RCPA CPS Provider Survey Regarding Plans for Reopening Question Title * 1. When your county enters the green status, are you prepared to open your facility: Immediately After a week of preparation After two weeks of preparation Need more time to plan and prepare Do not operate facility- based CPS (if so, skip to question 9) Question Title * 2. Prior to opening what actions is your AE requiring? Please check all that apply: Written transition plan Written transition plan approved by AE On-site visit by AE Individual meetings with families Approved floor plan Detailed policies/procedures for: Bathroom use Cleaning schedule Lunches & breaks Other (please specify) Question Title * 3. When you open your facility and allow individuals to attend, what percentage of your pre-COVID attendees do you expect to attend the first week? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 4. When you open your facility and allow individuals to attend, what percentage of your pre-COVID attendees do you expect to attend the second week? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 5. When you open your facility and allow individuals to attend, what percentage of your pre-COVID attendees do you expect to attend the third week? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 6. When you open your facility and allow individuals to attend, what percentage of your pre-COVID attendees do you expect to attend the fourth week? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 7. What percentage of pre-COVID attendees do you anticipate will return to your facility when the COVID crisis has passed? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 8. What challenges do you believe will impact your ability to serve individuals in your facility? Please check all that apply: Individuals or their families fear return Staff fear returning too soon Decreased revenue Transportation issues Individuals unable to follow safety rules Group homes concerned about individual’s risks attending Physical plant issues and limitations impacting capacity while implementing new safety standards Other (list) Question Title * 9. When your county enters the green status, what percentage of pre-COVID Community based CPS services do you expect to provide in the Community the first week? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 10. When your county enters the green status, what percentage of pre-COVID Community based CPS services do you expect to provide in the Community the second week? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 11. When your county enters the green status, what percentage of pre-COVID Community based CPS services do you expect to provide in the Community the third week? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 12. When your county enters the green status, what percentage of pre-COVID Community based CPS services do you expect to provide in the Community by the end of the first month? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 13. What challenges do you believe will impact your ability to serve individuals in the community? Please check all that apply: Individuals or their families fear going out Individuals unable to follow safety rules Staff concern about returning to the community too quickly Group homes concerned about individual going out Not enough community activities available Volunteer activity or job placements no longer available Other (list) Question Title * 14. Have you been providing remote services during COVID? Yes No Yes and plan to continue and/or expand this service No and do not plan to offer this service No but do plan to begin offering this service Question Title * 15. If you have provided remote services, or plan to begin to offer remote services, what impact do you expect it will have on your budget? We will make up all lost revenue from our previous service model We will make up under 25% of previous revenue We will make up to 50% of our previous revenue We will make more than 50% of our previous revenue Question Title * 16. Based upon individual transition meetings, are you experiencing an increase/decrease in billable units? Increase Decrease Question Title * 17. If you have experienced a change as indicated in number 16, what percentage difference? 0 - 9% 10 - 19% 20 - 29% 30 - 39% 40 - 49% 50 - 59% 60 - 69% 70% or more Question Title * 18. If you are willing to provide additional details, please complete the next questions. Otherwise, please submit your survey now. Question Title * 19. Please provide the number of units of service provided for the first two quarters of FY 19-20 by W Code: W9351 W9352 W5996 W5997 W5993 W5994 W7222 W7223 W7226 W7224 W7244 W9353 W7269 W9356 W9400 W7094 Question Title * 20. Please provide the number of units provided during the final quarter of FY 19-20 by W Code: W9351 W9352 W5996 W5997 W5993 W5994 W7222 W7223 W7226 W7224 W7244 W9353 W7269 W9356 W9400 W7094 Question Title * 21. Please provide the number of units anticipated for the first two quarters of FY 20-21 by W Code: W9351 W9352 W5996 W5997 W5993 W5994 W7222 W7223 W7226 W7224 W7244 W9353 W7269 W9356 W9400 W7094 Done