Lake County Ohio ADAMHS Board

Lake County ADAMHS Board SFY12 Non-Medicaid Request For Proposal Manual March, 2011

CONTENTS

Section I

INSTRUCTIONS TO PROPOSERS AND GENERAL CONDITIONS

Section II

SFY12 PROPOSAL FORM

SFY12 PROVIDER PROFILE

Section III

FISCAL SPECIFICATIONS

Section IV

SERVICE SPECIFICATIONS

Attachment 1

PROGRAM SUMMARY

Attachment 2

REPORTING REQUIREMENTS

Attachment 3

LAKE COUNTY ADAMHS TASK FORCE STRATEGIES MATRIX

Attachment 4

BOARD FEE SCHEDULE

Attachment 5

Budget Worksheets

GRANT LINE ITEM EXPENSE BUDGET FORM

GRANT LINE ITEM REVENUE BUDGET FORM

For Mental Health Service Proposals

DMH-UCR-FIS-047

MEDICAID RATE SHEET

For Alcohol and Drug Addiction Service Proposals

ODADAS-UCR-FIS-047

ODADAS-FIS-052

MEDICAID RATE SHEET

For Proposals that include Medicaid Reimbursements:

ESTIMATED SOURCE OF MATCHING FUNDS

Attachment 6

QUALITY IMPROVEMENT PLAN

Attachment 7

LAKE COUNTY ADAMHS BOARD POPULATION PRIORITIES