Boardworks The ABC's and 123's of CMH Finances

Boardworks The ABC's and 123's of CMH Finances

Director works 2.0 CMHSP and PIHP Finance 1 CMHSP Financing A CMH is government different accounting system than non-profit or business Not required to file 990 Do not have profit or loss statements in the traditional sense Contracts for funding are often cost settled.

2 CMH financing Not subject to ERISA (pension plan laws) Operate under GAAP (generally accepted accounting principles) and 2CFR200 (formally A-87) Governs how purchases and expenses are accounted for, and spread across cost centers to determine unit costs 3 CMH financing We

have federal, state and local sources of funds. Federal is OBRA, Medicaid, grants, Medicare. Will often have a federal grant number. Federal funds over $750,000 require a single audit separate from financial audit. State funds are general funds and anything categorical. 4 CMH financing Local funds are county match, interest, donations, and for CMHSPs that are

423 boards, client fees and insurance payments (3rd party) Not all CMHSPs are 423 boards. They are not able to count client fees and insurance payments as local. You must use GF to cover costs for 423 revenues. 5 CMHSP financing Under the Mental Health code, CMHs are responsible for 10% match on state expenditures. This includes GF and state inpatient. For state inpatient, we pay 10% of the States net cost for providing care for a client, after insurance reimbursement. We receive these bills periodically, and they may not be entirely accurate or easy to understand.

Local funds will also cover a general fund overrun, and is essentially a CMHSPs risk reserve. 6 Financing Unrestricted Fund balance is made up entirely of excess local that was not needed to match either general fund, pay for state hospital local, or used for the local match drawdown.

If a CMHSP has a negative fund balance, they are required to file a plan with the Michigan Department of Treasury to correct the deficiency within 5 years. These plans must be approved by treasury. 7 Everything has a history and most things have a reason logical or not.

CMHSPs used to have financing guidelines, which assisted CFOs in determining costs, programs, etc. Financing guidelines were last issued in October 1996. Gave instructions for allowable expenditures. Many were based on rules, laws and requirements. Most are applicable today. Defined matchable/unmatchable programs, local revenues, valid expenditures, etc. Is 12 pages long Also defined contracting requirements. Other sources for Medicaid and other funding

There are many places to find the source documents for the rules regarding Medicaid and other expenditures. The Code of Federal Regulations (CFR) governs Federal expenses, as does 2CFR200 Balanced Budget Act of 1997 governs managed care Michigan Administrative Rules Michigan Mental Health Code Michigan Constitution (investments, debts, fair consideration, rent, etc) Medicaid/General Fund contracts with MDHHS

Medicaid funding rules - examples Procurement laws No payments directly to beneficiaries Medicaid does not pay for room and board (substance used disorder residential excluded).

Medicaid does not pay for food for consumers in residential Medicaid does not pay for Alcohol (under any circumstances) Medicaid does not pay for services to incarcerated individuals Medicaid does not pay for services without a valid contract Medicaid does not pay for extravagant or unnecessary services Medicaid does not pay for services that are not medically necessary Medicaid does not pay retirement contributions in excess of the actuarially required distribution can not throw extra money at unfunded retirement Medicaid continued Medicaid does not pay for services not properly documented

Medicaid does not pay for rent in excess of fair market value or cost (depending on circumstances) Medicaid does not pay for car repairs for consumers Medicaid does not pay for transportation that is the requirement of another agency, or not related to programs Medicaid does not pay for long term housing costs for consumers Medicaid does not buy people cars, housing, or businesses Medicaid does not pay for services that are the responsibility of another party Medicaid does cover

IS the payor of last resort Will cover medically necessary services that are the responsibility of the CMHSP/PIHP under the Medicaid manual/contract IS a prudent purchaser of services Does support services provided in accordance with the Plan of Services, and authorized by the CMHSP/PIHP. Is an entitlement

Does not allow for a wait list/non-provision of medically necessary services If not allowable by Medicaid, then what? Some expenses may be covered by General Funds (excess room and board costs, spend-downs, etc.) Some expenses are not allowable by either (excessive costs, alcohol, etc.) For GF, it is called an unmatchable expense can not use general funds to cover it. Then must use local funds to cover must receive fair consideration for local expenditures can not

give something for nothing. Thus, we can not make donations, etc. to causes, fund raising, etc. with any funding source simply not allowable. Medicaid The Program which makes the rules! Medicaid is the vast majority of funding for all CMHSPs. Historically Medicaid became more prevalent in the 1980s, after de-institutionalization Medicaid historically was matched with a CMHSP general fund. We were paid the federal share, and used GF to pay ourselves the state share. After capitation began in 1998, we were paid both the State and Federal Share of Medicaid. All CMHSPs general fund allocations were reduced by the estimated amount of the state share for the capitated funds.

Michigan Medicaid Open-ended entitlement for enrolled beneficiaries Includes federal and state contributions Risk-based contract with PIHPs CMHSPs involved in multi-CMHSP affiliations receive their Medicaid through their PIHP, which is

now also called a Regional Entity PIHPs are paid per eligible per month (PEPM) Rates for traditional Medicaid will vary by person dependent on why they have Medicaid (TANF vs. DAB), age, etc. Healthy Michigan pays a flat rate per eligible 15 1115 Pathway to Integration A proposal was submitted to the federal government proposing to roll all existing waivers as well as Substance Use Disorder funding into one 1115 waiver. Allows the state to develop quality

financing and integrated care initiatives specifically for the Specialty Service populations. 16 1115 waiver goals: Increase coordination with the Health Plans and identity high risk populations Increase primary care access and coordination with physicians Decrease emergency room visits and psychiatric and regular hospital admissions for Specialty Service populations 17

Enrollment and costs There likely will still be enrollment caps for limited programs HSW (8,268), Childrens Waiver (469) and SED waiver (969). Estimated cost of the waiver is $15,011,501,458 for the five year duration of the waiver. 18 What is a waiver??? Waivers come from the federal government,

and waive portions of the social security act. All States have waivers it is easier to waive the Social Security Act than change it. We currently operate under a 1915 (b) and 1915 (c) waiver, with autism in an 1115 waiver. Waivers all of some commonality 1.Cost neutrality vs. fee for service 2.Actuarially sound funding 3.Defined service benefits and coverage 4.Defined eligibility for service benefits and coverage 5.Measures to define effectiveness of the waiver Waivers

Since 1998 we have operated under several waivers, including a1915(b), 1915(i) and 1915 (c) waiver the C waiver is for habilitation supports, Childrens Waiver and SED Waiver. There have been several changes to the Waiver, including the development of the PIHP systems, and changes to funding methodologies. 20 Waivers why change?

Michigan struggled to meet the cost effectiveness requirements of the 1915(b) waiver services. Alternative services are very popular, and grew at a faster rate than state plan services. Childrens Waiver and SED waiver are fee for service will change when new waiver is approved 21 Waivers and rates

The State has applied for an 1115 waiver, which has not been approved. We are in a holding pattern until it is either approved, or a different waiver application is filed. Rates are generally done annually, although the actuaries can make changes mid-year if they determine they are necessary (actuarially sound) 2018 Rate adjustment resulted in negative adjustments to funding, neutral adjustments, and some increases. In Michigan we are paid per member per month for each person with Medicaid eligibility. We do not have to serve everyone we are paid for

the payment is for service availability. We do have to serve everyone with Medicaid that meets the criteria of the Medicaid manual 1115 Waiver What do we know? Actuaries have changed how rates are calculated they now a model that looks at: Morbidity mix of eligibles in PIHP compared to State (based on diagnosis) Treatment prevalence count of persons served Staff shortage factor (for a few regions) Historical expenditures are no longer a factor

23 Section 298 What is it???? Many times we will refer to initiatives and requirements by a 3 digit number. This number represents the section of the Michigan DHHS Appropriation Act. Section 298 of the 2018 Appropriation Act is about CMHSPs forming partnerships with Health Plans to provide coordinated care services.

Intent is to test how to better integrate physical and behavioral to improve outcomes 24 Section 298 Began in 2016 with Governors proposed budget Led to formation of a 298 Workgroup that included MDHHS, consumers, advocates, CMHSP, PIHPs and Health Plans (that took input from 1,100 stakeholders through focus groups, and is known as

Affinity Group) Group developed a list of recommendations to MDHHS and the Governors office Final report was submitted in March, 2017 Included recommendations on policy recommendations, financing and benchmarks 25 Section 298 Legislature approved a revised version of Section 298 in 2017. This version requires:

MDHHS develop up to three pilots (in which the Medicaid behavioral health and IDD funds will go to the private health plans and then to the CMHSP) and one demonstration model to test the integration of physical and behavioral health Must also have a project facilitator and an evaluation by a State research facility At least 2 years in length Cost savings are reinvested in behavioral health 26 Section 298

There are 3 pilots sites Genesee, Saginaw and Muskegon/West Michigan Network 180 will be the demonstration project site. Will require agreements with health plans to coordinate care, and possibly payment structures. It is not possible to implement Section 298 under the current 1915 waiver. The State must wait for approval of the 1115 waiver, and then seek approval for an amendment of the waiver to allow for 298 pilot and demonstration projects. 27 Section 298 Issues

There are many barriers to implementation of the pilot project (current laws, statutes, etc.) These must be overcome for the implementation to occur. The required changes to the Social Welfare Act were recently made and signed by the Governor. It will require changes to administer the Substance Use Disorder benefit (Mental Health Code) About 25% of Medicaid recipients do not have care managed by the Health Plans. (fee for service) These people account for about 40 percent of the spending (mostly dual eligible) 28 Section 298

Has been delayed until October 1, 2019 or later, depending on the 1115 waiver approval. Also difficult to do mid-fiscal year. CMHSPs have to be able to return to the current system after the termination of the pilot. Requires different administrative and payment issues Need to figure out how to pay for people not currently in a managed care plan. (duals) 29

Affordable Care Act ACA was fully implemented January 1, 2014. Michigan did opt into Medicaid coverage for up to 138% of poverty, effective April 1, 2014. It is called Healthy Michigan. Healthy Michigan Medicaid was100% federally funded through 2017. Now the State of Michigan pays about 5% of costs 30

Childrens Waiver Closed end entitlement limited slots available that will likely continue Children are enrolled in the waiver until the age of 18 Childrens Waiver is currently fee-forservice benefit will become capitated Serves medically fragile or behaviorally challenged children with high needs 31

Most kids do not have Medicaid other than for this waiver. They have private insurance. State determines who gets the available slots based on a needs based system Slot based system will continue. Payments will become actuarially based when waiver is implemented 32 SED Waiver

Fee for Service program (currently) DHHS is providing this match to draw down federal funds Targets children served in multiple systems (court, DHHS, CMH, etc.) Currently 33 counties participate. Will become part of waiver for all CMHSPs. If a family isnt eligible for Medicaid, the SED waiver will make the child eligible. 33 State General Fund

Formula Funding share of state appropriated funds. General funds serve the priority population, which includes people Severe Mental Illness, Children with SED and persons with IDD who meet State determined service criteria but do not have Medicaid Mental Health code requires that GF funds serve the priority population, priority needs and core CMH functions (recipient rights, 24 hour emergency services, etc.)

There is currently $119 million in GF appropriation for operations 34 General funds also cover Prevention programs Community benefit programs e.g. Jail diversion and jail services, education/school programs, Multi-purpose

collaborative body, etc. Psychiatric inpatient for non-Medicaid consumers is the responsibility of the CMHSP Spend down expense MARA workers (DHHS employees) 35 General funds You can use GF for other programs after you have met your Mental Health Code obligations GF funds are annually fixed but may be reduced or increased by the state State released a plan to redistribute

GF over the next several years, starting 10/1/2018 36 What is a spend down anyway? Also known as a deductible If a person has too much income to qualify for Medicaid, they may be put on a spend down, which allows them to get Medicaid if they spend a certain portion of their income on qualified Medical expenses 37

Spend down how is it calculated? Varies by geographic location There is a PIL, or protected income level Can be as low as $341 a month. E.g. If income is = $1,000, the spenddown is difference, or $659 per month. Person is left with $341 to live on 38 Spend down Generally people with a spend down will have Medicare or other insurance Other spend downs without an

additional insurance generally qualified for Healthy Michigan They are what we call dual eligibles 39 Spend down Persons with a spend down do not have disposable income to pay medical expenses. CMH services count towards meeting the spend down (every month) When we calculate that persons ability to pay per MHC, it is generally zero We pay spend down expenses with GF

40 Spend down Not everyone meets their spend downs every month. With high spend downs, it requires a lot of services to meet it. If you dont meet spend down, then all services are GF they are considered indigent 41 Spend down Uses

a whole lot of GF (estimated 16.7 million out of 119 million total) to assist someone in meeting Medicaid eligibility For many this is seen as an ineffective use of general funds There is a great variation in serving spend downs due to lack of general fund for many CMHSPs. 42 State Hospitalizations

As of October 1, 2015, CMSHPs are no longer fully financially responsible for persons admitted to a State Facility. This is primarily due to the large reduction of general funds in 2014, and the lack of funds to pay for additional admissions to State Facilities. CMHSPs are still responsible for the local share of costs. CMHSPs are also responsible for admissions and discharge planning. 43 Allocating costs to Medicaid and other funding sources Cost

allocation plans Must determine how multiple expenditures are spread to programs/ cost centers. Many ways to spread costs should be consistent from year to year, and be logical in its base assumptions Costs that are administrative in nature are separated into administrative cost centers. Important source documents There are several documents that are go to documents for information when you need it. They include: Medicaid Manual describes services and benefit eligibility. It

is updated quarterly and is on-line. Cost per code document maintained and updated by EDIT. On the MDCH forms and documents page. Lists costing and coding of services, as well as detailed information about correctly coding all services. Michigan Medicaid Provider Qualifications chart - lists the minimum educational and licensure (if applicable) for each service. You must ensure that qualified professionals provide every service, or Medicaid will NOT pay for it. Medicaid bulletins and L-letters provide notice of upcoming proposed changes (that you can comment on) and newly issued regulations Department memos give guidance and clarifications on current issues and problems. Audits

Series of procedures followed by professional accounts to test selected financial transactions and internal controls Allows for opinion on fairness of presentation of financial statement for the period Gives accountant a basis for judging how effectively records were kept & degree of reliance that can be placed on internal controls Results in opinion on financial statements Audits are filed with the Michigan Department of Treasury 46 03/01/2020

Types of Audit Opinions Unqualified (clean) No material misstatement Qualified Takes exception to some aspect Adverse Opinion Information not presented fairly Disclaimer

Unable to form opinion 03/01/2020 47 CMHSP audits We have both a financial audit, which looks at financial status at a point in time, and a compliance audit, which measures compliance with contractual requirements. Financial audit is due March 31, or 6 months after fiscal year end Compliance audit is due June 30. 48

GASB what is it, and why do we care? Governmental Accounting Standards Board we must comply GASB issues statements followed by a number. GASB 67/68 deals with pension liability. We must now reflect net pension liability on our financial statements. This put many governmental agencies into a technical negative fund balance. 49 GASB 74/75 its next!

GASB 74/75 Starting in the next fiscal year, we must also now reflect net postemployment health liability on financial statements. For many, this is a pay as you you go expense, funding retiree health care. This will also cause negative fund balances for many CMHSPs. 50 Financial Statements Financial Statements Reflect the Organizations Financial Position at a Point in Time

Assets - Liabilities = Fund Balance Revenue Expense = Contribution to Fund Balance Asset s Revenu e 03/01/2020 Liabilitie s Expense Fund Balance Depreciatio n

51 Financial Statements Balance Sheet Balance Sheet = Assets less Liabilities equal Fund Balance General Operating Fund = Current Assets and Current Liabilities Proprietary Fund Type: Hedge Against Future Loss or Planned Event Internal Service Funds Enterprise Funds 03/01/2020 52

Balance sheet, continued Fiduciary Funds Payee Accounts or Donated Trusts Contingent of a Future Event Account Groups General Fixed Assets and General Long Term Debt 53 03/01/2020

Financial Statement Components Assets Cash and Investments Accounts Receivables (grants or fees) Funding receivable Inventory (not all CMHs record inventory) Prepaids (insurance premiums or maintenance contracts) Fixed Assets (buildings, vehicles, or equipment) 54 03/01/2020 Components

Liabilities Accounts Payable (vendor invoices, etc) Payroll Accrued payroll Other payroll-related liabilities Funding Accruals Accrued liabilities Deferred Revenue Debt (long term and short term) 55 03/01/2020 Financial Statement Components Contd Fund

Balance Fixed Assets Reserved by Donor Reserved for Long-Term Receivables Reserved for Prepaids Unreserved-Undesignated Fund Balance 03/01/2020 56 Financial statement components, continued

Revenue Funds Earned and Received Accrued Revenue Expense Expenses Incurred and Paid Accrued Expense 57 03/01/2020 Financial Statements Income Statement Revenue Federal

Funds Grants and Contracts Generally Through MDHHS that are Federally Funded (e.g. Medicaid) State Funds General Funds and other Grants and Contracts Generally Through MDHHS that are State Funded 03/01/2020 58 Revenue, Continued Local Funds County Appropriations

United Way Donations PA 423/client fees Interest 59 03/01/2020 Financial Statements Other misc. sources of revenue: Earned contracts Grants and contracts that are not federal, state or local generally offset against gross costs. Court contracts Some MDHHS contracts SSI/SSA and Food stamps

03/01/2020 60 Financial Statements Income Statement Expense Expense by Program Summary of Expense Incurred for Central Services, Adults with Mental Illness Children with Emotional Disturbance Adults and Children with Intellectual and Developmental Disabilities Autism

Substance Abuse Board Administration 03/01/2020 61 Financial Statements Income Statement Expense Expense by Line item Summary of Expenses Incurred

Salaries, Wages and Fringe Benefits Dues and Supplies Debt Service and Interest Repairs and Maintenance Rent and Utilities General Insurance Communications, Contract Services Transportation Capital Outlay 62

03/01/2020 Statement of cash flows Will show change in cash position over the course of the fiscal year for cash and cash equivalents 63 03/01/2020 Financial Statements Footnotes

Footnotes are essentially the audits detail supporting the totals in the financial statement. They will summarize the criteria used to determine the amounts listed in the financial statement. Footnotes will also detail the receivables, prepaids, and liabilities Also summarize deferred revenues 64 03/01/2020

Footnotes, continued Will detail the fund balance reserves, pension plans, long term debt and any other financial issues that may impact the CMH Board. Will list as subsequent event anything that has occurred between the end of the fiscal year and the audit which may significantly impact the CMH board. 65 03/01/2020

Footnotes - schedules Schedules at the end of the footnotes will detail line item expenditures as compared to budget. 66 03/01/2020 Solvency and Liquidity Liquidity measures Working capital

Current Assets Current Liabilities Current Ratio Current Assets/Current Liabilities Assumption: Higher working capital means better liquidity because more assets are currently available to pay existing short-term liabilities. 67 03/01/2020 Debt ratio

Total Liabilities (Debt)/Total Assets Percentage of funds provided by creditors Assumption: Lower debt ratio means greater protection because more assets are available to pay liabilities (debt) 68 03/01/2020 Capital assets

Depreciation is funded through the fund balance. Pay for capital items with your fund balance, and then seek reimbursement from MDHHS in accordance with depreciation schedule. Many CMHSPs have limited fund balance to pay for capital items This can have a dramatic negative impact on your cash flow 03/01/2020 69 Capital assets, continued. Depreciation

of capital assets will severely limit cash flow the money is paid out now, and not reimbursed for several years) Fund balance can not sustain large capital purchases may cause serious financial implications for CMHSPs. Currently many CMHSPs believe that depreciation of special revenue funds is a violation of GAAP. 03/01/2020 70 Capital assets, continued CMHSPs

may need to fund capital acquisitions through lease arrangements, e.g. vehicles, copy machines, etc. Major issue for CMH boards with low fund balance Many CMHs have been able to obtain financing that is consistent with the length of depreciation (eg 28 years for a new building). 03/01/2020 71 Compliance audit Requirement Compliance

audits are required by Medicaid Contract Section 39.0 FISCAL AUDITS AND COMPLIANCE EXAMINATIONS General Fund Contract Part II Section 7.6 Audits Compliance audits should be conducted in accordance with COMPLIANCE EXAMINATION GUI DELINES Updated Annually, 5885,7-339-73970_43164-150839--

Compliance Audit Background Pre FY07 Prior to FY07, Compliance audits were conducted by MDHHS Audits would take weeks or months to conduct Covered multiple fiscal years Findings could result in material amounts due to the number of years under audit Compliance audits were infrequent (ie 3-10 years) Compliance Audit Background FY07 to current FY07

to current, Compliance audits are conducted by external CPA firms Audits typically take days, possibly weeks Cover single fiscal year Findings typically do not result in material amounts When non-compliance is detected, management is notified so the non-compliance can be corrected in a timely manner Keeps issues from snowballing over multiple fiscal years before being detected Findings are still reported in the Comments and Recommendations Section which is similar to the Management Letter issued for Financial audits Practitioners conduct audits with the goal of expressing an opinion on the CMHSP/PIHPs compliance (in all material respects)

Requirements for Auditors 1) 2) 3) 4) 5) 6) Obtain an understanding of the specified compliance requirements Plan the engagement Consider the relevant portions of the PIHPs or CMHSPs internal control over compliance Obtain sufficient evidence including testing compliance with specified requirements Consider subsequent events

Form an opinion about whether the entity complied, in all material respects with specified requirements based on the specified criteria Budgets and Their Purpose Resource allocation Budgets provide detailed plans of how limited resources are to be distributed. Budgets set policy for personnel & other agency/program expenditures Must be aware of the funds availability for both Medicaid and General Funds 76 03/01/2020

Budgeting. Financial plan of action Expresses agency programs & operations in monetary terms Details agency goals, objectives and priorities Represents a specific period of time Is reflective of Board decisions about future 77 03/01/2020

Budget building basics.. Effective budgets are Well planned and prepared Integrate multiple perspectives and sources of information Approved by the Board of Directors Aligned with specific time period consistent with financial statements Monitored regularly and revised as needed 78 03/01/2020 Expense classifications

Personnel Expenses associated with employee compensation Non-personnel All expenses other than those associated with employee compensation 79 03/01/2020 Expense types Direct

All costs directly associated with the operation of a program Indirect All costs associated with agency supportive activities and those not directly identifiable to the operation of a particular program Example payroll, legal fees, etc. 03/01/2020 80 Budgets Have

to be balanced by State law Should amend as needed Are a guideline Balanced budget does not ensure that you will not overrun funding must monitor for changes in assumptions 81 DUAL ELIGIBLES WHAT ARE THEY AND HOW DO THEY AFFECT US??? 82 Duals in Michigan

In Michigan, there are approximately 221,000 dual eligible representing 12% of total Medicaid enrollees In Michigan, they are 38% of total Medicaid cost 2014 funding is about $8 billion Average 2011 (most recent year available) Medicaid cost for regular enrollee: $5,067 Average 2011 Medicaid cost for dual enrollee: $16,062

83 Dual eligibles who are they? Dual eligibles are individuals who qualify for both Medicaid and Medicare also known as duals. Significant numbers of CMH consumers are duals (approximately 25%) 55% of Medicaid consumers under age 65 also have Medicare

84 Dual eligibles In general, Medicare covers acute care services Medicaid covers Medicare premiums and long term care Tend to be poor and have lower health status than other beneficiaries Duals are estimated to be 42% of Medicare expenses and 25% of Medicaid nationally 85

Dual eligibles Medicare costs are covered by federal government State pays their share (varies) of Medicaid costs State largely spends its Medicaid money on long term care (nursing homes), behavioral health, and Medicare cost sharing (Medicaid covers Medicare premiums and copays) 86 Dual eligibles Problem

of coordinating benefits Medicare is the primary insurer Medicaid is secondary Medicare and Medicaid have separate payment systems that lead to numerous perverse incentives Current system does not coordinate care 87 Dual eligibles

It is estimated that duals are, on average, 45% of CMH Medicaid revenues, and 85% of HSW revenues People get dual eligible based upon disability (those with SSDI), and/or age According to Crains, more than of Michigan Dual Eligibles are served by behavioral health system. 88 Duals why care now????? Controlling Medicare & Medicaid cost is critical in controlling future health care costs If dual costs can come under control, it

is easier to solve other problems and issues The dual issue is somewhat separate from the Affordable Care Act, although related as service delivery systems are set up 89 Duals in Michigan In Michigan, there are approximately

221,000 dual eligible representing 12% of total Medicaid enrollees In Michigan, they are 38% of total Medicaid cost for all health care expenditures 2017 total health funding is about $11.2 billion One of the reasons for the MI Health Link pilot project 90 Summary CMH finance is complicated, and takes a long time to understand Ask questions most everything has an answer!

Let us know what areas to focus on for future trainings! 91 CONTACT INFORMATION Gary Smith Allegan County CMH [email protected] Phone # 269-673-6617 x2719 Cell # 269-303-8945 92

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