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{"sheet":"Overview","index":0,"n_rows":34,"n_cols":2,"rows_kept":34,"cut":false,"hidden":false,"merged":[[33,0,33,1],[6,0,6,1],[13,0,13,1],[5,0,5,1],[0,0,0,1],[1,0,1,1],[2,0,2,1]]}
["Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"]
["Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"]
["Minnesota Department of Human Services (DHS)"]
["Provider Cost & Wage Survey - General Instructions and Overview"]
["1. General Instructions"]
["This Provider Cost & Wage Survey (\"survey\") should be completed by providers who deliver services as part of the  Minnesota Department of Human Services (DHS) Aging and Adult Service array. \n\nThe survey includes a provider information, total costs, wages, benefits, service, transportation, and additional information worksheets, along with nine (9) service specific worksheets. Each worksheet includes questions that require responses from the provider organizations depending on the type of services that your organization provides.\n- Survey respondents should populate each yellow box, or response box, with an appropriate response. For descriptive or alternative responses in addition to selecting predetermined options, please enter information in the blue boxes marked \"(Specify)\".\n- The top section of each Worksheet highlights specific instructions for responses to the questions in the corresponding Worksheet.\n- Individual questions include in-line notes for clarity, and response boxes display notes to guide the survey respondent.\n- If a question is not applicable or information is not available, please leave the response box blank, unless otherwise specified in the Worksheet instructions.\n\nProviders should use data from the time period noted in the individual worksheet instructions (e.g., Time Period for Data Requested: October 1, 2024 - December 31, 2024).\n\nQuestions and requests for clarification may be sent to MNDHSRateStudy@Guidehouse.com. Responses to inquiries will be sent within 1 business day. All completed surveys should be sent to this email address as well."]
["2. Survey Color Legend"]
["Color","Description"]
["Yellow","Cell or response box should be populated by provider organization."]
["Blue - \"(Specify)\"","Cell or response box should be populated by provider organization with descriptive or alternative responses."]
["Gray","Cell is auto populated based on calculations or responses in other cells; cell should not be populated by provider organization."]
["Orange","Example data for illustrative and clarification purposes."]
["Green Text","Dates marked in Green text specify the time period for the data requested in each Worksheet."]
["3. Survey Overview"]
["Provider Cost & Wage Survey - General Instructions and Overview","Sections & Topics"]
["Worksheet A: Provider Information","1. Provider Identification\n2. Contact Information\n3. Site Information\n4. Total Revenue\n5. Home-Delivered Meal Revenue\n6. Provider Staffing"]
["Worksheet B: Total Cost","1. Total cost for employee salaries\n2. Employee taxes and benefits\n3. Non-payroll administrative costs\n4. Non-payroll program support costs\n5. Facility, vehicle, and equipment costs"]
["Worksheet C: Wages","1. Staff and supervisor hourly wages, regular wages, overtime and other supplemental pay\n2. Staff Training Time"]
["Worksheet D: Benefits","Information about full-time and part-time staff fringe benefits, including insurance, legally required benefits, retirement plans, and paid time off."]
["Worksheet E: Services","1. Select which services your organization provides"]
["Worksheet F: Adult Day Service","1. Fill out each section providing the service delivery information for the service"]
["Worksheet G: Chore Service","1. Fill out each section providing the service delivery information for the service"]
["Worksheet H: Homemaker","1. Fill out each section providing the service delivery information for the service"]
["Worksheet I: Adult Companion Services","1. Fill out each section providing the service delivery information for the service"]
["Worksheet J: Respite","1. Fill out each section providing the service delivery information for the service"]
["Worksheet K: Individual Community Living","1. Fill out each section providing the service delivery information for the service"]
["Worksheet L: Community Residential Living","1. Fill out each section providing the service delivery information for the service"]
["Worksheet M: Customized Living Supports","1. Fill out each section providing the service delivery information for the service"]
["Worksheet N: Home-Delivered Meals","1. Fill out each section providing the service delivery information for the service"]
["Worksheet O: Transportation","Transportation related information only filled out if the provider cannot breakout transportation metrics across their services."]
["Worksheet: Additional Information","Clarifying notes or comments in addition to information covered in other worksheets."]
[]
[]
["© 2025 Guidehouse Inc. All rights reserved. This deliverable was prepared by Guidehouse Inc. for the sole use and benefit of, and pursuant to a client relationship exclusively with the Minnesota Department of Human Services. The work presented in this deliverable represents Guidehouse’s professional judgement based on the information available at the time this deliverable was prepared. Guidehouse is not responsible for a third party’s use of, or reliance upon, the deliverable, nor any decisions based on the deliverable. "]

{"sheet":"A. Provider Info","index":1,"n_rows":77,"n_cols":5,"rows_kept":77,"cut":false,"hidden":false,"merged":[[4,0,4,4],[37,1,37,3],[36,1,36,3],[38,1,38,3]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet A. Provider Info"}]
["Instructions:\nEnter information about your provider organization and the contact details for the person who is primarily responsible for completing the provider survey. Please input \"N/A\" in the yellow cell for questions that are not applicable or if information is not available.\n-Section 1 (Questions 1-7): Enter general identification information about the provider organization.\n-Section 2 (Questions 8-12): Enter contact information for the individual responsible for completing the Provider Survey.\n-Section 3 (Questions 13-20): Enter the dollar amount associated with each revenue bucket based on the total revenue provided for Aging and Adult Services excluding Home-Delivered Meals.\n-Section 4 (Questions 21-26): Enter the dollar amount associated with each revenue bucket based on the total revenue provided for Home-Delivered Meals Only.\n-Section 5 (Questions 27-29): Enter the total number of full-time and part-time employees at the end of your provider fiscal year.\n-Section 6 (Questions 30-36): Enter the total number of participants for each program.\n-Section 7 (Questions 37-61): Enter the total number of sites your organization operates and the site specific information for the top four provider sites in terms of participants served in your organization"]
["1. PROVIDER IDENTIFICATION"]
["1","PROVIDER NAME:"]
["2","PRIMARY NPI NUMBER:"]
["3","CITY (list all cities that apply):"]
["4","ZIP CODE:"]
["5","PROVIDER FISCAL YEAR BEGINNING:"]
["6","PROVIDER FISCAL YEAR ENDING:"]
["7","IS YOUR AGENCY  FOR-PROFIT, NON-PROFIT, GOVERNMENTALLY OPERATED?"]
["2. CONTACT INFORMATION"]
[{"$f":"A13+1","v":8},"CONTACT PERSON:"]
[{"$f":"A15+1","v":9},"TITLE:"]
[{"$f":"A16+1","v":10},"PHONE NUMBER:"]
[11,"PHYSICAL ADDRESS: (Street Number, Street Name, City, State, Zip Code)"]
[12,"EMAIL ADDRESS:"]
["3. TOTAL REVENUE (Use Most Recent Fiscal Year) - EXCLUDING HOME-DELIVERED MEALS"]
[{"$f":"A19+1","v":13},"MEDICAL ASSISTANCE / MEDICAID"]
[{"$f":"A21+1","v":14},"MEDICARE"]
[{"$f":"A22+1","v":15},"GRANTS"]
[16,"SSI"]
[17,"PRIVATE PAY/COMMERCIAL"]
[18,"INDIAN HEALTH SERVICES"]
[19,"OTHER INCOME (Specify)",null,"(Specify)"]
[20,"TOTAL REVENUE FOR THE MOST RECENT FISCAL YEAR.",null,null,{"$f":"SUM(E21:E27)","v":0}]
["4. TOTAL HOME-DELIVERED MEAL REVENUE (Use Most Recent Fiscal Year)"]
[{"$f":"A28+1","v":21},"TOTAL MEDICAL ASSISTANCE HOME-DELIVERED MEALS REVENUE"]
[{"$f":"A30+1","v":22},"TOTAL OAA TITLE III C2 HOME-DELIVERED MEALS REVENUE"]
[{"$f":"A31+1","v":23},"TOTAL OAA C1 CONGREGATE MEALS REVENUE"]
[24,"TOTAL OTHER HOME-DELIVERED MEALS REVENUE"]
[25,"ALL OTHER REVENUE (DESCRIBE):",null,"(Specify)"]
[26,"TOTAL REVENUE FOR THE MOST RECENT FISCAL YEAR.",null,null,{"$f":"SUM(E30:E34)","v":0}]
["5. PROVIDER STAFFING"]
[{"$f":"A35+1","v":27},"TOTAL NUMBER OF FULL-TIME EMPLOYEES AT END OF PROVIDER FISCAL YEAR\n(30 or more hours/week or 130 hours/month)"]
[{"$f":"A37+1","v":28},"TOTAL NUMBER OF PART-TIME EMPLOYEES AT END OF PROVIDER FISCAL YEAR\n(Less than 30 hours/week or 130 hours/month)"]
[{"$f":"A38+1","v":29},"TOTAL NUMBER OF CONTRACTED EMPLOYEES AT END OF PROVIDER FISCAL YEAR"]
["6. PARTICIPANTS BY PROGRAM"]
[{"$f":"A39+1","v":30},"TOTAL NUMBER OF PARTICIPANTS - ELDERLY WAIVER"]
[{"$f":"A41+1","v":31},"TOTAL NUMBER OF PARTICIPANTS - COMMUNITY ACCESS FOR DISABILITY INCLUSION WAIVER"]
[{"$f":"A42+1","v":32},"TOTAL NUMBER OF PARTICIPANTS - BRAIN INJURY WAIVER"]
[33,"TOTAL NUMBER OF PARTICIPANTS - ALTERNATIVE CARE"]
[34,"TOTAL NUMBER OF PARTICIPANTS - ESSENTIAL COMMUNITY SUPPORTS"]
[35,"TOTAL NUMBER OF PARTICIPANTS - NON-WAIVER MEDICAL ASSISTANCE CLIENTS"]
[36,"TOTAL NUMBER OF PARTICIPANTS - TOTAL OTHER CLIENTS"]
["7. SITE INFORMATION"]
[{"$f":"A47+1","v":37},"TOTAL NUMBER OF SITES YOUR ORGANIZATION OPERATES"]
["SITE 1"]
[{"$f":"A49+1","v":38},"SITE NAME:"]
[{"$f":"A51+1","v":39},"CITY:"]
[{"$f":"A52+1","v":40},"ZIP CODE:"]
[41,"DOES THIS SITE OPERATE IN MINNESOTA’S TRIBAL AREAS OR JURISDICTIONS?"]
[42,"TOTAL NUMBER OF MEDICAL ASSISTANCE PARTICIPANTS SERVED DURING FISCAL YEAR:"]
[43,"TOTAL NUMBER OF PARTICIPANTS SERVED DURING PROVIDER FISCAL YEAR:"]
["SITE 2"]
[{"$f":"A56+1","v":44},"SITE NAME:"]
[{"$f":"A58+1","v":45},"CITY:"]
[{"$f":"A59+1","v":46},"ZIP CODE:"]
[47,"DOES THIS SITE OPERATE IN MINNESOTA’S TRIBAL AREAS OR JURISDICTIONS?"]
[48,"TOTAL NUMBER OF MEDICAL ASSISTANCE PARTICIPANTS SERVED DURING FISCAL YEAR:"]
[49,"TOTAL NUMBER OF PARTICIPANTS SERVED DURING PROVIDER FISCAL YEAR:"]
["SITE 3"]
[{"$f":"A63+1","v":50},"SITE NAME:"]
[{"$f":"A65+1","v":51},"CITY:"]
[{"$f":"A66+1","v":52},"ZIP CODE:"]
[53,"DOES THIS SITE OPERATE IN MINNESOTA’S TRIBAL AREAS OR JURISDICTIONS?"]
[54,"TOTAL NUMBER OF MEDICAL ASSISTANCE PARTICIPANTS SERVED DURING FISCAL YEAR:"]
[55,"TOTAL NUMBER OF PARTICIPANTS SERVED DURING PROVIDER FISCAL YEAR:"]
["SITE 4"]
[{"$f":"A70+1","v":56},"SITE NAME:"]
[{"$f":"A72+1","v":57},"CITY:"]
[{"$f":"A73+1","v":58},"ZIP CODE:"]
[59,"DOES THIS SITE OPERATE IN MINNESOTA’S TRIBAL AREAS OR JURISDICTIONS?"]
[60,"TOTAL NUMBER OF MEDICAL ASSISTANCE PARTICIPANTS SERVED DURING FISCAL YEAR:"]
[61,"TOTAL NUMBER OF PARTICIPANTS SERVED DURING PROVIDER FISCAL YEAR:"]

{"sheet":"B. Total Cost","index":2,"n_rows":84,"n_cols":7,"rows_kept":84,"cut":false,"hidden":false,"merged":[[7,0,7,6],[9,0,9,6]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet B. Total Cost"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"IF('A. Provider Info'!$E$11=\"\",\"Time Period for Data Requested: \",\"Time Period for Data Requested: \"&TEXT('A. Provider Info'!$E$11,\"MM/DD/YYYY\")&\" - \"&TEXT('A. Provider Info'!$E$12,\"MM/DD/YYYY\"))","v":"Time Period for Data Requested: "}]
["Instructions:\nGuidehouse is looking to understand costs associated with caring for Aging and Adult Services clients. Please fill out the financial information below.\n-Section 1 (Questions 1-8): Enter salary and wage information for the specified cost categories.\n-Section 2 (Questions 9-12): Enter employee tax and benefits information.\n-Section 3 (Questions 13-33): Enter any non-payroll administrative costs.\n-Section 4 (Questions 34-42): Enter any non-payroll program support costs.\n-Section 5 (Questions 43-57): Enter any costs associated with facility, vehicle, and equipment related costs.\n-Section 6 (Question 58): Enter any costs related to room & board."]
["Definitions:"]
["Direct Care Expenses - Any expense associated with providing direct services to participants. These are expenses for direct care costs which include time and material costs that are directly billable, including the salaries and employee-related expenses of direct care workers. Examples of direct care employees include but are not limited to Counselor, Registered Nurse, Case Manager, and Therapist.\nAdministrative Expenses - Administrative costs are costs associated with the operation of your agency, but which are not program specific. Employees that are typically considered administrative include general management, financial/accounting, and human resource staff. Expenses associated with these staff (e.g., their office space, utilities, etc.) are also considered administrative. \nMaintenance Expenses - Maintenance costs are expenses related to general upkeep of an agency. This could include cost for employees associated with providing upkeep and maintenance services. Examples of maintenance staff include janitors and maids.\nProgram Support Expenses - Program support costs are expenses that are neither direct care nor administrative. Such activities are program-specific, but not billable. Examples include training time for direct care workers, program development, supervision, and quality assurance, as well as the space in which programs are delivered, and program materials and supplies. Employees in charge of these activities would be expensed under this section."]
["DESCRIPTION",null,null,"All Costs from Provider General Ledger","What Proportion of this resource supports the AASD Program Costs?","Calculated AASD Program Costs","Non-Calculated AASD Program Costs"]
["1. EMPLOYEE SALARIES",null,null,1,2,3,4]
[null,null,"Example:",100000,0.95,95000,95000]
[1,"Total Direct Care Employee Salaries and Wages",null,null,null,{"$f":"E14*D14","v":0}]
[2,"Total Direct Care Supervisor Salaries and Wages",null,null,null,0]
[3,"Total Maintenance Employee Salaries and Wages",null,null,null,0]
[4,"Total Administrative Employee Salaries and Wages",null,null,null,0]
[5,"Total Program Support Employee Salaries and Wages",null,null,null,0]
[6,"Total Salaries and Wages for Contracted Direct Care Staff",null,null,null,0]
[7,"Total Salaries and Wages for Contracted Program Staff",null,null,null,0]
[8,"Total Salaries and Wages for Contracted Administrative Staff",null,null,null,0]
[null,"Total Employee Salaries and Wages",null,{"$f":"SUM(D14:D21)","v":0},{"$f":"IF(D22=0,\"\",F22/D22)","v":""},{"$f":"SUM(F14:F21)","v":0},{"$f":"SUM(G14:G21)","v":0}]
["2. EMPLOYEE TAXES AND BENEFITS"]
[9,"Total Employee Payroll Taxes",null,null,null,{"$f":"E24*D24","v":0}]
[10,"Total Employee Health Insurance",null,null,null,{"$f":"E25*D25","v":0}]
[11,"Total Other Insurance",null,null,null,{"$f":"E26*D26","v":0}]
[12,"Total Employee Other Benefits",null,null,null,{"$f":"E27*D27","v":0}]
[null,"Total Employee Taxes and Benefits",null,{"$f":"SUM(D24:D27)","v":0},{"$f":"IF(D28=0,\"\",F28/D28)","v":""},{"$f":"SUM(F24:F27)","v":0},0]
["3. NON-PAYROLL ADMINISTRATIVE COSTS"]
[13,"Office Equipment and Furniture ",null,null,null,{"$f":"E30*D30","v":0}]
[14,"Interest Expense (report mortgage on Line 45)",null,null,null,0]
[15,"Non-Payroll Taxes",null,null,null,0]
[16,"Licensing / Certification / Accreditation Fees",null,null,null,0]
[17,"Hiring Expenses",null,null,null,0]
[18,"Staff Training and Development (administrative related)",null,null,null,0]
[19,"Insurance (excluding benefits and auto insurance)",null,null,null,0]
[20,"Information Technology Expense (e.g., computers and software)",null,null,null,0]
[21,"Office Supplies",null,null,null,0]
[22,"Postage",null,null,null,0]
[23,"Advertising/Marketing",null,null,null,0]
[24,"Dues and Subscriptions",null,null,null,0]
[25,"Consulting - Training / Legal / Accounting / Etc. ",null,null,null,0]
[26,"Travel (excluding client transportation and direct care vehicles)",null,null,null,0]
[27,"Lobbying",null,null,null,0]
[28,"Cost for Translating Materials",null,null,null,0]
[29,"Bad Debt",null,null,null,0]
[30,"Corporate Office Overhead",null,null,null,0]
["30a","If Overhead is reported, describe allocation methodology here","(Specify)",null,null,0]
[31,"Other Administrative Costs","(Specify)",null,null,0]
[32,"Other Administrative Costs","(Specify)",null,null,0]
[33,"Other Administrative Costs","(Specify)",null,null,0]
[null,"Total Non-Payroll Administrative Costs",null,{"$f":"SUM(D30:D47,D49:D51)","v":0},{"$f":"IF(D52=0,\"\",F52/D52)","v":""},{"$f":"SUM(F30:F47,F49:F51)","v":0},0]
["4. NON-PAYROLL PROGRAM SUPPORT EXPENSES"]
[34,"Program Supplies",null,null,null,{"$f":"E54*D54","v":0}]
[35,"Devices / Technology (direct care related)",null,null,null,0]
[36,"Activity Cost (for direct care staff)",null,null,null,0]
[37,"Staff Training and Development (direct care related)",null,null,null,0]
[38,"Transportation Cost - Client related (e.g. NEMT, Other Client Transportation)",null,null,null,0]
[39,"Food Costs - Client related (e.g. Groceries, Snacks, Meals)",null,null,null,0]
[40,"Other Program Costs","(Specify)",null,null,0]
[41,"Other Program Costs","(Specify)",null,null,0]
[42,"Other Program Costs","(Specify)",null,null,0]
[null,"Total Non-Payroll Program Support Expenses",null,{"$f":"SUM(D54:D62)","v":0},{"$f":"IF(D63=0,\"\",F63/D63)","v":""},{"$f":"SUM(F54:F62)","v":0},{"$f":"SUM(G54:G62)","v":0}]
["5. FACILITY, VEHICLE, AND EQUIPMENT RELATED EXPENSES"]
[43,"Facility Rent",null,null,null,{"$f":"E65*D65","v":0}]
[44,"Facility Interest",null,null,null,0]
[45,"Facility Depreciation",null,null,null,0]
[46,"Total Sq. Ft. of Facility","(Specify)",null,null,0]
[47,"Sq. Ft. of Admin Space","(Specify)",null,null,0]
[48,"Utilities / Telecommunications / Etc. (administrative)",null,null,null,0]
[49,"Utilities / Telecommunications / Etc. (direct care facilities)",null,null,null,0]
[50,"Building Maintenance and Repairs",null,null,null,0]
[51,"Facility Janitorial / Landscaping / Repairs / Etc. (not part of rent)",null,null,null,0]
[52,"Vehicles Licensing / Acquisition / Registration / Lease Costs",null,null,null,0]
[53,"Vehicles Maintenance / Repair Costs",null,null,null,0]
[54,"Vehicles Insurance ",null,null,null,0]
[55,"Vehicles Depreciation",null,null,null,0]
[56,"Equipment Costs (non-administrative)",null,null,null,0]
[57,"Equipment Depreciation",null,null,null,0]
[null,"Total Facility, Vehicle and Equipment Related Expenses",null,{"$f":"SUM(D65:D67,D70:D79)","v":0},{"$f":"IF(D80=0,\"\",F80/D80)","v":""},{"$f":"SUM(F65:F67,F70:F79)","v":0},{"$f":"SUM(G65:G67,G70:G79)","v":0}]
["6. ROOM & BOARD EXPENSES"]
[58,"Room & Board",null,null,null,{"$f":"E82*D82","v":0}]
["7. TOTAL COSTS"]
[null,"Total Cost",null,{"$f":"D22+D28+D52+D63+D80+D82","v":0},{"$f":"IF(D84=0,\"\",F84/D84)","v":""},{"$f":"F22+F28+F52+F63+F80+F82","v":0},{"$f":"G22+G28+G52+G63+G80+G82","v":0}]

{"sheet":"C. Wages","index":3,"n_rows":47,"n_cols":19,"rows_kept":47,"cut":false,"hidden":false,"merged":[[7,0,7,18],[9,14,10,14],[9,1,10,1],[9,0,10,0],[9,17,9,18],[9,15,10,15],[9,9,10,9],[9,10,10,10],[9,12,10,12],[9,13,10,13],[9,11,10,11]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet C. Wages"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"IF('A. Provider Info'!$E$11=\"\",\"Time Period for Data Requested: \",\"Time Period for Data Requested: \"&TEXT('A. Provider Info'!$E$11,\"MM/DD/YYYY\")&\" - \"&TEXT('A. Provider Info'!$E$12,\"MM/DD/YYYY\"))","v":"Time Period for Data Requested: "}]
["Instructions:\nEnter the wages, supplemental pay, and training time for your current employees and supervisors of Aging and Adult Services. Other than under annual average percentage change, if questions are not applicable or if information is not available, please input \"N/A\" in the corresponding yellow cells.\n-Columns 1-6: Enter average, lowest, and highest hourly baseline wage for employed staff and contracted staff (exclude overtime, premiums, or other supplemental pay). If employees are paid on a salary basis, hourly wages can be calculated by dividing the annual salary by 2,080 (the number of working hours in a year based on a 40-hour work week), or for part-time salaried positions, a reasonable estimate of the number of hours worked over the course of a year. If employees regularly work overtime, the salary may be divided by more than 2,080 as appropriate.\n-Column 7: Record the number of full-time equivalent (FTE) staff in each job title employed by your agency. For example, if you employ eight (8) full-time direct service professionals and four (4) half-time direct service professionals, enter “10” in the line for which you selected “direct service professional” under this column.\n-Columns 8-9: Enter the total number of regular hours (non-overtime hours), total number of overtime hours, and total number of other supplemental hours for each staff or supervisor type.\n-Column 10: Do not enter any information; this column will auto populate based on hours entered in Columns 6-7.\n-Column 11-13: Enter the total regular pay (non-overtime), total overtime pay, total other supplemental pay, and total bonuses or lump-sum/one-time payments per staff or supervisor.\n-Column 14: Enter the annual average paid training hours per year per staff or supervisor.\n-Column 15-16: Enter the total full-time and part-time positions that are unfilled for each occupation."]
[null,null,null,1,{"$f":"D9+1","v":2},{"$f":"E9+1","v":3},4,5,6,{"$f":"I9+1","v":7},{"$f":"J9+1","v":8},{"$f":"K9+1","v":9},{"$f":"L9+1","v":10},{"$f":"M9+1","v":11},{"$f":"N9+1","v":12},{"$f":"O9+1","v":13},{"$f":"P9+1","v":14},{"$f":"Q9+1","v":15},{"$f":"R9+1","v":16}]
["Line","Staff Description",null,"Baseline Hourly Wage\n(As of December 2024 or most recent)",null,null,null,null,null,"Total Number of FTE Positions","Total Regular Hours Paid","Total Overtime Hours Paid","Total Hours Paid (Auto populated: Column 6 + Column 7)","Total Regular Wages Paid","Total Overtime Pay","Bonus \n(one-time or lump sum premiums)","Staff Training (Annual)","Unfilled Positions"]
[null,null,null,"Average\n(Employee)","Average\n(Contractor)","Lowest\n(Employee)","Lowest\n(Contractor)","Highest\n(Employee)","Highest\n(Contractor)",null,null,null,null,null,null,null,"Average Number of Annual Training Hours for Staff/Supervisor","Full-Time","Part-Time"]
[null,null,"Example:",15,15,13,13,17,17,5.5,11440,50,2130,171600,15000,2000,10,2,10]
[null,"Direct Staff Type:"]
[1,"Direct Care Worker",null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(K14:L14)","v":0}]
[{"$f":"A14+1","v":2},"Case Manager/Care Coordinator",null,null,null,null,null,null,null,null,null,null,0]
[{"$f":"A15+1","v":3},"Certified Nursing Assistant (CNA)",null,null,null,null,null,null,null,null,null,null,0]
[4,"Chef/Cook",null,null,null,null,null,null,null,null,null,null,0]
[{"$f":"A17+1","v":5},"Chore Worker",null,null,null,null,null,null,null,null,null,null,0]
[6,"Counselor",null,null,null,null,null,null,null,null,null,null,0]
[7,"Driver/Transportation",null,null,null,null,null,null,null,null,null,null,0]
[8,"Food Preparation Worker/Server",null,null,null,null,null,null,null,null,null,null,0]
[9,"Home Health Aide",null,null,null,null,null,null,null,null,null,null,0]
[10,"Homemaker/Housekeeper",null,null,null,null,null,null,null,null,null,null,0]
[11,"Licensed Clinical Social Worker (LCSW)",null,null,null,null,null,null,null,null,null,null,0]
[12,"Licensed Practical Nurse (LPN)",null,null,null,null,null,null,null,null,null,null,0]
[13,"Nurse Practitioner",null,null,null,null,null,null,null,null,null,null,0]
[14,"PCA/CFSS Worker",null,null,null,null,null,null,null,null,null,null,0]
[15,"Physician",null,null,null,null,null,null,null,null,null,null,0]
[16,"Physician Assistant (PA)",null,null,null,null,null,null,null,null,null,null,0]
[17,"Psychiatrist",null,null,null,null,null,null,null,null,null,null,0]
[18,"Recreation/Activity Worker",null,null,null,null,null,null,null,null,null,null,0]
[19,"Registered Nurse (RN)/Nurse",null,null,null,null,null,null,null,null,null,null,0]
[20,"Residential Worker",null,null,null,null,null,null,null,null,null,null,0]
[21,"Therapist/Social Worker",null,null,null,null,null,null,null,null,null,null,0]
[22,"Other Direct Care Staff","(Specify)",null,null,null,null,null,null,null,null,null,0]
[23,"Other Direct Care Staff","(Specify)",null,null,null,null,null,null,null,null,null,0]
[24,"Other Direct Care Staff","(Specify)",null,null,null,null,null,null,null,null,null,0]
[null,"Supervisor Staff Type:"]
[{"$f":"A37+1","v":25},"Manager/Supervisor/Director",null,null,null,null,null,null,null,null,null,null,{"$f":"SUM(K39:L39)","v":0}]
[{"$f":"A39+1","v":26},"Nurse Manager/Supervisor/Director",null,null,null,null,null,null,null,null,null,null,0]
[27,"Other Manager/Supervisor/Director",null,null,null,null,null,null,null,null,null,null,0]
[28,"Program Manager/Director",null,null,null,null,null,null,null,null,null,null,0]
[29,"Kitchen Supervisor",null,null,null,null,null,null,null,null,null,null,0]
[30,"Shift and Unit Supervisor",null,null,null,null,null,null,null,null,null,null,0]
[31,"Other Direct Care Staff","(Specify)",null,null,null,null,null,null,null,null,null,0]
[32,"Other Direct Care Staff","(Specify)",null,null,null,null,null,null,null,null,null,0]
[33,"Other Direct Care Staff","(Specify)",null,null,null,null,null,null,null,null,null,0]

{"sheet":"D. Benefits","index":4,"n_rows":42,"n_cols":6,"rows_kept":42,"cut":false,"hidden":false,"merged":[[17,1,17,2],[7,0,7,5],[15,1,15,2]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet D. Benefits"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"IF('A. Provider Info'!$E$11=\"\",\"Time Period for Data Requested: \",\"Time Period for Data Requested: \"&TEXT('A. Provider Info'!$E$11,\"MM/DD/YYYY\")&\" - \"&TEXT('A. Provider Info'!$E$12,\"MM/DD/YYYY\"))","v":"Time Period for Data Requested: "}]
["Instructions:\nEnter information on your current employee benefits offerings. Consider full-time and part-time direct service staff when completing this worksheet; do not include administration and program support staff. If questions are not applicable or if information is not available, please leave blank. If your organization cannot split out dental and vision insurance cost and information from your total insurance related costs and information please list this combined information (combined Health, Dental, and Vision) within the Health insurance specific questions.\n-Section 1 (Questions 1-14): Input information for the number of direct service staff employed, employees eligible for insurance coverage, and insurance costs.\n-Section 2 (Questions 15-17): Input information on retirement benefits.\n-Section 3 (Questions 18-19): Input information on unemployment and worker's compensation.\n-Section 4 (Questions 20-25): Input information on holidays, vacation, sick time, and personal days.\n-Section 5 (Questions 26-28): Input information on other benefits and please specify other benefits offered (e.g. years of service bonus, etc.)."]
["Questions",null,null,"Example","Full Time ","Part Time"]
["1. Staffing and Health, Vision, & Dental Insurance"]
[1,"How many direct service employees who provide services to clients does your organization currently employ?",null,52]
[{"$f":"A11+1","v":2},"Are direct service staff eligible to receive health insurance through your organization?",null,"Yes"]
[{"$f":"A12+1","v":3},"How many direct service staff are currently eligible for health insurance from your organization?",null,41]
[4,"Does your organization contribute towards health insurance premiums?",null,"Yes"]
[5,"How many direct service staff currently receive individual coverage health insurance from your organization?",null,29]
[6,"On average, how much does your organization (the employer) contribute towards the monthly plan premium of one typical employee with individual coverage? If your organization self-insures any portion of the health insurance, report the premium equivalent of self-insured costs plus any other premiums paid (e.g. stop-loss premiums, ACO fees).",null,502.23]
[7,"How many staff currently receive family coverage health insurance from your organization?",null,10]
[8,"On average,how much your organization contributes toward the monthly plan premium of one typical employee with family coverage?  If your organization self-insures any portion of the health insurance, report the premium equivalent of self-insured costs plus any other premiums paid (e.g. stop-loss premiums, ASO fees). ",null,502.23]
[9,"Are direct service staff eligible to receive vision insurance through your organization?",null,"Yes"]
[10,"How many direct service staff currently receive vision insurance from your organization?",null,19]
[11,"What was your organization's total contribution to vision insurance costs for direct service staff last year?",null,0]
[12,"Are direct service staff eligible to receive dental insurance through your organization?",null,"Yes"]
[13,"How many direct service staff currently receive dental insurance from your organization?",null,19]
[14,"What was your organization's total contribution to dental insurance costs for direct service staff last year?",null,0]
["2. Retirement"]
[{"$f":"A24+1","v":15},"Does your organization contribute to a 401k, 403b or other retirement plan for your direct service staff?",null,"Yes"]
[{"$f":"A26+1","v":16},"How many direct service staff currently receive retirement contributions from your organization?",null,19]
[{"$f":"A27+1","v":17},"What is your organization's average retirement contribution for participating direct service staff as a percent of wages?",null,0.04]
["3. Unemployment Insurance and Workers' Compensation"]
[18,"If your organization makes unemployment insurance payments based on a percentage of wages, what is your agency's state unemployment insurance tax rate?",null,1.4999999999999999E-2]
[19,"What is your average workers' compensation cost for direct service staff (per $100 in wages paid)?",null,5.25]
["4. Holidays, Vacation, Sick Time, and Personal Days"]
[{"$f":"A31+1","v":20},"Are direct service staff eligible for holiday pay?",null,"Yes"]
[{"$f":"A33+1","v":21},"How many paid holidays are direct care service staff eligible to receive per year?",null,19]
[{"$f":"A34+1","v":22},"Are direct service staff eligible to receive paid time off (vacation), in addition to holidays?",null,"Yes"]
[23,"How many paid time off (vacation) days are direct care service staff eligible to receive per year?",null,15]
[24,"How many sick days are direct care service staff eligible to receive per year?",null,10]
[25,"How many personal days are direct care service staff eligible to receive per year?",null,5]
["5. Other Benefits"]
[26,"Does your organization contribute to any other benefits for staff? (please specify)","(Specify)","No"]
[{"$f":"A40+1","v":27},"How many direct service staff currently receive these benefits from your organization?",null,19]
[{"$f":"A41+1","v":28},"What was your organization's cost for providing these benefits?",null,0]

{"sheet":"E. Services","index":5,"n_rows":36,"n_cols":4,"rows_kept":36,"cut":false,"hidden":false,"merged":[[1,0,1,2],[7,0,7,3],[35,1,35,2]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet E. Services"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"IF('A. Provider Info'!$E$11=\"\",\"Time Period for Data Requested: \",\"Time Period for Data Requested: \"&TEXT('A. Provider Info'!$E$11,\"MM/DD/YYYY\")&\" - \"&TEXT('A. Provider Info'!$E$12,\"MM/DD/YYYY\"))","v":"Time Period for Data Requested: "}]
["Instructions:\nIndicate whether your organization provides or provided any of the services during the time period stated above by toggling \"Yes\" next to the appropriate section in Column III."]
["Column I","Column II","Column III","Column IV"]
["Services","Procedure Code and Modifier(s)","Do you Provide This Service?","Which Tab(s) Should You Complete?"]
["Adult Day Service","S5100","-",{"$f":"IF(C11=\"Yes\", \"F. Adult Day Service\",\"\")","v":""}]
["Adult Day Service, Bath","S5100 TF","-",{"$f":"IF(C12=\"Yes\", \"F. Adult Day Service\",\"\")","v":""}]
["Adult Day Service, FADS","S5100 U7","-",""]
["Adult Day Service, Remote","S5100 U4","-",""]
["Chore Services - 15 Minutes","S5120","-",{"$f":"IF(C15=\"Yes\", \"G. Chore Service\",\"\")","v":""}]
["Chore Services - Daily","S5121","-",{"$f":"IF(C16=\"Yes\", \"G. Chore Service\",\"\")","v":""}]
["Homemaker, Assistance with Personal Cares","S5130 TG","-",{"$f":"IF(C17=\"Yes\", \"H. Homemaker\",\"\")","v":""}]
["Homemaker, Cleaning","S5130","-",""]
["Homemaker, Home Management","S5130 TF","-",""]
["Homemaker, Home Management, Remote","S5130 TF U4","-",""]
["Adult Companion Services","S5135","-",{"$f":"IF(C21=\"Yes\", \"I. Adult Companion Services\",\"\")","v":""}]
["Adult Companion Services, Remote","S5135 U5","-",{"$f":"IF(C22=\"Yes\", \"I. Adult Companion Services\",\"\")","v":""}]
["Respite Care Services, In Home - 15 Minutes","S5150","-",{"$f":"IF(C23=\"Yes\", \"J. Respite\",\"\")","v":""}]
["Respite Care Services, In Home - Daily","S5151","-",{"$f":"IF(C24=\"Yes\", \"J. Respite\",\"\")","v":""}]
["Respite Care Services, In Home, Remote","S5150 U4","-",""]
["Respite Care Services, Out of Home - 15 Minutes","S5150 UB","-",""]
["Respite Care Services, Out of Home - Daily","H0045","-",""]
["Individual Community Living Supports (ICLS), In Person/Remote","H2015 U3","-",{"$f":"IF(C28=\"Yes\", \"K. Individual Community Living\",\"\")","v":""}]
["Individual Community Living Supports (ICLS), Remote","H2015 U3 U4","-",{"$f":"IF(C29=\"Yes\", \"K. Individual Community Living\",\"\")","v":""}]
["Community Residential Living, Corporate (formerly Adult Foster Care)","S5140 U9","-",{"$f":"IF(C30=\"Yes\", \"L. Community Residential Living\",\"\")","v":""}]
["Community Residential Living, Family (formerly Adult Foster Care)","S5140","-",{"$f":"IF(C31=\"Yes\", \"L. Community Residential Living\",\"\")","v":""}]
["Customized Living","T2031","-",{"$f":"IF(C32=\"Yes\", \"M. Customized Living\",\"\")","v":""}]
["Customized Living, 24 Hour","T2031 TG","-",{"$f":"IF(C33=\"Yes\", \"M. Customized Living\",\"\")","v":""}]
["Customized Living, 24 Hour, Corporate Foster Care","T2031 TG U9","-",{"$f":"IF(C34=\"Yes\", \"M. Customized Living\",\"\")","v":""}]
["Home-Delivered Meals","S5170","-",{"$f":"IF(C35=\"Yes\", \"N. Home Delivered Meals\",\"\")","v":""}]
["Other Service - Enter Service Name and Procedure Code in \"Specify\" box","(Specify)"]

{"sheet":"F. Adult Day Service","index":6,"n_rows":48,"n_cols":7,"rows_kept":48,"cut":false,"hidden":false,"merged":[]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet F. Adult Day Service"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Line","Factor","Example","Adult Day Service","Adult Day Service, Bath","Adult Day Service, FADS","Adult Day Service, Remote"]
["1. SERVICE CHARACTERISTICS",null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(D$8,'E. Services'!$A:$A,0))","v":"S5100"},{"$f":"INDEX('E. Services'!$B:$B,MATCH('F. Adult Day Service'!E$8,'E. Services'!$A:$A,0))","v":"S5100 TF"},{"$f":"INDEX('E. Services'!$B:$B,MATCH('F. Adult Day Service'!F$8,'E. Services'!$A:$A,0))","v":"S5100 U7"},{"$f":"INDEX('E. Services'!$B:$B,MATCH('F. Adult Day Service'!G$8,'E. Services'!$A:$A,0))","v":"S5100 U4"}]
[1,"Number of individuals receiving Adult Day services from your organization",20]
[2,"Are services offered in individual and/or group settings?","Group"]
[3,"Site for delivering day services (Facility, Community, Both)","Facility"]
[4,"Average number of zero occupancy days per year (average number of days per year that an individual does not attend or is absent from scheduled services )",3.75]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[5,"Total cost of capital equipment purchased to perform services",500]
[6,"Average life (in years) of equipment purchased",2]
[7,"If costs are listed in Line 5, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)"]
[8,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[9,"If costs are listed in Line 8, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)"]
["3. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL WEEK\" FOR A DIRECT SERVICE STAFF PERSON):"]
[{"$f":"A19+1","v":10},"Client-facing services - Delivered In Person or Via Telehealth",0.6]
[{"$f":"A21+1","v":11},"Client-facing services - Delivered Via Telehealth",0.1]
[{"$f":"A22+1","v":12},"Recordkeeping and documentation for services",0.1]
[13,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",0.1]
[14,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",0.03]
[15,"Travel time to/from and between client residences/locations",0.05]
[16,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, time spent meeting with a supervisor etc.)",0.02]
[17,"Other activities",0]
[18,"Auto populated: Total percentage",{"$f":"IF(OR(SUM(C21:C28)=1,SUM(C21:C28)=0),SUM(C21:C28),\"Error Must Equal 100%\")","v":1},{"$f":"IF(OR(SUM(D21:D28)=1,SUM(D21:D28)=0),SUM(D21:D28),\"Error Must Equal 100%\")","v":0},{"$f":"IF(OR(SUM(E21:E28)=1,SUM(E21:E28)=0),SUM(E21:E28),\"Error Must Equal 100%\")","v":0},0,{"$f":"IF(OR(SUM(G21:G28)=1,SUM(G21:G28)=0),SUM(G21:G28),\"Error Must Equal 100%\")","v":0}]
[19,"Auto populated: Has all time been allocated? (Total in Line 9 should equal sum of Lines 1-8)",{"$f":"IF(SUM(C21:C28)=1,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D21:D28)=1,\"Yes\",\"No\")","v":"No"},"No","No","No"]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[{"$f":"A30+1","v":20},"How many staff or practitioners on average are typically supervised by one supervisor?",5]
[{"$f":"A32+1","v":21},"How many hours per week do supervisors spend supervising staff?",2]
["5. REGISTERED NURSE MANAGEMENT"]
[{"$f":"A33+1","v":22},"How many staff or practitioners on average are typically managed by one Registered Nurse?",8]
[{"$f":"A35+1","v":23},"How many hours per week do Registered Nurse spend managing staff?",5]
["6. STAFFING PATTERNS (STAFF TO CLIENT RATIO)"]
[{"$f":"A36+1","v":24},"How many individuals, on average, are typically served by one staff or practitioner at a single point in time (Staffing Ratio)?",5]
["7. STAFF TRANSPORTATION"]
[{"$f":"A38+1","v":25},"Is staff transportation bundled into the service? [Respond if Lines 23a, 23b, and 23c is marked as \"Yes\"]","Yes","-","-","-","-"]
["25a","Average number of trips (one way) per day for staff transportation for this service?",10]
["25b","Average minutes per trip (one way) per day for staff transportation for this service?",30]
["25c","Average miles per trip (one way) per day for staff transportation for this service?",40]
["8. CLIENT TRANSPORTATION"]
[26,"Is client transportation bundled into the service? [Respond if Lines 24a, 24b, and 24c is marked as \"Yes\"]","Yes","-","-","-","-"]
["26a","Average number of trips (one way) per day for client transportation for this service?",10]
["26b","Average minutes per trip (one way) per day for client transportation for this service?",30]
["26c","Average miles per trip (one way) per day for client transportation for this service?",40]

{"sheet":"G. Chore Service","index":7,"n_rows":38,"n_cols":5,"rows_kept":38,"cut":false,"hidden":false,"merged":[[7,0,7,4]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet G. Chore Service"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Instructions:\nIf questions are not applicable or if information is not available, please input \"N/A\" in the corresponding yellow cells.\nFollow the below instructions for each section:\n-Section 1 (Questions 1-10): Identify the percent of total time a service provider spends completing each of the activities. The sum of all activities for each service should add up to 100% in Line 9.\n-Section 2 (Questions 11-12): Identify the total number of particiapnts and the current average staffing patterns - i.e., the average number of individuals served by one staff or practitioner.\n-Section 3 (Question 13): Identify the current average time it takes to provide one session.\n-Section 4 (Question 14-15): Identify the current supervisor span of control - i.e., the average number of staff or practitioners supervised by one supervisor and the number of hours a supervisor spends performing supervisor activities.\n-Section 5 (Question 16): List the average percentage of time that services are unable to be provided/delivered due to client absences or no shows.\n-Section 6 (Questions 17-19): Identify the staff transportation requirements for each service; this should be for individuals delivering services. This is intended to capture the additional cost required for services where providers need to travel into the community.\n-Section 7 (Questions 20-22): Identify the client transportation requirements for each service; this should be for individuals receiving services."]
["Line","Factor","Example","Chore Services - 15 Minutes","Chore Services - Daily"]
["1. PRODUCTIVITY",null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(D$9,'E. Services'!$A:$A,0))","v":"S5120"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(E$9,'E. Services'!$A:$A,0))","v":"S5121"}]
[1,"Client-facing services - Delivered In Person or Via Telehealth",0.6]
[2,"Client-facing services - Delivered Via Telehealth",0.1]
[3,"Recordkeeping and documentation for services",0.1]
[4,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",0.1]
[5,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",0.03]
[6,"Travel time to/from and between client residences/locations",0.05]
[7,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, time spent meeting with a supervisor etc.)",0.02]
[8,"Other activities",0]
[9,"Auto populated: Total percentage",{"$f":"IF(OR(SUM(C11:C18)=1,SUM(C11:C18)=0),SUM(C11:C18),\"Error Must Equal 100%\")","v":1},{"$f":"IF(OR(SUM(D11:D18)=1,SUM(D11:D18)=0),SUM(D11:D18),\"Error Must Equal 100%\")","v":0},{"$f":"IF(OR(SUM(E11:E18)=1,SUM(E11:E18)=0),SUM(E11:E18),\"Error Must Equal 100%\")","v":0}]
[10,"Auto populated: Has all time been allocated? (Total in Line 9 should equal sum of Lines 1-8)",{"$f":"IF(SUM(C11:C18)=1,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D11:D18)=1,\"Yes\",\"No\")","v":"No"},"No"]
["2. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[11,"How many individuals in total are receiving Chore Services from your organization?",500]
[12,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time (for services delivered in a group setting)?",5]
["3. SESSION SERVICE PATTERNS"]
[13,"If the service provided is billed per session/assessment/visit how long (in hours) on average is one session? (Excluding any time not towards direct client facing services, ie. Documentation time, Recordkeeping, etc.)",2.5]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[14,"How many staff or practitioners on average are typically supervised by one supervisor?",10]
[15,"How many hours per week do supervisors spend supervising staff?","2"]
["5. ABSENCE AND NO SHOW PERCENTAGE"]
[16,"What percent of total visits do clients attend as scheduled?",0.9]
["6. STAFF TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Staff Transportation)"]
[17,"Average number of trips (one way) per day for each service",10]
[18,"Average minutes per trip (one way) per day for each service",30]
[19,"Average miles per trip (one way) per day for each service",40]
["7. CLIENT TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Client Transportation)"]
[20,"Average number of trips (one way) per day for each service",10]
[21,"Average minutes per trip (one way) per day for each service",30]
[22,"Average miles per trip (one way) per day for each service",40]

{"sheet":"H. Homemaker","index":8,"n_rows":38,"n_cols":7,"rows_kept":38,"cut":false,"hidden":false,"merged":[[7,0,7,6]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet H. Homemaker"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Instructions:\nIf questions are not applicable or if information is not available, please input \"N/A\" in the corresponding yellow cells.\nFollow the below instructions for each section:\n-Section 1 (Questions 1-10): Identify the percent of total time a service provider spends completing each of the activities. The sum of all activities for each service should add up to 100% in Line 9.\n-Section 2 (Questions 11-12): Identify the total number of particiapnts and the current average staffing patterns - i.e., the average number of individuals served by one staff or practitioner.\n-Section 3 (Question 13): Identify the current average time it takes to provide one session.\n-Section 4 (Question 14-15): Identify the current supervisor span of control - i.e., the average number of staff or practitioners supervised by one supervisor and the number of hours a supervisor spends performing supervisor activities.\n-Section 5 (Question 16): List the average percentage of time that services are unable to be provided/delivered due to client absences or no shows.\n-Section 6 (Questions 17-19): Identify the staff transportation requirements for each service; this should be for individuals delivering services. This is intended to capture the additional cost required for services where providers need to travel into the community.\n-Section 7 (Questions 20-22): Identify the client transportation requirements for each service; this should be for individuals receiving services."]
["Line","Factor","Example","Homemaker, Assistance with Personal Cares","Homemaker, Cleaning","Homemaker, Home Management","Homemaker, Home Management, Remote"]
["1. PRODUCTIVITY",null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(D$9,'E. Services'!$A:$A,0))","v":"S5130 TG"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(E$9,'E. Services'!$A:$A,0))","v":"S5130"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(F$9,'E. Services'!$A:$A,0))","v":"S5130 TF"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(G$9,'E. Services'!$A:$A,0))","v":"S5130 TF U4"}]
[1,"Client-facing services - Delivered In Person",0.6]
[2,"Client-facing services - Delivered Via Telehealth",0.1]
[3,"Recordkeeping and documentation for services",0.1]
[4,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",0.1]
[5,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",0.03]
[6,"Travel time to/from and between client residences/locations",0.05]
[7,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, time spent meeting with a supervisor etc.)",0.02]
[8,"Other activities",0]
[9,"Auto populated: Total percentage",{"$f":"IF(OR(SUM(C11:C18)=1,SUM(C11:C18)=0),SUM(C11:C18),\"Error Must Equal 100%\")","v":1},{"$f":"IF(OR(SUM(D11:D18)=1,SUM(D11:D18)=0),SUM(D11:D18),\"Error Must Equal 100%\")","v":0},0,0,{"$f":"IF(OR(SUM(G11:G18)=1,SUM(G11:G18)=0),SUM(G11:G18),\"Error Must Equal 100%\")","v":0}]
[10,"Auto populated: Has all time been allocated? (Total in Line 9 should equal sum of Lines 1-8)",{"$f":"IF(SUM(C11:C18)=1,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D11:D18)=1,\"Yes\",\"No\")","v":"No"},"No","No",{"$f":"IF(SUM(G11:G18)=1,\"Yes\",\"No\")","v":"No"}]
["2. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[11,"How many individuals in total are receiving Homemaker Services from your organization?",500]
[12,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time (for services delivered in a group setting)?",5]
["3. SESSION SERVICE PATTERNS"]
[13,"If the service provided is billed per session/assessment/visit how long (in hours) on average is one session? (Excluding any time not towards direct client facing services, ie. Documentation time, Recordkeeping, etc.)",2.5]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[14,"How many staff or practitioners on average are typically supervised by one supervisor?",10]
[15,"How many hours per week do supervisors spend supervising staff?","2"]
["5. ABSENCE AND NO SHOW PERCENTAGE"]
[16,"What percent of total visits do clients attend as scheduled?",0.9]
["6. STAFF TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Staff Transportation)"]
[17,"Average number of trips (one way) per day for each service",10]
[18,"Average minutes per trip (one way) per day for each service",30]
[19,"Average miles per trip (one way) per day for each service",40]
["7. CLIENT TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Client Transportation)"]
[20,"Average number of trips (one way) per day for each service",10]
[21,"Average minutes per trip (one way) per day for each service",30]
[22,"Average miles per trip (one way) per day for each service",40]

{"sheet":"I. Adult Companion Services","index":9,"n_rows":38,"n_cols":5,"rows_kept":38,"cut":false,"hidden":false,"merged":[[7,0,7,4]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet I. Adult Companion Services"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Instructions:\nIf questions are not applicable or if information is not available, please input \"N/A\" in the corresponding yellow cells.\nFollow the below instructions for each section:\n-Section 1 (Questions 1-10): Identify the percent of total time a service provider spends completing each of the activities. The sum of all activities for each service should add up to 100% in Line 9.\n-Section 2 (Questions 11-12): Identify the total number of particiapnts and the current average staffing patterns - i.e., the average number of individuals served by one staff or practitioner.\n-Section 3 (Question 13): Identify the current average time it takes to provide one session.\n-Section 4 (Question 14-15): Identify the current supervisor span of control - i.e., the average number of staff or practitioners supervised by one supervisor and the number of hours a supervisor spends performing supervisor activities.\n-Section 5 (Question 16): List the average percentage of time that services are unable to be provided/delivered due to client absences or no shows.\n-Section 6 (Questions 17-19): Identify the staff transportation requirements for each service; this should be for individuals delivering services. This is intended to capture the additional cost required for services where providers need to travel into the community.\n-Section 7 (Questions 20-22): Identify the client transportation requirements for each service; this should be for individuals receiving services."]
["Line","Factor","Example","Adult Companion Services","Adult Companion Services, Remote"]
["1. PRODUCTIVITY",null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(D$9,'E. Services'!$A:$A,0))","v":"S5135"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(E$9,'E. Services'!$A:$A,0))","v":"S5135 U5"}]
[1,"Client-facing services - Delivered In Person",0.6]
[2,"Client-facing services - Delivered Via Telehealth",0.1]
[3,"Recordkeeping and documentation for services",0.1]
[4,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",0.1]
[5,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",0.03]
[6,"Travel time to/from and between client residences/locations",0.05]
[7,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, time spent meeting with a supervisor etc.)",0.02]
[8,"Other activities",0]
[9,"Auto populated: Total percentage",{"$f":"IF(OR(SUM(C11:C18)=1,SUM(C11:C18)=0),SUM(C11:C18),\"Error Must Equal 100%\")","v":1},{"$f":"IF(OR(SUM(D11:D18)=1,SUM(D11:D18)=0),SUM(D11:D18),\"Error Must Equal 100%\")","v":0},{"$f":"IF(OR(SUM(E11:E18)=1,SUM(E11:E18)=0),SUM(E11:E18),\"Error Must Equal 100%\")","v":0}]
[10,"Auto populated: Has all time been allocated? (Total in Line 9 should equal sum of Lines 1-8)",{"$f":"IF(SUM(C11:C18)=1,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D11:D18)=1,\"Yes\",\"No\")","v":"No"},{"$f":"IF(SUM(E11:E18)=1,\"Yes\",\"No\")","v":"No"}]
["2. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[11,"How many individuals in total are receiving Adult Companion Services from your organization?",500]
[12,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time (for services delivered in a group setting)?",5]
["3. SESSION SERVICE PATTERNS"]
[13,"If the service provided is billed per session/assessment/visit how long (in hours) on average is one session? (Excluding any time not towards direct client facing services, ie. Documentation time, Recordkeeping, etc.)",2.5]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[14,"How many staff or practitioners on average are typically supervised by one supervisor?",10]
[15,"How many hours per week do supervisors spend supervising staff?","2"]
["5. ABSENCE AND NO SHOW PERCENTAGE"]
[16,"What percent of total visits do clients attend as scheduled?",0.9]
["6. STAFF TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Staff Transportation)"]
[17,"Average number of trips (one way) per day for each service",10]
[18,"Average minutes per trip (one way) per day for each service",30]
[19,"Average miles per trip (one way) per day for each service",40]
["7. CLIENT TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Client Transportation)"]
[20,"Average number of trips (one way) per day for each service",10]
[21,"Average minutes per trip (one way) per day for each service",30]
[22,"Average miles per trip (one way) per day for each service",40]

{"sheet":"J. Respite","index":10,"n_rows":38,"n_cols":8,"rows_kept":38,"cut":false,"hidden":false,"merged":[[7,0,7,7]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet J. Respite"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Instructions:\nIf questions are not applicable or if information is not available, please input \"N/A\" in the corresponding yellow cells.\nFollow the below instructions for each section:\n-Section 1 (Questions 1-10): Identify the percent of total time a service provider spends completing each of the activities. The sum of all activities for each service should add up to 100% in Line 9.\n-Section 2 (Questions 11-12): Identify the total number of particiapnts and the current average staffing patterns - i.e., the average number of individuals served by one staff or practitioner.\n-Section 3 (Question 13): Identify the current average time it takes to provide one session.\n-Section 4 (Question 14-15): Identify the current supervisor span of control - i.e., the average number of staff or practitioners supervised by one supervisor and the number of hours a supervisor spends performing supervisor activities.\n-Section 5 (Question 16): List the average percentage of time that services are unable to be provided/delivered due to client absences or no shows.\n-Section 6 (Questions 17-19): Identify the staff transportation requirements for each service; this should be for individuals delivering services. This is intended to capture the additional cost required for services where providers need to travel into the community.\n-Section 7 (Questions 20-22): Identify the client transportation requirements for each service; this should be for individuals receiving services."]
["Line","Factor","Example","Respite Care Services, In Home - 15 Minutes","Respite Care Services, In Home - Daily","Respite Care Services, In Home, Remote","Respite Care Services, Out of Home - 15 Minutes","Respite Care Services, Out of Home - Daily"]
["1. PRODUCTIVITY",null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(D$9,'E. Services'!$A:$A,0))","v":"S5150"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(E$9,'E. Services'!$A:$A,0))","v":"S5151"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(F$9,'E. Services'!$A:$A,0))","v":"S5150 U4"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(G$9,'E. Services'!$A:$A,0))","v":"S5150 UB"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(H$9,'E. Services'!$A:$A,0))","v":"H0045"}]
[1,"Client-facing services - Delivered In Person",0.6]
[2,"Client-facing services - Delivered Via Telehealth",0.1]
[3,"Recordkeeping and documentation for services",0.1]
[4,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",0.1]
[5,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",0.03]
[6,"Travel time to/from and between client residences/locations",0.05]
[7,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, time spent meeting with a supervisor etc.)",0.02]
[8,"Other activities",0]
[9,"Auto populated: Total percentage",{"$f":"IF(OR(SUM(C11:C18)=1,SUM(C11:C18)=0),SUM(C11:C18),\"Error Must Equal 100%\")","v":1},{"$f":"IF(OR(SUM(D11:D18)=1,SUM(D11:D18)=0),SUM(D11:D18),\"Error Must Equal 100%\")","v":0},0,0,0,{"$f":"IF(OR(SUM(H11:H18)=1,SUM(H11:H18)=0),SUM(H11:H18),\"Error Must Equal 100%\")","v":0}]
[10,"Auto populated: Has all time been allocated? (Total in Line 9 should equal sum of Lines 1-8)",{"$f":"IF(SUM(C11:C18)=1,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D11:D18)=1,\"Yes\",\"No\")","v":"No"},"No","No","No",{"$f":"IF(SUM(H11:H18)=1,\"Yes\",\"No\")","v":"No"}]
["2. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[11,"How many individuals in total are receiving Respite Services from your organization?",500]
[12,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time (for services delivered in a group setting)?",5]
["3. SESSION SERVICE PATTERNS"]
[13,"If the service provided is billed per session/assessment/visit how long (in hours) on average is one session? (Excluding any time not towards direct client facing services, ie. Documentation time, Recordkeeping, etc.)",2.5]
["4. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[14,"How many staff or practitioners on average are typically supervised by one supervisor?",10]
[15,"How many hours per week do supervisors spend supervising staff?","2"]
["5. ABSENCE AND NO SHOW PERCENTAGE"]
[16,"What percent of total visits do clients attend as scheduled?",0.9]
["6. STAFF TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Staff Transportation)"]
[17,"Average number of trips (one way) per day for each service",10]
[18,"Average minutes per trip (one way) per day for each service",30]
[19,"Average miles per trip (one way) per day for each service",40]
["7. CLIENT TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Client Transportation)"]
[20,"Average number of trips (one way) per day for each service",10]
[21,"Average minutes per trip (one way) per day for each service",30]
[22,"Average miles per trip (one way) per day for each service",40]

{"sheet":"K. Individual Community Living","index":11,"n_rows":47,"n_cols":5,"rows_kept":47,"cut":false,"hidden":false,"merged":[[7,0,7,4]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet K. Individual Community Living"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Instructions:\nIf questions are not applicable or if information is not available, please input \"N/A\" in the corresponding yellow cells.\nFollow the below instructions for each section:\n-Section 1 (Questions 1-10): Identify the percent of total time a service provider spends completing each of the activities. The sum of all activities for each service should add up to 100% in Line 9.\n-Section 2 (Questions 11-15): Enter information related to equipment and supply costs for delivering services.\n-Section 3 (Question 16-17): Identify the total number of particiapnts and the current average staffing patterns - i.e., the average number of individuals served by one staff or practitioner.\n-Section 4 (Question 18): Identify the current average time it takes to provide one session.\n-Section 5 (Question 19-20): Identify the current supervisor span of control - i.e., the average number of staff or practitioners supervised by one supervisor and the number of hours a supervisor spends performing supervisor activities.\n-Section 6 (Questions 21-22): Identify the current registered nurse management values - i.e., the average staff or practitioners managed by one registered nurse and the number of hours spent managing staff per week.\n-Section 7 (Question 23): List the average percentage of time that services are unable to be provided/delivered due to client absences or no shows.\n-Section 8 (Questions 24-26): Identify the staff transportation requirements for each service; this should be for individuals delivering services. This is intended to capture the additional cost required for services where providers need to travel into the community.\n-Section 9 (Questions 27-29): Identify the client transportation requirements for each service; this should be for individuals receiving services."]
["Line","Factor","Example","Individual Community Living Supports (ICLS), In Person/Remote","Individual Community Living Supports (ICLS), Remote"]
["1. PRODUCTIVITY",null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(D$9,'E. Services'!$A:$A,0))","v":"H2015 U3"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(E$9,'E. Services'!$A:$A,0))","v":"H2015 U3 U4"}]
[1,"Client-facing services - Delivered In Person",0.6]
[2,"Client-facing services - Delivered Via Telehealth",0.1]
[3,"Recordkeeping and documentation for services",0.1]
[4,"Recordkeeping and documentation for activities outside of services (e.g., travel planning, time keeping, etc.)",0.1]
[5,"Participating in scheduled care planning meetings with other professionals, interdisciplinary team members, or collaterals",0.03]
[6,"Travel time to/from and between client residences/locations",0.05]
[7,"Employer administrative or training activities (e.g., staff meetings, program coordination/development, time spent meeting with a supervisor etc.)",0.02]
[8,"Other activities",0]
[9,"Auto populated: Total percentage",{"$f":"IF(OR(SUM(C11:C18)=1,SUM(C11:C18)=0),SUM(C11:C18),\"Error Must Equal 100%\")","v":1},{"$f":"IF(OR(SUM(D11:D18)=1,SUM(D11:D18)=0),SUM(D11:D18),\"Error Must Equal 100%\")","v":0},0]
[10,"Auto populated: Has all time been allocated? (Total in Line 9 should equal sum of Lines 1-8)",{"$f":"IF(SUM(C11:C18)=1,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D11:D18)=1,\"Yes\",\"No\")","v":"No"},"No"]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[11,"Total cost of capital equipment purchased to perform services",500]
[12,"Average life (in years) of equipment purchased",2]
[13,"If costs are listed in Line 11, summarize the equipment included in the total here",null,"(Specify)","(Specify)"]
[14,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[15,"If costs are listed in Line 14, summarize the supplies included in the total here",null,"(Specify)","(Specify)"]
["3. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[16,"How many individuals in total are receiving Individual Community Living Services from your organization?",500]
[17,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time (for services delivered in a group setting)?",5]
["4. SESSION SERVICE PATTERNS"]
[18,"If the service provided is billed per session/assessment/visit how long (in hours) on average is one session? (Excluding any time not towards direct client facing services, ie. Documentation time, Recordkeeping, etc.)",2.5]
["5. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[19,"How many staff or practitioners on average are typically supervised by one supervisor?",10]
[20,"How many hours per week do supervisors spend supervising staff?","2"]
["6. REGISTERED NURSE MANAGEMENT"]
[21,"How many staff or practitioners on average are typically managed by one Registered Nurse?",8]
[22,"How many hours per week do Registered Nurse spend managing staff?",5]
["7. ABSENCE AND NO SHOW PERCENTAGE"]
[23,"What percent of total visits do clients attend as scheduled?",0.9]
["8. STAFF TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Staff Transportation)"]
[24,"Average number of trips (one way) per day for each service",10]
[25,"Average minutes per trip (one way) per day for each service",30]
[26,"Average miles per trip (one way) per day for each service",40]
["9. CLIENT TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Client Transportation)"]
[27,"Average number of trips (one way) per day for each service",10]
[28,"Average minutes per trip (one way) per day for each service",30]
[29,"Average miles per trip (one way) per day for each service",40]

{"sheet":"L. Community Residential Living","index":12,"n_rows":42,"n_cols":5,"rows_kept":42,"cut":false,"hidden":false,"merged":[[23,0,26,0],[23,1,26,1]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet L. Community Residential Living"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Line","Factor","Example","Community Residential Living, Corporate (formerly Adult Foster Care)","Community Residential Living, Family (formerly Adult Foster Care)"]
["1. HOME AND SERVICE CHARACTERISTICS",null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(D$8,'E. Services'!$A:$A,0))","v":"S5140 U9"},{"$f":"INDEX('E. Services'!$B:$B,MATCH(E$8,'E. Services'!$A:$A,0))","v":"S5140"}]
[1,"Number of residences or homes operated by your organization",20]
[2,"Number of residential coordinators employed by your organization",5]
[3,"How many homes, on average, is a coordinator responsible for?",3.75]
[4,"Average number of clients per home operated by your organization",14]
[5,"Average number of beds per home operated by your organization",14]
[6,"Average absence days per consumer per month (due to hospitalization, vacation, etc.)",5]
[7,"Average number of empty bed days, per home, per year",16]
["2. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[8,"Total cost of capital equipment purchased to perform services",500]
[9,"Average life (in years) of equipment purchased",2]
[10,"If costs are listed in Line 8, summarize the equipment included in the total here",null,"(Specify)","(Specify)"]
[11,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[12,"If costs are listed in Line 11, summarize the supplies included in the total here",null,"(Specify)","(Specify)"]
["3. STAFFING (TEAM STRUCTURE)"]
[13,"Select from the drop down which staff type(s) are a part of delivering this service. If you cannot determine a staff type that your organization uses for this service please enter it into the blue \"(Specify)\" box.","Direct Care Workers"]
[null,null,"Homemaker/Housekeepers"]
[null,null,"Driver/Transportation"]
[null,null,null,"(Specify)","(Specify)"]
["4. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[14,"How many individuals in total are receiving Community Residential Living Services from your organization?",500]
[15,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time during the day?",2]
[16,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time during the night?",5]
["5. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[17,"How many staff or practitioners on average are typically supervised by one supervisor?",10]
[18,"How many hours per week do supervisors spend supervising staff?","2"]
["6. STAFF TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Staff Transportation)"]
[19,"Average number of trips (one way) per day for each service",10]
[20,"Average minutes per trip (one way) per day for each service",30]
[21,"Average miles per trip (one way) per day for each service",40]
["7. CLIENT TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Client Transportation)"]
[22,"Average number of trips (one way) per day for each service",10]
[23,"Average minutes per trip (one way) per day for each service",30]
[24,"Average miles per trip (one way) per day for each service",40]

{"sheet":"M. Customized Living","index":13,"n_rows":51,"n_cols":10,"rows_kept":51,"cut":false,"hidden":false,"merged":[]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")&\" - Procedure Codes: T2031, T2031 TG, T2031 TG U9\"","v":"Worksheet M. Customized Living - Procedure Codes: T2031, T2031 TG, T2031 TG U9"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Questions",null,"Example","Activities of Daily Living (ADL) Assistance","Assistance with Mental Health, Cognitive or Behavioral Concerns","Health-Related Assistance\n(Clinical)","Health-Related Assistance\n(Non-Clinical)","Home Management Tasks","Meal Preparation","Socialization"]
["1. NUMBER OF PARTICIPANTS"]
[1,"Total number of participants",15]
["2. PRODUCTIVITY (STAFFING PATTERN FOR A \"TYPICAL DAY\" FOR A DIRECT SERVICE STAFF PERSON). INPUT THE PERCENT OF TIME SPENT ON EITHER DIRECT (BILLABLE TIME) VS. NON-BILLABLE TIME"]
[{"$f":"A10+1","v":2},"Client-facing services - Delivered In Person or Telehealth",0.8]
[{"$f":"A12+1","v":3},"Non-billable time (Recordkeeping, documentation, travel time, employer administrative or training activities, time keeping)",0.2]
[{"$f":"A13+1","v":4},"Auto populated: Total percentage",{"$f":"IF(OR(SUM(C12:C13)=1,SUM(C12:C13)=0),SUM(C12:C13),\"Error Must Equal 100%\")","v":1},{"$f":"IF(OR(SUM(D12:D13)=1,SUM(D12:D13)=0),SUM(D12:D13),\"Error Must Equal 100%\")","v":0},0,0,0,0,{"$f":"IF(OR(SUM(I12:I13)=1,SUM(I12:I13)=0),SUM(I12:I13),\"Error Must Equal 100%\")","v":0},0]
[5,"Auto populated: Has all time been allocated? (Total in Line 4 should equal sum of Lines 2-3)",{"$f":"IF(SUM(C12:C13)=1,\"Yes\",\"No\")","v":"Yes"},{"$f":"IF(SUM(D12:D13)=1,\"Yes\",\"No\")","v":"No"},"No","No",{"$f":"IF(SUM(G12:G13)=1,\"Yes\",\"No\")","v":"No"},"No",{"$f":"IF(SUM(I12:I13)=1,\"Yes\",\"No\")","v":"No"},{"$f":"IF(SUM(J12:J13)=1,\"Yes\",\"No\")","v":"No"}]
["3. EQUIPMENT & SUPPLIES (INPUT THE COST OF ITEMS ACQUIRED TO DELIVER THE SERVICE)"]
[{"$f":"A15+1","v":6},"Total cost of capital equipment purchased to perform services",500]
[{"$f":"A17+1","v":7},"Average life (in years) of equipment purchased",2]
[{"$f":"A18+1","v":8},"If costs are listed in Line 6, summarize the equipment included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
[9,"Total cost of supplies purchased and used to perform services (excludes Goods and Services)",250]
[10,"If costs are listed in Line 9, summarize the supplies included in the total here",null,"(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)","(Specify)"]
["4. SERVICE COMPONENT HOURS"]
[{"$f":"A21+1","v":11},"On average, how many hours per day are spent delivering this service component for Customized Living?",1.5]
[{"$f":"A23+1","v":12},"On average, how many hours per day are spent delivering this service component for Customized Living, 24 Hour?",2]
["5. STAFFING (SELECT A JOB TYPE FROM THE DROPDOWN)"]
[{"$f":"A24+1","v":13},"What staff type does your organization use to deliver this service?","Direct Care Workers"]
[{"$f":"A26+1","v":14},"What staff type does your organization use to deliver this service other than the selection above?","Registered Nurse (RN)/Nurse"]
["6. STAFFING PATTERNS (STAFF TO PARTICIPANT RATIO)"]
[15,"How many individuals in total are receiving Customized Living from your organization?",200]
[{"$f":"A29+1","v":16},"How many individuals in total are receiving Customized Living, 24 hour from your organization?",100]
[{"$f":"A30+1","v":17},"How many individuals in total are receiving Customized Living, 24 Hour, Corporate Foster Care from your organization?",20]
[{"$f":"A31+1","v":18},"How many individuals, on average, are typically served by one staff or practitioner at a single point in time for Customized Living?",2]
[19,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time for Customized Living, 24 hour?",5]
[20,"How many individuals, on average, are typically served by one staff or practitioner at a single point in time for Customized Living, 24 Hour, Corporate Foster Care?",4]
["7. REGISTERED NURSE MANAGEMENT"]
[{"$f":"A34+1","v":21},"How many staff or practitioners on average are typically managed by one Registered Nurse?",8]
[{"$f":"A36+1","v":22},"How many hours per week do Registered Nurse spend managing staff?",5]
["8. SUPERVISOR SPAN OF CONTROL (STAFF TO SUPERVISOR RATIO)"]
[{"$f":"A37+1","v":23},"Does your organization use another staff type for supervision outside of \"Registered Nurse Management\"?","Yes","-","-","-","-","-","-","-"]
[{"$f":"A39+1","v":24},"What staff type does your organization use for supervision?","Program Manager/Director"]
[{"$f":"A40+1","v":25},"How many staff or practitioners on average are typically supervised by one supervisor?",10]
[{"$f":"A41+1","v":26},"How many hours per week do supervisors spend supervising staff?","2"]
["9. STAFF TRANSPORTATION AND SERVICE TRIP INFORMATION (Only fill out if Staff Transportation)"]
[{"$f":"A42+1","v":27},"Average number of trips (one way) per day for each service",10]
[{"$f":"A44+1","v":28},"Average minutes per trip (one way) per day for each service",30]
[{"$f":"A45+1","v":29},"Average miles per trip (one way) per day for each service",40]
[]
["10. NON-MEDICALTRANSPORTATION - SERVICE TRIP INFORMATION (Only fill out for the Non-Medical Transportation service component)",null,null,"Non-Medical Transportation"]
[{"$f":"A46+1","v":30},"Average number of trips (one way) per day for each service",2]
[{"$f":"A49+1","v":31},"Average minutes per trip (one way) per day for each service",15]
[{"$f":"A50+1","v":32},"Average miles per trip (one way) per day for each service",10]

{"sheet":"N. Home-Delivered Meals","index":14,"n_rows":58,"n_cols":5,"rows_kept":58,"cut":false,"hidden":false,"merged":[[37,1,37,2]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet N. Home-Delivered Meals"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"IF('A. Provider Info'!$E$11=\"\",\"Time Period for Data Requested: \",\"Time Period for Data Requested: \"&TEXT('A. Provider Info'!$E$11,\"MM/DD/YYYY\")&\" - \"&TEXT('A. Provider Info'!$E$12,\"MM/DD/YYYY\"))","v":"Time Period for Data Requested: "}]
["Line","Factor",null,"Example","Home-Delivered Meals"]
["1. Service Delivery & Staffing Patterns",null,null,"Procedure Codes:",{"$f":"INDEX('E. Services'!$B:$B,MATCH(E$8,'E. Services'!$A:$A,0))","v":"S5170"}]
[1,"How many counties do you serve? (enter number)",null,4]
[{"$f":"A10+1","v":2},"Do you serve in Minnesota Tribal Nations areas? ",null,"Yes"]
[{"$f":"A11+1","v":3},"How many sites do you have? (enter number)",null,4]
[4,"How many sites provide services to Medicaid recipients? (enter number)",null,3]
[5,"Number of active non-Medical Assistance unduplicated home-delivered meal clients at time of survey (enter number)",null,15]
[6,"Number of active Medical Assistance unduplicated home-delivered meal clients at time of survey (enter number)",null,50]
[7,"Total number of active unduplicated home-delivered meal clients at the time of survey (all funding sources) ",null,{"$f":"SUM(D14:D15)","v":65},{"$f":"SUM(E14:E15)","v":0}]
["2. Home-Delivered Meal Expenses"]
[{"$f":"A16+1","v":8},"Project Management (Directly Employed)",null,12500]
[{"$f":"A18+1","v":9},"Meals (Site Staff-Directly Employed)",null,8000]
[{"$f":"A19+1","v":10},"Administrative Personnel",null,5000]
[11,"Fringe Benefits",null,5000]
[12,"Bulk Meal Transport Cost",null,2000]
[13,"HDM - Home Meal Delivery Costs (Vehicle/Gas/Car Insurance)",null,2000]
[14,"HDM Packaging Costs",null,2000]
[15,"Supplies",null,2000]
[16,"Utilities",null,2000]
[17,"Communications",null,2000]
[18,"Building Costs",null,2000]
[19,"Building Space Square Footage",null,2000]
[20,"Professional Services",null,2000]
[21,"Raw Food",null,2000]
[22,"Caterer (Sub-contract) Indicated in blue box if costs include delivery:","(Specify)",2000]
[23,"Equipment",null,2000]
[24,"Insurance",null,2000]
[25,"Agency Sponsored Volunteer Recognition",null,2000]
[26,"Other","(Specify)",2000]
[27,"Total Expenses",null,{"$f":"SUM(D18:D36)","v":60500},{"$f":"SUM(E18:E36)","v":0}]
[28,"Do the above costs include any congregate meal costs? (This should be marked 'yes' only if you are unable to separate HDM and congregate meal costs)",null,"No"]
["3. Kitchen Staff"]
[{"$f":"A38+1","v":29},"Average Number of Daily Cooks/Chefs per Kitchen",null,5]
[{"$f":"A40+1","v":30},"Average Number of Daily Kitchen Support Staff per Kitchen",null,5]
[{"$f":"A41+1","v":31},"Average Number of Daily Kitchen Supervisors per Kitchen",null,2]
["4. Transportation and Service Trip Information (Only fill out if Staff Transportation)"]
[{"$f":"A42+1","v":32},"Average number of trips (one way) per day for each service",null,10]
[{"$f":"A44+1","v":33},"Average minutes per trip (one way) per day for each service",null,30]
[{"$f":"A45+1","v":34},"Average miles per trip (one way) per day for each service",null,40]
["5. Meal Stats"]
[{"$f":"A46+1","v":35},"Total Number of Medical Assistance HDM",null,100]
[{"$f":"A48+1","v":36},"Total Number of Title III C2 HDM",null,50]
[{"$f":"A49+1","v":37},"Total Number of Title III C1 Congregate Meals",null,40]
[{"$f":"A50+1","v":38},"Total Number of All Other Meals",null,25]
[39,"Total Number of All Meals (inclusive of above)",null,{"$f":"SUM(D48:D51)","v":215},{"$f":"SUM(E48:E51)","v":0}]
["6. Donated Services"]
[{"$f":"A52+1","v":40},"Volunteer Miles (only include if currently tracked)",null,1000]
[{"$f":"A54+1","v":41},"Volunteer Recognition",null,200]
[{"$f":"A55+1","v":42},"Volunteer Hours",null,250]
[43,"Building/Facility Square Footage",null,2800]
[44,"Other (In Kind)","(Specify)",{"$f":"SUM(D54:D57)","v":4250}]

{"sheet":"O. Transportation","index":15,"n_rows":14,"n_cols":6,"rows_kept":14,"cut":false,"hidden":false,"merged":[[7,0,7,5],[1,0,1,5]]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet O. Transportation"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
[{"$f":"'E. Services'!$A$7","v":"Time Period for Data Requested: "}]
["Instructions:\nTransportation - Since you toggled on the [A. Provider Info] tab that you cannot breakout transportation information by each service please list the average transportation values across all services in the columns below."]
["Transportation",null,null,null,null,"All Services"]
[null,null,null,null,null,"Column I"]
["Transportation:"]
["Average number of trips (one way) per day"]
["Average minutes per trip (one way) per day"]
["Average miles per trip (one way) per day"]

{"sheet":"Additional Information","index":16,"n_rows":10,"n_cols":1,"rows_kept":10,"cut":false,"hidden":false,"merged":[]}
[{"$f":"Overview!$A$1","v":"Minnesota Aging and Adult Services Division Provider Cost & Wage Survey"}]
[{"$f":"Overview!$A$2","v":"Aging and Adult Services - Elderly Waiver, Community Access for Disability Inclusion Waiver, and Brain Injury Waiver"}]
[{"$f":"Overview!$A$3","v":"Minnesota Department of Human Services (DHS)"}]
[{"$f":"\"Worksheet: \"&_xlfn.TEXTAFTER(CELL(\"filename\",A1),\"]\")","v":"Worksheet: Additional Information"}]
[{"$f":"CONCATENATE(\"Provider Name: \",'A. Provider Info'!$E$7)","v":"Provider Name: "}]
[{"$f":"CONCATENATE(\"National Provider ID: \",'A. Provider Info'!$E$8)","v":"National Provider ID: "}]
["Instructions:\nEnter any clarifying comments in addition to the information covered in previous worksheets or sections. Please specify the data period for the additional information. If there is no additional information, please mark as \"N/A\". You may also use this box to communicate any overall feedback for Minnesota Aging and Adult Services."]
["HOW LONG (IN HOURS) DID IT TAKE YOU TO COMPLETE THIS SURVEY FROM START TO FINISH?"]
[]
["ADDITIONAL INFORMATION"]