This Certification Statement must be signed by the CEO or other responsible supervisory official of an agency and is to be submitted with the MH/ID17 fiscal form either as a separate attached page or photocopied on the back side of the MH/MR 17 form. It is not to be signed by the person completing the MH/ID 17 invoice.
Agencies that are program funded are required to attach this form to the monthly billing form (MH/ID 17) to provide the detail for wage and salary expenses.
Agencies that are program funded must complete this form and attach it to the monthly invoice (MH/ID 17) to provide the details of any equipment purchased by MH/ID funds.
The Beaver County Personnel Action Plan (PAP) is to be used by agencies funded by the Beaver County MH/ID Program through program funding and is also the allowable cost standard for programs that are fee for service where the BCBH Office negotiates the fee. It is not applicable to programs where the rate is established by the PA Department of Public Welfare (DPW) or establizhed by Value Behavioral Health (VBH) for HealthChoices programs.
These guidelines are to be followed by all MH/ID agencies funded through the Beaver County Behavioral Health Office (BCBH) that are funded through program funding or by fee for service where the fee is negotiated through the BCBH Office.
This form must be completed for all personnel funded through the Beaver County Behavioral Health Office for all MH/IDagencies that have programs that are program funded.
This personal data form is to be complete by all program funded programs for all staff funded by the Beaver County Behavioral Health Office. An agency's application form containg the same date may be substituted.
This form must be completed for the personnel of all agences funded through program funding by the Beaver County Behavioral Health Office and submitted with the Request for Position Approval form.
This amendment is used to increase a provider's allocation during a fiscal year. It can also be used when the rates change in conjunction with an allocation increase.
These are the instructions to complete the contract amendments for 1) allocation increase, 2) allocation decrease, 3) rate change and 4) allocation redistribution.
