Reimbursement to an agency may be based on total costs agreed to by the parties regardless of the actual number of service units to be furnished, when the agency is entering into a contract for a new or expanded service that the purchaser recognizes will require a start-up period not to exceed 180 days. This reimbursement applies only if identified client needs necessitate the establishment of a new service or expansion of an existing service.
If the purchaser finds it necessary to terminate a contract prior to the contract expiration date for reasons other than nonperformance by the provider, the actual cost incurred by the provider may be reimbursed in an amount determined by mutual agreement of the parties.
For purposes of this section and as a condition of reimbursement, each provider under contract shall:
Except as provided in this subsection, maintain a uniform double entry accounting system and a management information system that are compatible with cost accounting and control systems prescribed by the department.
Cooperate with the department and purchaser in establishing costs for reimbursement purposes.
Unless waived by the department, biennially, or annually if required under federal law, provide the purchaser with a certified financial and compliance audit report if the care and services purchased exceed $100,000. The audit shall follow standards that the department prescribes.
Transfer a client from one category of care or service to another only with the approval of the purchaser.
Charge a uniform schedule of fees as specified under s. 49.32 (1)
unless waived by the purchaser with the approval of the department. Whenever providers recover funds attributed to the client, such funds shall offset the amount paid under the contract.
Except as provided in sub. (5m)
, the purchaser shall recover from provider agencies money paid in excess of the conditions of the contract from subsequent payments made to the provider.
“Provider" means a nonstock corporation organized under ch. 181
that is a nonprofit corporation, as defined in s. 181.0103 (17)
, and that contracts under this section to provide client services on the basis of a unit rate per client service or a county department under s. 46.215
, or 51.437
that contracts under this section to provide client services on the basis of a unit rate per client service.
“Rate-based service" means a service or a group of services, as determined by the department, that is reimbursed through a prospectively set rate and that is distinguishable from other services or groups of services by the purpose for which funds are provided for that service or group of services and by the source of funding for that service or group of services.
If revenue under a contract for the provision of a rate-based service exceeds allowable costs incurred in the contract period, the contract shall allow the provider to retain from the surplus up to 5 percent of the revenue received under the contract unless a uniform rate is established by rule under subd. 5.
, in which case the contract shall allow the provider to retain the uniform percentage rate established by the rule. The retained surplus is the property of the provider.
If on December 31 of any year the provider's accumulated surplus from all contract periods ending during that year for a rate-based service exceeds the allowable retention rate under subd. 1.
, the provider shall provide written notice of that excess to all purchasers of the rate-based service. Upon the written request of such a purchaser received no later than 6 months after the date of the notice, the provider shall refund the purchaser's proportional share of that excess. If the department determines based on an audit or fiscal review that the amount of the excess identified by the provider was incorrect, the department may seek to recover funds after the 6-month period has expired. The department shall commence any audit or fiscal review under this subdivision within 6 years after the end of the contract period.
The department, in consultation with the department of health services and the department of corrections, shall promulgate rules to implement this subsection including all of the following:
Requiring that contracts for rate-based services under this subsection allow a provider to retain from any surplus revenue up to 5 percent of the total revenue received under the contract, or a different percentage rate determined by the department. The percentage rate established under this subd. 5. a.
shall apply uniformly to all rate-based service contracts under this subsection.
Establishing a procedure for reviewing rate-based service contracts to determine whether a contract complies with the provisions of this subsection.
Notwithstanding par. (b)
, a county department under s. 46.215
, or 51.437
providing client services in a county having a population of 750,000 or more or a nonstock, nonprofit corporation providing client services in such a county may not retain a surplus generated by a rate-based service or accumulate funds from more than one contract period for a rate-based service from revenues that are used to meet the maintenance-of-effort requirement under the federal temporary assistance for needy families program under 42 USC 601
All providers that are subject to this subsection shall comply with any financial reporting and auditing requirements that the department may prescribe. Those requirements shall include a requirement that a provider provide to any purchaser and the department any information that the department needs to claim federal reimbursement for the cost of any services purchased from the provider and a requirement that a provider provide audit reports to any purchaser and the department according to standards specified in the provider's contract and any other standards that the department may prescribe.
Contracts may be renegotiated by the purchaser under conditions specified in the contract.
The service provider under this section may appeal decisions of the purchaser in accordance with terms and conditions of the contract and ch. 68
Rates for residential care centers, group homes, and child welfare agencies. 49.343(1d)(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.
“Child welfare agency" means a child welfare agency that is authorized under s. 48.61 (7)
to license foster homes.
“Performance-based contracting system" means a system of paying a provider for services based on the achievement of specified measurable outcomes.
“Provider" means a residential care center for children and youth, a group home, or a child welfare agency.
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.
, 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.
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.
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:
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.
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.
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.
Changes in program utilization that affect the per client rate or per client administrative rate.
Changes in the department's expectations relating to service delivery.
Changes in service delivery proposed by the provider and agreed to by the department.
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.
Whether the agency is accredited by a national accrediting body that has developed child welfare standards.
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)
The availability of funding to pay for the services to be provided under the proposed rate.
Any other factor relevant to the setting of a rate that the department may determine by rule promulgated under sub. (4)
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.
The department may require an audit of any provider for the purpose of collecting federal funds.
The department shall promulgate rules to implement this section. Those rules shall include rules providing for all of the following:
Standards for determining whether a proposed rate is appropriate to the level of services to be provided, the qualifications of a provider to provide those services, and the reasonable and necessary costs of providing those services.
Factors for the department to consider in reviewing a proposed rate.
Procedures for reviewing proposed rates, including procedures for ordering a rate when negotiations and mediation fail to produce an agreed to rate.
The secretary shall create an advisory committee under s. 15.04 (1) (c)
consisting of representatives of purchasers; county departments; the department, in a county having a population of 750,000 or more; tribes; consumers; and a statewide association of private, incorporated family and children's social service agencies representing all groups of providers that are affected by the rate regulation process. The committee shall advise the department on all of the following:
The implementation of rate regulation for providers as authorized under this section.
Performance-based contracting system. 49.343(6)(a)
For purposes of implementing a performance-based contracting system, the department, in cooperation with the advisory committee created under sub. (5)
, shall identify measurements by which to evaluate the performance of providers in meeting both the goals for the children placed in their care and the goals for the out-of-home care system in this state and adjust, as needed, those measurements.
Beginning on January 1, 2011, the department shall select a representative sample of providers and evaluate the performance of those providers in attaining the measurements identified under par. (a)
. Based on that evaluation, the department, in consultation with the advisory committee created under sub. (5)
, shall adjust, as needed, those measurements by December 31, 2011.
Beginning on January 1, 2013, the department shall evaluate the performance of all providers in this state in attaining the measurements identified under par. (a)
. Based on that evaluation, the department, in consultation with the advisory committee created under sub. (5)
, shall adjust, as needed, those measurements by December 31, 2013, and in subsequent years as determined necessary by the department.
History: 2007 a. 20
; Stats. 2007 s. 49.343; 2009 a. 28
; 2011 a. 260
; 2015 a. 172
; 2017 a. 59
Cost of care and maintenance; liability; collection and deportation counsel; collections; court actions; recovery. 49.345(1)(1)
Liability and the collection and enforcement of such liability for the care, maintenance, services, and supplies specified in this section are governed exclusively by this section, except in cases of child support ordered by a court under s. 48.355 (2) (b) 4.
or (4g) (a)
, 48.357 (5m) (a)
, 48.363 (2)
, 938.183 (4)
, 938.355 (2) (b) 4.
, 938.357 (5m) (a)
, or 938.363 (2)
or ch. 767
Except as provided in sub. (14) (b)
, any person, including a person placed under s. 48.32 (1) (am)
, 48.345 (3)
, 48.357 (1)
, 938.34 (3)
, or 938.357 (1)
, or (5) (e)
, receiving care, maintenance, services, and supplies provided by any institution in this state, in which the state is chargeable with all or part of the person's care, maintenance, services, and supplies, and the person's property and estate, including the homestead, and the spouse of the person, and the spouse's property and estate, including the homestead, and, in the case of a minor child, the parents of the person, and their property and estates, including their homestead, and, in the case of a foreign child described in s. 48.839 (1)
who became dependent on public funds for his or her primary support before an order granting his or her adoption, the resident of this state appointed guardian of the child by a foreign court who brought the child into this state for the purpose of adoption, and his or her property and estate, including his or her homestead, shall be liable for the cost of the care, maintenance, services, and supplies in accordance with the fee schedule established by the department under s. 49.32 (1)
. If a spouse, widow, or minor, or an incapacitated person may be lawfully dependent upon the property for his or her support, the court shall release all or such part of the property and estate from the charges that may be necessary to provide for the person. The department shall make every reasonable effort to notify the liable persons as soon as possible after the beginning of the maintenance, but the notice or the receipt of the notice is not a condition of liability.
After investigation of the liable persons' ability to pay, the department shall make collection from the person who in the opinion of the department under all of the circumstances is best able to pay, giving due regard to relationship and the present needs of the person or of the lawful dependents. However, the liability of relatives for maintenance shall be in the following order: first, the spouse of the person; then, in the case of a minor, the parent or parents.
If a person liable under sub. (2)
fails to make payment or enter into or comply with an agreement for payment, the department may bring an action to enforce the liability or may issue an order to compel payment of the liability. Any person aggrieved by an order issued by the department under this paragraph may appeal the order 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.
If judgment is rendered in an action brought under par. (a)
for any balance that is 90 or more days past due, interest at the rate of 12 percent per year shall be computed by the clerk and added to the liable person's costs. That interest shall begin on the date on which payment was due and shall end on the day before the date of any interest that is computed under s. 814.04 (4)
If the department issues an order to compel payment under par. (a)
, interest at the rate of 12 percent per year shall be computed by the department and added at the time of payment to the person's liability. That interest shall begin on the date on which payment was due and shall end on the day before the date of final payment.
If any person named in an order to compel payment issued under sub. (4) (a)
fails to pay the department any amount due under the terms of the order, and no contested case to review the order is pending, and the time for filing for a contested case review has expired, the department may present a certified copy of the order to the circuit court for any county. The circuit court shall, without notice, render judgment in accordance with the order. A judgment rendered under this subsection shall have the same effect and shall be entered in the judgment and lien docket and may be enforced in the same manner as if the judgment had been rendered in an action tried and determined by the circuit court.
The sworn statement of the collection and deportation counsel, or of the secretary, shall be evidence of the fee and of the care and services received by the person.
The department shall administer and enforce this section. It shall appoint an attorney to be designated “collection and deportation counsel" and other necessary assistants. The department may delegate to the collection and deportation counsel such other powers and duties as it considers advisable. The collection and deportation counsel or any of the assistants may administer oaths, take affidavits and testimony, examine public records, and subpoena witnesses and the production of books, papers, records, and documents material to any matter of proceeding relating to payments for the cost of maintenance. The department shall encourage agreements or settlements with the liable person, having due regard to ability to pay and the present needs of lawful dependents.
The department may do any of the following:
Appear for the state in any and all collection and deportation matters arising in the several courts, and may commence suit in the name of the department to recover the cost of maintenance against the person liable therefor.
Determine whether any person is subject to deportation, and on behalf of this state enter into reciprocal agreements with other states for deportation and importation of persons who are public charges, upon such terms as will protect the state's interests and promote mutual amicable relations with other states.
From time to time investigate the financial condition and needs of persons liable under sub. (2)
, their present ability to maintain themselves, the persons legally dependent upon them for support, the protection of the property and investments from which they derive their living and their care and protection, for the purpose of ascertaining the person's ability to make payment in whole or in part.
After due regard to the case and to a spouse and minor children who are lawfully dependent on the property for support, compromise or waive any portion of any claim of the state or county for which a person specified under sub. (2)
is liable, but not any claim payable by an insurer under s. 632.89 (2)
or by any other 3rd party.
Make an agreement with a person who is liable under sub. (2)
, or who may be willing to assume the cost of maintenance of any person, providing for the payment of such costs at a specified rate or amount.
Make adjustment and settlement with the several counties for their proper share of all moneys collected.
Pay quarterly from the appropriation under s. 20.437 (1) (gg)
the collection moneys due county departments under ss. 46.215
, and 46.23
. Payments shall be made as soon after the close of each quarter as is practicable.
Any person who willfully testifies falsely as to any material matter in an investigation or proceeding under this section shall be guilty of perjury. Banks, employers, insurers, savings banks, savings and loan associations, brokers, and fiduciaries, upon request of the department, shall furnish in writing and duly certified, full information regarding the property, earnings, or income or any funds deposited to the credit of or owing to any person liable under sub. (2)
. That certified statement shall be admissible in evidence in any action or proceeding to compel payment under this section, and shall be evidence of the facts stated in the certified statement, if a copy of the statement is served upon the party sought to be charged not less than 3 days before the hearing.
The department shall make all reasonable and proper efforts to collect all claims for maintenance, to keep payments current, and periodically to review all unpaid claims.
Except as provided in par. (b)
, in any action to recover from a person liable under this section, the statute of limitations may be pleaded in defense.
If a person who is liable under this section is deceased, a claim may be filed against the decedent's estate and the statute of limitations specified in s. 859.02
shall be exclusively applicable. This paragraph applies to liability incurred on or after July 20, 1985.
Except as provided in pars. (b)
, liability of a person specified in sub. (2)
or s. 49.32 (1)
for care and maintenance of persons under 18 years of age in residential, nonmedical facilities such as group homes, foster homes, subsidized guardianship homes, and residential care centers for children and youth is determined in accordance with the cost-based fee established under s. 49.32 (1)
. The department shall bill the liable person up to any amount of liability not paid by an insurer under s. 632.89 (2)
or by other 3rd-party benefits, subject to rules that include formulas governing ability to pay established by the department under s. 49.32 (1)
. Any liability of the person not payable by any other person terminates when the person reaches age 18, unless the liable person has prevented payment by any act or omission.