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