Annual Mental Health Services Act Revenue and Expenditure Report for Fiscal Year Community Services and Supports (CSS) Summary

Transcription

1 Annual Mental Health Services Act Revenue and Expenditure Report for Fiscal Year 01-1 Community Services and Supports (CSS) Summary Date: //01 Total (Gross) Mental Health Community Services and Supports Component Expenditures FSP Programs Client Family Operated Services $, Triumph and Recovery $,1 Rural Health Initiative $1,1 Older Adult Services $1,0 Crisis Services $1,,1 Access/Outreach $, Co-Occurring Primary Care $0,1 Subtotal FSP Programs $,, Non-FSP Programs Subtotal Non-FSP Programs Total FSP and Non-FSP Programs $,, CSS Evaluation CSS Administration $,1 CSS MHSA Housing Program Assigned Funds Total CSS Expenditures $,,1 Updated: 0/0/01

2 Annual Mental Health Services Act Revenue and Expenditure Report for Fiscal Year 01-1 Prevention and Early Intervention (PEI) Summary Enclosure Date: //01 (A) Prevention and Early Intervention Component PEI Programs-Prevention 1 Stigma and Discrimination Suicide Prevention Subtotal PEI Programs-Prevention PEI Programs-Early Intervention 1 Children and Youth in Stressed Families Older Adults Individuals Experiencing Onset of Serious Psychiatric Illness Total (Gross) Mental Health Expenditures $, $0,01 $, $1, $1, $, Subtotal PEI Programs-Prevention $,1 PEI Programs-Other 1 Subtotal PEI Programs-Other Subtotal PEI Programs-Prevention & Early Intervention and Other $,1 PEI Evaluation PEI Administration $1,1 Total PEI Expenditures $1,0, Updated: 0/0/01

3 Annual Mental Health Services Act Revenue and Expenditure Report for Fiscal Year 01-1 Innovation (INN) Summary Date: //01 (A) Innovation Component Innovation Programs 1 Community Intervention - Pre Crisis Team Subtotal Innovation Evaluation Innovation Administration Total Innovation Expenditures Total (Gross) Mental Health Expenditures $,1 $,1 $,1 Updated: 0/0/01

4 Annual Mental Health Services Act Revenue and Expenditure Report for Fiscal Year 01-1 Workforce Education and Training (WET) Summary Date: //01 (A) Workforce Education and Training Component WET Funding Category Workforce Staffing Support Training and Technical Assistance Mental Health Career Pathways Programs Residency and Internship Programs Financial Incentive Programs Total WET Expenditures Total (Gross) Mental Health Expenditures $1, Total WET Programs $1, WET Administration $1, Updated: 0/0/01

5 Annual Mental Health Services Act Revenue and Expenditure Report Fiscal Year 01-1 Capital Facilities/Technological Needs (CF/TN) Summary Date: //01 (A) Capital Facility/Technological Needs Projects Capital Facility Projects 1 Predevelopment Costs Renovation & Construction Project Management Total (Gross) Mental Health Expenditures $1,0 $1,0 $,01 Total CF Projects $, Capital Facility Administration Total Capital Facility Expenditures $, Technological Needs Projects 1 1 Total TN Projects Technological Needs Administration Total Technological Needs Expenditures Total CFTN Expenditures $, Updated: 0/0/01

6 Annual Mental Health Services Act Revenue and Expenditure Report Fiscal Year 01-1 Other MHSA Funds Summary Date: //01 Training, Technical Assistance and Capacity Building (A) Total (Gross) Expenditures WET Regional Partnerships PEI Statewide Projects Updated: 0//01

7 TABLE A Annual Mental Health Services Act Revenue and Expenditure Report FY 01-1 Summary COUNTY: DATE: //01 PEI Statewide Funds assigned to CalMHSA? (Y/N) N (A) (B) (C) (D) (E) (F) (G) (H) (I) (J) Fiscal Year 01-1 Community Services and Supports Prevention and Early Intervention Innovation Workforce Education and Training Capital Facilities and Technological Needs TTACB WET Regional Partnerships PEI Statewide Projects Funds Prudent Reserve Total-All Components 1 Unspent Funds Available From Prior Fiscal Years 1 a Local Prudent Reserve b FY 00-0 Funds c FY 00-0 Funds $, $1,0 $1,, d FY 00-0 Funds $1,00 $1,00 e FY 00- Funds f FY 0- Funds $1,0, $1,0, g FY 0- Funds $, $,00 $01 $, h FY 0-1 Funds $,, $1,, $, $,0,1 i Cumulative Interest $,1 $, $, $1, $,0 $1 $,1 j TOTAL $,,1 $1,00,1 $1,, $,1 $1,, $ $,, MHSA Funds Revenue in FY 01-1 a Transfer of funds from the Local Prudent Reserve b FY 01-1 MHSA Revenue Received $,, $1,1, $, $,, c FY 01-1 Interest Earned on MHSA Funds $1, $, $, $1,0 $,00 $ $, d TOTAL $,,00 $1,1,0 $0, $1,0 $,00 $ $,0, Expenditure and Funding Sources for FY 01-1 A MHSA Funds a FY 00-0 MHSA Funds b FY 00-0 MHSA Funds $1, $, $1, c FY 00-0 MHSA Funds d FY 00- MHSA Funds e FY 0- MHSA Funds f FY 0- MHSA Funds $, $, $,1 g FY 0-1 MHSA Funds $,, $,0 $,,00 h FY 01-1 MHSA Funds $1,, $1,, MHSA Net Expenditures Subtotal for FY 01-1 $,00, $1,0, $, $1, $, $,,0 i Interest $,1 $, $, $1, $,0 $, B Other Funds a Realignment b Behavioral Health Subaccount c Other $,01 $, $0, d TOTAL MHSA and Other Funds $,,1 $1,0, $,1 $1, $, $,0,1 e Total Program Expenditures $,,1 $1,0, $,1 $1, $, $,0,1 NOTE TO COUNTY: Total Program Expenditures, (d), MUST match Total Expenditure Funding Sources, (e). If ERROR, recheck and correct. Updated: 0//01

8 PEI Statewide Funds assigned to CalMHSA? (Y/N) N (A) (B) (C) (D) (E) (F) (G) (H) (I) (J) Fiscal Year 01-1 Community Services and Supports Prevention and Early Intervention Innovation Workforce Education and Training Capital Facilities and Technological Needs TTACB WET Regional Partnerships PEI Statewide Projects Funds Prudent Reserve Total-All Components Transfers to Prudent Reserve, WET, CFTN a FY 0- b FY 0-1 c FY 01-1 Adjustments a Local Prudent Reserve b FY 00-0 Funds c FY 00-0 Funds d FY 00-0 Funds e FY 00- Funds f FY 0- Funds g FY 0- Funds h FY 0-1 Funds i FY 01-1 Funds j Interest k TOTAL Unspent Funds in the Local MHS Fund a Local Prudent Reserve Balance b FY 00-0 Funds c FY 00-0 Funds $, $,1 $1,0, d FY 00-0 Funds $1,00 $1,00 e FY 00- Funds f FY 0- Funds $1,0, $1,0, g FY 0- Funds $, $01 $, h FY 0-1 Funds $, $, $1,, i FY 01-1 Funds $,0,0 $1,1, $, $,,0 j Interest $1, $, $, $1,0 $,00 $ $, k TOTAL $,1, $,00, $1,1, $, $1,00,0 $ $,1, TABLE B RER Contact Person Estimated FFP Revenue Generated In FY 01-1 Amount Name Mike Rodriguez Federal Financial Participation (FFP) $0, Title Phone Accountant-Auditor II 0-- mrodriguez@co.shasta.ca.us Updated: 0//01

9 Annual Mental Health Services Act Revenue and Expenditure Report for Year 01-1 Adjustments Summary Fiscal Date: //01 FY Amount Reason For Adjustment TOTAL NOTE TO COUNTY: Total Adjustments recorded in the Adjustments Summary worksheet MUST match Total Adjustments recorded on the RER Summary Worksheet. If ERROR, recheck and correct. Updated: 0/0/01

10 Annual Mental Health Services Act Revenue and Expenditure Report FY 01-1 END NOTES: 1 Total unspent funds from prior fiscal years MUST match the Total Unspent Funds in the Local MHS Fund from prior year RER. DHCS will utilize the allocation report provided by the SCO and counties should utilize the same report when determining the total State MHSA Fund revenue to be reported on the FY 01-1 RER. The report is available at: Expenditure funding sources for each component must equal the total program expenditures as reported on the Component Summary Worksheets. WIC Section (b) permits a County to use up to 0 percent of the average amount of funds allocated to the county for the previous five years to fund technological needs and capital facilities, human resource needs, and a prudent reserve. The amount of funds transferred from CSS will be reported in the CSS column as a negative amount. The funds transferred into WET, CFTN, or Prudent Reserve should be reflected as a positive amount. For each year reported, the amount transferred from CSS should equal zero when added to the funds transferred into WET, CFTN, or Prudent Reserve. Payments from the MHSA Fund should be reflected in the Adjustments section as a negative amount. Receipts into the MHSA Fund should be reflected in the Adjustments section as a positive amount. Total Unspent funds in the Local MHS Fund will auto populate for each Fiscal Year. The FFP amount represents the estimated FFP revenue generated in FY 01-1 and attributable to MHSA funds. Updated: 0//01