Wisconsin Department of Health Services Contracting and Wis. Stat Shelley Malofsky DHS Office of Legal Counsel May 7, 2015 Wisconsin Department of Health Services

Protecting and promoting the health and safety of the people of Wisconsin 2 What are you buying? How long will you buy it? How will you pay for it? How will you monitor? Special conditions? What if things go bad? Essence of Contracting

Wis. Stat requires a written agreement for purchases over $10,000. – Must indicate, as applicable: Maximum dollar amount of contract Number of clients Number of client service units Unit rate per client service Total dollar amount for each service unit Protecting and promoting the health and safety of the people of Wisconsin 3

What are you buying? Sec applies to purchase of care and services for clients. – Does not apply to purchase of items – Does not apply to purchase of administrative services – Does not apply to DCF or DOC client services; they have their own statutory requirements Protecting and promoting the health and safety of the people of Wisconsin 4

What are you buying? Be clear and specific as to client services and outcomes/goals: – Services to be provided – Standards to be met – may be several standards – How performance will be measured – may be several measurements within each standard – Services that apply to all clients – Services that are specific to each client, e.g., individualized service plan Protecting and promoting the health and safety of the people of Wisconsin 5

What are you buying? List or refer to program requirements that must be met in providing the services: – Those required by law – Those required by policy and procedure manuals Sec requires purchaser approval before a provider may transfer a client from one category of care/service to another. Who will determine client eligibility? Protecting and promoting the health and safety of the people of Wisconsin 6

How long will you buy it? Set the term of the contract. Are there renewal options? – Tie to satisfactory performance, not automatic renewal Protecting and promoting the health and safety of the people of Wisconsin 7

How will you pay for it? Sec permits paying actual allowable costs or paying by a unit rate per client service. Regardless of method used, payments are limited by contract maximum. If a start-up period is needed for a new or expanded service, sec permits paying start-up costs. Protecting and promoting the health and safety of the people of Wisconsin 8

How will you pay for it? Sec permits advance payments up to one-twelfth of the annual contract amount. – Sec requires a surety bond if advance is over $10,000 – Indicate how reconciliation will occur Take-back start at certain point in the contract? Final reconciliation at contract end? Protecting and promoting the health and safety of the people of Wisconsin 9

How will you pay for it? Actual allowable costs (cost reimbursement): – Per Allowable Cost Policy Manual – Must carefully monitor that costs are allowable Protecting and promoting the health and safety of the people of Wisconsin 10

How will you pay for it? Unit rate per client service multiplied by actual client units furnished: – High risk if there has been limited experience to assure that the unit price is reasonable – May want to limit the profit or reserves available under this method Final settlement would bring payments to actual allowable cost plus the agreed-upon limited profit or reserve Protecting and promoting the health and safety of the people of Wisconsin 11

How will you pay for it? Sec permits for-profit providers to include a percentage add-on for profit as an allowable cost. – Calculator is in the Allowable Cost Policy Manual Sec permits nonprofit providers to retain a portion of a surplus generated through a rate-based service contract. Protecting and promoting the health and safety of the people of Wisconsin 12

How will you pay for it? If revenue under a rate-based service exceeds allowable costs, the nonprofit provider may retain from the surplus up to 5% of the contract revenue. – Each rate-based contract can have a reserve Retention is used to cover past or future deficits for the same rate-based service OR to address clients’ program needs. Protecting and promoting the health and safety of the people of Wisconsin 13

How will you pay for it? The nonprofit provider may accumulate retained funds over multiple contract periods. However, if the accumulation exceeds 10% of the revenue received under current contracts for the same rate-based services, it may have to return funds to the purchaser from the excess. Protecting and promoting the health and safety of the people of Wisconsin 14

How will you pay for it? Sec requires that the provider return to the purchaser, at purchaser’s request, the purchaser’s proportional share of the accumulated excess. Any excess not returned must be used to reduce the unit rate per client for the rate- based service in the next contract period. Protecting and promoting the health and safety of the people of Wisconsin 15

How will you pay for it? If an accumulated reserve has been held for 4 consecutive contract periods and is equal to or exceeds 10% of the revenue under current contracts, sec requires that the nonprofit provider apply 50% of the accumulated amount to reduce its unit rate in the next contract period. Protecting and promoting the health and safety of the people of Wisconsin 16

How will you pay for it? Sec requires a uniform fee be charged to clients, unless waived by the purchaser, to offset the amount paid under the contract. – Determine if purchaser or provider will charge the client or liable third party Protecting and promoting the health and safety of the people of Wisconsin 17

How will you pay for it? Sec requires that purchaser recover payments made in excess of the contract conditions from subsequent payments to the provider. – Add ‘collection through other means’ in case there are no subsequent payments to the provider. Protecting and promoting the health and safety of the people of Wisconsin 18

How will you monitor? Sec requires: – Uniform double entry accounting system – Management information system – Certified financial and compliance audits for contracts over $25,000, unless waived by DHS – Nonprofit providers in rate-based contracts must comply with any financial reporting and audit requirements that DHS prescribes Protecting and promoting the health and safety of the people of Wisconsin 19

How will you monitor? Good contracting also includes: – Record retention – Purchaser’s right to inspect – Reporting requirements as needed Protecting and promoting the health and safety of the people of Wisconsin 20

Special conditions? Confidentiality requirements Civil rights compliance Indemnification and insurance Renegotiation Dispute resolution – Sec permits appeals of purchaser decisions under ch. 68 (municipal administrative procedure) Protecting and promoting the health and safety of the people of Wisconsin 21

What if things go bad? Corrective action plans Withholding funds pending correction Liquidated damages Termination – For cause (nonperformance) with right to cure – For non-cause – best interest of purchaser Sec permits reimbursing provider’s actual costs Protecting and promoting the health and safety of the people of Wisconsin 22

Resources Financial Management Manual for Counties, Tribes and 51 Boards toc.htmhttps:// toc.htm Allowable Cost Policy Manual manual.htm manual.htm Wis. Stat Protecting and promoting the health and safety of the people of Wisconsin 23