- Grantees that receive multiple awards (in addition to or other than CHC funding) must complete a for the combined grants and Universal Report individual for their HCH, MCH, and PHPC funding, if Grant Reports applicable. The following line items contain critical information: Key Line Items – a. Table 5 Staffing and Utilization – (1) Line 8 Total Physicians – (2) Line 15 Total Medical Care Services – (3) Line 19 Total Dental Services – (4) Line 29 Total Enabling Services – (5) Line 33 Total Administration and Facility – b. Table 8 Part A Financial Costs – (1) Line 4(c) Total Medical Care Services – (2) Line 10(c) Total Other Clinical Services – (3) Line 13(c) Total Enabling and Other Services – (4) Line 16 Total Overhead – (5) Line 18 Value of Donated Facilities, Services, and Supplies – c. Table 9 Part D Patient Related Revenue – (1) Line 1 Medicaid Non-managed Care – (2) Line 2a Medicaid Managed Care (capitated) – (3) Line 2b Medicaid Managed Care (fee-for-service) – (4) Line 7 Other Public including Non-Medicaid CHIP – care) (5) Line 10 Private Non-Managed Care – (6) Line 11a Private Managed Care (capitated) – (7) Line 11b Private Managed Care (fee-for-service) – (8) Line 13 – Self Pay
- Grantees that receive multiple awards (in addition to or other than CHC funding) must complete a Universal Report for the combined grants and individual Grant Reports for their HCH, MCH, and PHPC funding, if applicable. Key Line Items – The following line items contain critical information: a. Table 5 – Staffing and Utilization (1) Line 8 – Total Physicians (2) Line 15 – Total Medical Care Services (3) Line 19 – Total Dental Services (4) Line 29 – Total Enabling Services (5) Line 33 – Total Administration and Facility b. Table 8 Part A – Financial Costs (1) Line 4(c) – Total Medical Care Services (2) Line 10(c) – Total Other Clinical Services (3) Line 13(c) – Total Enabling and Other Services (4) Line 16 – Total Overhead (5) Line 18 – Value of Donated Facilities, Services, and Supplies c. Table 9 Part D – Patient Related Revenue (1) Line 1 – Medicaid Non-managed Care (2) Line 2a – Medicaid Managed Care (capitated) (3) Line 2b – Medicaid Managed Care (fee-for-service) (4) Line 7 – Other Public including Non-Medicaid CHIP care) (5) Line 10 – Private Non-Managed Care (6) Line 11a – Private Managed Care (capitated) (7) Line 11b – Private Managed Care (fee-for-service) (8) Line 13 – Self Pay
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