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HomeMy WebLinkAboutSTATE Department of Health Care Services-FY 2022-23 Health Care Program for Children in Foster Care_A-22-500.pdf co U Y Count of Fresno Hall of Records,Room 301 2281 Tulare Street Fresno,California 116 Board of Supervisors 93721-2198 O� i83 O Telephone:(559)600-3529 FRE`7 Minute Order Toll Free: 1-800-742-1011 www.co.fresno.ca.us October 25, 2022 Present: 5- Supervisor Nathan Magsig, Supervisor Buddy Mendes, Chairman Brian Pacheco,Vice Chairman Sal Quintero, and Supervisor Steve Brandau Agenda No. 48. Public Health File ID: 22-0862 Re: Approve retroactive submission of the FY 2022-23 California Department of Health Care Services allocation plan for child health services under the Child Health and Disability Prevention Program and authorize the Chairman to execute Certification Statements as required by the California Department of Health Care Services, effective July 1, 2022 to June 30,2023($1,132,109);and approve retroactive submission of the FY 2022-23 California Department of Health Care Services allocation plan for child health services under the Health Care Program and Children in Foster Care and authorize the Chairman to execute the Certification Statements as required by the California Department of Health Care Services, effective July 1, 2022 to June 30, 2023($2,273,160) APPROVED AS RECOMMENDED Ayes: 5- Magsig, Mendes, Pacheco, Quintero, and Brandau Agreement No.22-499,Agreement No.22-500 County of Fresno Page 52 co q Board Agenda Item 48 0 1856 0 � FRE`'11 DATE: October 25, 2022 TO: Board of Supervisors SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health SUBJECT: Retroactive FY 2022-23 California Department of Health Care Services Allocation Plans RECOMMENDED ACTION(S): 1. Approve retroactive submission of the FY 2022-23 California Department of Health Care Services allocation plan for child health services under the Child Health and Disability Prevention Program and authorize the Chairman to execute Certification Statements as required by the California Department of Health Care Services, effective July 1,2022 to June 30, 2023 ($1,132,109); and 2. Approve retroactive submission of the FY 2022-23 California Department of Health Care Services allocation plan for child health services under the Health Care Program and Children in Foster Care and authorize the Chairman to execute the Certification Statements as required by the California Department of Health Care Services,effective July 1,2022 to June 30, 2023 ($2,273,160). There is no additional Net County Cost associated with the recommended actions. Approval of the recommended actions will allow the County to continue to receive non-competitive funding from the California Department of Health Care Services (DHCS)for four mandated child health services programs: Child Health and Disability Prevention (CHDP), Health Care Program for Children in Foster Care (HCPCFC), Health Care Program for Children in Foster Care -Caseload Relief(HCPCFC-CR), and Psychotropic Medication Monitoring and Oversight(PMM&O). The allocations offset the administrative costs of the four programs and include full recovery of all indirect costs.The anticipated County match will be funded with Health Realignment. This item is countywide. ALTERNATIVE ACTION(S): There are no viable alternative actions as the County is mandated by DHCS to administer all four programs. Should your Board not approve the recommended action, the Department would not have sufficient funds to offset these mandated program service costs. RETROACTIVE AGREEMENT: The Department received FY 2022-23 budget allocations from DHCS on June 23, 2022 for CHDP, HCPCFC, HCPCFC-CR, and PMM&O components. All four allocations are retroactive to July 1, 2022. The approved CHDP and HCPCFC allocation plan submission deadline was September 1, 2022 however DHCS has approved an extension deadline due to the Department's late receipt of the allocation notice. FISCAL IMPACT: County of Fresno Page 1 File Number:22.0862 File Number:22-0862 There is no increase in Net County Cost associated with the recommended actions. DHCS approved a total non-competitive allocation of$3,405,269 for FY 2022-23. The State and Federal funding broken down to the programs is as followed: • $1,132,109-Child Health and Disability Prevention • $1,521,270- Health Care Program for Children in Foster Care • $532,378- Health Care Program for Children in Foster Care-Caseload Relief • $219,512- Psychotropic Medication Monitoring and Oversight(Foster Care) The HCPCFC program allocation increased by 6.7% compared to last fiscal year's allocation. There is no increase in allocation to the other programs. The total estimated FY 2022-23 DHCS Plan expenditures are $2,515,509. Sufficient appropriations and estimated revenues are included in the Department's Org 5620 FY 2022-23 Adopted Budget. DISCUSSION: The State began CHDP programs in 1972. Your Board's approval of the recommended DHCS allocation plan will allow the County to continue receiving funds to administer these mandated programs, pursuant to California Code of Regulations Title 22, Division 2, Subdivision 7. The recommended CHDP allocation plan requires the County to provide CHDP case management health care services for eligible children.The CHDP program oversees the provision of complete health assessments for the early detection and prevention of disease and disability for eligible children. In FY 2021-22, approximately 300 medical providers delivered services at 120 sites enrolled in the CHDP program throughout the County. The CHDP program also encompasses the HCPCFC program whereby Public Health Nurses (PHN) consult and collaborate with the County's Department of Social Services (DSS)-Child Welfare Service Programs and the Probation Department to provide PHN expertise in meeting the medical, dental, mental, and developmental needs of children and youth in foster care. The HCPCFC program coordinates health care services for these children by: • Collaborating with social workers, probation officers, and case managers; • Assessing the health care status of children and promoting access to comprehensive preventive health and specialty services; • Attending multi-disciplinary Team Decision Meetings to explain the health needs of the child; and • Acting as a liaison between Child Welfare Services and health care providers. DSS funds four of the HCPCFC program's ten FTE (full-time equivalent) PHNs. PMM&O funding, which started in FY 2016-17, is used exclusively to hire or augment existing PHN staff to permit PHN monitoring and oversight of foster children and youth treated with psychotropic medications. In FY 2021-22, there were approximately 2,900 children in foster care, 260 of which are on psychotropic medications and approximately 75 children on probation that received services from the programs. To finalize the allocation process, DHCS requires your Board to certify approval of the recommended CHDP and HCPCFC allocation plan and sign certifications stating that the County will comply with applicable laws, regulations, and policies related to the CHDP and HCPCFC program. The recommended CHDP and HCPCFC allocation plan is retroactive to July 1, 2022 and serves in lieu of an agreement. Historically, the DHCS allocation plan included the presentation of the California Children's Services (CCS) program, however, CCS have not received their allocation letter from DHCS. Once approved by your Board, no additional Board executed documents are required to receive the CHDP and HCPCFC funding. County of Fresno page 2 File Number:22-0862 File Number:22-0862 REFERENCE MATERIAL: BAI #47, November 16, 2021 BAI #12, November 24, 2020 ATTACHMENTS INCLUDED AND/OR ON FILE: On file with Clerk-FY 2022-23 CHDP Plan and Budget On file with Clerk- FY 2022-23 HCPCFC Plan and Budget CAO ANALYST: Ron Alexander County of Fresno Page 3 File Number:22-0862 Agreement No. 22-500 Health Care Program for Children in Foster Care Plan and Budget Reporting Checklist Page Number 1. HCPCFC Plan and Budget Reporting Checklist 1 2. HCPCFC Certification Statement 2 3. HCPCFC Organizational Chart Retain Locally 4. HCPCFC MOU with Local Child Welfare/Social Services N/A 5. HCPCFC Probation IA N/A 6. If Applicable: a. Contractor Equipment Purchased with DHCS Funds Form (DHCS1203) N/A b. Inventory/Disposition of DHCS Funded Equipment Form (DHCS1204) N/A c. Property Survey Report Form (STD 152) N/A 7. HCPCFC Plan and Budget Reporting Spreadsheet a. Agency Information Sheet 3 b. Memorandum of Understanding and Interagency Agreement 4 List c. HCPCFC Incumbent List 5 d. HCPCFC Budgets i. Base 6 — Summary and Worksheet 7 — Budget Narrative ii. Psychotropic Medication Monitoring and Oversight 8 — Summary and Worksheet g — Budget Narrative iii. Caseload Relief 10 - 11 — Summary and Worksheet 12 — Budget Narrative iv. Optional County/City- Federal Match N/A — Summary and Worksheet N/A — Budget Narrative DHCS State of California—Health and Human Services Agency unr Department of Health Care Services MICHELLE BAASS GAVIN NEWSOM DIRECTOR GOVERNOR Health Care Program for Children in Foster Care Certification Statement County/City: Fresno Fiscal Year: 2022-23 1 certify that the Health Care Program for Children in Foster Care (HCPCFC) will comply with all applicable state and federal and state laws and regulations, including all federal laws and regulations governing recipients of federal funds granted to states for medical assistance pursuant to Title XIX of the Social Security Act(42 U.S.C. Section 1396 et seq). I further certify that the HCPCFC will comply with all rules promulgated by DHCS pursuant to these authorities, including the Integrated Systems of Care Plan and Fiscal Guidelines Manual. I further agree that this HCPCFC may be subject to sanctions or other remedies if this HCPCFC violates any of the above. AJ- ` 9/13/22 Signature of HCPCFC Director/County Authorized Date Signed Representative r' Signature of Director or ealth Officer Date Signed Signature and Title of Other—Optional Date Signed I certify that this plan has been approved by the local governing body. Signature of Local Governing Body Chairperson Uate Signed ATTEST: BERNICE E.SEIDEL Clerk of the Board of Supervisors Countv of Fresno,state of California By Deputy Systems of Care Division 1515 K Street, Suite 400, Sacramento, CA 95814 P.O. Box 997413,MS 8100 Sacramento, CA 95899-7413 (916)327-1400 Intemet Address:www.dhcs.ca.gov DHCS State of California—Health and Human Services Agency Department of Health Care Services Health Care Program for Children in Foster Care ;i MICHELLE BAASS Agency Information GAVIN NEWSOM DIRECTOR GOVERNOR County/City: lFresno Fiscal Year: 2022-23 Official Agency Street Address:1221 Fulton Street Health Officer: Rais Vohra, MD (interim) City: Fresno Local HCPCFC Zip Code: 93721 Central Inbox: Parent Agency Director(if applicable) Name: David Luchini, Director Street Address: 1221 Fulton Street Phone: City: Fresno Email: Zip Code: 93721 Authorized HCPCFC Program Administrative Representative Name: Ankara Lee Street Address: 380 W. Ashlan Phone: 559-600-6591 City: Clovis Email: alee@fresnocountyca.gov Zip Code: 93612 Clerk of the Board of Supervisors or City Council Name: Bernice Seidel Street Address: 2281 Tulare St, 3rd Floor Phone: 559-600-6592 City: Fresno Email: bseidel@fresnocountyca.gov Zip Code: 93721 Director of Social Services Agency Name: Sanja Bugay Street Address: 205 W Pontiac Way, Bldg 2 Phone: 559-600-2301 City: Clovis Email: sbugay@fresnocountyca.gov Zip Code: 93612 Chief Probation Officer Name: Kirk Haynes Street Address: 3333 E. American Ave, STE B Phone: 559-600-1298 City: Fresno Email: khaynes Zip Code: 93725 � � . e f k 5 2 ) ® & s\� § \ n � 2 d / % / 2 # § — < = a o ± 2 w / ° G . .. a d = / g 7 / 76 � coG f \ % k \ L $CO % m \ cc $ ƒ $ � «_ y k 0 ® in \ K E ƒ @ z co / lu C m @ ) a) ¢ m 2 % 2 k •� 0 cn cn c » § % § k 0 E ■ 2 � 2 S § Cc ° 0 \ 7 / ? � � cn kE 2 § ƒ 2 (L a222 � c a 0 8 0 4- CDk 2 ƒ m o 0 U o § / � ■ � / J C � \ j Z ƒ , § \ \ \ « ® & \ o / e � � E J \ LU cc > g E » a / o - f U / \ j § . . 2 -EL) § E k ] ! CD 2 / / z U) .2 2 w ) / v co cu ° \ k § CO o _ \ U m # m m » 00 c 2 o O Q) c O�r M e Z Lu FW— C) o a IL O O Q) Ln Ltd '•y�,�lML,.i C9 "' U) U) m cn U 0 0 E o o co o 0 0 . 0 0 o 0 0 0 0 0 c o 'IT LO Cl) 3 v a LL- LUi LL- LL U- u o co c' U U U U U U cli > > > > U O O O > O a1 .0 O co Q) 0) m cp co v m m ca m C (n N ;t 1- O 7 C 7 U_ cJ 'O C 0 O 0 = O O LL- Q Q OU uCi C p U) c O O N C (B .� C a) a) U)•' E N V Q) U Lu Q) a rn ca cn cn c c� cu o Cl)c cpu cn co CC o rn a C U U) 2 Q, co m L a m rn Q N ca aD w cn ( N L) `= u~ O1 z o v .V 0 a`� a aa)i CL a LL ... iu �2 a. aa)) ( C O a�i c to U) Cl) LL E L U p cu >- cc O V E .c C L L N Q) O cz 0co C `o E &- mU cin D `o 'C d O � io v m M v - CD U_ rL i U " o co _ � m z OL U7 Z Z Z Z c e a s c � C) p in 2 2 2 2 Q co U_ U U_ U a) co O U a- m cL CL O N O _ c a m a cri O a c C a c a' U °' N 0 a UCC U a> m -o m W E o CID a� U CL Q Cn -i U) (D a- � U �- N Cl) "t Cn CO r- CO DHCS State of California-Health and Human Services Agency AMP&P Department of Health Care Services Health Care Program for Children in Foster Care �M Y ` MICHELLE BAASS Budget Worksheet GAVIN NEWSOM DIRECTOR GOVERNOR StatelFederal Funding Source: I Base CountylCity Name: I Fresno I Fiscal Year: 2022-23 Column 1A 113 1 2A 2 3A 3 Category/Line Item Total Base FTE Enhanced FIFE Enhanced Non-Enhanced Non-Enhanced ,/a Annual Salary Total Budget (25/75) FTE% (50/50) I.Personnel Expenses # Name 1 supervising Public Health Nurse(Ankara Lee) 40% $129,644 $51,858 75.00% $38,893 25.00% $12,964 2 Public Health Nurse(Lupe Wade) 50% $105,019 $52,510 75.00% $39,382 25.00% $13,127 3 Public Health Nurse(Sally Lopez) 50% $109,408 $54,704 75.00% $41,028 25.00% $13,676 4 Public Health Nurse(Samantha Campbell) 100% $90,683 $90,683 75.00% $68,012 25.00% $22,671 5 Public Health Nurse(Gursimran Deol) 100% $90,683 $90,683 75.00% $68,012 25.00% $22,671 6 Office Assistant(Pa Xiong) 100% $36,620 $36,620 0.00% $0 100.00% $36,620 7 $0 $0 100% $0 8 $0 $0 10F/ $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional rows as needed) 1 $0 $0 100% $0 Total PHN FTE% 500% 375.00% 125.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $377,057 $255,328 $121,729 Staff Benefits(Specify% 81.814% $308,485 $208,894 $99,591 I.Total Personnel Expenses $685,542 $464,222 $221,320 II.Operating Expenses 1. Travel $12,000 75.00% $9,000 25.00% $3,000 2. Training $12,000 75.00% $9,000 25.00% $3,000 II.Total Operating Expenses $24,000 $18,000 $6,000 III.Total Capital Expenses IV.Indirect Expenses 1. 1 Internal(Specify%) 18.816% $133,507 $133,507 IV.Total Indirect Expenses $133,507 $133,507 7 Total Other Expenses Budget Grand Total $843,049 1 $482,222 $360,827 Prepared By: Sign Print Title Date Email Authorized HCPCFC Sign Print Title Date Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. DHCS State of California—Health and Human Services Agency �,.►-� __;, Department of Health Care Services Cw- NAP Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR StatelFederal Funding Source: Base County/City Name Fresno I Fiscal Yearl 2022-23 1. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 6 positions,total of 4.4 FTE. Benefits calculated with estimated total benefits rate for the positions. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits II. Operating Expenses Identify and Explain All Operating Expense Line Items Private auto mileage reimbursement at$0.625/mile for program staff to travel to Travel: complete program activities and attend State-sponsored meetings, including regional Registration costs for PHNs to attend State recommended training and workshops to Training: maintain professional competence and gain program specific skills. Also includes 111. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.816%of personnel costs Internal: approved reviewed for metholody, accounting standards, and data used by Fresno V. Other Expenses cannot be included in this budget Prepared-By: Sign Print Title Date Email Alb 0 0 0 Authorized HCPCFC Program Representative: Sign Print Title Date Email DHCS State of California—Health and Human Services Agency Department of Health Care Services ! ,y NP Health Care Program for Children in Foster Care MICHELLEBAASS Budget Worksheet GAVINNEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: I Psychotropic Medication Monitoring&Oversight County/City Name: IFresno IFiscal Year: 2022-23 Column 1A 113 1 2A 2 3A 3 Budget Cate o ILine Item Total PMM% O Annual Sala Total Budg Enhanced FTE Enhanced Non-Enhanced Non-Enhanced 9 ry ° ry FTE % (25/75) FTE% (50/50) I.Personnel Expenses # Name 1 Public Health(Michael Hughes) 100% $103,782 $103,782 75.00% $77,837 25.00% $25,946 2 $0 $0 100% $0 3 $0 $0 100% $0 4 $0 $0 100% $0 5 $0 $0 100% $0 6 $0 $0 100% $0 7 $0 $0 1007/ $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional lines as needed) 1 $0 $0 100% $0 Total PHN FTE% 100% 75.00% 25.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $103,782 $77,837 $25,946 Staff Benefits(Specify%) 81.814% $84,908 $63,682 $21,227 I.Total Personnel Expenses $188,690 $141,519 $47,173 It.Operating Expenses 1. Travel $3,000 75.00% $2,250 25.00% $750 2. Training $3,000 75.00% $2,250 25.00% $750 II.Total Operating Expenses $6,000 $4,500 $1,500 III.Total Capital Expenses IV.Indirect Expenses 1. 1 Internal(Specify%) 18.816% $36,633 $36,633 IV.Total Indirect Expenses $36,633 $36,633 V.Total Other Expenses Budget Grand Total $231,323 $146,019 $85.306 0 0 0 0 Prepared By: Sign Print Title Date Email , 0 0 0 0 Authorized HCPCFC Sign Print Title Date Email Program Representative: Budget Summary tables can be found on the"Summary Tables"sheet of this workbook. State of California—Health and Human Services Agency DHCS Department of Health Care Services qkop Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: Psychotropic Medication Monitoring& Oversight County/City Name Fresno IFiscal Year 2022-23 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 1 FTE PHN. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benfefits Administration. Il. Operating Expenses Identify and Explain All Operating Expense Line Items Registration costs and ancillary costs for PHN to attend State recommended training and Training: workshops to maintain professional competence and gain program specific skills. Travel: III. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.816% of personnel costs Internal: approved reviewed for metholody, accounting standards, and data used by Fresno V. Other Expenses cannot be included in this budget 0 0 0 Prepared By: Sign Print Title Date Email Authorized HCPCFC Program Representative: Sign Print Title Date Email DHCS State of California—Health and Human Services Agency `: Department of Health Care Services _ i l � �t arm Health Care Program for Children in Foster Care MICHELLESAASS Budget Worksheet GAVINNEWSOM DIRECTOR GOVERNOR State/Federal Funding Source: I Caseload Relief County/City Name; Fresno Fiscal Year: 2022-23 Column 1A 1B 1 2A 2 3A 3 Total Caseload Enhanced FTE Enhanced Non- Non- Category/Line Item Relief FTE% % (25/75)Annual Salary Total Budget Enhanced FTE Enhanced (50/50) I.Personnel Expenses % # Name 1 Vacant PHN 100% $90,683 $90.683 75.00% $68,012 25.00% $22,671 2 Vacant PHN 100% $ 90,683.00 $90,683 75.00% $68,012 25.00% $22,671 3 $0 $0 100% $0 4 $0 $0 100% $0 5 $0 $0 100% $0 6 $0 1 $0 100% $0 7 $0 $0 100% $0 8 $0 $0 100% $0 9 $0 $0 100% $0 10 $0 $0 100% $0 (insert additional lines as needed) $0 $0 100% $0 Total PHN FTE% 200% 150.00% 50.00% Total Direct Support Staff FTE% 100% 75.00% 25.00% Net Salaries and Wages $181,366 $136,025 $45,342 Staff Benefits Specify% 81.184% $147,240 $110,431 $36,810 I.Total Personnel Expenses $328,606 $246,456 $82,152 II.Operating Expenses 1. Travel $6,000 75.00% $4,500 25.00% $1,500 2. Training $6,000 75.00% $4,500 25.00% $1,500 II.Total Operating Expenses $12 000 $9,000 $3,000 III.Total Capital Expenses IV.Indirect Expenses 1. I Internal(Specify%) 18.816% $64,088 $64,088 IV.Total Indirect Expenses $64,088 $64,088 V.Total Other Expenses Budget Grand Total $404,694 $255,456 $149,240 0--- 0 0 0 0 Prepared By: Sign Print Title Date Email � 0 0 0 0 Authorized HCPCFC Sign Print Title Dale Email Program Representative: Budget5ummary tables can be found on the'Summary Tables"sheet of this workbook. U v C m W tOij IOFT yOj x lc COfT VOT 604 `o o c O O _ z w a V s cfT � N c� less _ CN N W W p N c r- E E CV = W W O y v c y' m m o O O O CD � — V> EfT U FN LL d O O C N O m O C O O CV L Zoo Zoo CV c m W m M fD -t W r r r (U al C v> tfT U) z Et! Z Et} d a' (o O O N ? N CD lap cn U A (D C7 m cl cli In C N In C O (ALO QI N W ER Cf9 W CfT N V Cp m C) c U L. 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X N C U- -6 C pC_p LL J U w W N ¢ J c W W a w O j a c0.. vl a A2 0 C (6 U LU � y O : u ow a5 d !Z CD L CT 7 (Q CJ) m a V ti m a 0 U c � N �° a> j v (U cli m m m d mO o � � > a Q �HCS State of California—Health and Human Services Agency 14., y� Department of Health Care Services y` I :A��:• . qRp Health Care Program for Children in Foster Care MICHELLE BAASS Budget Narrative GAVIN NEWSOM DIRECTOR GOVERNOR StatelFederal Funding Source: Caseload Relief County/City Namej Fresno I Fiscal Year 2022-23 I. Personnel Expenses Identify and Explain Any Changes in Personnel/Personnel Expenses Salary and Benefits for 2 FTE PHNs. Includes retirement, health insurance, OASDI, Unemployment Insurance, and Benefits Administration. II. Operating Expenses Identify and Explain All Operating Expense Line Items Private auto mileage reimbursement at$0.625/mile for program staff travel to complete Travel: program activities and attend State-sponsored meetings, including regional meetings, subcommittee meetings, and training specific to job duties. Registration costs for PHNs to attend State recommended trainings and workshops to Training: maintain professional competence and gain program specific skills. Also includes ancillary costs related to attending training and State-convened meetings. III. Capital Expenses cannot be included in this budget IV. Indirect Expenses Indirect External Expenses cannot be included in this budget Identify and Explain All Indirect Expense Line Items Fresno County Department of Public Health's indirect rate is 18.816% of personnel costs Internal: approved reviewed for metholody, accounting standards, and data used by Fresno County's Auditor Controller/Treasurer-Tax Collector and approved by CDPH. V. Other Expenses cannot be included in this budget Alb— 0 0 0 Prepared By: Sign Print Title Date Email ; 1b_ 0 0 0 Authorized HCPCFC Program Representative: Sign Print Title Date Email