In addition to the per diem payment, a nursing facility may be entitled to receive a Medicaid supplemental payment to care for medically-fragile recipients under the age of 21.
Nursing Home Supplemental Payments for Medically-Fragile Recipients Under Age 21
Nursing facilities pays supplemental payments for certain recipients under age 21 determined by the Children's Multidisciplinary Assessment Team (CMAT) to be medically fragile who:
- Have a medical condition that causes the recipient to be technologically dependent on medical apparatus or procedures to sustain life; and
- Could expire without warning unless continually under observation.
Prior to billing Medicaid:
- The provider must obtain prior authorization from the Children's Multidisciplinary Assessment Team (CMAT) to receive a supplemental payment for a medically-fragile recipient under 21; and
- The Medicaid field office service authorization nurse must approve the Children's Multidisciplinary Assessment Team (CMAT) for the level of care decision.
Refer to Chapter 3 of the Florida Medicaid Provider Reimbursement Handbook, UB04 for prior authorization procedures.
Refer to Appendix B of the Florida Medicaid Provider General Handbook for the definition of medically fragile. You may access the Florida Medicaid handbooks from the Medicaid Rules page.
Medically Fragile Recipients Under 21 Supplemental Payment
- January 2004 Rate: $211.59
- July 2004: $214.84
- January 2005: Rate: $218.60
- July 2005: $222.19
- January 2006 Rate: $225.49
- July 2006: $229.13
- January 2007 Rate: $233.59
- July 2007: $237.80
- January 2008 Rate: $241.52
- July 2008 Rate: $245.63
- January 2009 Rate: $249.36
- July 2009 Rate: $252.97
- January 2010 Rate: $255.80
- July 2010 Rate: $258.37
- January 2011 Rate: $261.11
- July 2011 Rate: $263.53
- January 2012 Rate: $266.07
- July 2012 Rate: $268.96
- January 2013 Rate: $271.85
- July 2013 Rate: $274.53
- January 2014 Rate: $277.90
- July 2014 Rate: $280.38
- January 2015: $285.50
- September 2015: $292.28
- September 2016: $299.63
- September 2017: $307.75
- October 2018: $316.78
- October 2019: $325.70
- October 2020: $335.97
- October 2021: $344.26
- October 2022 $357.61
- October 2023 $367.93
Recipients Acquired Immune Deficiency Syndrome (AIDS) Supplemental Payment
- January 2004 Rate: $117.39
- July 2004: $119.20
- January 2005: Rate: $121.29
- July 2005: $123.28
- January 2006 Rate: $125.11
- July 2006: $127.13
- January 2007 Rate: $129.60
- July 2007: $131.94
- January 2008 Rate: $134.00
- July 2008 Rate: $136.28
- January 2009 Rate: $138.35
- July 2009 Rate: $140.35
- January 2010 Rate: $141.92
- July 2010 Rate: $143.34
- January 2011 Rate: $144.86
- July 2011 Rate: $146.20
- January 2012 Rate: $147.61
- July 2012 Rate: $149.21
- January 2013 Rate: $150.81
- July 2013 Rate: Per SB 1500, AIDS payment removed
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