Attachment 8b Annual Availability Assessment

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Overview

PRA disclosure statement
SMI - SED Introduction
SMI - SED Instructions
SMI - SED Definitions
SMI - SED Avail Assessment

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Sheet 1: PRA disclosure statement

Serious Mental Illness and Serious Emotional Disturbance (SMI/SED)

Note: PRA Disclosure Statement to be added here

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Sheet 2: SMI - SED Introduction

Medicaid Section 1115 SMI/SED Demonstrations Annual Availability Assessment - Introduction (Version 3.0)

Introduction to the Annual Assessment of the Availability of Mental Health Services

This template has three main tabs: 1) SMI - SED Instructions, 2) SMI - SED Definitions, and 3) SMI - SED Avail Assessment.

For questions, please contact the section 1115 demonstration monitoring and evaluation mailbox ([email protected]), copying the CMS demonstration team on the message.










Version 3.0

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Sheet 3: SMI - SED Instructions

Medicaid Section 1115 SMI/SED Demonstrations Annual Availability Assessment - Instructions (Version 3.0)
blank	Instructions for Completing the Assessment of the Availability of Mental Health Services ("SMI - SED Avail Assessment" tab)
Before you begin:	The state will submit multiple Availability Assessments. The state will submit an Initial Availability Assessment at the time of application and annual assessments thereafter.
Before you begin:	Enter the state name, date of assessment, and time period reflected in assessment in cells B2-4.
Before you begin:	To hide pop-up instructions as you complete the Availability Assessment, hit "escape."
Before you begin:	In populating its Initial Availability Assessment and each subsequent Annual Availability Assessment, the state should report data as of the same month and day each year. In other words, if the Initial Availability Assessment displays values as of August 1, 2019, subsequent Availability Assessments should display values as of August 1, 2020, August 1, 2021, August 1, 2022, etc. Within each assessment, the state should enter this information into the cell labeled “Time Period Reflected in Assessment (month/day/year)" (found in the "SMI - SED Avail Assessment" tab). It is also important to use the same data sources to populate the Initial and Annual Availability Assessments. The state should enter information on its data sources into the columns labeled “Brief description of data source(s) used to populate this (sub-)section” (found in the “SMI - SED Avail Assessment” tab).
Before you begin:	Please note: To add rows for additional geographic designations you must click the "Add Row" button in cell F4 or use the keyboard shortcut SHIFT+CTRL+T. (As a first step, click "Enable Content" in the yellow message bar if it appears at the top of the tab). Please do not add rows manually.
Column	Instructions
B	In column B, enter each geographic designation starting in cell B10. Add rows using the "Add Row" button as needed to capture all geographic designations. Geographic designation means a state-defined geographic unit for reporting data, such as county, region, or catchment area. The state should consider how it divides its mental health system into smaller units or catchment areas to select geographic designations that will yield meaningful, actionable information.
C	In column C, starting in cell C10, please select whether geographic designation entered in the corresponding cell in column B could be considered urban or rural. If the geographic designation should be categorized as something other than urban or rural, select "Other-please explain" and record an explanation in the corresponding notes cell (column D). Urban is defined as a Metropolitan Statistical Area or a Metropolitan division (in the case where a Metropolitan Statistical Area is divided into Metropolitan Divisions), as defined by the Executive Office of Management and Budget (42 CFR § 412.64(b)) Rural is defined as any area outside an urban area as defined in 42 CFR § 412.64(b).
D	In column D, beginning in cell D10, please use this space to explain the state's response if the state selects 'Other-please explain' in column C.
E	In column E, starting in cell E10, enter the total number of adult Medicaid beneficiaries ages 18-20 in each geographic designation at the selected point in time. Medicaid beneficiary means a person who has been determined to be eligible to receive Medicaid services as defined at 42 CFR §400.200. Note: We are asking for this information in order to avoid double counting beneficiaries in the residential treatment category and to facilitate the calculation of certain ratios in the assessment. See the note in the following cell for additional explanation.
F	In column F, starting in cell F8, enter the number of adult Medicaid beneficiaries ages 18-20 with SMI in each geographic designation at the selected point in time. As defined on page 1 of the State Medicaid Directors Letter, serious mental illness means persons age 18 and over who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria, that has resulted in functional impairment which substantially interferes with or limits one or more major life activities. Note: We are asking this information because the State Medicaid Director letter (SMDL #18-011), defines SMI to include individuals age 18 years and older, while SED includes children younger than 18. However, the residential treatment section of the Availability Assessment requests data on PRTFs, and the federal definition for PRTFs includes facilities that serve individuals under the age of 21. In order to avoid double counting beneficiaries in the residential treatment category, the assessment requests data on beneficiaries age 0-17, 18-20, and 21 and older separately.
G	In column G, starting in cell G8, enter the total number of adult Medicaid beneficiaries age 21 and older in each geographic designation at the selected point in time. Note: We are asking for this information in order to avoid double counting beneficiaries in the residential treatment category and to facilitate the calculation of certain ratios in the assessment. See the note in the following cell for additional explanation.
H	In column H, starting in cell H10, enter the number of adult Medicaid beneficiaries age 21 and older with SMI in each geographic designation at the selected point in time. Note: We are asking this information because the State Medicaid Director letter (SMDL #18-011), defines SMI to include individuals age 18 years and older, while SED includes children younger than 18. However, the residential treatment section of the Availability Assessment requests data on PRTFs, and the federal definition for PRTFs includes facilities that serve individuals under the age of 21. In order to avoid double counting beneficiaries in the residential treatment category, the assessment requests data on beneficiaries age 0-17, 18-20, and 21 and older separately.
I	In column I, starting in cell I10, the Availability Assessment will automatically calculate the percent of adult Medicaid beneficiaries who have SMI in each geographic designation. The state should not input any values into this column or modify the formulas in this column.
J	In column J, starting in cell J10, enter the total number of Medicaid beneficiaries under the age of 18 (ages 0 - 17) in each geographic designation at the selected point in time.
K	In column K, starting in cell K10, enter the number of beneficiaries under the age of 18 (ages 0 - 17) with SED in each geographic designation at the selected point in time. As defined on page 2 of the SMDL #18-011, individuals with SED are those from birth up to age 18 who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria that resulted in functional impairment which substantially interferes with or limits the child’s role or functioning in family, school, or community activities. Functional impairment is defined as difficulties that substantially interfere with or limit a child or adolescent from achieving or maintaining one or more developmentally-appropriate social, behavioral, cognitive, communicative, or adaptive skills.
L	In column L starting in cell L10, the Availability Assessment will automatically calculate the percent of beneficiaries under the age of 18 who have SED in each geographic designation. The state should not input any values into this column or modify the formulas in this column.
M	In column M, starting in cell M10, the Availability Assessment will automatically calculate the number of Medicaid beneficiaries (total) in each geographic designation.
N	In column N, starting in cell N10, the Availability Assessment will automatically calculate the percent with Medicaid beneficiaries with SMI or SED (total) in each geographic designation.
O	In column O, starting in cell O10, the Availability Assessment will automatically calculate the percent with SMI or SED (total) in each geographic designation.
P	In column P, beginning in cell P10, please use this space to provide notes about the data source(s) used to populate the section.
Q	In column Q, beginning in cell Q10, please use this space to provide any additional notes regarding the section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
R	In column R, starting in cell R10, enter the number of psychiatrists or other practitioners who are authorized to prescribe psychiatric medications in each geographic designation. A psychiatrist is any psychiatrist licensed to practice in the state under state licensure laws. "Other prescribers authorized to prescribe psychiatric medications" means mental health practitioners other than psychiatrists who are authorized to prescribe psychiatric medications as defined by state licensure laws.
S	In column S, starting in cell S10, enter the number of Medicaid-enrolled psychiatrists or other practitioners who are authorized to prescribe psychiatric medications in each geographic designation. "Medicaid-enrolled" means any provider enrolled in Medicaid to obtain Medicaid billing privileges, as defined in 42 CFR §455.410.
T	In column T, starting in cell T10, enter the number of Medicaid-enrolled psychiatrists or other practitioners who are authorized to prescribe psychiatric medications and are accepting new Medicaid patients in each geographic designation. "Accepting new Medicaid patients" means any provider enrolled in Medicaid to obtain Medicaid billing privileges who will treat new Medicaid-enrolled patients.
U-W	In columns U-W, starting in cell U10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
X	In column X, beginning in cell X10, please use this space to provide details on the specific types of practitioners used to populate this sub-section.
Y	In column Y, beginning in cell Y10, please use this space to provide notes about the data source(s) used to populate the sub-section.
Z	In column Z, beginning in cell Z10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
AA	In column AA, starting in cell AA10, enter the number of other practitioners certified or licensed to independently treat mental illness in each geographic designation. "Other types of practitioners certified or licensed to independently treat mental illness" means non-psychiatrist mental health providers who are certified or licensed to independently treat mental illness as defined by state licensure laws. This may include, but is not limited to, licensed psychologists, clinical social workers, and professional counselors.
AB	In column AB, starting in cell AB10, enter the number of Medicaid-enrolled other practitioners certified or licensed to independently treat mental illness in each geographic designation.
AC	In column AC, starting in cell AC10, enter the number of Medicaid-enrolled other practitioners certified or licensed to independently treat mental illness accepting new Medicaid patients in each geographic designation.
AD-AF	In columns AD-AF, starting in cell AD10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
AG	In column AG, beginning in cell AG10, please use this space to provide details on the specific types of practitioners used to populate this sub-section.
AH	In column AH, beginning in cell AH10, please use this space to provide notes about the data source(s) used to populate the sub-section.
AI	In column AI, beginning in cell AI10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
AJ	In column AJ, starting in cell AJ10, enter the number of community mental health centers (CMHCs) in each geographic designation. A community mental health center is an entity that provides outpatient mental health services, 24 hour emergency care services, day treatment, screenings, and consultation and educational services, as defined at 42 CFR §410.2.
AK	In column AK, starting in cell AK10, enter the number of Medicaid-enrolled CMHCs in each geographic designation.
AL	In column AL, starting in cell AL10, enter the number of Medicaid-enrolled CMHCs accepting new Medicaid patients in each geographic designation.
AM-AO	In columns AM-AO, starting in cell AM10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
AP	In column AP, beginning in cell AP10, please use this space to provide notes about the data source(s) used to populate the section.
AQ	In column AQ, beginning in cell AQ10, please use this space to provide any additional notes regarding the section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
AR	In column AR, starting in cell AR10, enter the number of providers offering intensive outpatient services in each geographic designation. Intensive outpatient services are designed to meet the needs of individuals who may be at risk for crisis or requiring a higher level of care, or who are in transition from a higher level of care. Intensive outpatient services may include partial hospitalization programs, day treatment, intensive outpatient programs, assertive community treatment, and other services and settings more intensive than regular outpatient and less intensive than inpatient or residential care.
AS	In column AS, starting in cell AS10, enter the number of Medicaid-enrolled providers offering intensive outpatient services providers in each geographic designation.
AT	In column AT, starting in cell AT10, enter the number of Medicaid-enrolled providers offering intensive outpatient services accepting new Medicaid patients in each geographic designation.
AU-AW	In columns AU-AW, starting in cell AU10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
AX	In column AX, beginning in cell AX10, please use this space to provide details on the specific types of services used to populate this section.
AY	In column AY, beginning in cell AY10, please use this space to provide notes about the data source(s) used to populate the section.
AZ	In column AZ, beginning in cell AZ10, please use this space to provide any additional notes regarding the section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
BA	In column BA, starting in cell BA10, enter the number of residential mental health treatment facilities (adult) in each geographic designation. A residential mental health treatment facility (adult) is a facility not licensed as a psychiatric hospital, whose primary purpose is to provide individually planned programs of mental health treatment services in a residential care setting for adults as defined for SAMHSA's National Substance Use and Mental Health Services Survey (N-SUMHSS). Note: please exclude residential SUD treatment facilities.
BB	In column BB, starting in cell BB10, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) in each geographic designation.
BC	In column BC, starting in cell BC10, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) accepting new Medicaid patients in each geographic designation.
BD-BF	In columns BD-BF, starting in cell BD10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
BG	In column BG, starting in cell BG10, enter the total number of residential mental health treatment facility beds (adult) in each geographic designation.
BH	In column BH, starting in cell BH10, enter the total number of Medicaid-enrolled residential mental health treatment beds (adult) in each geographic designation.
BI	In column BI, starting in cell BI10, enter the total number of Medicaid-enrolled residential mental health treatment beds available to adult Medicaid patients in each geographic designation. "Available to adult Medicaid patients" means any facility or bed available to serve Medicaid patients ages 18 and older.
BJ-BL	In columns BJ-BL, starting in cell BJ10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
BM	In column BM, beginning in cell BM10, please use this space to provide details on the specific types of facilities used to populate this sub-section.
BN	In column BN, beginning in cell BN10, please use this space to provide notes about the data source(s) used to populate the sub-section.
BO	In column BO, beginning in cell BO10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
BP	In column BP, starting in cell BP10, enter the number of psychiatric residential treatment facilities (PRTF) in each geographic designation. A PRTF is a non-hospital facility with a provider agreement with a state Medicaid agency to provide the inpatient psychiatric services to individuals under age 21 benefit (psych under 21 benefit). The facility must be accredited by the Joint Commission, the Council on Accreditation of Services for Families and Children, the Commission on Accreditation of Rehabilitation Facilities, or any other accrediting organization with comparable standards recognized by the State. PRTFs must also meet the requirements at 42 CFR §441.151 - §441.1102, and 42 CFR §4103.350 – §4103.376.
BQ	In column BQ, starting in cell BQ10, enter the number of Medicaid-enrolled PRTFs in each geographic designation.
BR	In column BR, starting in cell BR10, enter the number of Medicaid-enrolled PRTFs accepting new Medicaid patients in each geographic designation.
BS-BU	In columns BS-BU, starting in cell BS10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
BV	In column BV, starting in cell BV10, enter the total number of PRTF beds in each geographic designation.
BW	In column BW, starting in cell BW10, enter the number of Medicaid-enrolled PRTF beds in each geographic designation.
BX	In column BX, starting in cell BX10, enter the number of Medicaid-enrolled PRTF beds available to Medicaid patients in each geographic designation. Available to Medicaid patients means any facility or bed available to serve Medicaid patients.
BY-CA	In columns BY-CA, starting in cell BY10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
CB	In column CB, beginning in cell CB10, please use this space to provide details on the specific types of facilities used to populate this sub-section.
CC	In column CC, beginning in cell CC10, please use this space to provide notes about the data source(s) used to populate the sub-section.
CD	In column CD, beginning in cell CD10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
CE	In column CE, starting in cell CE10, enter the number of public and private psychiatric hospitals in each geographic designation. A psychiatric hospital is an institution which provides diagnosis and treatment of mentally ill persons, as defined at 42 USC §1395x.
CF	In column CF, starting in cell CF10, enter the number of public and private psychiatric hospitals available to Medicaid patients in each geographic designation.
CG-CH	In columns CG-CH, starting in cell CG10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
CI	In column CI, beginning in cell CI10, please use this space to provide notes about the data source(s) used to populate the sub-section.
CJ	In column CJ, beginning in cell CJ10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
CK	In column CK, starting in cell CK10, enter the number of psychiatric units in acute care hospitals in each geographic designation. A psychiatric unit is a separate inpatient psychiatric unit of a general hospital that provides inpatient mental health services and has specifically allocated staff and space (beds) for the treatment of persons with mental illness, as defined for SAMHSA's N-SUMHSS.
CL	In column CL, starting in cell CL10, enter the number of psychiatric units in critical access hospitals (CAHs) in each geographic designation. A critical access hospital is a small facility that provides 24-hour emergency care, outpatient services, as well as inpatient services to people in rural areas, as defined in 42 CFR §4105.606.
CM	In column CM, starting in cell CM10, enter the number of Medicaid-enrolled psychiatric units in acute care hospitals in each geographic designation.
CN	In column CN, starting in cell CN10, enter the number of Medicaid-enrolled psychiatric units in CAHs in each geographic designation.
CO	In column CO, starting in cell CO10, enter the number of Medicaid-enrolled psychiatric units in acute care hospitals accepting new Medicaid patients in each geographic designation.
CP	In column CP starting in cell CP10, enter the number of Medicaid-enrolled psychiatric units in CAHs accepting new Medicaid patients in each geographic designation.
CQ-CV	In columns CQ-CV, starting in cell CQ10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
CW	In column CW, beginning in cell CW10, please use this space to provide notes about the data source(s) used to populate the sub-section.
CX	In column CX, beginning in cell CX10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
CY	In column CY, starting in cell CY10, enter the total number of licensed psychiatric hospital beds (adding together beds in psychiatric hospitals, beds in psychiatric units in acute care hospitals, and beds in psychiatric units in critical access hospitals) in each geographic designation. Please enter the number of licensed psychiatric hospital beds as defined by state licensure requirements.
CZ	In column CZ, starting in cell CZ10, enter the number of licensed psychiatric hospital beds (adding together beds in psychiatric hospitals, beds in psychiatric units in acute care hospitals, and beds in psychiatric units in critical access hospitals) available to Medicaid patients in each geographic designation.
DA-DB	In columns DA-DB, starting in cell DA10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
DC	In column DC, beginning in cell DC10, please use this space to provide notes about the data source(s) used to populate the sub-section.
DD	In column DD, beginning in cell DD10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
DE	In column DE, starting in cell DE10, enter the number of residential mental health treatment facilities (adult) that qualify as an institution for mental diseases (IMDs) in each geographic designation. An IMD is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services per section 1905(i) of the Social Security Act. See also 42 CFR §435.1010 and section 4390 of the State Medicaid Manual.
DF	In column DF, starting in cell DF10, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) that qualify as IMDs in each geographic designation.
DG	In column DG, starting in cell DG10, enter the number of Medicaid-enrolled residential mental health treatment facilities (adult) that qualify as IMDs accepting Medicaid patients in each geographic designation.
DH-DJ	In columns DH-DJ, starting in cell DH10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
DK	In column DK, beginning in cell DK10, please use this space to provide details on the specific types of facilities used to populate this sub-section.
DL	In column DL, beginning in cell DL10, please use this space to provide notes about the data source(s) used to populate the sub-section.
DM	In column DM, beginning in cell DM10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
DN	In column DN, starting in cell DN10, enter the number of psychiatric hospitals that qualify as IMDs in each geographic designation.
DO	In column DO, starting in cell DO10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
DP	In column DP, beginning in cell DP10, please use this space to provide notes about the data source(s) used to populate the sub-section.
DQ	In column DQ, beginning in cell DQ10, please use this space to provide any additional notes regarding the sub-section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
DR	In column DR, starting in cell DR10, enter the number of crisis call centers in each geographic designation. Please enter the number of crisis call centers as defined by the state.
DS	In column DS, starting in cell DS10, enter the number of mobile crisis units in each geographic designation. A mobile crisis unit is a team that intervenes during mental health crises, as defined by the state.
DT	In column DT, starting in cell DT10, enter the number of crisis observation/assessment centers in each geographic designation. Please enter the number of crisis observation or assessment centers as defined by the state.
DU	In column DU, starting in cell DU10, enter the number of crisis stabilization units in each geographic designation. Crisis stabilization units offer medically monitored short-term crisis stabilization services, as defined by the state.
DV	In column DV, starting in cell DV10, enter the number of coordinated community crisis response teams in each geographic designation. "Coordinated community crisis response" means a community-based program or entity that manages crisis response across various community entities or programs, as defined by the state.
DW-EA	In columns DW-EA, starting in cell DW10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
EB	In column EB, beginning in cell EB10, please use this space to provide details on the specific types of services used to populate this section.
EC	In column EC, beginning in cell EC10, please use this space to provide notes about the data source(s) used to populate the section.
ED	In column ED, beginning in cell ED10, please use this space to provide any additional notes regarding the section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
EE	In column EE, starting in cell EE10, enter the number of federally qualified health center (FQHCs) that offer behavioral health services in each geographic designation. Federally qualified health center (FQHC) means an entity that has entered into an agreement with CMS to meet Medicare program requirements under 42 CFR §405.2434 and 42 CFR §405.2401.
EF	In column EF, starting in cell EF10, the Availability Assessment will automatically calculate the ratios in each geographic designation. The state should not input any values into these columns or modify the formulas in these columns.
EG	In column EG, beginning in cell EG10, please use this space to provide notes about the data source(s) used to populate the section.
EH	In column EH, beginning in cell EH10, please use this space to provide any additional notes regarding the section, such as notes on data limitations, explanations for specific values, or information that could assist with data interpretation.
EI	Beginning in column EI, add additional counts and ratios for provider and setting types that the state considers important to its mental health system. The state should not modify any of the previous columns.
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Sheet 4: SMI - SED Definitions

Medicaid Section 1115 SMI/SED Demonstrations Annual Availability Assessment - Definitions (Version 3.0)
Terms used in Availability Assessment	Definitions of terms
Term	Definition
Accepting new Medicaid patients	Accepting new Medicaid patients means any provider enrolled in Medicaid to obtain Medicaid billing privileges who will treat new Medicaid-enrolled patients.
Adult	An adult is a person age 18 and over [SMDL #18-011].
Available to Medicaid patients	Available to Medicaid patients means any facility or bed available to serve Medicaid patients.
Community mental health center (CMHC)	A community mental health center (CMHC) is defined in §410.2 as “an entity that (1) provides outpatient services, including specialized outpatient services for children, the elderly, individuals who are chronically mentally ill, and clients of its mental health service area who have been discharged from inpatient treatment at a mental health facility; (2) provides 24-hour-a-day emergency care services; (3) provides day treatment or other partial hospitalization services, or psychosocial rehabilitation services; (4) provides screening for patients being considered for admission to state mental health facilities to determine the appropriateness of this admission; (5) meets applicable licensing or certification requirements for CMHCs in the state in which it is located; and (6) provides at least 40 percent of its services to individuals who are not eligible for benefits under title XVIII of the Social Security Act.
Coordinated community crisis response	Coordinated community crisis response means a community-based program or entity that manages crisis response across various community entities or programs, as defined by the state.
Crisis call center	Crisis call centers are defined by the state.
Crisis stabilization unit	Crisis stabilization units offer medically monitored short-term crisis stabilization services, as defined by the state.
Critical access hospital	A critical access hospital is a small facility that provides 24-hour emergency care, outpatient services, as well as inpatient services to people in rural areas, as defined in 42 CFR §485.606.
Federally qualified health center	Federally qualified health center (FQHC) means an entity that meets all the requirements at 1905(l)(2)(B) of the Social Security Act.
Geographic designation	Geographic designation means a state-defined geographic unit for reporting data, such as county, region, or catchment area.
Institution for mental diseases (IMD)	An institution for mental diseases is a hospital, nursing facility, or other institution of more than 16 beds that is primarily engaged in providing diagnosis, treatment or care of persons with mental diseases, including medical attention, nursing care and related services per section 1905(i) of the Social Security Act. See also 42 CFR §435.1010 and section 4390 of the State Medicaid Manual.
Intensive outpatient services	Intensive outpatient services are designed to meet the needs of individuals who may be at risk for crisis or requiring a higher level of care, or who are in transition from a higher level of care. Intensive outpatient services may include partial hospitalization programs, day treatment services, intensive outpatient programs, Assertive Community Treatment, intensive case management, intensive peer supports, written standardized protocols for escalating outpatient services when an individual is experiencing a crisis or increased need, and other services and settings more intensive than regular outpatient and less intensive than inpatient or residential care.
Licensed psychiatric hospital bed	Licensed psychiatric hospital bedsare defined by state licensure requirements.
Medicaid beneficiary	Medicaid beneficiary means a person who has been determined to be eligible to receive Medicaid services as defined at 42 CFR §400.200.
Medicaid-enrolled	Medicaid-enrolled means any provider enrolled in Medicaid to obtain Medicaid billing privileges, as defined in 42 CFR §455.410.
Mental health practitioners other than psychiatrists who are certified or licensed by the state to independently treat mental illness	Mental health practitioners other than psychiatrists who are certified or licensed to independently treat mental illness are non-psychiatrist mental health providers who are certified or licensed to independently treat mental illness as defined by state licensure laws. This may include, but is not limited to, licensed psychologists, clinical social workers, and professional counselors. Practitioners who are required to work under the supervision of another practitioner and/or who are required to bill Medicaid under another practitioner should be excluded.
Mobile crisis unit	A mobile crisis unit is a team that intervenes during mental health crises, as defined by the state.
Observation or assessment centers	Observation or assessment centers are defined by the state.
Other practitioners who are authorized to prescribe psychiatric medications	Other practitioners who are authorized to prescribe psychiatric medications are defined by state licensure laws.
Psychiatric hospital	A psychiatric hospital is an institution which provides diagnosis and treatment of mentally ill person, as defined at 42 USC §1395x. The state should report on both public and private psychiatric hospitals.
Psychiatric residential treatment facility (PRTF)	A psychiatric residential treatment facility is a non-hospital facility with a provider agreement with a state Medicaid agency to provide the inpatient psychiatric services to individuals under age 21 benefit (psych under 21 benefit). The facility must be accredited by the Joint Commission, the Council on Accreditation of Services for Families and Children, the Commission on Accreditation of Rehabilitation Facilities, or any other accrediting organization with comparable standards recognized by the State. PRTFs must also meet the requirements at 42 CFR §441.151 - §441.182, and 42 CFR §483.350 – §483.376.
Psychiatric unit	A psychiatric unit is a separate inpatient psychiatric unit of a general hospital that provides inpatient mental health services and has specifically allocated staff and space (beds) for the treatment of persons with mental illness, as defined for SAMHSA's National Substance Use and Mental Health Services Survey (N-SUMHSS).
Psychiatrist	A psychiatrist is any psychiatrist licensed to practice in the state under state licensure laws.
Residential mental health treatment facilities (adult)	A residential mental health treatment facilities (adult) is a facility not licensed as a psychiatric hospital, whose primary purpose is to provide individually planned programs of mental health treatment services in a residential care setting for adults as defined for SAMHSA's N-SUMHSS. Please exclude residential SUD treatment facilities.
Rural	Rural means any area outside an urban area as defined in 42 CFR § 412.64(b).
Serious emotional disturbance (SED)	Persons with serious emotional disturbance means individuals from birth up to age 18 who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria that resulted in functional impairment which substantially interferes with or limits the child’s role or functioning in family, school, or community activities. Functional impairment” is defined as difficulties that substantially interfere with or limit a child or adolescent from achieving or maintaining one or more developmentally-appropriate social, behavioral, cognitive, communicative, or adaptive skills [SMDL #18-011].
Serious mental illness (SMI)	Persons with serious mental illness means individuals, age 18 and over, who currently, or at any time during the past year, have had a diagnosable mental, behavioral, or emotional disorder of sufficient duration to meet diagnostic criteria, that has resulted in functional impairment which substantially interferes with or limits one or more major life activities. [SMDL #18-011] Note: in the SMDL, SMI is defined to include individuals age 18 years and older, and SED includes children younger than 18. However, the residential treatment section of the availability assessment requests data on PRTFs, and the federal definition for PRTFs includes facilities that serve individuals under the age of 21. In order to avoid double counting beneficiaries in the residential treatment category, the assessment requests data on beneficiaries age 0-17, 18-20, and 21 and older separately.
Urban	Urban means a Metropolitan Statistical Area or a Metropolitan division (in the case where a Metropolitan Statistical Area is divided into Metropolitan Divisions), as defined by the Executive Office of Management and Budget (42 CFR § 412.64(b)).
End of worksheet

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Sheet 5: SMI - SED Avail Assessment

Medicaid Section 1115 SMI/SED Demonstrations Annual Availability Assessment (Version 3.0)				To add a new row, use button below or the keyboard shortcut SHIFT+CTRL+T
State Name
Date of Assessment
Time Period Reflected in Assessment (month/day/year)		PLEASE NOTE: The state should use the same reporting month and day (under “Time Period Reflected in Assessment”) and data sources across its Initial and Annual Availability Assessment submissions.
blank row
Table: Serious Mental Illness and Serious Emotional Disturbance Annual Availability Assessment
Geographic Designation	Geographic Designation	Geographic Designation	Geographic Designation	Beneficiaries													Providers																		Community Mental Health Centers								Intensive Outpatient Services									Residential Mental Health Treatment Facilities																														Inpatient																										Institutions for Mental Diseases													Crisis Stabilization Services													Federally Qualified Health Centers
Geographic Designation	Geographic Designation	Geographic Designation	Geographic Designation	Beneficiaries: Adult					Beneficiaries: Children			Beneficiaries: Total					Psychiatrists and Other Practitioners Who Are Authorized to Prescribe Psychiatric Medications									Other Practitioners Certified and Licensed to Independently Treat Mental Illness									Community Mental Health Centers	Community Mental Health Centers	Community Mental Health Centers	Community Mental Health Centers	Community Mental Health Centers	Community Mental Health Centers	Community Mental Health Centers	Community Mental Health Centers	Intensive Outpatient Services	Intensive Outpatient Services	Intensive Outpatient Services	Intensive Outpatient Services	Intensive Outpatient Services	Intensive Outpatient Services	Intensive Outpatient Services	Intensive Outpatient Services	Intensive Outpatient Services	Residential Mental Health Treatment Facilities (Adult)															Psychiatric Residential Treatment Facilities															Public and Private Psychiatric Hospitals						Psychiatric Units														Psychiatric Beds						Residential Treatment Facilities That Qualify As IMDs									Psychiatric Hospitals That Qualify As IMDs				Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Crisis Stabilization Services	Federally Qualified Health Centers	Federally Qualified Health Centers	Federally Qualified Health Centers	Federally Qualified Health Centers
Geographic designation #	Geographic designation name	Geographic designation: Is this geographic designation primarily urban or rural?	Geographic designation: Additional notes on Geographic Designation sub-section, including data limitations	Adult Beneficiaries: Number of adult Medicaid beneficiaries (18 - 20)	Adult Beneficiaries: Number of adult Medicaid beneficiaries with SMI (18 - 20)	Adult Beneficiaries: Number of adult Medicaid beneficiaries (21+)	Adult Beneficiaries: Number of adult Medicaid beneficiaries with SMI (21+)	Adult Beneficiaries: Percent with SMI (Adult)	Children Beneficiaries: Number of Medicaid beneficiaries (0 - 17)	Children Beneficiaries: Number of Medicaid beneficiaries with SED (0 - 17)	Children Beneficiaries: Percent with SED (0-17)	Total Beneficiaries: Number of Medicaid beneficiaries (Total)	Total Beneficiaries: Number of Medicaid beneficiaries with SMI or SED (Total)	Total Beneficiaries: Percent with SMI or SED (Total)	Brief description of data source(s) used to populate the Beneficiaries section	Additional notes on the Beneficiaries section, including data limitations	Providers: Number of Psychiatrists and Other Practitioners Who Are Authorized to Prescribe Psychiatric Medications	Providers: Number of Medicaid-Enrolled Psychiatrists and Other Practitioners Who Are Authorized to Prescribe Psychiatric Medications	Providers: Number of Medicaid-Enrolled Psychiatrists and Other Practitioners Who Are Authorized to Prescribe Psychiatric Medications Accepting New Medicaid Patients	Providers: Ratio of Medicaid beneficiaries with SMI/SED to Medicaid-Enrolled Psychiatrists and Other Prescribers	Providers: Ratio of Total Psychiatrists or Other Prescribers to Medicaid-Enrolled Psychiatrists and Other Prescribers	Providers: Ratio of Medicaid-Enrolled Psychiatrists and Other Prescribers to Medicaid-Enrolled Psychiatrists and Other Prescribers Accepting New Medicaid Patients	Psychiatrists and Other Practitioners Who Are Authorized to Prescribe Psychiatric Medications: Specific type(s) of practitioners used to populate this sub-section	Psychiatrists and Other Practitioners Who Are Authorized to Prescribe Psychiatric Medications: Brief description of data source(s) used to populate this sub-section	Psychiatrists and Other Practitioners Who Are Authorized to Prescribe Psychiatric Medications: Additional notes on this sub-section, including data limitations	Providers: Number of Other Practitioners Certified or Licensed to Independently Treat Mental Illness	Providers: Number of Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness	Providers: Number of Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness Accepting New Medicaid Patients	Providers: Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness	Providers: Ratio of Other Practitioners Certified or Licensed to Independently Treat Mental Illness to Medicaid-Enrolled Other Practitioners Certified or Licensed to Independently Treat Mental Illness	Providers: Ratio of Medicaid-Enrolled Other Practitioners Certified and Licensed to Independently Treat Mental Illness to Medicaid-Enrolled Other Practitioners Certified and Licensed to Independently Treat Mental Illness Accepting New Patients	Other Practitioners Certified and Licensed to Independently Treat Mental Illness: Specific type(s) of practitioners used to populate this sub-section	Other Practitioners Certified and Licensed to Independently Treat Mental Illness: Brief description of data source(s) used to populate this sub-section	Other Practitioners Certified and Licensed to Independently Treat Mental Illness: Additional notes on this sub-section, including data limitations	Community Mental Health Centers: Number of CMHCs	Community Mental Health Centers: Number of Medicaid- Enrolled CMHCs	Community Mental Health Centers: Number of Medicaid-Enrolled CMHCs Accepting New Medicaid Patients	Community Mental Health Centers: Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid- Enrolled CMHCs	Community Mental Health Centers: Ratio of Total CMHCs to Medicaid- Enrolled CMHCs	Community Mental Health Centers: Ratio of Medicaid-Enrolled CMHCs to Medicaid-Enrolled CMHCs Accepting New Patients	Community Mental Health Centers: Brief description of data source(s) used to populate this section	Community Mental Health Centers: Additional notes on this section, including data limitations	Intensive Outpatient Services: Number of Providers Offering Intensive Outpatient Services	Intensive Outpatient Services: Number of Medicaid-Enrolled Providers Offering Intensive Outpatient Services	Intensive Outpatient Services: Number of Medicaid-Enrolled Providers Offering Intensive Outpatient Services Accepting New Medicaid Patients	Intensive Outpatient Services: Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid- Enrolled Providers Offering Intensive Outpatient Services	Intensive Outpatient Services: Ratio of Total Providers Offering Intensive Outpatient Services to Medicaid-Enrolled Providers Offering Intensive Outpatient Services	Intensive Outpatient Services: Ratio of Medicaid-Enrolled Providers Offering Intensive Outpatient Services to Medicaid- Enrolled Providers Offering Intensive Outpatient Services Accepting New Medicaid Patients	Intensive Outpatient Services: Specific type(s) of services used to populate this section	Intensive Outpatient Services: Brief description of data source(s) used to populate this section	Intensive Outpatient Services: Additional notes on this section, including data limitations	Residential Mental Health Treatment Facilities: Number of Residential Mental Health Treatment Facilities (Adult)	Residential Mental Health Treatment Facilities: Number of Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult)	Residential Mental Health Treatment Facilities: Number of Medicaid-Enrolled Residential Mental Health Treatment Facilities Accepting New Medicaid Patients (Adult)	Residential Mental Health Treatment Facilities: Ratio of Medicaid Beneficiaries with SMI (Adult) to Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult)	Residential Mental Health Treatment Facilities: Ratio of Total Residential Mental Health Treatment Facilities (Adult) to Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult)	Residential Mental Health Treatment Facilities: Ratio of Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult) to Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) Accepting New Patients	Residential Mental Health Treatment Facilities: Total Number of Residential Mental Health Treatment Facility Beds (Adult)	Residential Mental Health Treatment Facilities: Total Number of Medicaid- Enrolled Residential Mental Health Treatment Beds (Adult)	Residential Mental Health Treatment Facilities: Total Number of Medicaid-Enrolled Residential Mental Health Treatment Beds Available to Adult Medicaid Patients	Residential Mental Health Treatment Facilities: Ratio of Medicaid Beneficiaries with SMI (Adult) to Medicaid-Enrolled Residential Mental Health Treatment Beds	Residential Mental Health Treatment Facilities: Ratio of Total Residential Mental Health Treatment Beds to Medicaid-Enrolled Residential Mental Health Treatment Beds	Residential Mental Health Treatment Facilities: Ratio of Medicaid-Enrolled Residential Mental Health Treatment Beds to Medicaid- Enrolled Residential Mental Health Treatment Beds Available to Medicaid Patients	Residential Mental Health Treatment Facilities (Adult): Specific type(s) of facilities used to populate this sub-section	Residential Mental Health Treatment Facilities (Adult): Brief description of data source(s) used to populate this sub-section	Residential Mental Health Treatment Facilities (Adult): Additional notes on this sub-section, including data limitations	Residential Mental Health Treatment Facilities: Number of Psychiatric Residential Treatment Facilities (PRTF)	Residential Mental Health Treatment Facilities: Number of Medicaid- Enrolled PRTFs	Residential Mental Health Treatment Facilities: Number of Medicaid-Enrolled PRTFs Accepting New Medicaid Patients	Residential Mental Health Treatment Facilities: Ratio of Medicaid Beneficiaries with SED to Medicaid-Enrolled PTRFs	Residential Mental Health Treatment Facilities: Ratio of Total PTRFs to Medicaid- Enrolled PRTFs	Residential Mental Health Treatment Facilities: Ratio of Medicaid-Enrolled PRTFs to Medicaid-Enrolled PRTFs Accepting New Medicaid Patients	Residential Mental Health Treatment Facilities: Total Number of PRTF Beds	Residential Mental Health Treatment Facilities: Number of Medicaid-Enrolled PRTF Beds	Residential Mental Health Treatment Facilities: Number of Medicaid-Enrolled PRTF Beds Available to Medicaid Patients	Residential Mental Health Treatment Facilities: Ratio of Medicaid Beneficiaries with SED to Medicaid-Enrolled PRTF Beds Available to Medicaid Patients	Residential Mental Health Treatment Facilities: Ratio of Total Number of PRTF Beds to Medicaid- Enrolled PRTF Beds	Residential Mental Health Treatment Facilities: Ratio of Medicaid- Enrolled PRTF Beds to Medicaid- Enrolled PRTFs Available to Medicaid Patients	Psychiatric Residential Treatment Facilities: Specific type(s) of facilities used to populate this sub-section	Psychiatric Residential Treatment Facilities: Brief description of data source(s) used to populate this sub-section	Psychiatric Residential Treatment Facilities: Additional notes on this sub-section, including data limitations	Inpatient: Number of Public and Private Psychiatric Hospitals	Inpatient: Public and Private Psychiatric Hospitals Available to Medicaid Patients	Inpatient: Ratio of Medicaid Beneficiaries with SMI/SED to Public and Private Psychiatric Hospitals Available to Medicaid Patients	Inpatient: Ratio of Public and Private Psychiatric Hospitals to Public and Private Psychiatric Hospitals Available to Medicaid Patients	Inpatient Public and Private Psychiatric Hospitals: Brief description of data source(s) used to populate this sub-section	Inpatient Public and Private Psychiatric Hospitals: Additional notes on this sub-section, including data limitations	Inpatient: Number of Psychiatric Units in Acute Care Hospitals	Inpatient: Number of Psychiatric Units in Critical Access Hospitals (CAHs)	Inpatient: Number of Medicaid- Enrolled Psychiatric Units in Acute Care Hospitals	Inpatient: Number of Medicaid-Enrolled Psychiatric Units in CAHs	Inpatient: Number of Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals Accepting New Medicaid Patients	Inpatient: Number of Medicaid-Enrolled Psychiatric Units in CAHs Accepting New Medicaid Patients	Inpatient: Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals	Inpatient: Ratio of Medicaid Beneficiaries with SMI/SED to Medicaid-Enrolled Psychiatric Units in CAHs	Inpatient: Ratio of Psychiatric Units in Acute Care Hospitals to Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals	Inpatient: Ratio of Psychiatric Units in CAHs to Medicaid-Enrolled Psychiatric Units in CAHs	Inpatient: Ratio of Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals to Medicaid-Enrolled Psychiatric Units in Acute Care Hospitals Accepting New Medicaid Patients	Inpatient: Ratio of Medicaid-Enrolled Psychiatric Units in CAHs to Medicaid-Enrolled Psychiatric Units in CAHs Accepting New Medicaid Patients	Inpatient Psychiatric Units: Brief description of data source(s) used to populate this sub-section	Inpatient Psychiatric Units: Additional notes on this sub-section, including data limitations	Inpatient: Number of Licensed Psychiatric Hospital Beds (Psychiatric Hospital + Psychiatric Units)	Inpatient: Number of Licensed Psychiatric Hospital Beds (Psychiatric Hospital + Psychiatric Units) Available to Medicaid Patients	Inpatient: Ratio of Medicaid Beneficiaries with SMI/SED to Licensed Psychiatric Hospital Beds Available to Medicaid Patients	Inpatient: Ratio of Licensed Psychiatric Hospital Beds to Licensed Psychiatric Hospital Beds Available to Medicaid Patients	Inpatient Psychiatric Beds: Brief description of data source(s) used to populate this sub-section	Inpatient Psychiatric Beds: Additional notes on this sub-section, including data limitations	IMDs: Number of Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs	IMDs: Number of Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs	IMDs: Number of Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs Accepting Medicaid Patients	IMDs: Ratio of Medicaid Beneficiaries with SMI (Adult) to Medicaid- Enrolled Residential Mental Health Treatment Facilities that Qualify as IMDs	IMDs: Ratio of Total Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs to Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs	IMDs: Ratio of Medicaid-Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs to Medicaid- Enrolled Residential Mental Health Treatment Facilities (Adult) that Qualify as IMDs Accepting New Medicaid Patients	Residential Treatment Facilities That Qualify As IMDs: Specific type(s) of facilities used to populate this sub-section	Residential Treatment Facilities That Qualify As IMDs: Brief description of data source(s) used to populate this sub-section	Residential Treatment Facilities That Qualify As IMDs: Additional notes on this sub-section, including data limitations	Institutions for Mental Diseases: Number of Psychiatric Hospitals that Qualify as IMDs	Institutions for Mental Diseases: Ratio of Medicaid Beneficiaries with SMI/SED to Psychiatric Hospitals that Qualify as IMDs	Psychiatric Hospitals That Qualify As IMDs: Brief description of data source(s) used to populate this sub-section	Psychiatric Hospitals That Qualify As IMDs: Additional notes on this sub-section, including data limitations	Crisis Stabilization Services: Number of Crisis Call Centers	Crisis Stabilization Services: Number of Mobile Crisis Units	Crisis Stabilization Services: Number of Crisis Observation/ Assessment Centers	Crisis Stabilization Services: Number of Crisis Stabilization Units	Crisis Stabilization Services: Number of Coordinated Community Crisis Response Teams	Crisis Stabilization Services: Ratio of Medicaid Beneficiaries with SMI/SED to Crisis Call Centers	Crisis Stabilization Services: Ratio of Medicaid Beneficiaries with SMI/SED to Mobile Crisis Units	Crisis Stabilization Services: Ratio of Medicaid Beneficiaries with SMI/SED to Crisis Observation/ Assessment Centers	Crisis Stabilization Services: Ratio of Medicaid Beneficiaries with SMI/SED to Crisis Stabilization Units	Crisis Stabilization Services: Ratio of Medicaid Beneficiaries with SMI/SED to Coordinated Community Crisis Response Teams	Crisis Stabilization Services: Specific type(s) of services used to populate this section	Crisis Stabilization Services: Brief description of data source(s) used to populate this section	Crisis Stabilization Services: Additional notes on this section, including data limitations	Federally Qualified Health Centers: Number FQHCs that Offer Behavioral Health Services	Federally Qualified Health Centers: Ratio of Medicaid Beneficiaries with SMI/SED to FQHCs that Offer Behavioral Health Services	Federally Qualified Health Centers: Brief description of data source(s) used to populate this section	Federally Qualified Health Centers: Additional notes on this section, including data limitations
1.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
2.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
3.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
4.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
5.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
6.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
7.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
8.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
9.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
10.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
11.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
12.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
13.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
14.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
15.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
16.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
17.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
18.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
19.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
20.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
21.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
22.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
23.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
24.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
25.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
26.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
27.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
28.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
29.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
30.								-			-	0	0	-						-	-	-							-	-	-							-	-	-						-	-	-							-	-	-				-	-	-							-	-	-				-	-	-						-	-									-	-	-	-	-	-					-	-						-	-	-					-								-	-	-	-	-					-
Totals:	n.a.	n.a.	n.a.	0	0	0	0	-	0	0	-	0	0	-	n.a.	n.a.	0	0	0	-	-	-	n.a.	n.a.	n.a.	0	0	0	-	-	-	n.a.	n.a.	n.a.	0	0	0	-	-	-	n.a.	n.a.	0	0	0	-	-	-	n.a.	n.a.	n.a.	0	0	0	-	-	-	0	0	0	-	-	-	n.a.	n.a.	n.a.	0	0	0	-	-	-	0	0	0	-	-	-	n.a.	n.a.	n.a.	0	0	-	-	n.a.	n.a.	0	0	0	0	0	0	-	-	-	-	-	-	n.a.	n.a.	0	0	-	-	n.a.	n.a.	0	0	0	-	-	-	n.a.	n.a.	n.a.	0	-	n.a.	n.a.	0	0	0	0	0	-	-	-	-	-	n.a.	n.a.	n.a.	0	-	n.a.	n.a.
	End of worksheet