Table 8 - Financial Costs

direct and loaded costs (Column Definitions)

Column A: This column reports the accrued direct costs associated with each of the cost centers / services listed. See Line Definitions for costs to be included in each category. Column A also reports the total cost of administration and facility (Overhead) separately on Lines 14 and 15.

Column B: This column shows the allocation of overhead costs (from lines 14 and 15, Column A) to each of the direct cost centers. The total of facility and administration costs, reported in Column A, lines 14 and 15, are to be distributed in Column B. The total amounts entered in Column B will thus equal the amount reported on Line 16, Column A. Lines 1 and 3 refer to aspects of the medical practice. It is acceptable to report all medical overhead on Line 1 if a more appropriate allocation between lines 1 and 3 is not available. All pharmacy overhead is to be allocated to the non-supply line (Line 8a). No overhead costs are reported on the pharmaceutical supplies line (line 8b) which is blacked out in the reporting software.

The allocation of administration and facility costs should be done as follows, unless your center has a more accurate system:

Facility Costs should be allocated based on the amount of square footage utilized for Medical, Dental, Mental Health, Substance Abuse, Pharmacy, Other Professional, Enabling, Other Program Related Services and Administration. Square Footage refers to the portion of the grantee's facility space used in the operation of the organization, not including common spaces such as hallways, rest rooms, and utility closets. For reporting purposes, the square footage associated with space owned by the grantee and leased or rented to other parties should not be included if it is considered to be outside of the scope of the project. If it has been included inside the scope of project, it should be allocated to Other Related Services (Row 12) and the rent received should be included on Table 9E under Other Revenue (Line 10).

Administrative Costs should be allocated after facility costs have been allocated, and should include the facility costs allocated to it. Administrative cost is allocated based on a straight line allocation method. The proportion of total cost (excluding administrative cost) that is attributable to each service category should be used to allocate administrative cost. For example, if medical staff account for 50 percent of total cost (excluding administration) then 50 percent of administrative cost is allocated to medical staff. If you have an alternative method that provides more accurate allocations, it may be used, but save your paperwork for review and explain the methods used in the table note.

Column C : This column shows the “fully loaded” cost of each of the cost centers listed on Lines 1 - 13. The loaded cost is the sum of the direct cost, reported in Column A, plus the allocation of overhead, reported in Column B. This calculation is now done automatically in the reporting software. Column C also shows the value of any donated facilities, services and supplies on Line 18. These non-cash donations should be reflected as a positive number, and are not included in any of the lines above. Note that this is the only place that the value of non-cash donations are shown. Non-cash donations are never reported on Table 9E. Line 19, Column C is the total cost including the value of donations.

BPHC Major Service Categories (Line Definitions)

A.      Medical Care Services (Lines 1 - 4) – This category includes costs for medical care personnel; services provided under agreement; X-ray and laboratory; and other direct costs wholly attributable to medical care (e.g., equipment depreciation, supplies, or professional dues and subscriptions). It does not include costs associated with pharmacy, dental care, substance abuse specialists, or mental health (psychiatrists, clinical psychologists, clinical social workers, etc.) services.

Staff Costs (Line 1) – Include all staff costs, including salaries and fringe benefits for personnel supported directly or under contract, for medical care staff except lab and x-ray staff. The costs of intake, medical records and billing and collections are considered administrative and should be included on Line 15 and allocated in Column B. Include the cost for vouchered or contracted medical services on line 1.

Lab and X-ray Costs (Line 2) – Include all costs for lab and x-ray, including salaries and fringe benefits for personnel supported directly or under contract, for lab and x-ray staff; and all other direct costs including, but not limited to, supplies, equipment depreciation, related travel, contracted or vouchered lab and x-ray services, etc. The costs of intake, medical records, billing and collections are considered administrative and should be included on Line 15 and allocated in Column B. Note that dental lab and x-ray costs are reported on the dental line, line 5.

Other Direct Costs (Line 3) – Include all other direct costs for medical care including, but not limited to, supplies, equipment depreciation, related travel, CME, laundering of uniforms, membership in professional societies, books and journal subscriptions, etc.

Total Medical (Line 4) – The sum of lines 1 + 2 + 3.

B.      Other Clinical Services (Lines 5 - 10) – This category includes staff and related costs for dental, mental health, substance abuse services, pharmacy, and services rendered by other professional personnel (e.g., optometrists, occupational and physical therapists, and podiatrists).

Dental (Line 5) – Report all costs for the provision of dental services including but not limited to staff, fringe benefits, supplies, equipment depreciation, related travel, dental lab services and dental x-ray. Corporate administrative and facility costs should be included on Line 15 Column A and allocated in Column B.

Mental Health (Line 6) – Report all direct costs for the provision of mental health services, other than substance abuse services, including but not limited to staff, fringe benefits, supplies, equipment depreciation, and related travel. If a “behavioral health” program provides both mental health and substance abuse services, the cost should be allocated between the two programs. Allocations may be based on staffing or encounters (from Table 5) or any other appropriate methodology. Corporate administrative and facility costs should be included on Line 15 Column A and allocated in Column B.

Substance Abuse (Line 7) – Report all direct costs for the provision of substance abuse services including but not limited to staff, fringe benefits, supplies, equipment depreciation, and related travel. If a “behavioral health” program provides both mental health and substance abuse services, the cost should be allocated between the two programs. Allocations may be based on staffing or encounters (from Table 5) or any other appropriate methodology. Corporate administrative and facility costs should be included on Line 15 Column A and allocated in Column B.

Pharmacy (not including pharmaceuticals) (Line 8a) – Report all direct costs for the provision of pharmacy services including but not limited to staff, fringe benefits, non-pharmaceutical supplies, equipment depreciation, related travel, contracted purchasing services, etc. Corporate administrative and facility costs should be included on Line 15 Column A and allocated in Column B.

Pharmaceuticals (Line 8b) – Report all direct costs for the purchase of pharmaceuticals, including the cost of vaccines and other injectable drugs. Do not include other supplies. Do not include the value of donated pharmaceutical supplies (these are recorded on Line 18, Column C.)

Other Professional (Line 9) – Report all direct costs for the provision of other professional and ancillary health care services including but not limited to: optometry, podiatry, chiropractic, acupuncture, naturopathy, speech, occupational and physical therapy, etc. (A more complete list appears at Appendix A.) Included in direct costs are staff, fringe benefits, supplies, equipment depreciation, related travel, and contracted services. Corporate administrative and facility costs should be included on Line 15 Column A and allocated in Column B. Note that there is a new “specify” cell for this line.

Total Other Clinical (Line 10) – The sum of lines 5 + 6 + 7 + 8a + 8b + 9.

C.     Enabling and Other Program Related Services (Lines 11 - 13) – This category includes enabling staff and related costs for case management, outreach, transportation, translation and interpretation, education, eligibility assistance – including pharmacy assistance program eligibility, environmental risk reduction and other services that support and assist in the delivery of primary medical services and facilitate patient access to care. The cost of these services are also reported on Table 8B. For definitions of specific enabling services, see Appendix B.

It also includes the cost of staff and related costs for other program related services such as WIC, day care, job training, delinquency prevention and other activities not included in other BPHC categories.

Enabling (Line 11) – Enabling services include a wide range of services which support and assist primary medical care and facilitate patient access to care. A non-exclusive list of 15 such services is included in Appendix B. Report all direct costs for the provision of enabling services including but not limited to costs such as staff, fringe benefits, supplies, equipment depreciation, related travel, and contracted services. Corporate administrative and facility costs should be included on Line 15 Column A and allocated in Column B.

Lines 11a – 11g provide room to detail six specific types of enabling services as well as an “other” category for all other forms of enabling services:

·         Case Management (11a)

·         Transportation (11b)

·         Outreach (11c)

·         Patient and community education (11d)

·         Eligibility assistance (11e)

·         Translation / Interpretation Services (11f)

·         Other (11g)

If the “other” category is used, there is room to provide an explanation for what other forms of enabling services are being included on this line.

Other Program Related (Line 12) – Report all direct costs for the provision of services not included in any other category here. This includes services such as WIC, childcare centers, and training programs. Report all direct costs for staff, fringe benefits, supplies, equipment depreciation, related travel and contracted services. (Staff for these programs are now reported on line 29a of Table 5.) Corporate administrative and facility costs should be included on Line 15 Column A and allocated in Column B. Grantees are asked to describe the program costs so the UDS editor can make sure that the classification of the program as an “other related program” is appropriate.

Total Enabling and other Program Related Services (Line 13) – The sum of lines 11 + 12.

D.     Facility and Administrative Costs (Lines 14 - 16) – This includes all traditional overhead costs that are later allocated to other cost centers. Specifically:

Facility Costs (Line 14) – Facility costs include rent or depreciation, interest payments, utilities, security, grounds keeping, facility maintenance, janitorial services, and all other related costs.

Administrative Costs (Line 15) – Administrative costs include the cost of all corporate administrative staff, billing and collections staff, medical records and intake staff, and the costs associated with them including, but not limited to, supplies, equipment depreciation, travel, etc. In addition, include other corporate costs (e.g., purchase of insurance, audits, legal fees, interest payments on non-facility loans, Board of Directors’ costs, etc.) The cost of all patient support services (e.g., medical records and intake) should be included in Administrative Costs. Note that the “cost” of bad debts is NOT to be included in administrative costs or shown on this table in any way. Instead, the UDS reduces gross income by the amount of patient bad debt on table 9D.

Note: Some grant programs have limitations on the proportion of grant funds that may be used for administration. Limits on administrative costs for those programs is not to be considered in completing lines 14 and 15. The Administration and Facility categories for this report includes all administrative costs and personnel working in a BPHC-supported program, whether or not that cost was identified as administrative in any specific grant application.

Total Overhead (Line 16) – The sum of lines 14 + 15.

E.      Total Accrued Cost (Line 17) – It is the sum of lines 4 + 10 +13 + 16

F.      Value of Donated Facilities, Services and Supplies (Line 18) - Include here the total imputed value of all in-kind and donated services, facilities and supplies applicable to the reporting period that are within your scope of project, using the methodology discussed below. In-kind services and donations include all services (generally volunteers, but sometimes paid staff donated to the grantee by another organization), supplies, equipment, space, etc. that are necessary and prudent to the operation of your program that you do not pay for directly and which you included in your budget as donated. Line 18 reports the estimated reasonable acquisition cost of donated personnel, supplies, services, space rental, and depreciation for the use of donated facilities and equipment. The value of these services should not be included in the lines above.

The estimated reasonable acquisition cost should be calculated according to the cost that would be required to obtain similar services, supplies, equipment or facilities within the immediate area at the time of the donation. Donated pharmaceuticals, for example, would be shown at the price that would be paid under the federal drug pricing program, not the manufacturer’s suggested retail price. Donated value should only be recognized when the intent of the donating parties is explicit and when the services, supplies, etc., are both prudent and necessary to the grantee's operation.

If the grantee is not paying NHSC for assignees, the full market value of National Health Service Corps (NHSC) Federal assignee(s) , including “ready responders”, should also be included in this category. NHSC-furnished equipment, including dental operatories, should be capitalized at the amount shown on the NHSC Equipment Inventory Document, and the appropriate depreciation expense should be shown in this category for the reporting period.

Grantees are asked to describe the items included so the UDS editor can make sure that the classification of donated items is appropriate.

G.     Total With Donations (Line 19) – It is the sum of lines 17 and 18, column C.

CONVERSION FROM FISCAL TO CALENDAR YEAR

Grantees whose cost allocation system permits them to provide accurate accrued cost data should use that system. Grantees whose fiscal year does not correspond to the calendar year and whose accounting system is unable to provide accurate accrued cost data may calculate calendar year costs, using the following straight-line allocation methodology:

Step 1: Calculate the proportion of the calendar reporting period covered by the cost report and use that ratio to calculate the proportion of cost in each category attributable to the calendar year. Example: A grantee whose fiscal year ends March 31, 2008, allocates 25 percent of costs in each cost category to the 2008 calendar year.

Step 2: Using the trial balance for the end of December, determine the total cost for the remainder of the calendar year for each column. For example, a grantee whose fiscal year ends March 31, 2008 would use the nine-month trial balance for December 31. (Note: Grantees who do not accrue depreciation monthly should adjust depreciation to an annual total.)

Step 3: Sum results of Steps 1 and 2 and enter the total in Column A.

Questions and Answers for Table 8.

1.      Are there any changes to this table?

Lines previously included on Table 8B are now included on the new combined Table 8

2.      My auditor says that the cost of bad debts must be reflected in my financial statement as a cost. Where do I show it on Table 8?

The UDS report does not follow all FASBI accounting rules; and this is one of the FASBI values. Bad debt is not shown as a cost. Instead, it is shown (accounted for) on Table 9D where it is viewed by BPHC as an adjustment to income.

3.      How are donated services accounted for?

If an individual comes to your health center and provides a service to your patients, you show both the FTE (on table 5) and the value, which is determined by “what a reasonable person would pay for” the time – (not the service), is reported on line 18. For example, if an optometrist sees five patients in a two hour period, the amount shown is what you would pay an optometrist for two hours of work, not the total charges for the five visits. However, if you refer a patient for a service to a provider outside of your site who donates these services neither the charge nor the value of the time is reported on the UDS. For example, if you refer a patient to the county hospital for a hip replacement which is provided to your patient at no cost to you or the patient, neither the time of the surgical team nor the UCR charge for the service is reported on the UDS.

4.      How are donated drugs accounted for?

If drugs are donated directly to the health center which then dispenses them to a patient, the value of the drugs is calculated at what a reasonable payor would pay for them and is reported on line 18. This is NOT the retail cost of the drug, it is the 340(b) price of the drug – an amount which is generally 40% - 60% of the average wholesale price (AWP). Technically if the drug is donated directly to the patient, even though it may be sent to the health center, this is not a donation to the center and need not be accounted for or reported. I

5.      We get most of our vaccines through the Vaccines For Children (VFC) program. Are these considered to be donated drugs and accounted for here?

Yes. The value of donated drugs that are used in the clinic, such as vaccines, should also be reported on Line 18, again at the reasonable cost.

TABLE 8A – FINANCIAL COSTS