Better Birth Outcomes EDF Instructions

Helping Families. Supporting Communities. Empowering Individuals.

Better Birth Outcomes (BBO)
FY 2016

Summary Expenditure Documentation Form (EDF) Instructions for Better Birth Outcomes Program

For FY16 provider agencies that receive prospective payments for the Better Birth Outcomes (BBO) must use the BBO Expenditure Documentation Form (EDF) to report all expenditures. DO NOT USE THE DEPARTMENT'S GENERIC EDF FORM TO SUBMIT BBO EXPENDITURES. The EDF may be photocopied or a reasonable electronic duplication developed. However, the electronic format is in Excel so that calculations will automatically occur as expenses are entered. The amounts reported must be the total expenditures for the period for a single program. The instructions below will assist you in completing the EDF:

  1. Person Completing Form - Contact person (Mandatory)
  2. Phone & Ext - List the phone number and extension for a contact person who will be able to answer questions concerning the submitted expenditure form. (Mandatory)
  3. Email Address - Provide the email address of the contact person
  4. Amount Claimed - Enter dollar amount for each month claimed. A report should be submitted, showing $0.00 as the expenditure, even when no dollars are spent to assure that there are no gaps in documentation. (Mandatory)
  5. Personal Services/Fringes - All BBO staff whose salary and/or fringe benefits are paid in full or in part from grant funds for this program (fringe benefits are the employer's portion of fringe benefits actually paid on behalf of direct services employees) NOTE: For staff working in both Family Case Management (FCM) and BBO enter the employee's full salary/fringe amount as "staff expense" in the Cornerstone system; enter the portion of the salary/fringe for time spent working in BBO on the EDF.
  6. Contractual Services - This category includes such items as contractual employees or consultants, utilities, rent or lease of equipment, space or facilities, postage, repair and maintenance of furniture and equipment, software for support of program objectives, training and education costs, conference fees, membership dues/fees (agency memberships only), subscriptions.
  7. Travel - This category includes staff mileage, parking, per diem, meals, lodging and other associated travel items. NOTE: This category is not to include costs associated with BBO client transportation.
  8. Supplies - This category includes such items as office supplies, medical supplies, educational and instructional material and supplies, cleaning supplies, equipment items costing less than $100 each, printing. NOTE: This category also includes costs associated with BBO client incentive items.
  9. Equipment - Equipment costing $100 or over per item. Prior approval is necessary for equipment items costing $500 or above per unit and having a useful life of more than one year (written approval must be given by Department program staff).
  10. Components -The components under BBO include:

Services - all costs for delivery of the program exclusive of outreach and client transportation

Outreach - refer to the current BBO Outreach Policy as revised July 14, 2014 for allowable costs associated with outreach activities. Costs associated with conducting outreach activities are to be documented in this column, by appropriate category (refer to items 4 through 8 above for appropriate categories of expense)

NOTE: Conducting case finding from the list of clients downloaded via the Medicaid Match process is not an outreach activity. Example: agency has outreach workers or other administrative support personnel whose responsibility is to use the list to make telephone calls or other contacts to arrange for an appointment with the case manager. Costs associated with this process are included in the Personal Services/Fringe line.

Client Transportation - all costs for BBO specific to the provision of client-related transportation, including but not limited to bus tokens/tickets, cab fair, train fair, use of an agency-owned vehicle, etc.

10. Authorized Agency Official - This form must be signed and dated by an authorized official of the provider agency. (Mandatory)

Submission of EDF: EDF's are due to DHS by the 15th of each month, for costs incurred the prior month. One copy of the EDF is submitted to the contact person specified in Exhibit C of the BBO contract. Please also send a copy of the EDF each month to your assigned Community Support Services Consultant.