Section 1.04. Fee establishment, calculation and approval.

 

(1)   Applicability. With respect to client services for which responsible parties incur liability and may be billed, each facility operated by the department, a county department of social services, county department established under s. 46.23 , 51.42 or 51.437 , Stats., or an agency providing services pursuant to a contract with the department, a county department of social services or a county department established under s. 46.23 , 51.42 or 51.437 , Stats., shall establish a fee or set of fees as follows if required by the appropriate fee approval authority in par. (g) :

(a) Facility fee or service fee. The division, county department of social services, board established under s. 51.42 , 51.437 or 46.23 , Stats., or private firm in charge of the facility shall establish a uniform facility fee, except that if the facility provides 2 or more services of a disparate nature with associated wide differences in per-service cost, separate per-service fees shall be established.

(b) Fee calculation. Fees shall be determined in advance for each calendar year, except that divisions may determine fees in advance for each fiscal year. For purchased services, the contract rate and billable units to the purchaser should be identical to the fee and billable units to the responsible party or parties, wherever possible. Fees shall be determined by dividing either the number of patient days projected by the year in question, or, if the facility or service provides less than 24 hour care, the number of hours of billable client service projected for the year in question, into allowable anticipated facility or service-related expenditures for the year in question. For purchased services not easily converted to time units and where the contract or agreement specifies purchase units other than time, fees shall be set using the contract unit.

(c) Expenditures. Expenditures mean ordinary and necessary budgeted non-capital expenses and depreciation on capital equipment. Cost standards that govern purchase of care and services under s. 46.036 , Stats., shall apply to expenditures for calculating the fee. Outlays associated with non-client-specific community service and with client services exempted under s. DHS 1.01 (4) plus a pro-rata share of depreciation and associated administration or indirect costs are excluded. Where the facility establishes separate per-service fees, expenditures mean ordinary and necessary per-service expenses plus a pro-rata share of depreciation and indirect or administration costs.

(d) Calculating fees. A division, a county department of social services, a county department established under s. 46.23 , 51.42 or 51.437 , Stats., or a private firm under contract to a division or county department responsible for the calculation of the facility or service fees may use forms provided by the department for the calculation of unit rates. Budgeted costs shall be segregated among cost centers based on groupings of programs which have significantly different costs. A single facility fee may be used if the facility does not provide services of a disparate nature with associated wide discrepancies in cost. Multi-service facilities providing services which are not covered by the uniform fee system may not include costs for those services in their calculations of fees.

(e) Multiple therapist fees. Where fees are computed according to professional disciplines (i.e. psychiatrist, psychologist, social worker, nurse, etc.), a fee for an hour of service provided by 2 or more professionals would be the sum of the hourly rates for each professional.

(f) Group therapy fees. Group therapy fees shall be computed by dividing the fee calculated according to par. (d) or (e) by the projected number of non-family-related clients per group.

(g) Fee approval.

1. Divisions, county departments of social services, and county departments established under s. 51.42 , 51.437 or 46.23 , Stats., shall approve rates for facilities they operate. This subdivision does not apply where another form of approval is set by law.

2. The administrative unit of a purchasing agency authorized to enter into contracts or agreements for purchased services may approve the fee or fees for purchased services. Any fee approval shall occur before execution of the contract or agreement and the approved fee or fees shall be part of the contract. If the purchaser chooses not to approve fees under this subdivision, fees shall be established in accordance with sub. (2) (a) .

3. Where 2 or more agencies purchase the same service(s) from the same provider, the agency with the largest dollar contract shall have final approval of the facility fee or service fee(s) in question.

(h) Effective date of fee. Fees in effect at any time shall remain in effect until new fees are determined and approved pursuant to these rules. No fees shall be modified without the prior consent of the fee-approving authority.

(2)   Exceptions.

(a) Contracted services. Facilities providing services pursuant to contracts or agreements with a division, a county department of social services or a county department established under s. 46.23 , 51.42 or 51.437 , Stats., where the purchaser chooses not to approve fees under sub. (1) (g) 2. , shall establish fees which are equal to the facility's usual and customary charge. Contracted facilities shall inform the purchasing authority of the usual and customary charges and of any changes in fees that take place during the contract period.

(b) Private practitioners. For services provided by a private practitioner the fee shall be the usual and customary charge for such services when such charges are in accord with all laws or regulations governing such charges.

(c) Statewide rates. Where the department has established a statewide rate for a service, that rate shall be the fee.

(d) County departments of social services. In special circumstances with approval of the department, county departments of social services may use a fee of $12 per hour for services delivered by professional staff and $8 per hour for services provided by paraprofessionals instead of establishing fees under sub. (1) . The department may adjust these rates to reflect changes in the Milwaukee consumer price index for all items, published by the U.S. department of labor. The base time for these adjustments shall be November 1978 at which time the index was 199.0.

(e) Other procedures. With the approval of the department, fee approval authorities may use other fee-setting procedures for designated services or groups of services. The procedures shall follow these guidelines:

1. Only costs associated with the service may be considered;

2. Those costs must be included in the department's allowable cost policy established under s. 46.036 , Stats.;

3. The procedures may set more restrictive requirements for the costs to be considered; and

4. The procedures shall result in a fee per unit of service.

History: Cr. Register, August, 1978, No. 272 , eff. 9-1-78; am. (1) (intro.) and (a), renum. (1) (d) and (e) to be (1) (g) and (h), r. and recr. (1) (g), cr. (1) (d) to (f), Register, November, 1979, No. 287 , eff. 1-1-80; am. (1) (d) (intro.) and (2) (e), cr. (2) (f), Register, September, 1984, No. 345 , eff. 10-1-84; am. (1) (intro.), (g) 1. and 2., r. and recr. (1) (d) and (2) (a), Register, December, 1987, No. 384 , eff. 1-1-88.

Note

An example of services of a disparate nature is services provided by psychiatrists in comparison with services provided by social workers. Microsoft Windows NT 6.1.7601 Service Pack 1 A form that may be used to calculate unit rates is DMT 143, Uniform Fee Application, which is available along with instructions for filling it out from the Bureau of Fiscal Services, P.O. Box 7853, Madison, Wisconsin 53707-7853. Microsoft Windows NT 6.1.7601 Service Pack 1 Example: The fee for an hour of service provided by a psychologist and social worker would be the sum of the hourly rate computed for each discipline. Microsoft Windows NT 6.1.7601 Service Pack 1 Examples: Microsoft Windows NT 6.1.7601 Service Pack 1 For group sessions conducted by one therapist with an average size of 7. Microsoft Windows NT 6.1.7601 Service Pack 1 Group fee = Therapist fee ÷ 7 Microsoft Windows NT 6.1.7601 Service Pack 1 For group sessions conducted by more than one therapist with an average group size of 10. Microsoft Windows NT 6.1.7601 Service Pack 1 Group fee = (Therapist 1 + Therapist 2 etc.) ÷ 10 Microsoft Windows NT 6.1.7601 Service Pack 1