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ENACTED ACTION Final Appendix 5122-26-19 FORM A-4 MENTAL HEALTH SERVICES ADMINISTRATIVE OVERHEAD COST DISTRIBUTION WORKSHEET DATE 05/23/2012 10 34 AM Agency Name and MACSIS UPI Prepared by Date Step 1 Determine Base Column 1 Step 2 Calculate of Base per service/total Base Step 3 Column 3 multiplied by total Administration costs from UCR column 6 Transfer administration allocation result by service to UCR column 7 BASE VALUE FOR EACH SERVICE TYPE ...
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