Possible Rate Models. Minnesota Association of Community Mental Health Programs, Inc. prepared by:

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1 Minnesota Association of Community Mental Health Programs, Inc Possible Rate Models prepared by: Burns & Associates, Inc North 3rd Street, Suite 200 Phoenix, Arizona (602) August 21 & 22, 2014

2 List of Services 1 Possible Rate Models Targeted Case Management 2 ARMHS Basic Living and Social Skills 3 ARMHS Community Intervention 4 ARMHS Medication Education 5 ARMHS Transition to Community Living 6 ARMHS Transition to Community Living Intervention 7 Discussion: Crisis Services MACMHP Possible Rate Models Table of Contents Burns & Associates, Inc. i August 21, 2014

3 Services Considered in the Discussion General Wage Levels Specific Services Licensed Professional* MH Practioner MH Rehabilitation Worker T2023HE Adult Mental Health Targeted Case Management Per Month Unit Current Rate Varies $208 to $816 Calculated Rate H2017 ARMHS Basic Living and Social Skills Licensed Professional, MH Practioner* 15 min $ $ H2017HM ARMHS Basic Living and Social Skills Rehabilitation Worker 15 min $ 9.75 H2017HQ ARMHS Basic Living and Social Skills - Group 15 min $ ARMHS Community Intervention Licensed Professional, MH Practioner* Session $ $ HM ARMHS Community Intervention Rehabilitation Worker Session $ H0034 ARMHS Medication Education** 15 min $ H0034HQ ARMHS Medication Education** - Group 15 min $ 8.36 H2017UD ARMHS Transitioning to Community Living Lic Prof, MH Practioner* 15 min $ $ H2017UDHM ARMHS Transitioning to Community Living Rehab Worker 15 min $ 9.75 $ UD ARMHS Transitioning to Community Living Intervention Lic Prof, MH Practioner* Session $ $ UDHM ARMHS Transitioning to Community Living Intervention Rehab Worker Session $ For Discussion HK Adult Crisis - Community Intervention Lic Prof, MH Practioner* Session $ HKHM Adult Crisis - Community Intervention Rehab Worker Session $ S9484 Adult Crisis - Adult MH crisis assessment, intervention and stabilization Lic Prof 60 min $ S9484HN Adult Crisis - Adult MH crisis assessment, intervention and stabilization Practioner 60 min $ S9484HM Adult Crisis - Adult MH crisis stabilization, non-residential Rehab Worker 60 min $ S9484HQ Adult Crisis - Adult MH crisis stabilization, group, non-residential (all categories) 60 min $ H0018 Adult Crisis - Stabilization, Residential Per diem Varies $222 to $777 Modifiers HE HK HM HN HQ UD Mental Health Intensive Adult MH Rehabilitation Worker or Mental Health Behavioral Aide Level II MH Practioner or Bachelor Degree Level (Clinical Trainee) Group Modality ARMHS Transitioning to community living * Licensed Professional LP (Licensed Psychologist) LICSW (Licensed Independent Clinical Social Worker) LMFT (Licensed Marriage and Family Therapist) LPCC (Licensed Professional Clinical Counselor) CNS MH (Clinical Nurse Specialist in Mental Health) Psychiatrist Nurse Practioner (with psychiatric specialty) Certified MH Rehabilitation Professional MH Practioner ** Medication Education Physician RN Pharmacist Physicians Assistant Burns & Associates, Inc. 1 August 21, 2014

4 Possible Rate Models Case Management Unit of Service Month Wages Direct Staff Hourly Wage $25.03 Employee Related Expenses ERE (as a percent of wages) 39.6% Direct Support Staff Wages and ERE Hourly Staff Cost Before Productivity Adj. (wages + ERE) $34.94 Productivity Assumptions Total Hours Participating in ISP/PCP meetings Travel Time (Between Members) Program development Program preparation/ set-up/ clean-up Missed appointments Recordkeeping Employer and One-on-One Supervision Time Training 1.00 "Billable" Hours Productivity Adjustment 1.18 Hourly Staff Cost per Billable Hour $41.11 Caseload Assumptions Number of Cases 30 Hours per Client per Month 4.91 Monthly Staff Cost per Client $ Mileage Admin. and Prog. Support - Number of Miles Traveled per Month 900 Allocated Miles per Client per Month 30 - Amount per Mile $0.560 Monthly Mileage Cost per Client $16.80 Monthly Cost per Client Before Admin. and Support $ Program Support Percent 10.0% Monthly Program Support Cost per Client $ Administration Percent 10.0% Monthly Administrative Cost per Client $27.34 Rate per Month $ Burns & Associates, Inc 2 August 21, 2014

5 Possible Rate Models Direct Support Staff Wages and Benefits Mileage Admin. and Prog. Support Multiple Member Rates Basic Living and Social Skills Professional & Rehab Practioner Worker Unit of Service 15 Minute 15 Minute Wages Direct Staff Hourly Wage $17.47 $17.47 Employee Benefits Benefit Rate (as a percent of wages) 47.7% 47.7% Hourly Staff Cost Before Productivity Adj. (wages + benefits) $25.81 $25.81 Productivity Assumptions Total Hours Participating in ISP/PCP meetings Travel Time (Between Members) Program development Program preparation/ set-up/ clean-up Missed appointments Recordkeeping Employer and One-on-One Supervision Time Training "Billable" Hours Productivity Adjustment Staff Cost After Productivity Adjustment $36.87 $ Number of Miles Traveled per Week Amount per Mile $0.560 $0.560 Weekly Mileage Cost $84.00 $84.00 Mileage Cost per Billable Hour $3.00 $3.00 Cost per Billable Hour Before Admin. and Support $39.87 $ Program Support Percent 20.0% 20.0% Program Support Cost per Billable Hour $11.39 $ Administration Percent 10.0% 10.0% Administrative Cost per Billable Hour $5.70 $5.70 Total Base Cost per Billable Hour $56.96 $56.96 Rate per 15 Minutes $14.24 $14.24 Groups Larger than 3 Members Group Size Rate per Member per 15 Minutes #DIV/0! #DIV/0! 2 Members Rate Premium 10% 10% Total Hourly Rate $62.65 $62.66 Rate per Member per 15 Minutes $7.83 $ Members Rate Premium 20% 20% Total Hourly Rate $68.35 $68.35 Rate per Member per 15 Minutes $5.70 $5.70 Burns & Associates, Inc 3 August 21, 2014

6 Possible Rate Models Direct Support Staff Wages and Benefits Mileage Admin. and Prog. Support Community Intervention Professional & Rehab Practioner Worker Unit of Service Session Session Wages Direct Staff Hourly Wage $23.71 $23.71 Employee Benefits Benefit Rate (as a percent of wages) 41.1% 41.1% Hourly Staff Cost Before Productivity Adj. (wages + benefits) $33.45 $33.45 Productivity Assumptions Total Hours Participating in ISP/PCP meetings Travel Time (Between Members) Program development Program preparation/ set-up/ clean-up Missed appointments Recordkeeping Employer and One-on-One Supervision Time Training "Billable" Hours Productivity Adjustment Staff Cost After Productivity Adjustment $73.52 $ Number of Miles Traveled per Week Amount per Mile $0.560 $0.560 Weekly Mileage Cost $ $0.00 Mileage Cost per Billable Hour $6.15 $0.00 Cost per Billable Hour Before Admin. and Support $79.67 $ Program Support Percent 20.0% 20.0% Program Support Cost per Billable Hour $22.76 $ Administration Percent 10.0% 10.0% Administrative Cost per Billable Hour $11.38 $3.72 Total Base Cost per Billable Hour $ $37.20 Average Length of Session 0.50 Rate per Session $56.91 $0.00 Burns & Associates, Inc 4 August 21, 2014

7 Possible Rate Models Medication Education Direct Support Staff Wages and Benefits Mileage Admin. and Prog. Support Multiple Member Rates Unit of Service Professional 15 Minute Wages Direct Staff Hourly Wage $57.64 Employee Benefits Benefit Rate (as a percent of wages) 0.0% Hourly Staff Cost Before Productivity Adj. (wages + benefits) $57.64 Productivity Assumptions Total Hours Participating in ISP/PCP meetings Travel Time (Between Members) Program development Program preparation/ set-up/ clean-up Missed appointments Recordkeeping Employer and One-on-One Supervision Time Training 1.00 "Billable" Hours Productivity Adjustment 1.18 Staff Cost After Productivity Adjustment $ Number of Miles Traveled per Week 75 - Amount per Mile $0.560 Weekly Mileage Cost $42.00 Mileage Cost per Billable Hour $1.24 Cost per Billable Hour Before Admin. and Support $ Program Support Percent 20.0% Program Support Cost per Billable Hour $ Administration Percent 10.0% Administrative Cost per Billable Hour $9.86 Total Base Cost per Billable Hour $98.64 Rate per 15 Minutes $24.66 Groups Larger than 3 Members Group Size Rate per Member per 15 Minutes #DIV/0! 2 Members Rate Premium 10% Total Hourly Rate $ Rate per Member per 15 Minutes $ Members Rate Premium 20% Total Hourly Rate $ Rate per Member per 15 Minutes $9.86 Burns & Associates, Inc 5 August 21, 2014

8 Possible Rate Models Direct Support Staff Wages and Benefits Mileage Admin. and Prog. Support Transitioning to Community Living Professional & Rehab Practioner Worker Unit of Service 15 Minute 15 Minute Wages Direct Staff Hourly Wage $25.17 $17.47 Employee Benefits Benefit Rate (as a percent of wages) 39.6% 47.7% Hourly Staff Cost Before Productivity Adj. (wages + benefits) $35.13 $25.81 Productivity Assumptions Total Hours Participating in ISP/PCP meetings Travel Time (Between Members) Program development Program preparation/ set-up/ clean-up Missed appointments Recordkeeping Employer and One-on-One Supervision Time Training "Billable" Hours Productivity Adjustment Staff Cost After Productivity Adjustment $61.10 $ Number of Miles Traveled per Week Amount per Mile $0.560 $0.560 Weekly Mileage Cost $84.00 $84.00 Mileage Cost per Billable Hour $3.65 $3.23 Cost per Billable Hour Before Admin. and Support $64.75 $ Program Support Percent 20.0% 20.0% Program Support Cost per Billable Hour $18.50 $ Administration Percent 10.0% 10.0% Administrative Cost per Billable Hour $9.25 $4.78 Total Base Cost per Billable Hour $92.50 $47.76 Rate per 15 Minutes $23.13 $11.94 Burns & Associates, Inc 6 August 21, 2014

9 Possible Rate Models Direct Support Staff Wages and Benefits Mileage Admin. and Prog. Support Transitioning to Community Living Intervention Professional & Rehab Practioner Worker Unit of Service Session Session Wages Direct Staff Hourly Wage $23.30 $0.00 Employee Benefits Benefit Rate (as a percent of wages) 41.1% 0.0% Hourly Staff Cost Before Productivity Adj. (wages + benefits) $32.87 $0.00 Productivity Assumptions Total Hours Participating in ISP/PCP meetings Travel Time (Between Members) Program development Program preparation/ set-up/ clean-up Missed appointments Recordkeeping Employer and One-on-One Supervision Time Training "Billable" Hours Productivity Adjustment Staff Cost After Productivity Adjustment $82.18 $ Number of Miles Traveled per Week Amount per Mile $0.560 $0.560 Weekly Mileage Cost $ $0.00 Mileage Cost per Billable Hour $10.50 $0.00 Cost per Billable Hour Before Admin. and Support $92.68 $ Program Support Percent 20.0% 20.0% Program Support Cost per Billable Hour $26.48 $ Administration Percent 10.0% 10.0% Administrative Cost per Billable Hour $13.24 $0.00 Total Base Cost per Billable Hour $ $0.03 Average Length of Session 1.00 Rate per Session $ $0.00 Burns & Associates, Inc 7 August 21, 2014

10 Minnesota Association of Community Mental Health Programs, Inc Background Materials for Rate Setting Wages, ERE and Productivity prepared by: Burns & Associates, Inc North 3rd Street, Suite 200 Phoenix, Arizona (602) August 21 & 22, 2014

11 MACMHP Wages, ERE and Productivity Table of Contents List of Services 1 Wage Assumptions 2 Benefits Assumptions to Establish Benefit Rates 11 Productivity Assumptions 15 Burns & Associates, Inc. i July 22, 2014

12 Services Considered in the Discussion General Wage Levels Specific Services Licensed Professional* MH Practioner MH Rehabilitation Worker Unit Current Rate Calculated Rate T2023HE Adult Mental Health Targeted Case Management Per Month Varies $208 to $816 H2017 ARMHS Basic Living and Social Skills Licensed Professional, MH Practioner* 15 min $ H2017HM ARMHS Basic Living and Social Skills Rehabilitation Worker 15 min $ 9.75 H2017HQ ARMHS Basic Living and Social Skills - Group 15 min $ ARMHS Community Intervention Licensed Professional, MH Practioner* Session $ HM ARMHS Community Intervention Rehabilitation Worker Session $ H0034 ARMHS Medication Education** 15 min $ H0034HQ ARMHS Medication Education** - Group 15 min $ 8.36 H2017UD ARMHS Transitioning to Community Living Lic Prof, MH Practioner* 15 min $ H2017UDHM ARMHS Transitioning to Community Living Rehab Worker 15 min $ UD ARMHS Transitioning to Community Living Intervention Lic Prof, MH Practioner* Session $ UDHM ARMHS Transitioning to Community Living Intervention Rehab Worker Session $ For Discussion HK Adult Crisis - Community Intervention Lic Prof, MH Practioner* Session $ HKHM Adult Crisis - Community Intervention Rehab Worker Session $ S9484 Adult Crisis - Adult MH crisis assessment, intervention and stabilization Lic Prof 60 min $ S9484HN Adult Crisis - Adult MH crisis assessment, intervention and stabilization Practioner 60 min $ S9484HM Adult Crisis - Adult MH crisis stabilization, non-residential Rehab Worker 60 min $ S9484HQ Adult Crisis - Adult MH crisis stabilization, group, non-residential (all categories) 60 min $ H0018 Adult Crisis - Stabilization, Residential Per diem Varies $222 to $777 Modifiers HE HK HM HN HQ UD Mental Health Intensive Adult MH Rehabilitation Worker or Mental Health Behavioral Aide Level II MH Practioner or Bachelor Degree Level (Clinical Trainee) Group Modality ARMHS Transitioning to community living * Licensed Professional LP (Licensed Psychologist) LICSW (Licensed Independent Clinical Social Worker) LMFT (Licensed Marriage and Family Therapist) LPCC (Licensed Professional Clinical Counselor) CNS MH (Clinical Nurse Specialist in Mental Health) Psychiatrist Nurse Practioner (with psychiatric specialty) Certified MH Rehabilitation Professional MH Practioner ** Medication Education Physician RN Pharmacist Physicians Assistant Burns & Associates, Inc. 1 August 21, 2014

13 Bureau of Labor Statistics Data (Inflated to Mar 2014) BLS Wage Information Selected SOC - Minnesota SOC Code Description MN 10th %-ile MN 25th %-ile MN Median MN Mean MN 75th %-ile MN 90th %-ile Medical and Health Services Managers $27.20 $34.30 $43.30 $47.39 $55.20 $ Social and Community Service Managers $20.40 $23.65 $30.25 $32.85 $39.43 $ Clinical, Counseling, and School Psychologists $19.21 $24.93 $32.45 $34.76 $41.64 $ Psychologists, All Other $21.18 $27.73 $47.92 $60.29 $83.61 # Substance Abuse and Behavioral Disorder Counselors $17.11 $19.85 $22.37 $23.16 $26.37 $ Educational, Guidance, School, and Vocational Counselors $15.56 $19.03 $24.25 $26.42 $32.31 $ Marriage and Family Therapists $14.39 $18.83 $22.73 $24.06 $28.05 $ Mental Health Counselors $14.15 $17.20 $21.02 $22.13 $25.59 $ Rehabilitation Counselors $10.97 $13.53 $17.47 $18.87 $22.78 $ Counselors, All Other $12.40 $15.07 $18.16 $20.05 $24.40 $ Child, Family, and School Social Workers $16.95 $21.87 $29.04 $29.18 $35.20 $ Healthcare Social Workers $17.13 $20.04 $24.27 $25.34 $29.80 $ Mental Health and Substance Abuse Social Workers $17.05 $20.06 $23.71 $25.58 $30.05 $ Social Workers, All Other $21.88 $28.02 $32.63 $31.05 $35.46 $ Community Health Workers $12.32 $15.97 $19.93 $20.24 $24.63 $ Community and Social Service Specialists, All Other $14.68 $17.54 $21.82 $22.83 $27.98 $ Psychiatrists $42.73 $70.07 $ $ # # Physician Assistants $33.78 $41.37 $48.95 $48.76 $56.56 $ Occupational Therapists $22.61 $27.80 $32.88 $32.77 $36.96 $ Physical Therapists $28.51 $32.50 $37.71 $37.35 $42.94 $ Recreational Therapists $16.17 $18.28 $21.71 $22.58 $25.34 $ Speech-Language Pathologists $21.05 $26.19 $33.88 $34.81 $43.48 $ Registered Nurses $24.24 $28.27 $34.41 $34.71 $41.36 $ Nurse Practitioners $37.34 $40.79 $46.67 $47.37 $54.28 $ Emergency Medical Technicians and Paramedics $10.58 $13.36 $16.70 $18.09 $21.53 $ Psychiatric Technicians $11.54 $13.07 $15.33 $16.24 $18.89 $ Licensed Practical and Licensed Vocational Nurses $15.72 $17.40 $20.04 $20.21 $22.57 $ Home Health Aides $9.36 $10.16 $11.25 $11.54 $12.94 $ Psychiatric Aides $10.16 $12.41 $15.13 $14.73 $17.41 $ Nursing Assistants $10.13 $11.23 $13.09 $13.39 $15.00 $ Orderlies $10.85 $12.69 $14.82 $14.61 $16.94 $ Occupational Therapy Assistants $16.50 $19.21 $21.74 $22.11 $25.09 $ Occupational Therapy Aides $10.37 $12.27 $14.31 $15.34 $19.48 $ Physical Therapist Assistants $17.03 $19.95 $22.76 $22.91 $26.49 $ Physical Therapist Aides $9.71 $11.93 $13.72 $14.00 $16.16 $ Security Guards $9.74 $11.01 $13.28 $14.78 $16.88 $ Chefs and Head Cooks $13.83 $17.65 $22.16 $23.31 $29.20 $ Cooks, Institution and Cafeteria $9.67 $10.86 $12.93 $13.31 $15.40 $ Childcare Workers $8.06 $8.89 $10.50 $10.77 $12.65 $ Personal Care Aides $9.29 $10.03 $10.96 $11.25 $12.03 $ Residential Advisors $9.92 $12.43 $15.21 $15.44 $18.33 $ Receptionists and Information Clerks $8.90 $10.87 $13.81 $14.01 $16.91 $ Medical Secretaries $14.73 $16.35 $18.68 $18.69 $21.28 $ Secretaries and Administrative Assistants, Except Legal, Medical, an $12.37 $15.06 $17.94 $18.23 $21.60 $ Maintenance and Repair Workers, General $12.17 $15.63 $19.49 $19.99 $23.52 $ Bus Drivers, School or Special Client $10.67 $13.10 $15.85 $15.86 $18.18 $ Taxi Drivers and Chauffeurs $8.13 $9.07 $11.07 $11.74 $13.81 $16.95 Note: "#" Denotes reported wages greater than $90.00 per hour or $187,199 per year. Burns & Associates, Inc 2 August 21, 2014

14 Wage Determination - Example Packet Bureau of Labor Statistics Description of Duties * * * SOC Code Description Duties Medical and Health Services Managers Plan, direct, or coordinate medical and health services in hospitals, clinics, managed care organizations, public health agencies, or similar organizations Social and Community Service Managers Plan, direct, or coordinate the activities of a social service program or community outreach organization. Oversee the program or organization's budget and policies regarding participant involvement, program requirements, and benefits. Work may involve directing social workers, counselors, or probation officers Clinical, Counseling, and School Psychologists Psychologists, All Other All psychologists not listed separately Substance Abuse and Behavioral Disorder Counselors Diagnose and treat mental disorders; learning disabilities; and cognitive, behavioral, and emotional problems, using individual, child, family, and group therapies. May design and implement behavior modification programs. Counsel and advise individuals with alcohol, tobacco, drug, or other problems, such as gambling and eating disorders. May counsel individuals, families, or groups or engage in prevention programs. Excludes "Social Workers" ( through ), "Psychologists" ( through ), and "Mental Health Counselors" ( ) providing these services Educational, Guidance, School, and Vocational Counselors Counsel individuals and provide group educational and vocational guidance services Marriage and Family Therapists Diagnose and treat mental and emotional disorders, whether cognitive, affective, or behavioral, within the context of marriage and family systems. Apply psychotherapeutic and family systems theories and techniques in the delivery of services to individuals, couples, and families for the purpose of treating such diagnosed nervous and mental disorders. Excludes "Social Workers" ( through ) and "Psychologists" of all types ( through ) Mental Health Counselors Counsel with emphasis on prevention. Work with individuals and groups to promote optimum mental and emotional health. May help individuals deal with issues associated with addictions and substance abuse; family, parenting, and marital problems; stress management; self-esteem; and aging. Excludes "Social Workers" ( through ), "Psychiatrists" ( ), and "Psychologists" ( through ) Rehabilitation Counselors Counsel individuals to maximize the independence and employability of persons coping with personal, social, and vocational difficulties that result from birth defects, illness, disease, accidents, or the stress of * daily life. Coordinate activities for residents of care and treatment facilities. Assess client needs and design and implement rehabilitation programs that may include personal and vocational counseling, training, and job placement. * Counselors, All Other All counselors not listed separately. * Child, Family, and School Social Workers Provide social services and assistance to improve the social and psychological functioning of children and their families and to maximize the family well-being and the academic functioning of children. May assist parents, arrange adoptions, and find foster homes for abandoned or abused children. In schools, they address such problems as teenage pregnancy, misbehavior, and truancy. May also advise teachers Healthcare Social Workers Provide individuals, families, and groups with the psychosocial support needed to cope with chronic, acute, or terminal illnesses. Services include advising family care givers, providing patient education and counseling, and making referrals for other services. May also provide care and case management or interventions designed to promote health, prevent disease, and address barriers to access to healthcare Mental Health and Substance Abuse Social Workers Assess and treat individuals with mental, emotional, or substance abuse problems, including abuse of alcohol, tobacco, and/or other drugs. Activities may include individual and group therapy, crisis intervention, case management, client advocacy, prevention, and education Social Workers, All Other All social workers not listed separately Community Health Workers Assist individuals and communities to adopt healthy behaviors. Conduct outreach for medical personnel or health organizations to implement programs in the community that promote, maintain, and improve individual and community health. May provide information on available resources, provide social support and informal counseling, advocate for individuals and community health needs, and provide services such as first aid and blood pressure screening. May collect data to help identify community health needs. Excludes Health Educators ( ) Community and Social Service All community and social service specialists not listed separately. Specialists, All Other * Psychiatrists Physicians who diagnose, treat, and help prevent disorders of the mind Physician Assistants Provide healthcare services typically performed by a physician, under the supervision of a physician. Conduct complete physicals, provide treatment, and counsel patients. May, in some cases, prescribe medication. Must graduate from an accredited educational program for physician assistants. Excludes "Emergency Medical Technicians and Paramedics" ( ), "Medical Assistants" ( ), "Registered Nurses" ( ), "Nurse Anesthetists" ( ), "Nurse Midwives" ( ), and "Nurse Practitioners" ( ) Occupational Therapists Assess, plan, organize, and participate in rehabilitative programs that help build or restore vocational, homemaking, and daily living skills, as well as general independence, to persons with disabilities or developmental delays Physical Therapists Assess, plan, organize, and participate in rehabilitative programs that improve mobility, relieve pain, increase strength, and improve or correct disabling conditions resulting from disease or injury. Burns & Associates, Inc. 3 August 21, 2014

15 Wage Determination - Example Packet Bureau of Labor Statistics Description of Duties SOC Code Description Duties Recreational Therapists Plan, direct, or coordinate medically-approved recreation programs for patients in hospitals, nursing homes, or other institutions. Activities include sports, trips, dramatics, social activities, and arts and crafts. May assess a patient condition and recommend appropriate recreational activity. Excludes "Recreation Workers" ( ) Speech-Language Pathologists Assess and treat persons with speech, language, voice, and fluency disorders. May select alternative communication systems and teach their use. May perform research related to speech and language problems Registered Nurses Assess patient health problems and needs, develop and implement nursing care plans, and maintain medical records. Administer nursing care to ill, injured, convalescent, or disabled patients. May advise * patients on health maintenance and disease prevention or provide case management. Licensing or registration required. Includes Clinical Nurse Specialists. Excludes "Nurse Anesthetists" ( ), "Nurse Midwives" ( ), and "Nurse Practitioners" ( ) Nurse Practitioners Diagnose and treat acute, episodic, or chronic illness, independently or as part of a healthcare team. May * focus on health promotion and disease prevention. May order, perform, or interpret diagnostic tests such as lab work and x rays. May prescribe medication. Must be registered nurses who have specialized graduate education Emergency Medical Technicians and Paramedics Assess injuries, administer emergency medical care, and extricate trapped individuals. Transport injured or sick persons to medical facilities Psychiatric Technicians Care for individuals with mental or emotional conditions or disabilities, following the instructions of physicians or other health practitioners. Monitor patients' physical and emotional well-being and report to medical staff. May participate in rehabilitation and treatment programs, help with personal hygiene, and administer oral or injectable medications Licensed Practical and Licensed * Vocational Nurses * Care for ill, injured, or convalescing patients or persons with disabilities in hospitals, nursing homes, clinics, private homes, group homes, and similar institutions. May work under the supervision of a registered nurse. Licensing required Home Health Aides Provide routine individualized healthcare such as changing bandages and dressing wounds, and applying topical medications to the elderly, convalescents, or persons with disabilities at the patient's home or in a care facility. Monitor or report changes in health status. May also provide personal care such as bathing, dressing, and grooming of patient Psychiatric Aides Assist mentally impaired or emotionally disturbed patients, working under direction of nursing and medical staff. May assist with daily living activities, lead patients in educational and recreational activities, or accompany patients to and from examinations and treatments. May restrain violent patients. Includes psychiatric orderlies Nursing Assistants Provide basic patient care under direction of nursing staff. Perform duties such as feed, bathe, dress, groom, or move patients, or change linens. May transfer or transport patients. Includes nursing care attendants, nursing aides, and nursing attendants. Excludes Home Health Aides ( ), Orderlies ( ), Personal Care Aides ( ), and Psychiatric Aides ( ) Orderlies Transport patients to areas such as operating rooms or x-ray rooms using wheelchairs, stretchers, or moveable beds. May maintain stocks of supplies or clean and transport equipment. Psychiatric orderlies are included in Psychiatric Aides ( ). Excludes Nursing Assistants ( ) Occupational Therapy Assistants Assist occupational therapists in providing occupational therapy treatments and procedures. May, in accordance with State laws, assist in development of treatment plans, carry out routine functions, direct activity programs, and document the progress of treatments. Generally requires formal training Occupational Therapy Aides Under close supervision of an occupational therapist or occupational therapy assistant, perform only delegated, selected, or routine tasks in specific situations. These duties include preparing patient and treatment room Physical Therapist Assistants Assist physical therapists in providing physical therapy treatments and procedures. May, in accordance with State laws, assist in the development of treatment plans, carry out routine functions, document the progress of treatment, and modify specific treatments in accordance with patient status and within the scope of treatment plans established by a physical therapist. Generally requires formal training Physical Therapist Aides Under close supervision of a physical therapist or physical therapy assistant, perform only delegated, selected, or routine tasks in specific situations. These duties include preparing the patient and the treatment area Security Guards Guard, patrol, or monitor premises to prevent theft, violence, or infractions of rules. May operate x-ray and metal detector equipment. Excludes "Transportation Security Screeners" ( ) Chefs and Head Cooks Direct and may participate in the preparation, seasoning, and cooking of salads, soups, fish, meats, vegetables, desserts, or other foods. May plan and price menu items, order supplies, and keep records and accounts Cooks, Institution and Cafeteria Prepare and cook large quantities of food for institutions, such as schools, hospitals, or cafeterias Childcare Workers Attend to children at schools, businesses, private households, and childcare institutions. Perform a variety of tasks, such as dressing, feeding, bathing, and overseeing play. Excludes "Preschool Teachers, Except Special Education" ( ) and "Teacher Assistants" ( ). Burns & Associates, Inc. 4 August 21, 2014

16 Wage Determination - Example Packet Bureau of Labor Statistics Description of Duties SOC Code Description Duties Personal Care Aides Assist the elderly, convalescents, or persons with disabilities with daily living activities at the person's home or in a care facility. Duties performed at a place of residence may include keeping house (making * beds, doing laundry, washing dishes) and preparing meals. May provide assistance at non-residential care facilities. May advise families, the elderly, convalescents, and persons with disabilities regarding such things as nutrition, cleanliness, and household activities Residential Advisors Coordinate activities in resident facilities in secondary and college dormitories, group homes, or similar establishments. Order supplies and determine need for maintenance, repairs, and furnishings. May maintain household records and assign rooms. May assist residents with problem solving or refer them to counseling resources Receptionists and Information Clerks Answer inquiries and provide information to the general public, customers, visitors, and other interested parties regarding activities conducted at establishment and location of departments, offices, and employees within the organization. Excludes "Switchboard Operators, Including Answering Service" ( ) Medical Secretaries Perform secretarial duties using specific knowledge of medical terminology and hospital, clinic, or laboratory procedures. Duties may include scheduling appointments, billing patients, and compiling and recording medical charts, reports, and correspondence Secretaries and Administrative Assistants, Except Legal, Medical, and Executive Maintenance and Repair Workers, General Perform routine clerical and administrative functions such as drafting correspondence, scheduling appointments, organizing and maintaining paper and electronic files, or providing information to callers. Excludes legal, medical, and executive secretaries ( through ). Perform work involving the skills of two or more maintenance or craft occupations to keep machines, mechanical equipment, or the structure of an establishment in repair. Duties may involve pipe fitting; boiler making; insulating; welding; machining; carpentry; repairing electrical or mechanical equipment; installing, aligning, and balancing new equipment; and repairing buildings, floors, or stairs. Excludes "Maintenance Workers, Machinery" ( ) Bus Drivers, School or Special Client Transport students or special clients, such as the elderly or persons with disabilities. Ensure adherence to safety rules. May assist passengers in boarding or exiting Taxi Drivers and Chauffeurs Drive automobiles, vans, or limousines to transport passengers. May occasionally carry cargo. Includes hearse drivers. Excludes "Ambulance Drivers and Attendants, Except Emergency Medical Technicians" ( ) and "Bus Drivers" ( ). Burns & Associates, Inc. 5 August 21, 2014

17 2014 MACMHP Survey of Member Organizations Job Descriptions Clinical Director Clinical Manager (All education levels) Key management position with authority to make decisions that impact the entire operations, such as directing multiple clinical programs, procedure or policy changes. Generally reports to the Executive Director. Includes job titles such as Clinical Director, Clinical Supervisor and Senior Operations Director, among others. There were no new hires (since 2012) or contractors reported. Degrees and licenses included: (20) Masters, (3) Ph.D.'s, (8) LICSWs, (6) LPs, (3) CPRPs; and one each of the following: Psy.D., RN, CCC-SLP, CRC and LMFT. Key middle management positions where decision-making authority is more limited than that of a director. Generally reports to and is directly responsible to the Executive Director or another manager or director. Includes a broad range of program management roles, including psychologists and other mental health professionals (licensed) with significant management and/or supervisory responsibilities. (Following pages break down Clinical Managers based on education level: All Education Levels; Ph.D. and Psy.D.; Masters; and, Bachelors/Non-Degreed.) Clinical Manager (Ph.D. and Psy.D. level) See position description on page 6. Includes job titles such as: Clinic Manager, Outpatient Services Manager, Program Manager and Site Manager. There was one new hire (since 2012) reported. Licenses included: (12) LPs and (2) LPCCs. Clinical Manager (Masters level) See position description on page 6. Includes job titles such as: Clinic Manager, Clinical Supervisor, Clinical Site Manager, Outpatient Services Manager and Program Coordinator. There was one new hire (since 2012) reported. Licenses included: (30) LICSWs, (6) LMFTs, (8) LPs, (1) LPCC and (1) CPRP. Clinical Manager (Bachelors/nondegreed level) Licensed Psychologist (Ph.D./Psy.D. level; noncontracted) Licensed Psychologist (Masters level; non-contracted) Licensed Independent Clinical Social Worker (LICSW; noncontracted) Psychiatrist or other MD (noncontracted) Advanced Practice Nurse/CNS in Psych Nursing with Rx Privileges (non-contracted) See position description on page 6. Includes job titles such as: Clinical Manager, Community Health Program Manager, Program Coordinator/Director, Team Leader and Unit Director. There was one new hire (since 2012) reported. Licenses included: (5) LICSWs, (2) LSWs, (2) LADCs, (1) LPCC and (1) CPRP. These therapists were broken down into two categories based on education level: Ph.D. and Psy.D.; and Masters. Note: Psychologists and other mental health professionals (licensed) with significant management and/or supervisory responsibility are reported in the Clinical Managers section. There were (13) new hires (since 2012) reported for the Ph.D./Psy.D. education group. These therapists were broken down into two categories based on education level: Ph.D. and Psy.D.; and Masters. Note: Psychologists and other mental health professionals (licensed) with significant management and/or supervisory responsibility are reported in the Clinical Managers section. There was one new hire (since 2012) reported for the Masters education group. There were (17) new hires (since 2012) reported. Contractors in this category are included in the Mental Health Professional Contractors section. Includes job titles such as Psychiatrist, Medical Director and On-Call Psychiatrist. There was one new hire (since 2012) reported. These nurses have advanced degrees, have passed a specialist certification exam, have taken coursework to qualify to prescribe, and have a collaborative agreement with a psychiatrist. Includes job titles such as: APRN, CNS, Nurse Practitioner and Psychiatric Nurse Practitioner. There were (7) new hires (since 2012) reported. Contractors in this category are included in the Mental Health Professional Contractors section. Advanced Graduate Nurse RN/CNS in Psych Nursing without Rx Privileges (non-contracted) These nurses have advanced degrees and have passed a specialist certification exam. There was one new hire (since 2012) reported. NOTE: In 2012 and again in 2014, there were only two people reported in this category. However, the 2012 data was not retained, resulting in missing information in the table and bar chart. Registered Nurse (RN) Registered Nurse, Certified (RNC) Licensed Practical Nurse (LPN) These registered nurses include those with and without Bachelor degrees. There were (23) new hires (since 2012) reported. These registered nurses have passed a certification exam in mental health nursing. There were no new hires (since 2012) reported. Includes job titles such as: Support Nurse, Crisis Team Nurse, Detox Nurse, LPN Extender, Outpatient Nurse and LPN. There were (30) new hires (since 2012) reported. Burns & Associates, Inc. 6 August 17, 2014

18 2014 MACMHP Survey of Member Organizations Job Descriptions Licensed Marriage and Family Therapist (LMFT; non-contracted) Includes job titles such as: Mobile Crisis Clinician, Outpatient Therapist, IRTS Treatment Director, Early Childhood Mental Health Therapist, School Therapist and LMFT. There were (8) new hires (since 2012) reported. Chemical Dependency Counselor Includes professionals with chemical dependency licensure as their primary or only credential, with job titles such as Alcohol and Drug Counselor, Chemical Dependency Counselor and Chemical Health Assessor. Other Licensed or Certified Clinical Staff (Masters level) Other Licensed or Certified Clinical Staff (Bachelors/COTA level) These professionals were broken down into two categories based on education level: Masters level or Bachelors level. The Masters level includes Licensed Psychological Practitioners (LPP) and Licensed Professional Counselors (LPC), with job titles such as: Case Manager, Care Guide, Counselor, Outpatient Therapist, School Therapist. There were (9) new hires (since 2012) reported. These professionals were broken down into two categories based on education level: Masters level or Bachelors level. The Bachelors level includes job titles such as: Certified Occupational Therapy Assistant (COTA), licensed social worker (LSW), Speech Language Pathologist, School Therapist, Case Manager, Rehab Therapist, Counselor and Care Coordinator. There were (11) new hires (since 2012) reported. Mental Health Practitioner with Degree Mental Health Practitioner without Degree Unlicensed Clinical Staff with Degrees (Board Eligible, Completing Licensure) Includes Mental Health Practitioners defined by the State of Minnesota as follows: Holds a Bachelors degree in behavioral sciences or related fields and have 2,200 hours of supervised experience delivering mental health services. Also, the organization can bill for services provided by the Mental Health Practitioner. These people are not licensed. Includes job titles such as Activities Coordinator, Case Manager, Certified Peer Specialist, Community/Housing Support Specialist, IRTS Mental Health Practitioner, Mental Health Behavior Aides, Peer Recovery Specialist and Mental Health Practitioner. There were (33) new hires (since 2012) reported. Note: There were no Mental Health Practitioners with Ph.D./Psy.D. degrees reported this year. Includes Mental Health Practitioners defined by the State of Minnesota as follows: Have 6,000 hours of supervised experience delivering mental health services but does not hold a Masters or Bachelors degree. Also, the organization can bill for services provided by the Mental Health Practitioner. These people are not licensed. Includes job titles such as Case Manager, Certified Peer Specialist, Community Support Specialist, Homeless Services Coordinator, Rehab Worker, Outreach Social worker, IRTS Mental Health Practitioner and Mental Health Practitioner. There were (41) new hires (since 2012) reported. Includes staff who are completing the supervised experience requirement for licensure as a Qualified Mental Health Professional (QMHP), as well as staff who work in outpatient, day treatment, child mental health or other qualifying supervised experiences. This category also includes Licensed Graduate Social Workers (LGSW) and Mental Health Practitioners working on their licensure. There were (19) new hires (since 2012) reported. Unlicensed Clinical Staff (Ph.D. and Master degrees; not MH Practitioners) Includes staff with Ph.D. and Masters level degrees, but are not qualified Mental Health Practitioners because of their degree or lack of experience. Includes job titles such as: Care Guide, Case Manager, Community Mental Health Worker, Counselor, Crisis Line Counselor, In-Home Family Therapist, Overnight Mental Health Worker, Peer Recovery Specialist, Social Service Lead and Mental Health Worker. There were (29) new hires (since 2012) reported. Unlicensed Clinical Staff (Bachelor and other degrees; not MH Practitioners) Unlicensed and Non-Degreed Clinical Staff/Direct Service Staff (not MH Practitioners) Includes staff with Bachelors degrees, but are not qualified Mental Health Practitioners because of their degree or lack of experience. Includes job titles such as: ACT Provider, Counselor, Case Manager, Community Mental Health Worker, Housing Support Services, Mental Health Rehab Worker, Overnight Mental Health Worker, Social Services, Youth Outreach Specialist, Targeted Case Manager and Mental Health Worker. There were (81) new hires (since 2012) reported. Clinical staff who do not have a degree nor do they qualify as a Mental Health Practitioner. Includes job titles such as Behavioral Aide, CD Technician, Counseling Assistant, Detox Technician, Human Services Technician, Mental Health Rehab Worker, Mental Health Worker, Medical Assistant, Peer Recovery/Support Specialist, Program Assistant, Social Rehabilitation Specialist, Developmental Specialist and Treatment Technician/Coordinator. There were (63) new hires (since 2012) reported. Burns & Associates, Inc. 7 August 17, 2014

19 2014 MACMHP Survey of Member Organizations Job Descriptions Category Count SOC BLS MN Mean BLS MN Median Psychiatrist or other MD (non-contracted) Direct Care $ # Advanced Practice Nurse/CNS in Psych Nursing with Rx Privileges (non-contracted) Direct Care $ $ Advanced Graduate Nurse RN/CNS in Psych Nursing without Rx Privileges (non-contracted) Direct Care $ $ Registered Nurse, Certified (RNC) Direct Care $ $ Licensed Psychologist (Ph.D./Psy.D. level; non-contracted) Direct Care $ $ Registered Nurse (RN) Direct Care $ $ Licensed Psychologist (Masters level; non-contracted) Direct Care $ $ Licensed Independent Clinical Social Worker (LICSW; noncontracted) Direct Care $ $ Licensed Marriage and Family Therapist (LMFT; non-contracted) Direct Care $ $ Other Licensed or Certified Clinical Staff (Bachelors/COTA level) Direct Care $ $ Other Licensed or Certified Clinical Staff (Masters level) Direct Care $ $ Chemical Dependency Counselor Direct Care $ $ Mental Health Practitioner with Degree Direct Care $ $ Unlicensed Clinical Staff with Degrees (Board Eligible, Completing Licensure) Direct Care $ $ Licensed Practical Nurse (LPN) Direct Care $ $ Unlicensed Clinical Staff (Ph.D. and Master degrees; not MH Practitioners) Direct Care $ $ Unlicensed Clinical Staff (Bachelor and other degrees; not MH Practitioners) Direct Care $ $ Mental Health Practitioner without Degree Direct Care $ $ Unlicensed and Non-Degreed Clinical Staff/Direct Service Staff (not MH Practitioners) Direct Care $ $ Guess Clinical Director Program Support 28 $ Clinical Manager Program Support 99 $ Burns & Associates, Inc. 8 August 17, 2014

20 Wage Derivation Based on Similar Job Duties ARMHS Basic Living and Social Skills Licensed Professional ARMHS Basic Living and Social Skills Rehabilitation Worker ARMHS Community Intervention Licensed Professional* ARMHS Community Intervention Rehabilitation Worker ARMHS Medication Education** ARMHS Traansitioning to Community Living Lic ARMHS Traansitioning to Community Living ARMHS Traansitioning to Community Living ARMHS Traansitioning to Community Living BLS Code and Title Medical and Health Services Managers Social and Community Service Managers Clinical, Counseling, and School Psychologists Psychologists, All Other Substance Abuse and Behavioral Disorder Counselors Educational, Guidance, School, and Vocational Counselors Marriage and Family Therapists 10% 10% Mental Health Counselors 85% Rehabilitation Counselors 100% 100% 100% 80% Counselors, All Other Child, Family, and School Social Workers Healthcare Social Workers Mental Health and Substance Abuse Social Workers 100% 100% Social Workers, All Other Community Health Workers Community and Social Service Specialists, All Other Psychiatrists 25% 5% Physician Assistants 25% Occupational Therapists Physical Therapists Recreational Therapists Speech-Language Pathologists Registered Nurses 25% 10% Nurse Practitioners 25% Emergency Medical Technicians and Paramedics Psychiatric Technicians Licensed Practical and Licensed Vocational Nurses Home Health Aides Psychiatric Aides Nursing Assistants Orderlies Occupational Therapy Assistants Occupational Therapy Aides Physical Therapist Assistants Physical Therapist Aides Security Guards Chefs and Head Cooks Cooks, Institution and Cafeteria Childcare Workers Personal Care Aides 100% 100% 100% 100% 100% 100% 100% 100% 0% Burns & Associates, Inc 9 August 21, 2014

21 Possible Rate Models BLS Derived Wages Wage Assumptions Bureau of Labor Statistics (Using Job Requirement Assumptions) ARMHS Basic Living and Social Skills Licensed Professional ARMHS Basic Living and Social Skills Rehabilitation Worker ARMHS Community Intervention Licensed Professional* ARMHS Community Intervention Rehabilitation Worker ARMHS Medication Education** ARMHS Traansitioning to Community Living ARMHS Traansitioning to Community Living ARMHS Traansitioning to Community Living ARMHS Traansitioning to Community Living Bureau of Labor Statistics (inflated to Mar 2014) 10th %ile $10.97 $10.97 $17.05 $17.05 $34.52 $15.60 $10.97 $12.64 $ th %ile $13.53 $13.53 $20.06 $20.06 $45.13 $20.01 $13.53 $15.53 $ th %ile $17.47 $17.47 $23.71 $23.71 $57.64 $25.17 $17.47 $19.69 $0.00 Mean $18.87 $18.87 $25.58 $25.58 $57.85 $26.24 $18.87 $20.97 $ th %ile $22.78 $22.78 $30.05 $30.05 $38.05 $24.56 $22.78 $25.17 $ th %ile $31.18 $31.18 $35.87 $35.87 $43.24 $32.23 $31.18 $33.33 $0.00 Burns & Associates, Inc. 10 August 21, 2014

22 ERE Determination - Example Packet Base ERE Data & Calculations Employee Related Expense (ERE) Assumptions Hourly Rate $12.50 $15.00 $17.50 $20.00 $22.50 $25.00 $30.00 $35.00 $50.00 Annual Wage 1 $26,000 $31,200 $36,400 $41,600 $46,800 $52,000 $62,400 $72,800 $104,000 FUTA / SUTA % $ % $ % $ % $ % $ % $ % $ % $ % $ % FICA % $1, % $2, % $2, % $3, % $3, % $3, % $4, % $5, % $7, % Workers' Compensation 2.00% $ % $ % $ % $ % $ % $1, % $1, % $1, % $2, % Legally required benefits 12.45% $2, % $3, % $3, % $4, % $4, % $5, % $6, % $7, % $9, % Paid Time Off 25 days/yr $2, % $3, % $3, % $4, % $4, % $5, % $6, % $7, % $10, % Extended Illness Benefit 0 days/yr $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% Other Benefits Retirement Plan 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% Health Insurance $ $4, % $4, % $4, % $4, % $4, % $4, % $4, % $4, % $4, % Dental Insurance $0.00 $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% Vision Insurance $0.00 $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% $0 0.00% Other Benefits $35.00 $ % $ % $ % $ % $ % $ % $ % $ % $ % Total ERE per employee $10, % $11, % $12, % $13, % $14, % $15, % $17, % $19, % $24, % 1 Assumes 2,080 hours/year 2 FUTA/SUTA values combined to reflect single amount 3 Combined Social Security tax rate of 6.2% and the Medicare tax rate of 1.45% on a maximum of $113,700 in Burns & Associates, Inc. 11 August 21, 2014