49.34(6)
(6) Contracts may be renegotiated by the purchaser under conditions specified in the contract.
49.34(7)
(7) The service provider under this section may appeal decisions of the purchaser in accordance with terms and conditions of the contract and ch.
68 or
227.
49.343
49.343
Rates for residential care centers, group homes, and child welfare agencies. 49.343(1d)(a)
(a) “Administrative rate" means the difference between the rate charged by a child welfare agency to a purchaser of foster care services and the rate paid by the child welfare agency to a foster parent for the care and maintenance of a child.
49.343(1d)(b)
(b) “Child welfare agency" means a child welfare agency that is authorized under s.
48.61 (7) to license foster homes.
49.343(1d)(cg)
(cg) “Performance-based contracting system" means a system of paying a provider for services based on the achievement of specified measurable outcomes.
49.343(1d)(cr)
(cr) “Provider" means a residential care center for children and youth, a group home, or a child welfare agency.
49.343(1g)
(1g)
Establishment of rates. For services provided beginning on January 1, 2011, the department shall establish the per client rate that a residential care center for children and youth or a group home may charge for its services, and the per client administrative rate that a child welfare agency may charge for the administrative portion of its foster care services, as provided in this section. In establishing rates for a placement specified in s.
938.357 (4) (c) 1. or
2., the department shall consult with the department of corrections. A residential care center for children and youth and a group home shall charge all purchasers the same rate for the same services and a child welfare agency shall charge all purchasers the same administrative rate for the same foster care services. The department shall determine the levels of care created under the rules promulgated under s.
48.62 (8) to which this section applies.
49.343(2)(a)(a) By October 1, annually, a residential care center for children and youth or a group home shall submit to the department the per client rate that it proposes to charge for services provided in the next year and a child welfare agency shall submit to the department the proposed per client administrative rate that it proposes to charge for foster care services provided in the next year. The department shall provide forms and instructions for the submission of proposed rates under this paragraph and a residential care center for children and youth, group home, or child welfare agency that is required to submit a proposed rate under this paragraph shall submit that proposed rate using those forms and instructions.
49.343(2)(b)
(b) The department shall review a proposed rate submitted under par.
(a) and audit the provider submitting the proposed rate to determine whether the proposed rate is appropriate to the level of services to be provided, the qualifications of the provider to provide those services, and the reasonable and necessary costs of providing those services. In reviewing a proposed rate, the department shall consider all of the following factors:
49.343(2)(b)1.
1. Changes in the consumer price index for all urban consumers, U.S. city average, as determined by the U.S. department of labor, for the 12 months ending on June 30 of the year in which the proposed rate is submitted.
49.343(2)(b)1m.
1m. Changes in the consumer price index for all urban consumers, U.S. city average, for the medical care group, as determined by the U.S. department of labor, for the 12 months ending on June 30 of the year in which the proposed rate is submitted.
49.343(2)(b)2.
2. Changes in the allowable costs of the residential care center for children and youth, group home, or child welfare agency based on current actual cost data or documented projections of costs.
49.343(2)(b)3.
3. Changes in program utilization that affect the per client rate or per client administrative rate.
49.343(2)(b)4.
4. Changes in the department's expectations relating to service delivery.
49.343(2)(b)5.
5. Changes in service delivery proposed by the provider and agreed to by the department.
49.343(2)(b)6.
6. The loss of any source of revenue that had been used to pay expenses, resulting in a lower per client rate or per client administrative rate for services.
49.343(2)(b)6m.
6m. Whether the agency is accredited by a national accrediting body that has developed child welfare standards.
49.343(2)(b)7.
7. Changes in any state or federal laws, rules, or regulations that result in any change in the cost of providing services, including any changes in the minimum wage, as defined in s.
49.141 (1) (g).
49.343(2)(b)9.
9. The availability of funding to pay for the services to be provided under the proposed rate.
49.343(2)(b)10.
10. Any other factor relevant to the setting of a rate that the department may determine by rule promulgated under sub.
(4).
49.343(2)(c)
(c) If the department determines under par.
(b) that a proposed rate submitted under par.
(a) is appropriate, the department shall approve the proposed rate. If the department does not approve a proposed rate, the department shall negotiate with the provider to determine an agreed to rate. If after negotiations a rate is not agreed to, the department and the provider shall engage in mediation under the rate resolution procedure promulgated by rule under sub.
(4) to arrive at an agreed to rate. If after mediation a rate is not agreed to, the department shall order a rate for the service after considering the factors under par.
(b). A provider may appeal the rate set by the department as a contested case under ch.
227 by filing with the department a request for a hearing within 30 days after the date of the order.
49.343(3)
(3)
Audit. The department may require an audit of any provider for the purpose of collecting federal funds.