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Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 andIndividual Budgeting Waivers Provider Rate Tables 59G-13.081Tables are to be used in conjunction with the Developmental Disabilities Waivers Services Coverage and Limitations Handbooks. The Handbooks can be accessed at:iBudget WaiverLine #iBudget WaiverService ncyRateshttp://www.mymedicaid-florida.comMonroe CountySoloRatesAgencyRatesMax #UnitsDayMax #UnitsWeek/MonthMax #UnitsYearUnits andFrequencyOther Limitations *10 Units/DayUnit defined by dental provider forprocedures that are medically necessary.Maximum allowable unit cost is 493.49.No more than 10 units of any dollar amountper day within this threshold, with a totalmaximum dollar amount of 4,934.90 for10 units.584016 QH/Day496 QH/Month and5840 QH/Year.496584016 QH/Day496 QH/Month and5840 QH/Year.16496584016 QH/Day496 QH/Month and5840 QH/Year.4.5932--32 QH/DayNoneUsual and Customary Rate is 274.74Maximum Allowable Rate is 549.481-1One Assessmenta YearUnitNoneMaximum Allowable Rate is 246.751097802UCQuarterHourNoneDurable Medical EquipmentE1399UCUnit10Environmental Accessibility AdaptationsS5165UC11Environmental Accessibility Adaptations Assessment121Adult DentalD0160UC2Behavior Analysis - Level 13Unit Rate Cost negotiated by provider per procedureMaximum Allowable Unit Cost is 820.7113.5619.0514.2021.0016496Behavior Analysis - Level 18.35164Behavior Analysis - Level 415Behavior Assistant 466Behavioral AssessmentH2020UCUnit7Consumable Medical SuppliesS5199UC8Dietitian Services9Maximum rate must be approved by theAPD Behavioral Analyst. Assessmentrequired prior to service.No more than 10Units a Day14.2412--No more than 12QH/DayRequires prescription.NoneMaximum Allowable Rate is 4,934.885--5 Units/DayRequires prescription. No duplication withMSP. No duplication of equipment oradaptation at a minimal5 year period.UnitNoneMaximum Allowable Rate is 740.245--No more than 5Units/Day and nomore than 20,000 ina 5 year periodNo duplication at a minimal 5 year period.Place of residence only.S5165UCSCUnitNoneMaximum Allowable Rate is 789.581-11 Assessment a Yearto own home orfamily homeCan include 3 prospective dwellings,interior lifts, van conversions, inspections.Family and Legal Representative .00--8080 Hours a Year13Life Skills Development - Level .022.686419842329614Life Skills Development - Level .022.686419842329610.20Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms.14.0310.0413.301 of 1010.3764 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/YearNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDFor Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.
Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 andIndividual Budgeting Waivers Provider Rate Tables 59G-13.081Tables are to be used in conjunction with the Developmental Disabilities Waivers Services Coverage and Limitations Handbooks. The Handbooks can be accessed at:iBudget WaiverLine #iBudget WaiverService e CountySoloRatesAgencyRatesMax #UnitsDayMax #UnitsWeek/MonthMax #UnitsYear6419842329664198423296Units andFrequency15Life Skills Development - Level 1(Companion)S5135UCQuarterHour(QH)1:31.4216Life Skills Development - Level 2(Supported Employment - nit Rate Cost negotiated by provider per procedureMaximum Allowable Unit Cost is 493.493.723.023.633.183.8617Life Skills Development - Level 2(Supported Employment - .926419842329618Life Skills Development - Level 2(Supported Employment - .396419842329619Life Skills Development - Level 2(Supported Employment - .306419842329620Life Skills Development - Level 2(Supported Employment - .246419842329621Life Skills Development - Level 2(Supported Employment - .206419842329622Life Skills Development - Level 2(Supported Employment - .186419842329623Life Skills Development - Level 2(Supported Employment - .166419842329624Life Skills Development - Level 2(Supported Employment - 37.829.576419842329664 QH/Day and1984 QH/Month and23296 QH/YearHour1:1N/A15.00N/A14.91N/A15.338-20648 Hour/Day and2064 Hours/Year2526272829Life Skills Development - Level 3(ADT) - Facility Based - Hour(Effective July 1, 2013)Life Skills Development - Level 3(ADT) - Facility Based - Hour(Effective July 1, 2013)Life Skills Development - Level 3(ADT) - Facility Based - Hour(Effective July 1, 2013)Life Skills Development - Level 3(ADT) - Facility Based - Hour(Effective July 1, 2013)Life Skills Development - Level 3(ADT) - Off Site - Hour(Effective July 1, 2013)S5102UC64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/Year64 QH/Day and1984 QH/Month and23296 QH/YearS5102UCHour1:3N/A8.49N/A8.40N/A8.788-20648 Hour/Day and2064 48 Hour/Day and2064 20648 Hour/Day and2064 20648 Hour/Day and2064 Hours/YearPlease refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms.2 of 10Other Limitations *No more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINEDNo more than 112 hours a week of all LifeSkills Development COMBINED.The General Appropriations Act requires a12.5% match from local sources fordevelopmental training programs. Thisrequirement has been incorporated into therate as established and does not representa reduction in the rate.No more than 112 hours a week of all LifeSkills Development COMBINED.The General Appropriations Act requires a12.5% match from local sources fordevelopmental training programs. ThisFor Residential Habilitation Services, refer requirementto Level of SupportsDescriptorstables.has beenRateincorporatedintofollowingtherate as established and does not representa reduction in the rate.
Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 andIndividual Budgeting Waivers Provider Rate Tables 59G-13.081Tables are to be used in conjunction with the Developmental Disabilities Waivers Services Coverage and Limitations Handbooks. The Handbooks can be accessed at:iBudget WaiverLine #303132iBudget WaiverService DescriptionLife Skills Development - Level 3(ADT) - Off Site - Hour(Effective July 1, 2013)Life Skills Development - Level 3(ADT) - Off Site - Hour(Effective July 1, 2013)Life Skills Development - Level 3(ADT) - Off Site - Hour(Effective July 1, onroe CountySoloRatesAgencyRatesMax #UnitsDayMax #UnitsWeek/MonthMax #UnitsYearUnits andFrequencyN/A8.498.788-20648 Hour/Day and2064 Hours/Year8-20648 Hour/Day and2064 Hours/YearN/A8.40N/AOther Limitations *No more than 112 hours a week of all LifeSkills Development COMBINED.The General Appropriations Act requires a12.5% match from local sources fordevelopmental training programs. Thisrequirement has been incorporated into therate as established and does not representa reduction in the rate.T2021UCHour1:5N/AUnit Rate Cost negotiated by provider per procedureMaximum Allowable Unit Cost is A4.57N/A4.668-20648 Hour/Day and2064 Hours/Year4 QH/Day and1464 QH/YearPrescription by a physician, ARNP, orphysician assistant required. Assessmentrequired prior to service.33Occupational .0216.0216.024-146434Occupational Therapy - Assessment(MSP Therapy Assessments Rates Effective 8.50--22 Assessment Visitsa YearVisits at 6 month intervals.35Personal Emergency Response System ServiceS5161UCUnitNoneMaximum Allowable Rate is 39.48-1121 Unit Per Month forMonitoring ServicePerson must live alone or alone for part ofthe day and require a limited degree ofsupervision. Does not cover cost oftelephone line.36Personal Emergency Response System - InstallS5160UCUnitNoneMaximum Allowable Rate is 246.751-11 Unit/Year(1 Installation)Not allowed for licensed residentialfacilities.96 QH/DayFor more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.96 QH/DayFor more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.96 QH/DayFor more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.373839Personal Supports - Quarter HourPersonal Supports - Quarter HourPersonal Supports - Quarter rterHour1:11:21:33.092.362.04Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms.3.522.942.533.062.332.023.462.852.473 of 103.372.572.233.853.172.76969696------For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.
Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 andIndividual Budgeting Waivers Provider Rate Tables 59G-13.081Tables are to be used in conjunction with the Developmental Disabilities Waivers Services Coverage and Limitations Handbooks. The Handbooks can be accessed at:iBudget WaiverLine #40414243iBudget WaiverService DescriptionPersonal Supports - DayPersonal Supports - DayPersonal Supports - DayPersonal Supports - Quarter 44Personal Supports - DayS5130UCHO45Physical Max #UnitsDay11196Max #UnitsWeek/Month313131-Max #UnitsYearUnits andFrequencyOther Limitations *31 Days/Month and365 Days/YearFor more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.36531 Days/Month and365 Days/YearFor more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.36531 Days/Month and365 Days/YearFor more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.96 QH/DayFor more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.For more than 8 hours a day, the day rateshould be used as the most cost effectiverate. Age 18-20 in own home or supportedliving arrangement. Age 21 or older infamily home.365-13136531 Days/Month and365 Days/Year16.024-14644 QH/Day and1464 QH/YearPrescription by a physician, ARNP, orphysician assistant required. Assessmentrequired prior to service.48.5048.50--22 Assessment Visitsa YearVisits at 6 month intervals.5.825.825.8296--96 QH/DayPrescription by a physician, ARNP, orphysician assistant required. No more than96 QH/Day for any combination (RN/LPN).7.287.287.2896--96 QH/DayPrescription by a physician, ARNP, orphysician assistant required. No more than96 QH/Day for any combination HourNone16.0216.0216.0216.0216.02Physical Therapy - Assessment(MSP Therapy Assessment RatesEffective vate Duty Nursing - LPN(MSP Nursing Rates Effective te Duty Nursing - RN(MSP Nursing Rates Effective e refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms.AgencyRatesUnit Rate Cost negotiated by provider per procedure99.52112.09114.64126.84Maximum Allowable Unit Cost is 493.4973.83http://www.mymedicaid-florida.comMonroe County4 of 10NegotiatedFor Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.
Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 andIndividual Budgeting Waivers Provider Rate Tables 59G-13.081Tables are to be used in conjunction with the Developmental Disabilities Waivers Services Coverage and Limitations Handbooks. The Handbooks can be accessed at:iBudget WaiverLine #495051525354555657585960616263646566676869iBudget WaiverService DescriptionPrivate Duty Nursing (RN) - Assessment(MSP Nursing Rates Effective 4-1-2012)Residential Habilitation Basic - DayResidential Habilitation Basic - MonthResidential Habilitation Minimal - DayResidential Habilitation Minimal - MonthResidential Habilitation Moderate - DayResidential Habilitation Moderate - MonthResidential Habilitation Behavioral Focus - Extensive 1 - DayResidential Habilitation Behavioral Focus - Extensive 1 - MonthResidential Habilitation Behavioral Focus - Extensive 2 - DayResidential Habilitation Behavioral Focus - Extensive 2 - MonthResidential Habilitation Behavioral Focus - Minimal - DayResidential Habilitation Behavioral Focus - Minimal - MonthResidential Habilitation Behavioral Focus - Moderate - DayResidential Habilitation Behavioral Focus - Moderate - MonthResidential Habilitation Extensive 1 - DayResidential Habilitation Extensive 1 - MonthResidential Habilitation Extensive 2 - DayResidential Habilitation Extensive 2 - MonthResidential Habilitation Intensive Behavioral - DayLevel 1(Standard Rate Effective 1-1-2012)Residential Habilitation Intensive Behavioral - DayLevel 2(Standard Rate Effective medicaid-florida.comMonroe CountyMax #UnitsDayMax #UnitsWeek/MonthMax #UnitsYear7.288-2/Yr.8 QH/Day perAssessment2 Assessments per Year.Unit Rate Cost negotiated by provider per procedure37.67Maximum37.6745.2045.20Allowable UnitCost is 493.49123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly rate.1,318.24-1121 Unit/Month and12 Units/Year24 days or more requires monthly rate.90.3490.34123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly rate.2,195.482,634.802,634.80-1121 Unit/Month and12 Units/Year24 days or more requires monthly rate.112.95112.95135.54135.54123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly rate.3,541.723,294.483,294.483,953.323,953.32-1121 Unit/Month and12 Units/Year24 days or more requires monthly rate.173.16173.16161.08161.08193.30193.30123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly ,637.80-1121 Unit/Month and12 Units/Year24 days or more requires monthly 3-23 Days/Month23 days or less at daily rate.24 days or more requires monthly 6.567,406.56-1121 Unit/Month and12 Units/Year24 days or more requires monthly rate.DayNone85.8085.8079.8179.8195.7795.77123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly 27.922,793.282,793.28-1121 Unit/Month and12 Units/Year24 days or more requires monthly 0143.70123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly 92.724,191.324,191.32-1121 Unit/Month and12 Units/Year24 days or more requires monthly 2182.32123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly 31.565,317.765,317.76-1121 Unit/Month and12 Units/Year24 days or more requires monthly 2239.52123-23 Days/Month23 days or less at daily rate.24 days or more requires monthly 21.766,986.006,986.00-1121 Unit/Month and12 Units/Year24 days or more requires monthly 40.0013136531 Days/Month and365 50.00250.0013136531 Days/Month and365 HPT2020UCPlease refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms.5 of 10Units andFrequencyOther Limitations *For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.
Developmental Disabilities Home and Community Based Medicaid Waiver Services Tiers 1 through 4 andIndividual Budgeting Waivers Provider Rate Tables 59G-13.081Tables are to be used in conjunction with the Developmental Disabilities Waivers Services Coverage and Limitations Handbooks. The Handbooks can be accessed at:iBudget WaiverLine #7071727374757677iBudget WaiverService DescriptionResidential Habilitation Intensive Behavioral - DayLevel 3(Standard Rate Effective 1-1-2012)Residential Habilitation Intensive Behavioral - DayLevel 4(Standard Rate Effective 1-1-2012)Residential Habilitation Intensive Behavioral - DayLevel 5(
Service Description Procedure Code Billing Unit Ratio Solo Rates Agency Rates Rates Rates Rates Rates . (Companion) S5135UC Quarter Hour 1:1 1.71 2.28 1.68 2.16 2.02 2.68 64 1984 23296 64 QH/Day and 1984 QH/Month and 23296 QH/Year . (ADT
