Cal. Code Regs. tit. 17 § 58864

Current through Register 2024 Notice Reg. No. 40, October 4, 2024

Section 58864 - Required Cost Statement Information

(a) The vendor shall report the following in the form and time period required by the Department utilizing the DS 1950 (3/2005), Work Activity Program Cost Statement and instructions incorporated in these regulations by reference, including Tab A (Staff Survey Report), Tab B (Space Utilization Report), Tab C (Revenue Statement), Tab D (Expense Statement), Tab E (Other Expense Statement), Tab F (Revenue and Expense Statement Reconciliation), Tab G (Consumer Survey Report), Tab H (Rate Computation Sheet), Tab I (General Information/Certification), Tab J (Allocation Guidelines), Tab K (Facility Questionnaire), Tab L (Adjustments):

(1) All revenue and expenses biennially;

(2) Actual attendance of all consumers and non-consumer production workers, and productivity rates of all habilitation and vocational rehabilitation consumers biennially; and

(3) Any request for rate adjustment.

(b) For each of the forms listed below the specified objective and required documentation which must be retained for review and audit are as follows:

(1) Staff Survey Report, Form DS 1950 (3/05), Tab A,

(A) Objective: To report staff salaries and wages and allocate them to the appropriate cost centers

(B) Required Documentation:

1. Payroll records, including W-2s, quarterly payroll tax returns, and canceled checks.

2. Time studies used as the basis for allocating salaries and wages;

(2) Space Utilization Report, Form DS 1950 (3/05), Tab B;

(A) Objective: To report, by cost center, the use of buildings owned or leased by the facility for use in allocating costs related to the building;

(B) Required Documentation: The floor plan identifying size and area;

(3) Revenue Statement, Form DS 1950 (3/05), Tab C;

(A) Objective: To report all revenue (cash and in-kind) received by the service provider;

(B) Required Documentation: All revenue records;

(4) Expense Statement, Form DS 1950 (3/05), Tab D;

(A) Objective: To report all expenses incurred by the facility.

(B) Required Documentation: All expense records, including ledgers, journals, invoices, and canceled checks, depreciation records, records of the basis for allocating all expenses.

(5) Revenue and Expenses Statement Reconciliation, Form DS 1950 (3/05), Tab F;

(A) Objective: To reconcile the year-end financial statements with the Revenue and Expense Statements (Forms DS 1950 (3/05), Tab C and DS 1950 (3/05), Tab D to ensure accuracy.

(B) Required Documentation: Year-end financial statements (audited or unaudited), annual reviews or independent audit reports, including management letters from independent auditors;

(6) Consumer Survey Report, Form DS 1950 (3/05), Tab G;

(A) Objectives:

(i) To provide a basis for allocating work activity program costs based upon consumer and worker participation and HSP consumer productivity.

(ii) To provide a basis for determining the unit cost for HSP consumers.

(B) Required Documentation: Consumer attendance records (should be summarized monthly), consumer payroll records, records of individual consumer productivity rates, consumer productivity rate calculations (should be summarized monthly), workdays or work hours for non-consumer production workers (should be summarized monthly);

(7) Rate Computation Sheet, Form DS 1950 (3/05), Tab H,

(A) Objective: To calculate daily or hourly rates for Work Activity Programs;

(8) General Information/Certification, Form DS 1950 (3/05), Tab I.

(A) Objective: This form is required and shall be completed after the ratesetting forms are completed. To provide an overview of the organization and to obtain assurance from the directors of the facilities that, to the best of their knowledge, all of the data submitted for the setting of the rate is accurate.

(c) The vendor shall consistently use the same headings or titles for services or programs on all reporting forms required by the Department.

Cal. Code Regs. Tit. 17, § 58864

1. New section filed 7-22-2004 as an emergency; operative 7-22-2004 (Register 2004, No. 30). A Certificate of Compliance must be transmitted to OAL by 11-19-2004 or emergency language will be repealed by operation of law on the following day.
2. Repealed by operation of Government Code section 11346.1(g) (Register 2004, No. 49).
3. New section refiled 11-29-2004 as an emergency; operative 11-29-2004 (Register 2004, No. 49). A Certificate of Compliance must be transmitted to OAL by 3-29-2005 or emergency language will be repealed by operation of law on the following day.
4. New section refiled 3-30-2005 as an emergency; operative 3-30-2005 (Register 2005, No. 13). A Certificate of Compliance must be transmitted to OAL by 7-28-2005 or emergency language will be repealed by operation of law on the following day.
5. Certificate of Compliance as to 3-30-2005 order, including amendment of section, transmitted to OAL 6-21-2005 and filed 8-1-2005; amendments operative 8-31-2005 (Register 2005, No. 31).

Note: Authority cited: Section 11152, Government Code; and Section 4866, Welfare and Institutions Code. Reference: Section 4859(a), Welfare and Institutions Code.