Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 19% < 22% 19% < 23% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 N/A *14.6 N/A *TBD N/A COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 N/A *$1,106,635 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 N/A *9.1 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Schedule E3: LHIN Local Indicators LHIN Local Indicator – LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Sector: CMH Activity: Health Equity Environmental Scan Measure/Obligation: The HSP will complete a Health Equity Environmental Scan and submit it to the Central West LHIN on or before September 30, 2011. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note to M-SAA: This project template is intended to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)
Appears in 1 contract
Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel Xxxxxx Xxxxx Memorial Hospital Accountability Indicators 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0-1% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 190% < 220% 190% < 230% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 1.6 N/A *14.6 1.6 N/A *TBD N/A COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 1500 1350 - 1650 1500 1350 - 1650 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 42 34 - 50 42 34 - 50 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 166,430 N/A *$1,106,635 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 166,430 N/A *TBD N/A COM ClinicsPrimary Care COM Clinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 12.2 N/A *9.1 12.2 N/A *TBD N/A COM ClinicsClinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 10200 9690 - 10710 10200 9690 - 10710 XXX XXX COM ClinicsClinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 80 64 - 96 80 64 - 96 XXX XXX COM ClinicsClinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 1,321,361 N/A *$629,119 1,321,361 N/A *TBD N/A COM - Clinics/Programs - MH Early Intervention -MH Concurrent Disorders 72 5 10 76 51 45 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 0.4 N/A *2.2 0.4 N/A *TBD N/A COM - Clinics/Programs - MH Early Intervention -MH Concurrent Disorders 72 5 10 76 51 45 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 525 446 - 604 525 446 - 604 XXX XXX COM - Clinics/Programs - MH Early Intervention -MH Concurrent Disorders 72 5 10 76 51 45 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs 50 40 - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs 60 50 40 - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 60 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 5.1 N/A *31.7 5.1 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 1300 1170 - 1430 1300 1170 - 1430 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS- ALL SECTORS Healthcare Service Provider: Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention 800 680 - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 920 800 680 - 920 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 509,618 N/A *$2,801,718 509,618 N/A *TBD N/A CSS In-Home and Community Services (CSS IH COM) CSS IH COM Residential Services COM Res. Mental Health - Support within Housing Social and Congregate Dining 72 5 40 76 30 82 12 S 403483*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 60 48 - 72 60 48 - 72 XXX XXX CSS IH COM - Social and Congregate Dining 72 5 82 12 S 483*, 455* Attendance Days Face-to-Face S 483* 1350 1215 - 1485 1350 1215 - 1485 XXX XXX CSS IH COM - Social and Congregate Dining 72 5 82 12 S 483*, 455* Total Cost for Functional Centre *$70,999 N/A *$70,999 N/A *TBD N/A CSS IH COM - Day Services 72 5 82 20 S 483*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 13.33 N/A *4 13.32 N/A *TBD N/A CSS IH COM Res. Mental Health - Support within Housing Day Services 72 5 40 76 30 82 20 S 403483*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 320 256 - 384 320 256 - 384 XXX XXX CSS IH COM - Day Services 72 5 82 20 S 483*, 455* Attendance Days Face-to-Face S 483* 14720 13984 - 15456 14720 13984 - 15456 XXX XXX CSS IH COM - Day Services 72 5 82 20 S 483*, 455* Total Cost for Functional Centre *$1,223,153 N/A *$1,227,412 N/A *TBD N/A CSS IH COM - Caregiver Support 72 5 82 50 S 448*, 449*, 450*, 451*, 455* Full-time equivalents (FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *0.38 N/A *0.33 N/A *TBD N/A CSS IH COM - Caregiver Support 72 5 82 50 S 448*, 449*, 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 725 616 - 834 725 616 - 834 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard CSS IH COM - Caregiver Support 72 5 82 50 S 448*0.1 , 449*, 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 550 468 - 633 550 468 - 633 XXX XXX CSS IH COM - Caregiver Support 72 5 82 50 S 448*, 449*, 450*, 451*, 455* Total Cost for Functional Centre *$36,398 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD 32,139 N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Schedule E2b: MH&A Specific Indicators Sector Specific Indicators- Mental Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 & Addictions > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Xxxxxx Xxxxx Memorial Hospital Accountability Indicators 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Schedule E2c : CSS Specific Indicators Sector Specific Indicators- CSS Sector > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > TBD - To be determined Healthcare Service Provider: Xxxxxx Xxxxx Memorial Hospital Accountability Indicators 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Average Number of Days on Waitlist 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators # Persons waiting for service (by functional centre) Schedule E3: LHIN Local Indicators LHIN Local Indicator – Indicators- LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/ObligationObligation Health service providers are required to update their organization's Community Information Centre information sheet annually to reflect its current services and are to update their organization's information sheet when a change in program occurs (i.e. start, stop, change hours, etc.) 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: The HSP will complete a ALL SECTORS - - - - - - Activity Measure/Obligation Health Equity Environmental Scan service providers are to work and submit it collaborate as appropriate with the French Language Health Planning Entity to the Central West LHIN on or before September 30, 2011. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note improve access to M-SAA: This project template is intended to be used to fund one-off projects or for the provision and accessibility of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)French language services.
Appears in 1 contract
Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel Xxxxxx Xxxxx Memorial Hospital Accountability Indicators 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0-1% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 190% < 220% 190% < 230% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE Activity*FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 1.6 N/A *14.6 1.6 N/A *TBD N/A COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 1500 1350 - 1650 1500 1350 - 1650 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 42 34 - 50 42 34 - 50 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 166,430 N/A *$1,106,635 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 166,430 N/A *TBD N/A COM ClinicsPrimary Care COM Clinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 12.2 N/A *9.1 12.2 N/A *TBD N/A COM ClinicsClinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 10200 9690 - 10710 10200 9690 - 10710 XXX XXX COM ClinicsClinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 80 64 - 96 80 64 - 96 XXX XXX COM ClinicsClinic s/Programs - Programs-MH Clubhouses Assertive Community Treatment Teams 72 5 10 76 41 20 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 1,321,361 N/A *$629,119 1,321,361 N/A *TBD N/A COM - Clinics/Programs - MH Early Intervention -MH Concurrent Disorders 72 5 10 76 51 45 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 0.4 N/A *2.2 0.4 N/A *TBD N/A COM - Clinics/Programs - MH Early Intervention -MH Concurrent Disorders 72 5 10 76 51 45 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 525 446 - 604 525 446 - 604 XXX XXX COM - Clinics/Programs - MH Early Intervention -MH Concurrent Disorders 72 5 10 76 51 45 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs 50 40 - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs 60 50 40 - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 60 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 5.1 N/A *31.7 5.1 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 1300 1170 - 1430 1300 1170 - 1430 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS- ALL SECTORS Healthcare Service Provider: Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity*FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention 800 680 - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 920 800 680 - 920 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 509,618 N/A *$2,801,718 509,618 N/A *TBD N/A CSS In-Home and Community Services (CSS IH COM) CSS IH COM Residential Services COM Res. Mental Health - Support within Housing Social and Congregate Dining 72 5 40 76 30 82 12 S 403483*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 60 48 - 72 60 48 - 72 XXX XXX CSS IH COM - Social and Congregate Dining 72 5 82 12 S 483*, 455* Attendance Days Face-to-Face S 483* 1350 1215 - 1485 1350 1215 - 1485 XXX XXX CSS IH COM - Social and Congregate Dining 72 5 82 12 S 483*, 455* Total Cost for Functional Centre *$70,999 N/A *$70,999 N/A *TBD N/A CSS IH COM - Day Services 72 5 82 20 S 483*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 13.33 N/A *4 13.32 N/A *TBD N/A CSS IH COM Res. Mental Health - Support within Housing Day Services 72 5 40 76 30 82 20 S 403483*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 320 256 - 384 320 256 - 384 XXX XXX CSS IH COM - Day Services 72 5 82 20 S 483*, 455* Attendance Days Face-to-Face S 483* 14720 13984 - 15456 14720 13984 - 15456 XXX XXX CSS IH COM - Day Services 72 5 82 20 S 483*, 455* Total Cost for Functional Centre *$1,223,153 N/A *$1,227,412 N/A *TBD N/A CSS IH COM - Caregiver Support 72 5 82 50 S 448*, 449*, 450*, 451*, 455* Full-time equivalents (FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *0.38 N/A *0.33 N/A *TBD N/A CSS IH COM - Caregiver Support 72 5 82 50 S 448*, 449*, 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 725 616 - 834 725 616 - 834 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS- ALL SECTORS Healthcare Service Provider: Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity*FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard CSS IH COM Res. Mental Health - Caregiver Support within Housing 72 5 40 76 30 82 50 S 403448*, 449*, 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 550 468 - 633 550 468 - 633 XXX XXX CSS IH COM Res. Mental Health - Caregiver Support within Housing 72 5 40 76 30 82 50 S 403448*, 449*, 450*, 451*, 455* Total Cost for Functional Centre *$260,099 36,398 N/A *$260,099 32,139 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service ProviderE2b: CMHA/Peel MH&A Specific Indicators Sector Specific Indicators- Mental Health & Addictions Accountability Indicators 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Healthcare Service Provider: Xxxxxx Xxxxx Memorial Hospital > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c : CSS Specific Indicators Sector Specific Indicators- CSS Sector Accountability Indicators 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Average Number of Days on Waitlist 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators # Persons waiting for service (by functional centre) Healthcare Service Provider: Xxxxxx Xxxxx Memorial Hospital > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > TBD - To be determined Schedule E3: LHIN Local Indicators LHIN Local Indicator – Indicators- LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Xxxxxx Xxxxx Memorial Hospital 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/ObligationObligation Health service providers are required to update their organization's Community Information Centre information sheet annually to reflect its current services and are to update their organization's information sheet when a change in program occurs (i.e. start, stop, change hours, etc.) 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: The HSP will complete a ALL SECTORS - - - - - - Activity Measure/Obligation Health Equity Environmental Scan service providers are to work and submit it collaborate as appropriate with the French Language Health Planning Entity to the Central West LHIN on or before September 30, 2011. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note improve access to M-SAA: This project template is intended to be used to fund one-off projects or for the provision and accessibility of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)French language services.
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Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel Algoma Family Services Accountability Indicators 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 1920% < 2224% 1920% < 2324% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel Algoma Family Services 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management Primary Care COM Clinics/Programs - Mental Health Addictions Treatment-Substance Abuse 72 5 09 76 10 78 11 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 2.5 N/A *14.6 2.5 N/A *TBD N/A COM Case Management Clinics/Programs - Mental Health Addictions Treatment-Substance Abuse 72 5 09 76 10 78 11 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 1042 938 - 1146 1042 938 - 1146 XXX XXX COM Case Management Clinics/Programs - Mental Health Addictions Treatment-Substance Abuse 72 5 09 76 10 78 11 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 333 266 - 400 333 266 - 400 XXX XXX COM Case Management Clinics/Programs - Mental Health Addictions Treatment-Substance Abuse 72 5 09 76 10 78 11 S 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 198,980 N/A *$1,106,635 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 198,980 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses Initial Assessment and Treatment Planning 72 5 10 76 41 78 30 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 0.5 N/A *9.1 0.5 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses Initial Assessment and Treatment Planning 72 5 10 76 41 78 30 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 208 166 - 250 208 166 - 250 XXX XXX COM Clinics/Programs - MH Clubhouses Initial Assessment and Treatment Planning 72 5 10 76 41 78 30 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 67 54 - 80 67 54 - 80 XXX XXX COM Clinics/Programs - MH Clubhouses Initial Assessment and Treatment Planning 72 5 10 76 41 78 30 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 38,946 N/A *$629,119 38,946 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Indicators- Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Algoma Family Services Accountability Indicators 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Schedule E3: LHIN Local Indicators LHIN Local Indicator – Indicators- LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Algoma Family Services 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/Obligation: Obligation Commitment to Integration The HSP will complete Board of Directors and management previously passed Board motions that committed the HSP to support the principles of integration as per the section 24 of the Local Health System Integration Act, 2006 (LHSIA) as a Health Equity Environmental Scan means of improving the health system in northern Ontario. On an annual basis the HSP is committed to completing the following: 1) An organizational self assessment tool of gaps, issues and submit it to pressures in the Central West LHIN on or before September 30, 2011. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note to M-SAA: This project template is intended delivery of health care services (tool to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is LHIN) 2) A report, by May 31st of each year, of integration opportunities and strategies to implement which would include at a minimum (template to be provided by the LHIN – whether or not LHIN) • Summary of discussions with HSPs for the HSP provides identification and implementation of integration opportunities within the services directly or subcontracts sector • Summary of discussions with HSPs for the provision identification and implementation of integration opportunities within the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) betweenHUB region 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) ALL SECTORS - and - [Legal Name of the Health Service Provider] (the “HSP”)- - - - Activity
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Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel Hamilton Program for Schizophrenia Inc. Accountability Indicators 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 1920% < 22<24% 19% < 23% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel Hamilton Program for Schizophrenia Inc. 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 10.3 N/A *14.6 10.27 N/A *TBD N/A COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 29000 27840 - 30160 29000 27840 - 30160 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 190 152 - 228 190 152 - 228 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 959,236 N/A *$1,106,635 947,549 N/A *TBD N/A COM Primary Care COM Clinics Programs - MH Counseling and Treatment 72 5 10 76 12 S 450*, 451*, 455* Full-time equivalents (FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *1.22 N/A *1.21 N/A *TBD N/A COM Clinics Programs - MH Counseling and Treatment 72 5 10 76 12 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1450 1305 - 1595 1450 1305 - 1595 XXX XXX COM Clinics Programs - MH Counseling and Treatment 72 5 10 76 12 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 190 152 - 228 190 152 - 228 XXX XXX COM Clinics Programs - MH Counseling and Treatment 72 5 10 76 12 S 450*, 451*, 455* Total Cost for Functional Centre *$270,444 N/A *$263,606 N/A *TBD N/A COM Clinics/Programs - MH Social Rehab./Recreation 72 5 10 76 81 S 450*, 451*, 455* Full-time equivalents (FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *1.41 N/A *1.4 N/A *TBD N/A COM Clinics/Programs - MH Social Rehab./Recreation 72 5 10 76 81 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 13050 12398 - 13703 13050 12398 - 13703 XXX XXX COM Clinics/Programs - MH Social Rehab./Recreation 72 5 10 76 81 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 375 300 - 450 375 300 - 450 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel Xxxxxxxx Program for Schizophrenia Inc. 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment Social Rehab./Recreation 72 5 10 76 40 81 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 145,820 N/A *$73,586 145,199 N/A *TBD N/A COM Clinics/Programs Information and Referral Service COM Information and Referral Service - MH Clubhouses General 72 5 70 10 76 41 S 450452*, 451*, 455* ' Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 0.94 N/A *9.1 0.93 N/A *TBD N/A COM Clinics/Programs Information and Referral Service - MH Clubhouses General 72 5 70 10 76 41 S 450452*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 ' Not Uniquely Identified Service Recipient Interactions S. 452**00 900 765 - 1035 900 765 - 1035 XXX XXX COM Clinics/Programs Information and Referral Service - MH Clubhouses General 72 5 70 10 76 41 S 450452*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* ' Total Cost for Functional Centre *$665,784 83,809 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 83,368 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service ProviderE2b: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description MH&A Specific Indicators Sector Specific Indicators- Mental Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 Addictions > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Xxxxxxxx Program for Schizophrenia Inc. Accountability Indicators 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Schedule E3: LHIN Local Indicators LHIN Local Indicator – Indicators- LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Xxxxxxxx Program for Schizophrenia Inc. 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/ObligationObligation Health service providers are required to update their organization's Community Information Centre information sheet annually to reflect its current services and are to update their organization's information sheet when a change in program occurs (i.e. start, stop, change hours, etc.) 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: The HSP will complete a ALL SECTORS - - - - - - Activity Measure/Obligation Health Equity Environmental Scan service providers are to work and collaborate as appropriate with the French Language Health Planning Entity to improve access to and accessibility of French language services. 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: ALL SECTORS - - - - - - Activity Measure/Obligation As an identified health service provider for French language services, your organization is required to: 1. Complete/update and submit it to the Central West LHIN's French Language Services (FLS) Consultant its FLS Implementation Plan for 2011-2014 a) Draft by June 30, 2011 b) Final by December 31, 2011 2. Provide the LHIN on or before FLS Coordinator with a progress report of the organization's FLS Implementation Plan semi-annually per the following schedule: a) March 31, 2012 b) September 30, 2011. Submission Date: 2012 c) March 31, 2013 d) September 30, 2011 2013 e) March 31, 2014 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note to M-SAA: This project template is intended to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)
Appears in 1 contract
Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and SCHEDULE E - PERFORMANCE • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS SECTORS Healthcare Service Provider: CMHA/Peel The Aphasia Intstitute Accountability Indicators 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 1957% < 2268% 1957% < 2369% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel The Aphasia Intstitute 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard CSS In-Home and Community Services (CSS IH COM) CSS IH COM Case Management - Mental Health Caregiver Support 72 5 09 76 82 50 S 448*, 449*, 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 1.5 N/A *14.6 1.5 N/A *TBD N/A CSS IH COM Case Management - Mental Health Caregiver Support 72 5 09 76 82 50 S 448*, 449*, 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 2800 2520 - 3080 2800 2520 - 3080 XXX XXX CSS IH COM Case Management - Mental Health Caregiver Support 72 5 09 76 82 50 S 448*, 449*, 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 219 175 - 263 219 175 - 263 XXX XXX CSS IH COM Case Management - Mental Health Caregiver Support 72 5 09 76 82 50 S 448*, 449*, 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 93,120 N/A *$1,106,635 93,120 N/A *TBD N/A CSS-ABI Services CSS ABI - Day Services 72 5 83 20 S 483*, 455* Full-time equivalents (FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A CSS ABI - Day Services 72 5 83 20 S 483*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 200 160 - 240 200 160 - 240 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target CSS Community Support Initiatives 6935 - 7665 7300 Attendance Days Face-to-Face S 483* CSS ABI - Day Services 72 5 83 20 S 483*, 455* Performance Standard Target Performance Standard COM Clinics/Programs Target 2013-2014 2012-2013 2011-2012 Total Cost for Functional Centre CSS Com Sup Init - MH Vocational/Employment Support Service Training 72 5 84 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 N/A *TBD N/A COM Clinics/Programs CSS ABI - MH Clubhouses Day Services 72 5 10 76 41 83 20 S 450*, 451483*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 N/A *9.1 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD $192,070 N/A *$192,070 XXX XXX 320 - 480 400 320 - 480 400 XXX XXX 3510 - 4290 3900 3510 - 4290 3900 N/A *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 > 1N*2 N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N2 N/A 1N*TBD N/A 1N*$210,168 N/A 1N/A *$210,168 XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Schedule E3: LHIN Local Indicators LHIN Local Indicator – LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Sector: CMH Activity: Health Equity Environmental Scan Measure/Obligation: The HSP will complete a Health Equity Environmental Scan and submit it to the Central West LHIN on or before September 30, 2011. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note to M-SAA: This project template is intended to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) 6935 - and - [Legal Name of the Health Service Provider] (the “HSP”)7665 7300
Appears in 1 contract
Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • SCHEDULE E - PERFORMANCE will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel University of Waterloo Accountability Indicators 2011-2012 2012-2013 20130000 0000-2014 Accountability Indicators 0000 Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 190% < 220% 190% < 230% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel University of Waterloo 2011-2012 2012-2013 20130000 0000-2014 0000 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard CSS In-Home and Community Services (CSS IH COM) CSS IH COM Case Management - Mental Health Vision Impaired Care Services 72 5 09 76 82 75 S 448*, 449*, 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 2.8 N/A *14.6 2.8 N/A *TBD N/A CSS IH COM Case Management - Mental Health Vision Impaired Care Services 72 5 09 76 82 75 S 448*, 449*, 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 5460 5187 - 5733 5460 5187 - 5733 XXX XXX CSS IH COM Case Management - Mental Health Vision Impaired Care Services 72 5 09 76 82 75 S 448*, 449*, 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 680 578 - 782 680 578 - 782 XXX XXX CSS IH COM Case Management - Mental Health Vision Impaired Care Services 72 5 09 76 82 75 S 448*, 449*, 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 184,838 N/A *$1,106,635 190,384 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service ProviderE2d : CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 N/A *9.1 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 CSS Specific Indicators Sector Specific Indicators- CSS Sector > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel University of Waterloo Accountability Indicators 2011-2012 2012-0000 0000-0000 Target Performance Standard Target Performance Standard Target Performance Standard Average Number of Days from Referral to Assessment on Waitlist 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received # Persons waiting for service (by functional centre) Schedule E3: LHIN Local Indicators LHIN Local Indicator – Indicators- LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch University of Waterloo 2011-2012 2012-0000 0000-0000 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/Obligation: Obligation Core Local Performance Obligations (in all agreements) 1. Community Engagement The HSP will complete a is required to maintain Community Engagement records that capture the following information: • purpose of engagement • process of engagement • intended outcomes • feedback received • participants evaluation 2. WWLHIN Health Equity Environmental Scan System The HSP is required to fully participate in health system reviews and submit it to planning as well as the Central West LHIN on or before September 30, 2011implementation of related recommendations. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note to M-SAA: This project template The HSP is intended required to be used able to fund onedemonstrate how your services, impact reductions in Emergency Department wait times and Alternate Level of Care days, as a direct, diversion or preventative impact. 2011-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)2012 2012-0000 0000-0000 Target Performance Standard Target Performance Standard Target Performance Standard
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Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and SCHEDULE E - PERFORMANCE • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Supplemental: Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Core Indicators- All Sectors Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 Return to Main Page Baycrest Centre for Geriatric Care Accountability Indicators 2013-2014 Accountability Indicators Performance Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% 0.00 >=0% $0 0 0.0% < 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 19% < 22% 19% < 23% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX % Total Margin Fund Type 2- Balanced Budget Proportion of Budget Spent on Administration Variance Forecast to Actual Expenditures Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBDService Activity Indicators- All Sectors Supplemental: To be Determined Schedule E2a CORE INDICATORS- Service Activity Indicators- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 Baycrest Centre for Geriatric Care Return to Main Page 2013-2014 OHRS Description Health Service Activity & Functional Centre *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management IH - Mental Health Day Services 72 5 09 76 S 450*, 451*, 455* 82 20 Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned HoursFTE) divided by 1950= FTE *14.6 4.20 N/A *14.6 N/A *TBD N/A COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 XXX XXX COM Case Management N/A N/A Attendance Days Face-to-Face 6,000 5700 - Mental Health 72 5 09 76 S 450*, 451*, 455* 6300 Total Cost for Functional Centre *$1,081,979 307,561 N/A *$1,106,635 N/A *TBD N/A Supplemental Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS E2d : CSS Specific Indicators Sector Specific Indicators- CSS Sector Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 Baycrest Centre for Geriatric Care 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 N/A *9.1 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard Percentage ALC Days 15.0% <16.5% Average number of days waited for First Service (by functional centre) N/A N/A Explanatory Indicators Repeat Unscheduled Emergency Visits within 30 days for Mental Health Conditions Repeat Unscheduled Emergency Visits within 30 days for Substance Abuse Conditions Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Persons Waiting for Service (by functional centre) LHIN Local Indicators- LHIN Specific Supple me ntal Schedule E3: LHIN Local Indicators LHIN Local Indicator – LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Sector: CMH Activity: Health Equity Environmental Scan Measure/Obligation: The HSP will complete a Health Equity Environmental Scan and submit it to the Central West LHIN on or before September 30, 2011. Submission Date: September 30, 2011 Baycrest Centre for Geriatric Care 2013-2014 Description Target Performance Standard Number of Individuals served by Organization 922 784 - 1060 SCHEDULE F – PROJECT FUNDING AGREEMENT TEMPLATE Project Funding Agreement Template Note to M-SAA: This project template is intended to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)
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Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel Fort Erie Meals on Wheels Accountability Indicators 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 198% < 2210% 198% < 2310% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel Fort Erie Meals on Wheels 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard CSS In-Home and Community Services (CSS IH COM) CSS IH COM Case Management - Mental Health Meals Delivery 72 5 09 76 82 10 S 450*, 451*248**10, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 1.75 N/A *14.6 1.75 N/A *TBD N/A CSS IH COM Case Management - Mental Health Meals Delivery 72 5 09 76 82 10 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*248**10, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 192 154 - 230 195 156 - 234 XXX XXX CSS IH COM Case Management - Mental Health Meals Delivery 72 5 09 76 82 10 S 450*248**10, 451*455* Meal Delivered-Combined S. 248**10 17142 16285 - 17999 17485 16611 - 18359 XXX XXX CSS IH COM - Meals Delivery 72 5 82 10 S 248**10, 455* Total Cost for Functional Centre *$1,081,979 198,928 N/A *$1,106,635 202,005 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service ProviderE2b : CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 N/A *9.1 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 CSS Specific Indicators Sector Specific Indicators- CSS Sector > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel Fort Erie Meals on Wheels Accountability Indicators 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Average Number of Days from Referral to Assessment on Waitlist 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received # Persons waiting for service (by functional centre) Schedule E3: LHIN Local Indicators LHIN Local Indicator – Indicators- LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch Fort Erie Meals on Wheels 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/ObligationObligation Health service providers are required to update their organization's Community Information Centre information sheet annually to reflect its current services and are to update their organization's information sheet when a change in programs occurs (i.e. start, stop, change hours, etc.) 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: The HSP will complete a ALL SECTORS - - - - - - Activity Measure/Obligation Health Equity Environmental Scan service providers are to work and submit it collaborate as appropriate with the French Language Health Planning Entity to the Central West improve access to and accessibility of French language services. 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CSS 93 74-100 93 74-100 XXX XXX Activity Measure/Obligation Percent of clients assessed using Risk Assessment Tool Schedule E3: LHIN Local Indicators LHIN Local Indicators- LHIN Specific Healthcare Service Provider: Fort Erie Meals on or before September 30, Wheels 2011. Submission Date-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: September 30, 2011 CSS 92 74-100 92 74-100 XXX XXX Activity Measure/Obligation Percent of active clients identified as 'high risk' receiving food services SCHEDULE F – PROJECT FUNDING AGREEMENT TEMPLATE Project Funding Agreement Template Note to M-SAA: This project template is intended to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)
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Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors Schedule E1 CORE INDICATORS- All Sectors Schedule E1 CORE INDICATORS- All Sectors Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel St. Joseph's Healthcare Xxxxxxxx 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 193% < 223% 193% < 233% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined St. Joseph's Healthcare Xxxxxxxx M-SAA 2011-14 36 of 47 Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS SECTORS Healthcare Service Provider: CMHA/Peel St. Joseph's Healthcare Xxxxxxxx 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 9.39 N/A *14.6 9.27 N/A *TBD N/A COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 12625 11994 ‐ 10553 10050 9548 13256 12625 11994 ‐ 10553 13256 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 736 626 ‐ 378 315 252 846 736 626 ‐ 378 846 XXX XXX COM Case Management - Mental Health 72 5 09 76 S 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 1,076,879 N/A *$1,106,635 1,076,879 N/A *TBD N/A COM Primary Care COM Clinics Programs - MH Counseling and Treatment 72 5 10 76 12 S 450*, 451*, 455* Not Uniquely Identified Service Recipient Interactions S. 452**00 116 93 ‐ 139 116 93 ‐ 139 XXX XXX COM Clinics Programs - MH Counseling and Treatment 72 5 10 76 12 S 450*, 451*, 455* Total Cost for Functional Centre *$51,989 N/A *$51,989 N/A *TBD N/A COM Clinic s/Programs-MH Assertive Community Treatment Teams 72 5 10 76 20 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *37.34 N/A *37.14 N/A *TBD N/A COM Clinic s/Programs-MH Assertive Community Treatment Teams 72 5 10 76 20 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 48521 47065 ‐ 49977 48521 47065 ‐ 49977 XXX XXX COM Clinic s/Programs-MH Assertive Community Treatment Teams 72 5 10 76 20 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 352 282 ‐ 422 352 282 ‐ 422 XXX XXX COM Clinic s/Programs-MH Assertive Community Treatment Teams 72 5 10 76 20 S 450*, 451*, 455* Total Cost for Functional Centre *$4,242,596 N/A *$4,242,596 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *11.04 N/A *10.67 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel St. Joseph's Healthcare Xxxxxxxx 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 N/A *9.1 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 XXX XXX COM Clinics/Programs - MH Clubhouses 72 5 10 76 41 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 7459 7086 ‐ 2090 1900 1710 7832 7464 7091 ‐ 2090 7837 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 313 250 ‐ 36 30 24 376 313 250 ‐ 36 376 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 1,862,970 N/A *$153,330 1,862,970 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support Forensic 72 5 10 76 56 55 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 0.83 N/A *13 0.83 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support Forensic 72 5 10 76 56 55 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 1080 972 ‐ 7476 7120 6764 1188 1080 972 ‐ 7476 1188 XXX XXX COM Clinics/Programs - MH Forensic 72 5 10 76 55 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 60 48 ‐ 72 60 48 ‐ 72 XXX XXX COM Clinics/Programs - MH Forensic 72 5 10 76 55 S 450*, 451*, 455* Total Cost for Functional Centre *$86,508 N/A *$86,508 N/A *TBD N/A COM Clinics/Programs - MH Eating Disorders 72 5 10 76 70 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *3.08 N/A *3.04 N/A *TBD N/A COM Clinics/Programs - MH Eating Disorders 72 5 10 76 70 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 3588 3229 ‐ 3947 3588 3229 ‐ 3947 XXX XXX COM Clinics/Programs - MH Eating Disorders 72 5 10 76 70 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 179 143 ‐ 215 179 143 ‐ 215 XXX XXX COM Clinics/Programs - MH Eating Disorders 72 5 10 76 70 S 450*, 451*, 455* Total Cost for Functional Centre *$392,797 N/A *$392,797 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel St. Joseph's Healthcare Xxxxxxxx 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support Social Rehab./Recreation 72 5 10 76 56 81 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.05 N/A *3.96 N/A *TBD N/A COM Clinics/Programs - MH Social Rehab./Recreation 72 5 10 76 81 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 926 787 ‐ 1065 926 787 ‐ 1065 XXX XXX COM Clinics/Programs - MH Social Rehab./Recreation 72 5 10 76 81 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 75 60 ‐ 598 520 442 90 75 60 ‐ 598 90 XXX XXX COM Clinics/Programs - MH Diversion and Court Support Social Rehab./Recreation 72 5 10 76 56 81 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 415,755 N/A *$945,667 415,755 N/A *TBD N/A COM Clinics/Programs - MH Psycho-geriatric 72 5 10 76 96 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *11.43 N/A *11.39 N/A *TBD N/A COM Clinics/Programs - MH Psycho-geriatric 72 5 10 76 96 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 11412 10841 ‐ 11983 11317 10751 ‐ 11883 XXX XXX COM Clinics/Programs - MH Psycho-geriatric 72 5 10 76 96 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 1258 1132 ‐ 1384 1249 1124 ‐ 1374 XXX XXX COM Clinics/Programs - MH Psycho-geriatric 72 5 10 76 96 S 450*, 451*, 455* Total Cost for Functional Centre *$1,243,301 N/A *$1,243,301 N/A *TBD N/A COM Clinics/Programs - Addictions Withdrawal Mgmt. 72 5 10 78 20 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *20.32 N/A *20.38 N/A *TBD N/A COM Clinics/Programs - Addictions Withdrawal Mgmt. 72 5 10 78 20 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 9076 8622 ‐ 9530 9677 9193 ‐ 10161 XXX XXX COM Clinics/Programs - Addictions Withdrawal Mgmt. 72 5 10 78 20 S 450*, 451*, 455* Not Uniquely Identified Service Recipient Interactions S. 452**00 1115 1004 ‐ 1227 1115 1004 ‐ 1227 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: St. Joseph's Healthcare Xxxxxxxx 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - Addictions Withdrawal Mgmt. 72 5 10 78 20 S 450*, 451*, 455* Inpatient/Resident Days S 403* 7810 7420 ‐ 8201 7810 7420 ‐ 8201 XXX XXX COM Clinics/Programs - Addictions Withdrawal Mgmt. 72 5 10 78 20 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 852 724 ‐ 980 852 724 ‐ 980 XXX XXX COM Clinics/Programs - Addictions Withdrawal Mgmt. 72 5 10 78 20 S 450*, 451*, 455* Total Cost for Functional Centre *$1,637,197 N/A *$1,637,197 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 11.2 N/A *31.7 11.23 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 13272 12608 ‐ 21609 21207 20147 13936 13272 12608 ‐ 22267 13936 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 1965 1769 ‐ 3146 2982 2684 2162 1965 1769 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 2162 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 1,486,764 N/A *$2,801,718 1,486,764 N/A *TBD N/A COM Residential Services Health Promotion and Education COM Res. Mental Health Prom/Educ & Com Dev - Support within Housing Psycho-Geriatric 72 5 40 50 96 76 30 S 403450*, 455451*, 452* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 1.31 N/A *4 1.3 N/A *TBD N/A COM Res. Mental Health Prom/Educ & Com Dev - Support within Housing Psycho-Geriatric 72 5 40 50 96 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449452* 2600 2340 Not Uniquely Identified Service Recipient Interactions S. 452**00 2820 2538 ‐ 2860 2600 2340 3102 2820 2538 ‐ 2860 3102 XXX XXX COM Res. Mental Health Prom/Educ & Com Dev - Support within Housing Psycho-Geriatric 72 5 40 50 96 76 30 S 403450*, 451*, 452* Total Cost for Functional Centre *$151,121 N/A *$151,121 N/A *TBD N/A COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Alternative Businesses 72 5 51 76 12 S 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 55 44 ‐ 62 52 42 66 55 44 ‐ 62 66 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 St. Joseph's Healthcare Xxxxxxxx OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Performance Standard Target Performance Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 2013-2014 2012-2013 2011-2012 Total Cost for Functional Centre COM Consumer Survivor Initiatives - Alternative Businesses 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD 5 51 76 12 S 455* N/A *TBD N/A *TBD $57,238 N/A XXX XXX XXX XXX *TBD N/A COM $57,238 Schedule E2b: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* & Addictions 2011-2012 2012-2013 2013-2014 > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel St. Joseph's Healthcare Xxxxxxxx Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Schedule E3: LHIN Local Indicators Schedule E3: LHIN Local Indicator – Indicators LHIN Local Indicators‐ LHIN Specific Healthcare Service Provider: Canadian Mental Health Association, Peel Branch St. Joseph's Healthcare Xxxxxxxx Target 2011-2012 Performance Standard Target 2012-2013 Performance Standard Target 2013-2014 Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/ObligationObligation Health service providers are required to update their organization's Community Information Centre information sheet annually to reflect its current services and are to update their organization's information sheet when a change in program occurs (i.e. start, stop, change hours, etc.) Sector: The HSP will complete a ALL SECTORS Target - 2011-2012 Performance Standard - Target - 2012-2013 Performance Standard - Target - 2013-2014 Performance Standard - Activity Measure/Obligation Health Equity Environmental Scan service providers are to work and submit it collaborate as appropriate with the French Language Health Planning Entity to the Central West LHIN on or before September 30improve access to and accessibility of French language services. Target 2011-2012 Performance Standard Target 2012-2013 Performance Standard Target 2013-2014 Performance Standard Sector: ALL SECTORS - - - - - - Activity Measure/Obligation As an identified health service provider for French language services, 2011. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note to M-SAA: This project template your organization is intended to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is provided by the LHIN – whether or not the HSP provides the services directly or subcontracts the provision of the services to another provider. THIS PROJECT FUNDING AGREEMENT (the “PFA”) is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (the “HSP”)required to:
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Explanatory Indicators. Without limiting the definition of “Explanatory Indicator” set out in s. 1.1, Explanatory Indicators: • are complementary indicators to the Accountability Indicators and will be documented in the technical specifications of the most appropriate Accountability Indicator(s); • support planning, negotiation or problem-solving at the provincial, LHIN level or agency level; • support transparency and enable planning discussions; • support of improving and sustaining health system quality, effectiveness and efficiency; SCHEDULE E – PERFORMANCE • are indicators where data may already be provided through existing reporting systems; and • will not trigger consequences under the SAA (unless otherwise specified in a Performance Improvement Plan or new funding obligations). Turnover Rate is an example of an Explanatory Indicator. Schedule E1 CORE INDICATORS- All Sectors CORE INDICATORS‐ INDICATORS- ALL SECTORS Healthcare Service Provider: CMHA/Peel North Shore Community Support Services, Inc. Accountability Indicators 2011-2012 2012-2013 2013-2014 Accountability Indicators Target Performance Standard Target Performance Standard Target Performance Standard % Total Margin 0% >=0% 0% >=0% XXX XXX Fund Type 2- Balanced Budget 0 0 0 0 XXX XXX Proportion of Budget Spent on Administration 1937% < 2244% 1937% < 2344% XXX XXX Variance Forecast to Actual Expenditures 0.0% < 5% 0.0% < 5% XXX XXX Variance Forecast to Actual Units of Service 0.0% < 5% 0.0% < 5% XXX XXX Explanatory Indicators Cost per Unit Service (by Functional Centre) Cost per Individual Served (by program/service) Turnover Rate Repeat Unplanned Emergency Visits within 30 days - Mental Health Conditions Repeat Unplanned Emergency Visits within 30 days - Substance Abuse Conditions Percentage of Alternate Level of Care (ALC) days > No negative variance is accepted for Total Margin > Fund Type 2- Balanced Budget: HSP's are required to submit a balanced budget. > TBD: To be Determined Schedule E2a CORE INDICATORS- All Sectors Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel North Shore Community Support Services, Inc. 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Case Management Primary Care COM Clinics/Programs - Mental Health MH Social Rehab./Recreation 72 5 09 10 76 81 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *14.6 2.49 N/A *14.6 2.49 N/A *TBD N/A COM Case Management Clinics/Programs - Mental Health MH Social Rehab./Recreation 72 5 09 10 76 81 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 10050 9548 ‐ 10553 10050 9548 ‐ 10553 6000 5700 - 6300 6000 5700 - 6300 XXX XXX COM Case Management Clinics/Programs - Mental Health MH Social Rehab./Recreation 72 5 09 10 76 81 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 315 252 ‐ 378 315 252 ‐ 378 140 112 - 168 140 112 - 168 XXX XXX COM Case Management Clinics/Programs - Mental Health MH Social Rehab./Recreation 72 5 09 10 76 81 S 450*, 451*, 455* Total Cost for Functional Centre *$1,081,979 134,157 N/A *$1,106,635 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Vocational/Employment 72 5 10 76 40 S 450*, 451*, 455* Total Cost for Functional Centre *$71,732 N/A *$73,586 134,157 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses Psycho-geriatric 72 5 10 76 41 96 S 450*, 451*, 455* Full-time equivalents (FTE)S FTE) S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *9.9 0.93 N/A *9.1 0.93 N/A *TBD N/A COM Clinics/Programs - MH Clubhouses Psycho-geriatric 72 5 10 76 41 96 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 16000 15200 ‐ 16800 20000 19000 ‐ 21000 420 336 - 504 420 336 - 504 XXX XXX COM Clinics/Programs - MH Clubhouses Psycho-geriatric 72 5 10 76 41 96 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 300 240 ‐ 360 400 320 ‐ 480 75 60 - 90 75 60 - 90 XXX XXX COM Clinics/Programs - MH Clubhouses Psycho-geriatric 72 5 10 76 41 96 S 450*, 451*, 455* Total Cost for Functional Centre *$665,784 82,428 N/A *$629,119 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *2.2 N/A *2.2 N/A *TBD N/A COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 1900 1710 ‐ 2090 1900 1710 ‐ 2090 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 30 24 ‐ 36 30 24 ‐ 36 XXX XXX COM Clinics/Programs - MH Early Intervention 72 5 10 76 51 S 450*, 451*, 455* Total Cost for Functional Centre *$148,271 N/A *$153,330 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *13 N/A *13 N/A *TBD N/A COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 7120 6764 ‐ 7476 7120 6764 ‐ 7476 XXX XXX Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service Provider: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Target Performance Standard Target Performance Standard Target Performance Standard COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 520 442 ‐ 598 520 442 ‐ 598 XXX XXX COM Clinics/Programs - MH Diversion and Court Support 72 5 10 76 56 S 450*, 451*, 455* Total Cost for Functional Centre *$890,333 N/A *$945,667 N/A *TBD N/A COM Crisis Intervention COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *32.7 N/A *31.7 N/A *TBD N/A COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 20580 19551 ‐ 21609 21207 20147 ‐ 22267 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 2860 2574 ‐ 3146 2982 2684 ‐ 3280 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Group Sessions (# of group sessions) S 492* 50 40 ‐ 60 50 40 ‐ 60 XXX XXX COM Crisis Intervention - Mental Health 72 5 15 76 S 450*, 451*, 455* Total Cost for Functional Centre *$2,851,727 N/A *$2,801,718 N/A *TBD N/A COM Residential Services COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Full-time equivalents (FTE)S 310*,350*,380*,390* (Earned Hours) divided by 1950= FTE *4.2 N/A *4 N/A *TBD N/A COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Visits Face-to-face, Telephone In-House, Contracted Out S 450*, 451*, 448*, 449* 2600 2340 ‐ 2860 2600 2340 ‐ 2860 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Individuals Served by Functional Centre or as appropriate Individuals Served by Organization S. 455*, 855* 52 42 ‐ 62 52 42 ‐ 62 XXX XXX COM Res. Mental Health - Support within Housing 72 5 40 76 30 S 403*, 455* Total Cost for Functional Centre *$260,099 N/A *$260,099 82,428 N/A *TBD N/A Schedule E2a CORE INDICATORS- All Sectors CORE INDICATORS‐ ALL SECTORS Healthcare Service ProviderE2c: CMHA/Peel 2011-2012 2012-2013 2013-2014 OHRS Description MH&A Specific Indicators Sector Specific Indicators- Mental Health Service Activity *FTE & Total Functional Centre Cost: These values are provided for information purposes only. They are not Accountability Indicators. Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 3500 3150 ‐ 3850 70 56 ‐ 84 *$233,018 N/A Performance Target Standard *0.1 N/A *$19,003 N/A *3.4 N/A 5000 4750 ‐ 5250 90 72 ‐ 108 *$239,391 N/A Performance Target Standard *TBD N/A *TBD N/A *TBD N/A XXX XXX XXX XXX *TBD N/A COM Health Promotion and Education COM Health Promo. /Education MH - Community Full-time equivalents (FTE) Development 72 5 50 76 40 S 310*,350*,380*,390* (Earned Hours) divided by S 452* 455* 1950= FTE COM Health Promo. /Education MH - Community Development 72 5 50 76 40 Total Cost for Functional Centre S 452* 455* COM Consumer/Survivor/Family Initiatives COM Consumer Survivor Initiatives - Peer/Self Help Full-time equivalents (FTE) 72 5 51 76 11 S 310*,350*,380*,390* (Earned Hours) divided by S 455* 1950= FTE COM Consumer Survivor Initiatives - Peer/Self Help Not Uniquely Identified Service Recipient 72 5 51 76 11 Interactions S 455* S. 452**00 COM Consumer Survivor Initiatives - Peer/Self Help Group Sessions (# of group sessions) 72 5 51 76 11 S 492* S 455* COM Consumer Survivor Initiatives - Peer/Self Help 72 5 51 76 11 Total Cost for Functional Centre S 455* 2011-2012 2012-2013 2013-2014 Addictions > 1N/A - not a Accountability indicator in 2011-12 or 2012-13 > *This is an Explanatory Indicator in 2013-14 only > TBD - To be determined Schedule E2c: MH&A Specific Indicators Sector Specific Indicators‐ Mental Health & Addictions Healthcare Service Provider: CMHA/Peel North Shore Community Support Services, Inc. Accountability Indicators 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Number of Days from Referral to Assessment 1N/A 1N/A 1N/A 1N/A XXX XXX Explanatory Indicators *% of Clients Satisfied with Services Received Schedule E3: LHIN Local Indicators LHIN Local Indicator – Indicators- LHIN Specific Healthcare Service Provider: Canadian Mental Health AssociationNorth Shore Community Support Services, Peel Branch Inc. 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: CMH Activity: Health Equity Environmental Scan ALL SECTORS - - - - - - Activity Measure/Obligation: Obligation Commitment to Integration The HSP will complete Board of Directors and management previously passed Board motions that committed the HSP to support the principles of integration as per the section 24 of the Local Health System Integration Act, 2006 (LHSIA) as a Health Equity Environmental Scan means of improving the health system in northern Ontario. On an annual basis the HSP is committed to completing the following: 1) An organizational self assessment tool of gaps, issues and submit it to pressures in the Central West LHIN on or before September 30, 2011. Submission Date: September 30, 2011 SCHEDULE F – PROJECT FUNDING AGREEMENT Project Funding Agreement Template Note to M-SAA: This project template is intended delivery of health care services (tool to be used to fund one-off projects or for the provision of services not ordinarily provided by the HSP. In both instances the HSP remains accountable for the funding that is LHIN) 2) A report, by May 31st of each year, of integration opportunities and strategies to implement which would include at a minimum (template to be provided by the LHIN) • Summary of discussions with HSPs for the identification and implementation of integration opportunities within the sector • Summary of discussions with HSPs for the identification and implementation of integration opportunities within the HUB region 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: ALL SECTORS - - - - - - Activity Measure/Obligation Alternate Level of Care Improvement In the North East LHIN, the percentage of ALC patient days remains the highest in the province at 34%. The 2010/11 MOHLTC-LHIN – whether or not Performance Agreement target is 17%. The current ALC situation in the HSP provides the services directly or subcontracts the provision of the services North East remains a priority for all leaders in our communities who are making a concerted effort to another providerintroduce new initiatives and improvements. THIS PROJECT FUNDING AGREEMENT (the “PFA”) It is effective as of [insert date] (the “Effective Date”) between: XXX LOCAL HEALTH INTEGRATION NETWORK (the “LHIN”) - and - [Legal Name of the Health Service Provider] (’s responsibility to participate in community planning initiatives to help reduce the “HSP”)number of Alternate Level of Care patients in the hospital and to help reduce the number of emergency department visits for at risk seniors. 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: ALL SECTORS - - - - - - Activity Measure/Obligation AAH Funding and Reporting Health Service Provider’s who have received Aging at Home funding will submit a quarterly report on the indicators provided in Schedule E, Appendix 1. The quarterly reports will be due at the same time as the OHRS/MIS reports in WERS/SRI, as indicated in Schedule C, plus a Q1 report which will be due on July 15th of each year. Schedule E3: LHIN Local Indicators LHIN Local Indicators- LHIN Specific Healthcare Service Provider: North Shore Community Support Services, Inc. 2011-2012 2012-2013 2013-2014 Target Performance Standard Target Performance Standard Target Performance Standard Sector: ALL SECTORS - - - - - - Activity
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