32 90846 Fam w/o Client 1 11 12 3 2 6 1 90847 Fam with Client 11 11 3 7 1 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

GCS 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 4 28 32 2 3 16 11 90804 Ind. 30 Min 2 137 139 8 14 79 38 90806 Ind 45 Min 13 194 207 12 30 86 79 90846 Fam w/o Client 9 97 106 3 8 47 48 90847 Fam with Client 4 50 54 4 1 27 22 90853 Group 70 70 10 19 23 18 90862 Medication Mgmt H2011 Crisis 2 2 2 H2010 Injection

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 In Home 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 1 12 13 1 7 5 90804 Ind. 30 Min 5 39 44 4 2 30 8 90806 Ind 45 Min 208 281 485 4 32 125 9 208 115 90846 Fam w/o Client 8 82 90 11 9 48 22 90847 Fam with Client 51 158 208 1 1 44 11 81 72 90853 Group 90862 Medication Mgmt H2011 Crisis 1 1 1 H2010 Injection

LCC 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 90804 Ind. 30 Min 90806 Ind 45 Min 90846 Fam w/o Client 90847 Fam with Client 90853 Group 90862 Medication Mgmt 25 25 25 H2011 Crisis H2010 Injection

NCC 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 133 50 4 179 0 14 25 23 61 60 90804 Ind. 30 Min 109 57 0 145 21 24 9 7 79 47 90805 Psych. Ass. 30 Min 11 11 1 3 3 4 90806 Ind 45 Min 773 281 1051 3 102 85 63 477 327 90807 Psych. Ass 45 Min 20 4 24 5 2 8 9 90846 Fam w/o Client 1 9 10 2 4 4 90847 Fam with Client 53 182 235 1 36 5 116 77 90853 Group 90862 Medication Mgmt 347 79 426 73 61 18 179 95 H2011 Crisis 6 6 1 1 H2010 Injection 9 1 8 3 6

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 OCC 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 519 172 34 636 21 63 110 104 262 152 90804 Ind. 30 Min 1233 330 1201 362 334 176 142 630 281 90805 Psych. Ass. 30 Min 41 4 45 5 4 10 20 6 90806 Ind 45 Min 2469 1255 1 3494 229 457 671 245 1701 650 90807 Psych. Ass 45 Min 141 86 227 14 40 22 99 52 90846 Fam w/o Client 13 166 1 177 1 1 22 8 97 51 90847 Fam with Client 72 367 437 2 7 111 19 206 96 90853 Group 592 45 637 132 62 151 194 98 90862 Medication Mgmt 2438 860 3298 776 690 203 1116 513 H2011 Crisis 8 1 1 7 1 3 1 1 2 2 H2010 Injection 87 87 53 14 1 19

Off Site 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 11 58 69 10 4 26 29 90804 Ind. 30 Min 6 95 101 10 5 57 29 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 80 265 345 3 70 26 138 108 90807 Psych. Ass 45 Min 90846 Fam w/o Client 4 44 48 7 7 22 12 90847 Fam with Client 8 35 43 15 5 15 8 90853 Group 208 4 212 94 18 22 55 23 90862 Medication Mgmt H2011 Crisis H2010 Injection

PCS 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 4 5 9 2 1 6 90804 Ind. 30 Min 9 28 37 2 2 23 10 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 167 205 372 9 98 17 142 106 90807 Psych. Ass 45 Min 90846 Fam w/o Client 5 2 7 1 3 3 90847 Fam with Client 2 10 12 1 3 8 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 SCC 2010 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 195 128 3 292 28 19 37 45 144 78 90804 Ind. 30 Min 371 162 489 44 83 19 71 238 122 90805 Psych. Ass. 30 Min 9 9 1 4 4 90806 Ind 45 Min 1989 896 2622 263 395 248 272 1339 631 90807 Psych. Ass 45 Min 39 17 56 1 3 5 30 17 90846 Fam w/o Client 20 117 137 1 13 6 88 29 90847 Fam with Client 24 103 126 1 2 20 7 60 38 90853 Group 84 84 9 11 17 23 24 90862 Medication Mgmt 825 145 969 1 255 79 63 363 210 H2011 Crisis 12 2 8 6 5 3 4 2 H2010 Injection 12 12 5 3 4

School 2010 (various schools, which are not a licensed satellite) Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 90804 Ind. 30 Min 3 21 24 1 4 11 8 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 11 65 76 12 10 29 25 90807 Psych. Ass 45 Min 90846 Fam w/o Client 17 17 1 11 5 90847 Fam with Client 2 7 9 3 1 3 2 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 2011

CAC 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 31 79 0 110 0 0 19 8 46 37 90804 Ind. 30 Min 16 111 0 127 0 1 8 12 80 26 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 109 335 0 444 0 0 43 63 234 104 90807 Psych. Ass 45 Min 90846 Fam w/o Client 0 16 0 16 0 0 1 1 12 2 90847 Fam with Client 2 8 0 10 0 0 0 2 4 4 90853 Group 148 0 0 148 0 6 8 24 95 15 90862 Medication Mgmt H2011 Crisis 4 3 0 7 0 0 0 1 1 5 H2010 Injection

FCS 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 0 19 0 19 0 0 2 2 9 6 90804 Ind. 30 Min 2 133 0 135 0 0 8 3 54 70 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 29 235 0 264 0 0 21 18 148 77 90807 Psych. Ass 45 Min 90846 Fam w/o Client 0 6 0 6 0 0 1 0 4 1 90847 Fam with Client 0 38 0 38 0 0 3 0 27 8 90853 Group 90862 Medication Mgmt H2011 Crisis 1 1 0 2 0 0 0 0 2 0 H2010 Injection

FES 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 90804 Ind. 30 Min 0 4 0 4 0 0 0 0 2 2 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 0 3 0 3 0 0 0 0 1 2 90807 Psych. Ass 45 Min 90846 Fam w/o Client 90847 Fam with Client 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 GCS 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 1 27 0 28 0 0 2 2 9 15 90804 Ind. 30 Min 0 108 0 108 0 0 0 17 69 22 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 2 181 0 183 0 0 4 21 85 73 90807 Psych. Ass 45 Min 90846 Fam w/o Client 3 69 0 72 0 0 4 9 40 19 90847 Fam with Client 5 59 0 64 0 0 2 5 34 23 90853 Group 0 73 0 73 0 0 0 16 30 27 90862 Medication Mgmt H2011 Crisis 4 1 0 5 0 0 1 2 2 0 H2010 Injection

In Home 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 1 1 1 90804 Ind. 30 Min 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 6 0 0 5 1 4 1 0 0 1 90807 Psych. Ass 45 Min 90846 Fam w/o Client 1 1 1 90847 Fam with Client 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

LCC 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 1 1 1 90804 Ind. 30 Min 5 0 0 0 5 4 1 0 0 0 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 1 1 1 90807 Psych. Ass 45 Min 90846 Fam w/o Client 90847 Fam with Client 90853 Group 90862 Medication Mgmt 13 0 13 0 0 13 0 0 0 0 H2011 Crisis H2010 Injection

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 NCC 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 225 75 21 279 0 20 30 35 134 81 90804 Ind. 30 Min 116 24 0 139 1 5 18 6 75 36 90805 Psych. Ass. 30 Min 22 1 23 0 0 1 1 4 12 5 90806 Ind 45 Min 969 413 0 1382 0 180 110 55 668 369 90807 Psych. Ass 45 Min 2 0 2 0 0 1 0 0 1 0 90846 Fam w/o Client 2 19 0 21 0 0 5 0 9 7 90847 Fam with Client 99 82 0 181 0 3 18 4 75 81 90853 Group 13 0 0 13 0 7 3 0 3 0 90862 Medication Mgmt 368 71 439 0 0 63 48 17 209 102 H2011 Crisis 30 4 0 33 1 2 3 4 19 6 H2010 Injection 29 0 2 4 23 0 6 0 7 16

OCC 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 593 407 196 738 66 60 140 125 433 242 90804 Ind. 30 Min 1661 322 1 1788 194 439 203 114 917 310 90805 Psych. Ass. 30 Min 170 22 192 0 0 31 16 33 82 30 90806 Ind 45 Min 1907 1334 0 3187 54 322 325 202 1682 710 90807 Psych. Ass 45 Min 1 2 3 0 0 0 0 0 2 1 90846 Fam w/o Client 15 99 1 113 0 6 15 1 68 24 90847 Fam with Client 47 407 0 453 1 12 62 13 232 135 90853 Group 361 0 0 361 0 77 39 63 111 71 90862 Medication Mgmt 2566 1007 3573 0 0 870 336 218 1585 564 H2011 Crisis 60 49 0 100 9 10 9 11 56 23 H2010 Injection 403 0 0 0 403 293 44 0 65 1

Off Site 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 10 25 0 35 0 2 5 3 18 7 90804 Ind. 30 Min 10 109 0 119 0 0 11 12 52 44 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 57 154 0 211 0 11 19 6 97 78 90807 Psych. Ass 45 Min 90846 Fam w/o Client 1 10 0 11 0 0 2 1 7 1 90847 Fam with Client 0 10 0 10 0 0 0 1 6 3 90853 Group 6 0 0 6 0 1 0 2 3 0 90862 Medication Mgmt H2011 Crisis 2 3 0 5 0 0 1 0 3 1 H2010 Injection

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 PCS 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 1 31 0 32 0 1 6 0 16 9 90804 Ind. 30 Min 13 174 0 187 0 0 25 0 122 40 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 100 226 0 326 0 18 64 5 163 76 90807 Psych. Ass 45 Min 90846 Fam w/o Client 4 10 0 14 0 1 3 0 7 3 90847 Fam with Client 3 24 0 27 0 2 2 0 7 16 90853 Group 90862 Medication Mgmt H2011 Crisis 2 4 0 6 0 0 1 1 2 2 H2010 Injection

PES 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 0 4 0 4 0 0 0 1 3 0 90804 Ind. 30 Min 0 23 0 23 0 0 1 5 16 1 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 0 22 0 22 0 0 3 4 15 0 90807 Psych. Ass 45 Min 90846 Fam w/o Client 0 5 0 5 0 0 2 0 3 0 90847 Fam with Client 0 6 0 6 0 0 1 0 5 0 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

SCC 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 243 165 38 341 29 20 21 61 212 94 90804 Ind. 30 Min 268 169 0 420 17 54 21 30 232 100 90805 Psych. Ass. 30 Min 39 0 39 0 0 4 5 3 22 5 90806 Ind 45 Min 2056 1187 0 2953 290 365 138 245 1841 654 90807 Psych. Ass 45 Min 2 5 7 0 0 0 1 0 2 4 90846 Fam w/o Client 9 107 0 115 1 0 7 1 77 31 90847 Fam with Client 25 49 0 73 1 3 4 0 44 23 90853 Group 4 0 0 4 0 0 0 1 2 1 90862 Medication Mgmt 906 175 1081 0 0 284 56 65 481 195 H2011 Crisis 48 29 0 73 4 7 3 8 46 13 H2010 Injection 48 0 0 0 48 20 1 12 11 4

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 School 2011 (various schools, which are not a licensed satellite) Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 90804 Ind. 30 Min 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 90807 Psych. Ass 45 Min 90846 Fam w/o Client 0 3 0 3 0 0 1 0 1 1 90847 Fam with Client 1 1 1 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

SES 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 0 4 0 4 0 0 0 1 2 1 90804 Ind. 30 Min 0 55 0 55 0 0 1 11 20 23 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 0 67 0 67 0 0 11 15 34 7 90807 Psych. Ass 45 Min 90846 Fam w/o Client 0 4 0 4 0 0 1 0 3 0 90847 Fam with Client 0 8 0 8 0 0 0 0 5 3 90853 Group 90862 Medication Mgmt H2011 Crisis 0 3 0 3 0 0 0 0 3 0 H2010 Injection

SMS 2011 Service Type Adult Child NPP Clini RN MDC MAD S/P MC 3rd & MD cian Party 90801 Initial 0 2 0 2 0 0 0 1 1 0 90804 Ind. 30 Min 0 8 0 8 0 0 1 0 7 0 90805 Psych. Ass. 30 Min 90806 Ind 45 Min 0 58 0 58 0 0 2 0 55 1 90807 Psych. Ass 45 Min 90846 Fam w/o Client 90847 Fam with Client 0 2 0 2 0 0 0 0 2 0 90853 Group 90862 Medication Mgmt H2011 Crisis H2010 Injection

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 Appendix D

Units of Service billed for Children with Medicaid, Medicaid Managed Care, and Third Party Insurance for 2011

Site Medicaid Managed Care Third Party CAC 63 304 140 Franklinville Central 35 212 162 School FES 0 3 4 GCS 6 265 179 NCC 56 414 170 OCC 529 2153 892 OFFSITE 36 174 83 PCS 75 262 129 PES 7 42 1 SCC 123 1212 475 SES 13 67 34 SMS 3 65 1 TOTAL 946 5173 2270

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 Appendix E

Financial Data

2010 CFR DATA

CLINICAL & FORENSIC ON-CALL SERVICES SERVICES COUNTY STAFF SALARIES $ 1,321,650 $ 14,887 $ 1,336,537 COUNTY STAFF BENEFITS $ 570,586 $ 2,430 $ 573,016 CONTRACTED STAFF* $ 983,172 $ - $ 983,172 CONTRACTED BILLING** $ - $ - $ - OTHER: Shared Services ( A ) $ 93,018 $ - $ 93,018 OTHER: Employee Expenses ( B ) $ 16,627 $ - $ 16,627 OTHER: Utilities $ 16,431 $ - $ 16,431 OTHER: Rent $ 31,500 $ - $ 31,500 OTHER: Prescriptions $ 13,000 $ - $ 13,000 OTHER: ( C ) $ 85,196 $ 1,742 $ 86,938 TOTAL EXPENDITURES $ 3,131,180 $ 19,059 $ 3,150,239

MEDICARE FEES MEDICAID FEES $ 378,348 MEDICAID SUPPLEMENTS: CSP-Medicaid MEDICAID SUPPLEMENTS: COPS-Medicaid $ 1,048,787 MEDICAID SUPPLEMENTS: COPS-Managed Care THIRD-PARTY FEES - Managed Care THIRD-PARTY FEES - other insurers $ 893,936 PRIVATE PAY FEES VETERAN'S ADMIN FEES TOTAL FEE REVENUE $ 2,321,071 $ - $ 2,321,071

EXP > REV BEFORE STATE AID $ (810,109) $ (19,059) $ (829,168)

OMH STATE AID $ 231,273 $ - $ 231,273

NET EXP > REV $ (578,836) $ (19,059) $ (597,895)

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 2011 RESULTS OF OPERATIONS NINE MONTHS AS OF 09/30/11 CLINICAL FORENSIC ON-CALL SERVICES SERVICES SERVICES COUNTY STAFF SALARIES $ 974,025 $ 36,500 $ 10,240 $ 1,020,765 COUNTY STAFF BENEFITS $ 443,490 $ 18,264 $ 2,289 $ 464,043 CONTRACTED STAFF* $ 593,203 $ 4,950 $ 5,500 $ 603,653 CONTRACTED BILLING** $ 100,500 $ 100,500 OTHER: Shared Services ( A ) $ 78,056 $ 1,131 $ 79,187 OTHER: Employee Expenses ( B ) $ 11,120 $ 380 $ 666 $ 12,166 OTHER: Utilities (SCC) $ 11,073 $ 11,073 OTHER: Rent (SCC) $ 26,250 $ 26,250 OTHER: Prescriptions $ 8,382 $ 8,382 OTHER: ( C ) $ 11,358 $ 11,358 TOTAL EXPENDITURES $ 2,257,457 $ 61,225 $ 18,695 $ 2,337,377

MEDICARE FEES $ 10,683 $ 10,683 MEDICAID FEES $ 255,166 $ 255,166 MEDICAID SUPPLEMENTS: CSP-Medicaid $ 23,210 $ 23,210 MEDICAID SUPPLEMENTS: COPS-Medicaid $ 626,176 $ 626,176 MEDICAID SUPPLEMENTS: COPS-Managed Care $ 231,598 $ 231,598 THIRD-PARTY FEES - Managed Care $ 383,828 $ 383,828 THIRD-PARTY FEES - other insurers $ 166,069 $ 166,069 PRIVATE PAY FEES $ 29,941 $ 29,941 VETERAN'S ADMIN FEES $ 117 $ 117 TOTAL FEE REVENUE $ 1,726,788 $ 1,726,788

EXP > REV BEFORE STATE AID $ (530,669) $ (61,225) $ (18,695) $ (610,589)

OMH STATE AID $ 106,352 $ 47,648 $ 16,585 $ 170,585

NET EXP > REV $ (424,317) $ (13,577) $ (2,110) $ (440,004)

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12 2012 ANNUAL BUDGET CLINICAL FORENSIC ON-CALL SERVICES SERVICES SERVICES COUNTY STAFF SALARIES $ 1,240,638 $ 52,118 $ 14,152 $ 1,306,908 COUNTY STAFF BENEFITS $ 596,690 $ 27,237 $ 4,271 $ 628,198 CONTRACTED STAFF* $ 988,120 $ 7,920 $ 11,500 $ 1,007,540 CONTRACTED BILLING** $ 145,250 $ 145,250 OTHER: Shared Services ( A ) $ 117,101 $ 1,689 $ 118,790 OTHER: Employee Expenses ( B ) $ 9,925 $ 918 $ 1,658 $ 12,501 OTHER: Utilities (SCC) $ 16,380 $ 16,380 OTHER: Rent (SCC) $ 32,130 $ 32,130 OTHER: Prescriptions $ 38,400 $ 38,400 OTHER: ( C ) $ 30,393 $ 200 $ 5,000 $ 35,593 TOTAL EXPENDITURES $ 3,215,027 $ 90,082 $ 36,581 $ 3,341,690

MEDICARE FEES $ 103,612 $ 103,612 MEDICAID FEES $ 467,984 $ 467,984 MEDICAID SUPPLEMENTS: CSP-Medicaid $ 12,545 $ 12,545 MEDICAID SUPPLEMENTS: COPS-Medicaid $ 451,170 $ 451,170 MEDICAID SUPPLEMENTS: COPS-Managed Care $ 302,764 $ 302,764 THIRD-PARTY FEES - Managed Care $ 723,398 $ 723,398 THIRD-PARTY FEES - other insurers $ 312,989 $ 312,989 PRIVATE PAY FEES $ 25,318 $ 25,318 VETERAN'S ADMIN FEES $ - $ - TOTAL FEE REVENUE $ 2,399,780 $ 2,399,780

EXP > REV BEFORE STATE AID $ (815,247) $ (90,082) $ (36,581) $ (941,910)

OMH STATE AID $ 94,042 $ 74,350 $ 9,981 $ 178,373

NET EXP > REV $ (721,205) $ (15,732) $ (26,600) $ (763,537)

* MDs, NPPs, MHT/MSW ** Billing Services are contracted through Healthcare Solutions WNY, LLC.

( A ) Shared Services: Telephone, Information Services, Insurance, Records Management and Maintenance costs related to County-owned buildings (OCC and NCC).

( B ) Employee Expenses: Employee Meal, Mileage and Travel, Training and Cell Phones.

( C ) Office related expenses: Tele-reminder calls, office supplies, copier maintenance, equipment repair and maintenance, et. al.

of 22 Cattaraugus County Clinic 599 RFP Answers 2/14/12