Title IV-E Foster CarePer Diem Rates & Percentage Report
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Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 1 - Children's Group Residential - Mental Health Cert. Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Avanti Center for Girls-Evaluation (VOA) Hennepin 5 1049979 B $283.00 53.94% 1.10% 0.00% 41.73% 5/1/2015 4/30/2019 Avanti Center for Girls-Residential (VOA) Hennepin 5 1049979 A $330.00 53.98% 1.09% 0.00% 41.70% 5/1/2015 4/30/2019 Bar None (VOA) - Stepping Stone SED & Evaluation Hennepin 5 1036848 A $305.00 43.78% 1.35% 0.00% 50.88% 5/1/2015 4/30/2019 Bar None (VOA) - Sunrise SED and Evaluation Hennepin 5 1036848 J $331.00 47.04% 1.26% 0.00% 47.98% 5/1/2015 4/30/2019 Children's Home Society - Boys Unit (South Dakota) Lyon 5 1056841 A $323.78 45.69% 1.34% 0.00% 46.49% 7/1/2014 6/30/2016 Children's Home Society - Madsen House (South Dakota) Lyon 5 1056841 B $239.38 43.22% 1.38% 0.00% 46.96% 7/1/2014 6/30/2016 Children's Home Society - VanDemark House (South Dakota) Lyon 5 1056841 C $239.38 51.92% 1.30% 0.00% 39.27% 7/1/2014 6/30/2016 Children's Residential Treatment Center (VOA) Hennepin 5 1004840 A $359.00 45.48% 1.28% 0.00% 43.63% 1/1/2015 12/31/2015 Eau Claire Academy - Transitional Living Program (Wisconsin) Hennepin 5 1056935 C $147.27 40.74% 1.63% 0.00% 59.27% 1/1/2015 6/30/2018 Eau Claire Academy - West Unit (STOP Program) (Wisconsin) Hennepin 5 1056935 B $267.09 44.60% 1.45% 0.00% 53.82% 1/1/2015 6/30/2018 Eau Claire Academy Res. Treat./Assess (Wisconsin) Hennepin 5 1056935 A $257.95 32.94% 1.72% 0.00% 62.67% 1/1/2015 6/30/2018 Gerard (Nexus) - Assessment Mower 5 831080 B $260.89 33.67% 1.95% 0.00% 59.53% 1/1/2015 12/31/2015 Gerard (Nexus) - Bridging Program Mower 5 831080 D $260.89 33.67% 1.95% 0.00% 59.53% 1/1/2015 12/31/2015 Gerard (Nexus) - Long Term Residential Mower 5 831080 A $248.89 34.87% 1.98% 0.00% 58.41% 1/1/2015 12/31/2015 Gerard (Nexus) - Short Term Residential Mower 5 831080 E $260.89 33.67% 1.95% 0.00% 59.53% 1/1/2015 12/31/2015 Leo A. Hoffmann Center - Evaluation Nicollet 5 801377 C $289.75 33.63% 1.66% 0.00% 59.83% 1/1/2016 12/31/2016 Leo A. Hoffmann Center - Main Nicollet 5 801377 D $279.75 33.70% 1.65% 0.00% 59.78% 1/1/2016 12/31/2016 Leo A. Hoffmann Center - North Cottage - Low Functioning Nicollet 5 801377 B $289.75 33.63% 1.66% 0.00% 59.83% 1/1/2016 12/31/2016 Mille Lacs Academy - The Navigators / Cornerstone Castle Mille Lacs 5 1036935 A $252.39 39.49% 1.53% 0.00% 54.47% 1/1/2015 12/31/2015 Mille Lacs Academy - The Ship / Cornerstone Safari Mille Lacs 5 1036935 J $279.62 47.00% 1.31% 0.00% 47.80% 1/1/2015 12/31/2015 Milwaukee Academy - Residential Treatment (Wisconsin) Hennepin 5 1056934 A $258.74 50.23% 1.16% 0.00% 42.19% 1/1/2015 6/30/2018 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 1 - Children's Group Residential - Mental Health Cert. Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date North Homes - I.T.A.S.K.I.N. Center Assessment/Evaluation Itasca 5 1010657 B $253.22 44.40% 3.44% 0.00% 48.17% 1/1/2015 12/31/2015 North Homes - I.T.A.S.K.I.N. Center Treatment Itasca 5 1010657 C $244.87 47.43% 1.57% 0.00% 47.10% 1/1/2015 12/31/2015 North Homes, Inc. - Cottage Treatment Itasca 5 1047010 A $244.87 44.40% 3.44% 0.00% 48.17% 1/1/2015 12/31/2015 Northwood Children's - Diagnostic & Assessment St. Louis 5 807289 A $250.78 28.83% 1.88% 0.00% 63.50% 1/1/2015 12/31/2015 Northwood Children's Home - Main St. Louis 5 801775 A $250.26 49.26% 1.35% 0.00% 44.34% 1/1/2015 12/31/2015 Northwood Children's Home - West St. Louis 5 801777 A $250.26 49.26% 1.35% 0.00% 44.34% 1/1/2015 12/31/2015 Omegon, Inc. Hennepin 5 804659 A $300.00 53.46% 1.12% 0.00% 42.12% 1/1/2013 12/31/2017 Pathfinders Children's Treat Ctr - Mental Health (Sanford) Pennington 5 830494 B $264.00 33.03% 1.69% 0.00% 60.27% 1/1/2013 12/31/2015 St. Cloud Children's Home - Evaluation (Cath. Char.) Stearns 5 803889 B $278.88 24.81% 1.70% 0.00% 68.48% 1/1/2015 12/31/2015 St. Cloud Children's Home - Secure Unit (Catholic Charities) Stearns 5 803889 C $440.60 35.30% 1.59% 0.00% 57.70% 1/1/2015 12/31/2015 St. Cloud Children's Home (Catholic Charities) Stearns 5 803889 A $258.85 34.66% 1.54% 0.00% 58.05% 1/1/2015 12/31/2015 St. Joseph's Home for Children-Residential Treatment Ctr. Hennepin 5 802343 B $255.00 39.04% 1.45% 0.00% 54.08% 1/1/2012 12/31/2015 Summit Oaks I (South Dakota) Lyon 5 1059190 A $234.41 62.38% 1.14% 0.00% 26.48% 1/1/2013 12/31/2016 Summit Oaks II (South Dakota) Lyon 5 1059190 B $366.68 42.81% 1.67% 0.00% 44.95% 1/1/2013 12/31/2016 Woodland Hills - Residential Treatment Mental Health St. Louis 5 1036983 K $260.22 40.63% 1.41% 0.00% 50.97% 1/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 1 - Group Residential Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Adolescent Treatment Center of Winnebago Treatment Faribault 8 804032 F $295.68 87.42% 5.08% 0.00% 0.00% 1/1/2015 12/31/2015 Ain Dah Yung Center Ramsey 8 800051 A $163.94 88.25% 9.70% 0.00% 0.00% 1/1/2015 12/31/2015 Arlington House Shelter - 704 Larpenter Ramsey 8 800116 S $305.82 85.33% 9.38% 0.00% 0.00% 1/1/2015 3/31/2016 Arlington House Shelter - 712 Larpenter Ramsey 8 800117 S $305.82 85.33% 9.38% 0.00% 0.00% 1/1/2015 3/31/2016 Avanti Center for Girls - Shelter (VOA) Hennepin 8 1049979 S $270.00 88.47% 7.69% 0.00% 0.00% 5/1/2015 4/30/2019 Bethany Crisis Shelter - 25 Day Evaluation (LSS) St. Louis 8 800188 B $176.40 85.10% 11.55% 0.00% 0.00% 1/1/2015 12/31/2015 Bethany Crisis Shelter (LSS) St. Louis 8 800188 A $169.68 86.86% 10.67% 0.00% 0.00% 1/1/2015 12/31/2015 Carlton Youth Shelter (LSS) Carlton 8 801438 A $162.80 86.46% 10.43% 0.00% 0.00% 1/1/2015 12/31/2016 Crisis Stabilization - Youth Shelter (Woodland Center) Kandiyohi 8 802474 S $258.00 71.55% 8.36% 0.00% 0.00% 1/1/2015 12/31/2015 Evergreen Shelter - 35 Day Evaluation Beltrami 8 800759 C $178.00 81.97% 7.28% 0.00% 0.00% 1/1/2015 12/31/2015 Evergreen Shelter - Crisis (14 Day) Beltrami 8 800759 A $160.50 82.97% 7.34% 0.00% 0.00% 1/1/2015 12/31/2015 Evergreen Shelter - Short Term Crisis (Over 21 Days) Beltrami 8 800759 B $160.50 82.97% 7.34% 0.00% 0.00% 1/1/2015 12/31/2015 Family Resource Ctr - (Bethany) Range Youth Shelter (LSS) St. Louis 8 800190 A $194.00 84.05% 10.88% 0.00% 0.00% 1/1/2015 12/31/2015 Franklin House - Regular (McLeod Treatment) McLeod 8 1026553 B $198.48 82.02% 10.93% 0.00% 0.00% 1/1/2015 12/31/2015 Greater Minnesota Family Services - Shelter Care Kandiyohi 8 811013 A $192.26 91.78% 2.57% 0.00% 0.00% 1/1/2015 12/31/2016 Harbor Shelter East-Hastings (Stivland,Inc) Dakota 8 807165 S $188.55 88.28% 9.65% 0.00% 0.00% 1/1/2014 12/31/2015 Little Sand Group Home - Lakeside Cass 8 801413 A $199.19 89.28% 4.34% 0.00% 0.00% 1/1/2016 12/31/2016 Little Sand Group Home - West Cass 8 801412 A $199.19 87.33% 3.08% 0.00% 0.00% 1/1/2016 12/31/2016 Mapletree Group Home Anoka 8 804016 A $168.33 87.51% 8.97% 0.00% 0.00% 1/1/2015 12/31/2015 Pathfinders Children's Treat Ctr - Residential (Sanford) Pennington 8 830494 A $187.00 75.56% 9.20% 0.00% 0.00% 1/1/2013 12/31/2015 Shelter Care for Kids Hennepin 8 802222 A $214.00 86.09% 8.72% 0.00% 0.00% 1/1/2015 6/30/2016 Sheppard House - Regular (McLeod Treatment) McLeod 8 1027055 B $198.48 82.02% 10.90% 0.00% 0.00% 1/1/2015 12/31/2015 St. Joseph's Home for Children-Main Shelter Hennepin 8 802343 S $217.11 87.72% 9.04% 0.00% 0.00% 1/1/2012 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 1 - Group Residential Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date The Vintage Place - Cottage Ave Ramsey 8 1040610 A $176.85 84.93% 7.43% 0.00% 0.00% 1/1/2015 12/31/2015 The Vintage Place - Ivy Ave Ramsey 8 1023779 B $176.85 84.93% 7.43% 0.00% 0.00% 1/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 1 - Other Facilities Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Anoka County Juvenile Center Anoka CP 1036841 A $190.00 87.83% 9.97% 0.00% 0.00% 1/1/2015 12/31/2015 Bar None (VOA) - Evaluation - Male Stabilization Unit Hennepin CP 1036848 I $274.00 86.73% 8.13% 0.00% 0.00% 5/1/2015 4/30/2019 Bar None (VOA) - Evergreen Hennepin CP 1036848 F $328.00 86.86% 8.96% 0.00% 0.00% 5/1/2015 4/30/2019 Bar None (VOA) - Shelter - Male Stabilization Unit Hennepin CP 1036848 S $252.00 86.73% 8.13% 0.00% 0.00% 5/1/2015 4/30/2019 Hayward Group Home (180 Degrees Inc) Freeborn CP 1062100 A $162.48 87.08% 8.00% 0.00% 0.00% 1/1/2015 12/31/2015 Heartland Girls Ranch Swift CP 1036870 A $213.00 83.71% 11.25% 0.00% 0.00% 1/1/2016 12/31/2016 Heartland Girls Ranch - Hearts For Freedom Swift CP 1036870 C $295.00 80.10% 11.42% 0.00% 0.00% 1/1/2016 12/31/2016 Heartland Girls Ranch - Strides Swift CP 1065991 A $183.00 79.69% 12.91% 0.00% 0.00% 1/1/2016 12/31/2016 Mesabi Academy - Fire Setter Residential St. Louis CP 1036899 A $295.36 85.33% 9.20% 0.00% 0.00% 1/1/2015 12/31/2015 Mesabi Academy KidsPeace - Chemical Dependency St. Louis CP 1036899 D $242.59 73.05% 8.63% 0.00% 0.00% 1/1/2015 12/31/2015 Mesabi Academy KidsPeace - Diagnostic Residential St. Louis CP 1036899 H $253.40 85.33% 9.20% 0.00% 0.00% 1/1/2015 12/31/2015 Mesabi Academy KidsPeace - Open Residential St. Louis CP 1036899 G $231.81 74.53% 8.84% 0.00% 0.00% 1/1/2015 12/31/2015 Mesabi Academy KidsPeace - Sexual Issues (Non-Secure) St. Louis CP 1036899 I $273.83 74.46% 8.69% 0.00% 0.00% 1/1/2015 12/31/2015 Mesabi Academy KidsPeace - Specialized Residential St. Louis CP 1036899 K $300.50 76.04% 9.42% 0.00% 0.00% 1/1/2015 12/31/2015 Mille Lacs Academy - New Trails Mille Lacs CP 1056498 A $166.06 85.96% 9.86% 0.00% 0.00% 1/1/2015 12/31/2015 North Homes - I.T.A.S.K.I.N - Shelter Itasca CP 1010657 E $244.87 87.92% 10.01% 0.00% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Girls Program (Bemidji) Itasca CP 1063371 A $217.33 88.33% 9.56% 0.00% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Girls Teens In Transition (Bemidji) Itasca CP 1063372 A $217.33 88.33% 9.56% 0.00% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Next Step (Boys) Itasca CP 1067172 A $217.33 88.94% 9.11% 0.00% 0.00% 1/1/2015 12/31/2015 North Homes, Inc. - Boys Program Itasca CP 1056074 A $217.33 88.94% 9.11% 0.00% 0.00% 1/1/2015 12/31/2015 North Homes, Inc. - Teens in Transition (Boys) Itasca CP 1028358 B $217.33 88.94% 9.11% 0.00% 0.00% 1/1/2015 12/31/2015 Northwestern MN Juv Ctr - Primary Residential (Non-Secure) Beltrami CP 1036937 G $208.00 89.31% 8.41% 0.00% 0.00% 1/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 1 - Other Facilities Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Northwestern MN Juvenile Center Consequence Beltrami CP 1036937 J $214.00 91.67% 6.84% 0.00% 0.00% 1/1/2015 12/31/2015 Northwestern MN Juvenile Center - Evaluation Beltrami CP 1036937 H $214.00 91.67% 6.84% 0.00% 0.00% 1/1/2015 12/31/2015 Port Boy's Group Homes (Port of Crow Wing) Crow Wing CP 1036940 G $169.80 82.26% 7.11% 0.00% 0.00% 1/1/2015 12/31/2015 Port Girl's Group Home (Port of Crow Wing) Crow Wing CP 1057221 A $169.80 82.26% 7.11% 0.00% 0.00% 1/1/2015 12/31/2015 Prairie Lakes Youth Programs - Alternative Kandiyohi CP 1036941 A $180.00 84.58% 11.57% 0.00% 0.00% 1/1/2015 12/31/2016 Prairie Lakes Youth Programs - Boys Home Kandiyohi CP 1049804 A $202.00 87.12% 10.42% 0.00% 0.00% 1/1/2015 12/31/2016 Prairie Lakes Youth Programs - Girls Home Kandiyohi CP 1049805 A $202.00 82.12% 10.42% 0.00% 0.00% 1/1/2015 12/31/2016 Red River Valley Juvenile Center - 90 Day (Non-Secure) Polk CP 1036943 I $139.00 78.97% 10.38% 0.00% 0.00% 1/1/2015 12/31/2016 Red River Valley Juvenile Center - Shelter Polk CP 1036943 G $139.00 78.97% 10.38% 0.00% 0.00% 1/1/2015 12/31/2016 Red River Valley Juvenile Center - Short Term (Non-Secure) Polk CP 1036943 H $139.00 78.97% 10.38% 0.00% 0.00% 1/1/2015 12/31/2016 Southwestern Youth Services SWHHS CP 1036948 A $149.00 76.78% 15.02% 0.00% 0.00% 1/1/2015 12/31/2016 St Cloud Group Home (180 Degrees Inc) Stearns CP 1062155 B $165.97 86.41% 8.42% 0.00% 0.00% 1/1/2015 12/31/2016 Steps of Success - Andover Anoka CP 1036963 A $158.97 94.74% 4.33% 0.00% 0.00% 1/1/2015 12/31/2015 Valley Lake Boys Home Wilkin CP 1036970 A $145.00 89.87% 8.21% 0.00% 0.00% 1/1/2015 12/31/2015 Village Ranch - Tier I Wright CP 1036977 J $170.65 80.67% 8.98% 0.00% 0.00% 1/1/2015 12/31/2015 Village Ranch - Tier II Wright CP 1036977 K $184.88 73.19% 8.16% 0.00% 0.00% 1/1/2015 12/31/2015 Village Ranch - Tier III Wright CP 1061311 A $146.04 85.19% 9.73% 0.00% 0.00% 1/1/2015 12/31/2015 Von Wald Group Home (180 Degrees Inc) Olmsted CP 1062101 B $176.29 88.60% 8.00% 0.00% 0.00% 1/1/2015 12/31/2015 West Central Regional Juvenile Center Consequence Clay CP 1036981 G $165.00 86.58% 11.05% 0.00% 0.00% 1/1/2015 12/31/2015 West Central Regional Juvenile Center Evaluation Clay CP 1036981 H $225.00 87.03% 10.68% 0.00% 0.00% 1/1/2015 12/31/2015 West Central Regional Juvenile Center Pathways Clay CP 1036981 D $225.00 86.58% 11.05% 0.00% 0.00% 1/1/2015 12/31/2015 West Central Regional Juvenile Center - Shelter Clay CP 1036981 I $165.00 87.02% 10.69% 0.00% 0.00% 1/1/2015 12/31/2015 Woodland Hills - Chisolm House - Short Term St. Louis CP 1036983 I $145.04 84.43% 8.89% 0.00% 0.00% 1/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 1 - Other Facilities Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Woodland Hills - Residential Treatment - Juv. Justice St. Louis CP 1036983 G $259.16 83.59% 9.95% 0.00% 0.00% 1/1/2015 12/31/2015 Woodland Hills - Transition St. Louis CP 1036983 J $188.44 85.93% 8.71% 0.00% 0.00% 1/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 2 - New Facilities Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date 180 Degrees - Shelter Care for Girls Ramsey 8 1074484 A $222.00 85.33% 9.20% 0.00% 0.00% 1/1/2015 7/31/2019 Auburn Lake Academy Carver CP 1036944 B $231.91 85.33% 9.20% 0.00% 0.00% 1/1/2015 12/31/2015 Aurora Plains Academy- Education Hennepin OSF OSF1034 A $96.65 85.33% 9.20% 0.00% 0.00% 9/1/2015 8/31/2019 Aurora Plains Academy Treatment Center Hennepin OSF OSF1034 B $355.01 85.33% 9.20% 0.00% 0.00% 9/1/2015 8/31/2019 Bar None (VOA) - Short Term - Male Stabilization Unit Hennepin CP 1036848 L $274.00 85.33% 9.20% 0.00% 0.00% 5/1/2015 4/30/2019 Gerard (Nexus) - Shelter Mower 8 831080 C $170.00 85.33% 9.20% 0.00% 0.00% 1/1/2015 12/31/2015 Lakeview Neuro Rehab Care & Supervision (St. Louis) St. Louis OSF OSF1033 A $400.00 85.33% 9.20% 0.00% 0.00% 6/16/2015 12/31/2015 Lakeview Neuro Rehab Intensive Supervision(St. Louis) St. Louis OSF OSF1033 B $400.00 85.33% 9.20% 0.00% 0.00% 6/16/2015 12/31/2015 Lakeview Neuro Rehab School (St. Louis) St. Louis OSF OSF1033 C $400.00 85.33% 9.20% 0.00% 0.00% 6/16/2015 12/31/2015 The Link/Passageways Shelter Ramsey 8 1074613 A $306.00 85.33% 9.20% 0.00% 0.00% 4/1/2015 3/31/2019 Village Ranch- Tier IV Wright CP 1077394 A $173.00 85.33% 9.20% 0.00% 0.00% 4/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 2 - Out of State Facilities Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Chileda Institute, Inc. (Hennepin) La Crosse, WI OSF OSF1002 A $400.00 85.33% 9.20% 0.00% 0.00% 1/1/2015 6/30/2016 Clarinda Academy Residential (Ramsey) Clarinda, IA OSF OSF1003 A $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2013 6/30/2018 Clarinda Academy Treatment (Ramsey) Clarinda, IA OSF OSF1003 B $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2013 6/30/2018 Family and Children's Center - RCC Assessment (Houston) LaCrosse, WI OSF OSF1005 B $400.00 85.33% 9.20% 0.00% 0.00% 1/1/2015 12/31/2015 Family and Children's Center - Residential RCC (Houston) LaCrosse, WI OSF OSF1005 A $400.00 85.33% 9.20% 0.00% 0.00% 1/1/2015 12/31/2015 Forest Ridge Youth Services-Anita College Trans Liv (Ramsey) Estherville, IA OSF OSF1006 C $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2014 6/30/2019 Forest Ridge Youth Services-Residential Treatment (Ramsey) Estherville, IA OSF OSF1006 A $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2014 6/30/2019 Forest Ridge Youth Services-Shelter (Ramsey) Estherville, IA OSF OSF1006 B $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2014 6/30/2019 Homme Programs-Journey/Alliance (Hennepin) Wittenberg, WI OSF OSF1010 C $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2012 6/30/2016 Homme Programs-Journey/Quest (Hennepin) Wittenberg, WI OSF OSF1010 D $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2012 6/30/2016 Homme Programs-Regular (Hennepin) Wittenberg, WI OSF OSF1010 A $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2012 6/30/2016 Indiana Developmental Training Ctr. - Intensive (Ramsey) Lafayette, IN OSF OSF1011 B $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2014 6/30/2019 Indiana Developmental Training Ctr. - Regular (Ramsey) Lafayette, IN OSF OSF1011 A $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2014 6/30/2019 Mingus Mountain Academy-Level I Residential (Ramsey) Prescott Valley, AZ OSF OSF1015 A $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2013 6/30/2018 Mingus Mountain Academy-Level II Beh. Health Res. (Ramsey) Prescott Valley, AZ OSF OSF1015 B $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2013 6/30/2018 Northwest Passage - Behavior Stabilization (Ramsey) Frederic, WI OSF OSF1032 D $400.00 85.33% 9.20% 0.00% 0.00% 10/1/2012 6/30/2020 Northwest Passage - CAC 30 Day Assessment (Ramsey) Frederic, WI OSF OSF1032 E $400.00 85.33% 9.20% 0.00% 0.00% 10/1/2012 6/30/2020 Northwest Passage I - Boys (Ramsey) Webster, WI OSF OSF1032 A $400.00 85.33% 9.20% 0.00% 0.00% 10/1/2012 6/30/2020 Northwest Passage II - Boys 90 Day (Ramsey) Spooner, WI OSF OSF1032 B $400.00 85.33% 9.20% 0.00% 0.00% 10/1/2012 6/30/2020 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 2 - Out of State Facilities Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Northwest Passage III - Girls (Ramsey) Frederic, WI OSF OSF1032 C $400.00 85.33% 9.20% 0.00% 0.00% 10/1/2012 6/30/2020 Woodward Academy-Community Residential Program (Ramsey) Woodward, IA OSF OSF1021 B $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2013 6/30/2018 Woodward Academy-Highly Structured Program (Ramsey) Woodward, IA OSF OSF1021 A $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2013 6/30/2018 Woodward Academy-Sex Offender Treatment (Ramsey) Woodward, IA OSF OSF1021 C $400.00 85.33% 9.20% 0.00% 0.00% 7/1/2013 6/30/2018 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 4 - Rule 4 - Child Placing Agencies Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date 180 Degrees - Professional Family Foster Home Standard Freeborn 4 1062259 B $35.15 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 American Indian Fam. & Children's Svcs-Standard Ramsey 4 806137 A $21.89 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Anu Family Services Inc. - Exceptional Treatment Foster Care Carver 4 1056702 A $76.08 0.00% 71.53% 2.05% 0.00% 10/1/2014 12/31/2016 Anu Family Services Inc. - Foster Care (Non-Treatment) Carver 4 1056702 B $34.13 0.00% 71.53% 2.05% 0.00% 10/1/2014 12/31/2016 Anu Family Services Inc. - Treatment Foster Care Carver 4 1056702 C $64.69 0.00% 71.53% 2.05% 0.00% 10/1/2014 12/31/2016 Bethany Christian Services- Pre Adopt Blue Earth 4 800187 A $25.38 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Bethany Christian Services- Shelter Blue Earth 4 800187 B $43.65 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Bethany Christian Services-Foster Care Blue Earth 4 800187 c $33.50 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Evolve Adoption & Family Services (formerly Hope) Ramsey 4 801079 A $25.25 0.00% 71.53% 2.05% 0.00% 7/1/2014 12/31/2015 Family Alternatives - Intensive Hennepin 4 800782 C $45.00 0.00% 71.53% 2.05% 0.00% 7/1/2012 6/30/2016 Family Alternatives - Treatment Hennepin 4 800782 B $33.00 0.00% 71.53% 2.05% 0.00% 7/1/2012 6/30/2016 Family and Children's Center- Shelter Care Fillmore 4 1056954 A $35.00 0.00% 71.53% 2.05% 0.00% 4/1/2015 3/31/2016 Family and Children's Center Standard Fillmore 4 1056954 b $33.00 0.00% 71.53% 2.05% 0.00% 4/1/2015 3/31/2016 Family and Children's CenterTreatment Fillmore 4 1056954 C $48.00 0.00% 71.53% 2.05% 0.00% 4/1/2015 3/31/2016 Fond Du Lac - On Reservation - Emergency Carlton 4 TR0006 A $35.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 Fond Du Lac - On Reservation - Standard Carlton 4 TR0006 B $20.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 Fond Du Lac Licensing and Placement St. Louis 4 800834 A $20.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Kindred Family Focus - Alternative to Residential Mower 4 801978 C $50.93 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Kindred Family Focus - Short Term Foster Care Mower 4 801978 D $33.08 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Kindred Family Focus - Specialized Foster Care Mower 4 801978 G $41.36 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Kindred Family Focus - Standard Mower 4 801978 A $33.08 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 LSS Bethany Foster Care St. Louis 4 801447 I $25.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 4 - Rule 4 - Child Placing Agencies Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date LSS Family & Behavioral Health Services (Moorhead) Standard Clay 4 801447 A $41.94 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 LSS Therapeutic Foster Care (Mankato) Intensive Nicollet 4 801447 E $39.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 LSS Therapeutic Foster Care (Mankato) Standard Nicollet 4 801447 C $39.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 LSS Therapeutic Foster Care (Willmar) Standard Kandiyohi 4 801447 G $32.97 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 LSS Treatment Foster Care (Brainerd) - Standard Benton 4 801447 K $33.95 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 LSS Treatment Foster Care (Metro) - Standard Clay 4 801447 L $41.94 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 LSS Treatment Foster Care (St. Cloud) Standard Benton 4 801447 J $33.95 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Emergency Crisis Shelter Care Itasca 4 804156 F $95.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Medical Fragile Itasca 4 804156 G $66.63 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Special Foster Treatment Itasca 4 804156 D $62.33 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Standard Itasca 4 804156 A $33.79 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 North Homes Inc. - Treatment Foster Care Itasca 4 804156 B $69.75 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Northwood Children's Services -Therapeutic Foster Care St. Louis 4 801776 A $34.36 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 PATH Inc. - Emergency Foster Care Faribault 4 1059883 F $43.29 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 PATH Inc. - Family Placement - CHILD Martin 4 1059883 D $32.47 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 PATH Inc. - Family Placement - TEEN PARENT Martin 4 1059883 E $56.27 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 PATH Inc. - Intensive Treatment Foster Care Martin 4 1059883 A $56.27 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 PATH Inc. - Short Term Foster Care Martin 4 1059883 B $32.47 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 PATH Inc. - Standard Martin 4 1059883 C $32.47 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 Pinehaven Youth & Family Services Professional Crow Wing 4 1046389 A $32.36 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Pinehaven Youth & Family Services - Specialized Crow Wing 4 1046389 B $38.11 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Pinehaven Youth & Family Services - Treatment Crow Wing 4 1046389 C $57.13 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Rate Expiration Reason Title IV-E Foster CarePer Diem Rates & Percentage Report Participating Facilities for Title IV-E Group Facilities Project Effective for Service Dates Beginning 10/1/2015 Group 4 - Rule 4 - Child Placing Agencies Facility & Program Name Lead Agency Rule Code License # IV-E Sub Code Approved Per Diem Approved IV-E Maint % Approved Approved IV-E Intake IV-E & Plan % Trng % Approved MA % Current Contract Start Date End Date Pinehaven Youth & Family Svcs - Corporate Foster Care Crow Wing 4 1046389 D $68.79 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 St David's - Multidimensional Treatment Foster Care Hennepin 4 830819 C $70.61 0.00% 71.53% 2.05% 0.00% 1/1/2013 6/30/2016 St. David's Child Dev. & Fam. Svcs-Intensive Fost. Care Hennepin 4 830819 B $45.00 0.00% 71.53% 2.05% 0.00% 7/1/2012 6/30/2016 St. David's Child Dev. & Fam. Svcs-Treat. Foster Care Hennepin 4 830819 A $33.00 0.00% 71.53% 2.05% 0.00% 7/1/2012 6/30/2016 TSA Inc. - Adolescent Treatment Pine 4 802496 C $80.05 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 TSA Inc. - Child Treatment Program Pine 4 802496 H $80.05 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 TSA Inc. - Family Foster Care - CHILD Pine 4 802496 J $17.66 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 TSA Inc. - Family Foster Care -TEEN PARENT Pine 4 802496 D $80.05 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 TSA Inc. - Shelter Pine 4 802496 G $95.50 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 TSA Inc. - Standard Foster Care Pine 4 802496 I $35.31 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 TSA Inc. - Support Network Pine 4 802496 E $65.92 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2016 Upper Midwest American Indian Center Standard Hennepin 4 830950 A $22.50 0.00% 71.53% 2.05% 0.00% 1/1/2015 6/30/2016 Village Ranch Child & Family Svcs - Intensive Foster Care Wright 4 1059305 C $43.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Village Ranch Child & Family Svcs - Moderate Foster Care Wright 4 1059305 B $35.00 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 Village Ranch Child & Family Svcs - Supportive Foster Care Wright 4 1059305 A $29.50 0.00% 71.53% 2.05% 0.00% 1/1/2015 12/31/2015 VOA - Multidimensional Treatment Foster Care Hennepin 4 802606 G $83.20 0.00% 71.53% 2.05% 0.00% 1/1/2013 6/30/2016 Volunteers of America - Intensive Hennepin 4 802606 C $45.00 0.00% 71.53% 2.05% 0.00% 7/1/2012 6/30/2016 Volunteers of America - Treatment Hennepin 4 802606 B $33.00 0.00% 71.53% 2.05% 0.00% 7/1/2012 6/30/2016 Volunteers of America-Emergency Shelter Hennepin 4 802606 E $45.00 0.00% 71.53% 2.05% 0.00% 7/1/2012 6/30/2016 Rate Expiration Reason
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