Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 and Individual Budgeting Waivers Provider Rate Tables

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Medicaid

RULE NO.: RULE TITLE:

59G-13.081: Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 and Individual Budgeting Waivers Provider Rate Tables

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 41 No. 24, February 5, 2015 issue of the Florida Administrative Register.

The following changes have been made to the Florida Medicaid Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 and Individual Budgeting Waivers Provider Rate Tables.

Line 12, Life Skills Development – Level 1 (Companion), rates section now reads: Geographical Solo Rates, 1.71 Non-Geographical Solo Rates, 1.68, Monroe County Solo Rates 2.02.

Line 32, Occupational Therapy, Max # of Units per Day now reads 4, Max # of Units per Year now reads 1,460.

Line 36, Personal Supports – Quarter Hour, rates section now reads 3.17, 3.61, 3.14, 3.55, 3.45, 3.95.

Line 37, Personal Supports – Quarter Hour, rates section now reads 2.42, 3.01, 2.39, 2.92, 2.63, 3.25.

Line 38, Personal Supports – Quarter Hour, rates section now reads 2.09, 2.59, 2.07, 2.53, 2.29, 2.83.

Line 39, Personal Supports – Day, rates section now reads 102.82, 117.23, 102.01, 114.89, 117.51, 130.01.

Line 40, Personal Supports – Day, rates section now reads 76.67, 95.30, 75.68, 92.51, 87.16, 104.65.

Line 41, Personal Supports – Day, rates section now reads 66.07, 82.24, 65.22, 79.84, 75.14, 90.32.

Line 44, Physical Therapy, Max # of Units per Day now reads 4, Max # of Units per Year now reads 1,460.

Lines 73-76, Resident Habilitation – Intensive Behavioral – Comprehensive Transitional Edcation Program – Day, Levels 3-6,  Max # of Units per Year now reads 345.

Line 79, Residential Habilitation – Live-In, rates section now reads: Geographical Solo Rates, 104.82, Non-Geographical, 103.53 and 126.75, Monroe County Solo Rates, 106.88.

Line 80 Residential Habilitation – Live-In, rates section now reads: Geographical Solo Rates, 88.04 Non-Geographical,  86.97 and 106.47, Monroe County Solo Rates 88.77.

Line 81 Residential Habilitation – Live-In, rates section now reads: Geographical Solo Rates, 75.48 Non-Geographical,  74.54 and 91.26, Monroe County Solo Rates 76.94.

Line 82, Residential Habilitation-Assisted Living Facility/Assistive Care Services – Day, Other Limitations now reads: 24 days or more requires monthly rate. The residential habilitation daily rate for a recipient residing in an ALF or AFCH is adjusted by the MSP ACS daily rate. The ALF or AFCH will bill MSP for the ACS rate.

Line 83, Residential Habilitation-Assisted Living Facility/Assistive Care Services – Month, Other Limitations now reads: 24 days or more requires monthly rate. The residential habilitation daily rate for a recipient residing in an ALF or AFCH is adjusted by the MSP ACS daily rate. The ALF or AFCH will bill MSP for the ACS rate.

Line 87, Respiratory Therapy, Max # Units per Day now reads 4, Max # Units per Year now reads 1,460.

Lines 89-91, Respite – Quarter hour (under 21 years of age only), Max # Units per Day now reads 96.

Line 92, Respite – Day, (under 21 years of age only), rates section now reads: Geographical, 110.90 and 116.86, Non-Geographical, 109.90 and 115.84, Monroe County Solo Rate, 122.17.

Line 93, Respite – Day, (under 21 years of age only), rates section now reads: Geographical, 74.00 and 77.93, Non-Geographical, 73.35 and 77.29, Monroe County Solo Rate, 81.50.

Line 94, Respite – Day, (under 21 years of age only), rates section now reads: Geographical, 61.08 and 64.39, Non-Geographical,  60.54 and 63.83, Monroe County Solo Rate, 67.32.

Line 98 and 99, Skilled Respite – LPN – Quarter Hour, Max # Units per Day now reads 96, Other Limitations text is stricken.

Line 105, Speech Therapy, Max # Units per Day now reads 4, Max # Units per Year now reads 1,460.

Line 110, Support Coordination – Full, rates section now reads 148.69 each.

Line 111, CDC Consultant – Full, rates section now reads 148.69 each.

Line 112, Support Coordination – Enhanced, rates section now reads 359.83 each.

Line 113, CDC Consultant – Enhanced, rates section now reads 359.83 each.

Line 114, Support Coordination – Limited, rates section now reads 74.35 each.

Line 115, CDC Consultant – Limited, rates section now reads 74.35 each.

Legend, Agency Rates section: The first sentence is stricken.

Legend, AFCH section was added, and definition now reads: Adult Family Care Home.

Legend, Non-Standard, section now reads: Residential habilitation services provided in an ALF or AFCH will incorporate a non-standard rate to avoid duplication of services for daily ACS billed through the MSP. The residential habilitation rate determined for use by the facility for an APD recipient in an ALF or AFCH will be reduced by the ACS rate before billing the waiver.

Legend, Solo Rates, section now reads: Represents rates for a provider who personally renders waiver services directly to recipients and does not employ others to render waiver services for which the rate is being paid. If the provider incorporates they are still considered a solo provider for rate purposes, unless they hire at least two employees including the owner and meet the definition of agency.