2004 S Health - NC Department of Health

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Consolidated Agreement -Final Page 8 of 21 iii. Line item 102 on the program budget must be used to budget TXIX Medicaid earned revenues. iv. Line item 103 on the program budget must be used to budget other earned revenues (e.g., Home Health fees, Environmental Health fees, patient fees (cash), other insurance payments, and other grants and donations). f. When reporting expenditures (local appropriations or earned fees) the department must use the electronic spreadsheet (Local Health Department/District Form DHHS 2949 revised 5/03/01) -hereafter referred as DHHS Spreadsheet -prepared and maintained by the DHHS Controller's Office. This report must be submitted monthly in an electronic format (DHHS 2949 -Local Health Dept/District Expenditure Report-Excel Spreadsheet File) as an attachment to an email to designated staff in the Benefits and Payment Section of the Controller's Office. At the time the electronic report is emailed to the DHHS Controller's Office, a "Certification of Expenditures" signed by the health director, shall be faxed to the DHHS Controller's Office. The "Certification" verifies in writing that the total State and Federal expenditures reported were valid. Local expenditures are part of the Expenditure report, but are not included in the amount verified in the "Certification." i. Line item 101 on the DHHS Form 2949 Spreadsheet must be used to report local appropriations that were expended ii. Line item 102 on the DHHS Form 2949 Spreadsheet must be used to report Title XIX (Medicaid) earned revenues that were expended. iii. Line item 103 on the DHHS Form 2949 Spreadsheet must be used to report other earned revenues that were expended. g. A local account shall be maintained for unexpended earned revenues [i.e., Title XIX fees, private Insurance or private pay {cash } ]. Accounts shall be maintained in sufficient detail to identify the program source generating the fees. h. The amount of Title XIX fees budgeted and expended in FY 2004-2005 must equal or exceed the amount of Title XIX revenues earned during FY 2002-2003. The state will not approve program activity budgets that do not include an amount of Title XIX fees sufficient to meet the requirements of this section. The State may waive this requirement if the Department provides sufficient justification. When reporting expenditures for Environmental Health, Childhood Lead, CDC . Childhood Lead Poisoning Prevention, or Food and Lodging, the Department must use the electronic Expenditure Report -prepared and maintained by the Department of Environment and Natural Resources, Division of Environmental Health (DENR- DEH). This report shall be submitted monthly in an electronic format as an attachment to an email to designated staff in the DENR Controller's Office and the Division of Environmental Health. A "Certification of Expenditures" (for items in "i." above), sinned by the health director and finance officer, shall be submitted annually with original Budget Forms