Geographical Non-Geographical Monroe County. Agency Rates. Solo Rates. Agency Rates. Solo Rates

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1 Rate Cost negotiated by provider per procedure 1 Adult Dental D0160UC None / Maximum Allowable Cost is $ Behavior Analysis - Level 1 H2019UCHP 3 Behavior Analysis - Level 2 H2019UCHO 4 Behavior Analysis - Level 3 H2019UCHN 5 Behavior Assistant Services H2019UCHM and None QH/ None QH/ None QH/ None QH/ defined by dental provider for procedures that are medically necessary. Maximum allowable unit cost is $ No more than 10 units of any dollar amount per day within this threshold, with a total maximum dollar amount of $4, for 10 units. 496 QH/ and 5840 QH/. 496 QH/ and 5840 QH/. 496 QH/ and 5840 QH/. Usual and Customary Rate is $ Behavioral Assessment H2020UC None 1-1 Maximum Allowable Rate is $ One Assessment a Maximum rate must be approved by the APD Behavioral Analyst. Assessment required prior to service. 7 Consumable Medical Supplies S5199UC None Maximum Allowable Rate is $ Dietitian Services 97802UC None No more than 10 a No more than 12 QH/ 9 Durable Medical Equipment E1399UC None Maximum Allowable Rate is $4, / 10 Environmental Accessibility Adaptations S5165UC None Maximum Allowable Rate is $ Environmental Accessibility Adaptations - Assessment S5165UCSC None Maximum Allowable Rate is $ No more than 5 / and no more than $20,000 in a 5 year period 1 Assessment a to own home or family home Requires prescription. Requires prescription. No duplication with MSP. No duplication of equipment or adaptation at a minimal 5 year period. No duplication at a minimal 5 year period. Place of residence only. Can include 3 prospective dwellings, interior lifts, van conversions, inspections. 12 Family and Legal Representative Training S5110UC None s a Life Skills Development - Level 1 (Companion) Life Skills Development - Level 1 (Companion) S5135UC S5135UC 1: : Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 1 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

2 Life Skills Development - Level 1 (Companion) (Supported Employment - Individual) (ADT) - Facility Based - (ADT) - Facility Based - (ADT) - Facility Based - (ADT) - Facility Based - (ADT) - Off Site - S5135UC T2021UCHI 1: Rate Cost negotiated by provider per procedure Maximum Allowable Cost is $ : : : : : : : : None S5102UC 1:1 N/A N/A N/A S5102UC 1:3 N/A 8.49 N/A 8.40 N/A S5102UC 1:5 N/A 5.93 N/A 5.85 N/A S5102UC 1:6-10 N/A 4.66 N/A 4.57 N/A T2021UC 1:1 N/A N/A N/A and 8 / and 2064 s/ 8 / and 2064 s/ 8 / and 2064 s/ 8 / and 2064 s/ 8 / and 2064 s/. The General Appropriations Act requires a 12.5% match from local sources for developmental training programs. This requirement has been incorporated into the rate as established and does not represent a reduction in the rate.. The General Appropriations Act requires a 12.5% match from local sources for developmental training programs. This requirement has been incorporated into the rate as established and does not represent a reduction in the rate. Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 2 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

3 (ADT) - Off Site - (ADT) - Off Site - (ADT) - Off Site - 33 Occupational Therapy 97530UC Occupational Therapy - Assessment (MSP Therapy Assessments Effective ) Personal Emergency Response System - Service T2021UC 1:3 N/A 8.49 N/A 8.40 N/A Rate Cost negotiated by provider per procedure Maximum Allowable Cost is $ T2021UC 1:5 N/A 5.93 N/A 5.85 N/A T2021UC 1:6-10 N/A 4.66 N/A 4.57 N/A None UC Visit None S5161UC None Maximum Allowable Rate is $ and 8 / and 2064 s/ 8 / and 2064 s/ 8 / and 2064 s/ 4 QH/ and 1464 QH/ 2 Assessment Visits a 1 Per for Monitoring Service. The General Appropriations Act requires a 12.5% match from local sources for developmental training programs. This requirement has been incorporated into the rate as established and does not represent a reduction in the rate. physician assistant required. Assessment required prior to service. Visits at 6 month intervals. Person must live alone or alone for part of the day and require a limited degree of supervision. Does not cover cost of telephone line. 36 Personal Emergency Response System - Install S5160UC None Maximum Allowable Rate is $ / (1 Installation) Not allowed for licensed residential facilities. 37 Personal Supports - S5130UC 1: QH/ 38 Personal Supports - S5130UC 1: QH/ 39 Personal Supports - S5130UC 1: QH/ Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 3 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

4 and Rate Cost negotiated by provider per procedure 40 Personal Supports - S5130UCSC 1: Maximum Allowable Cost is $ Personal Supports - S5130UCSC 1: Personal Supports - S5130UCSC 1: Personal Supports - S5130UCHA None Negotiated Negotiated Negotiated Negotiated Negotiated Negotiated QH/ 44 Personal Supports - S5130UCHO None Negotiated Negotiated Negotiated Negotiated Negotiated Negotiated Physical Therapy 97110UC 46 Physical Therapy - Assessment (MSP Therapy Assessment Effective ) None UC Visit None QH/ and 1464 QH/ 2 Assessment Visits a physician assistant required. Assessment required prior to service. Visits at 6 month intervals. 47 Private Duty Nursing - LPN (MSP Nursing Effective ) T1000UC None QH/ 96 QH/ for any combination (RN/LPN). 48 Private Duty Nursing - RN (MSP Nursing Effective ) T1000UCHN None QH/ 96 QH/ for any combination (RN/LPN). Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 4 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

5 Private Duty Nursing (RN) - Assessment (MSP Nursing Effective ) Basic - Basic - Minimal - Minimal - Moderate - Moderate - Behavioral Focus - Extensive 1 - Behavioral Focus - Extensive 1 - Behavioral Focus - Extensive 2 - Behavioral Focus - Extensive 2 - Behavioral Focus - Minimal - Behavioral Focus - Minimal - Behavioral Focus - Moderate - Behavioral Focus - Moderate - Extensive 1 - Extensive 1 - Extensive 2 - Extensive 2 - Intensive Behavioral - Level 1 Intensive Behavioral - Level 2 and T1000UCHM 8 QH/ per None /Yr. Assessment H0043UC None Rate Cost negotiated by provider per procedure Maximum Allowable Cost is $ s/ T2023UC None 1, , , , , , / H0043UCHI None s/ T2023UCSC None 2, , , , , , / H0043UCHM None s/ T2023UCU4 None 3, , , , , , / T2020UCHM None s/ T2023UCHO None 5, , , , , , / T2020UCHN None s/ T2023UCHP None 6, , , , , , / T2020UC None s/ T2023UCHM None 2, , , , , , / T2020UCHI None s/ T2023UCHN None 3, , , , , , / H0043UCHN None s/ T2023UCU6 None 4, , , , , , / H0043UCHO None s/ T2023UCU9 None 6, , , , , , T2013UC None T2013UCHM None / 2 Assessments per. Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 5 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

6 Intensive Behavioral - Level 3 Intensive Behavioral - Level 4 Intensive Behavioral - Level 5 Intensive Behavioral - Level 6 Intensive Behavioral - Comprehensive Transitional Education Program - Level 3 (Standard Rate Effective 1/1/2012) Intensive Behavioral - Comprehensive Transitional Education Program - Level 4 Intensive Behavioral - Comprehensive Transitional Education Program - Level 5 Intensive Behavioral - Comprehensive Transitional Education Program - Level 6 Intensive Behavioral - Trillium - Comprehensive Transitional Education Program - Child T2013UCHN None Rate Cost negotiated by provider per procedure Maximum Allowable Cost is $ T2013UCHO None T2013UCHP None T2013UCSC None T2033UC None T2033UCSE None T2033UCTF None T2033UCTG None T2033UCHA None and 350 s/ 350 s/ 350 s/ 350 s/ 350 s/ 79 Intensive Behavioral - Trillium - Comprehensive Transitional Education Program - Adult T2033UCHB None s/ Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 6 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

7 and 80 Live-In H0043UCSC 1: Rate Cost negotiated by provider per procedure Maximum Allowable Cost is $ Live-In H0043UCSC 1: Live-In H0043UCSC 1: Staff not require to live in facility to provide service. For facilities with a capacity of no more than 3 recipients per facility. Staff not require to live in facility to provide service. For facilities with a capacity of no more than 3 recipients per facility. Staff not require to live in facility to provide service. For facilities with a capacity of no more than 3 recipients per facility. 83 Assisted Living Facility/Optional State Supplementation - T2020UCHB None N/A N/A N/A s/ The residential habilitation daily rate for a recipient residing in an assisted living facility (ALF) is adjusted by the MSP Assistive Care Services (ASC) daily rate. The ALF will bill MSP for the ASC amount. 84 Assisted Living Facility/Optional State Supplementation - T2032UCHB None N/A N/A N/A / 24 days or more at monthly rate. The residential habilitation monthly rate for a recipient residing in an assisted living facility (ALF) is adjusted by the MSP Assistive Care Services (ASC) daily rate. The ALF will bill MSP for the ASC amount. 85 Residential Nursing - LPN (MSP Nursing Effective ) T1001UC None QH/ 96 QH/ for any combination (RN/LPN). 86 Residential Nursing - RN (MSP Nursing Effective ) T1002UC None QH/ 96 QH/ for any combination (RN/LPN). 87 Residential Nursing (RN) - Assessment (MSP Nursing Effective ) T1001UCSC 88 Respiratory Therapy S5181UC Respiratory Therapy - Assessment (MSP Therapy Assessment Effective ) Respite - Respite - None /Yr. None S5180UC Visit None S5151UCSC 1: S5151UCSC 1: QH/ per Assessment. 4 QH/ and 1464 QH/ 2 Assessment Visits a Daily Rate - For 10 or more hours a Daily Rate - For 10 or more hours a 2 Assessments per year. physician assistant required. Assessment required prior to service. Visits at 6 month intervals. 31 a, 365 a. 31 a, 365 a. Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 7 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

8 Respite - Respite - Respite - Respite - Skilled Nursing - LPN (MSP Nursing Effective ) Skilled Nursing - RN (MSP Nursing Effective ) Skilled Nursing (RN) - Assessment (MSP Nursing Effective ) and S5151UCSC 1: Daily Rate - For 10 or more hours a S5151UC 1: Rate Cost negotiated by provider per procedure 2.75Maximum 2.90 Allowable 3.05 Cost is $ Up to 39 QH/ S5151UC 1: Up to 39 QH/ S5151UC 1: Up to 39 QH/ T1001UCHM Visit None Visits/ T1002UCHN Visit None Visits/ T1001UCHO None /Yr. 99 Skilled Respite - LPN - S9125UCTE 1: Skilled Respite - LPN - S9125UCTE 1: Skilled Respite - LPN - T1005UCTE 102 Skilled Respite - LPN - T1005UCTE 8 QH/ per Assessment Daily Rate - For 10 or more hours a Daily Rate - For 10 or more hours a 1: Up to 39 QH/ 1: Up to 39 QH/ 103 Special Medical Home Care S9122UC None Negotiated Negotiated Negotiated Negotiated Negotiated Negotiated Specialized Mental Health Counseling H0046UC 105 Specialized Mental Health Counseling Assessment 106 Speech Therapy 92507UC 107 Speech Therapy - Assessment (MSP Therapy Assessment Effective ) None Up to 24 s a 365 a 4 QH/ and 416 QH/ 31 a, 365 a. If 10 or more hours a day (40 QH/) use Daily Rate. If 10 or more hours a day (40 QH/) use Daily Rate. If 10 or more hours a day (40 QH/) use Daily Rate. 4 visits per day for any combination of RN/LPN. 4 visits per day for any combination of RN/LPN. 2 Assessments per. 31 a, 365 a. 31 a, 365 a. If 10 or more hours a day (40 QH/) use Daily Rate. If 10 or more hours a day (40 QH/) use Daily Rate. Intensive Nursing Care in licensed facility. Maximum allowable rate is $ Limited to 2 hours a week (Two 1 hour sessions). Usual and Customary Rate is $ H0031UC None 1 1 / 1 Assessment a. Maximum Allowable Rate is $ None UC Visit None Support Coordination - Full G9012UC None CDC Consultant - Full G9012UCU5 None QH/ and 1464 QH/ 2 Assessment Visits a 12 / 12 / physician assistant required. Assessment required prior to service. Visits at 6 month intervals. Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 8 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

9 110 Support Coordination - Enhanced G9012UCSC None CDC Consultant - Enhanced T2041UCU5 None Rate Cost negotiated by provider per procedure Maximum Allowable Cost is $ Support Coordination - Limited T2022UC None CDC Consultant - Limited T2022UCU5 None Supported Living Coaching 97535UC None Transportation - Mile A0425UC Mile None Negotiated Negotiated Negotiated Negotiated Negotiated Negotiated Transportation - T2002UC None Negotiated Negotiated Negotiated Negotiated Negotiated Negotiated /Yr and 12 / 12 / 12 / 12 / 24 QH/ and 8760 QH/ 200 Miles/ and 234 Miles/ and 2808 Miles/ 12 / Customer in Supported Living or to transition to SL in 90 days. Can not be used to transport to MSP service. No duplication of public school transportation services to and from school. Can not be used to transport to MSP service. No duplication of public school transportation services to and from school. 117 Transportation - Trip (/Freq. Limitations Effective ) T2003UC Trip None Negotiated Negotiated Negotiated Negotiated Negotiated Negotiated Trips/ 80 one-way trips per month. Can not be used to transport to MSP Service. No duplication of public school transportation services to and from school. Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 9 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.

10 LEGEND: Individual Budgeting Waiver - Definitions for Column Headings and Specific Terminology Geographical References Line # MSP Negotiated and Represents rates for providers that have three (3) or more employees. Rate Cost If a negotiated provider has by provider less than per 3 procedure employees, the provider is to bill at the solo rate. Maximum Allowable Cost is $ A unit that describes how the service is billed (e.g. by the quarter hour or QH, by the hour, by the day, by the month, by the visit, etc.). Also used to capture a service level that has its own definition (e.g. assessment, mile, 1 piece of equipment, or 1 package of consumable supplies). Rounding instructions for services that may start or end within a billing unit's specific time construct (e.g. 31 minutes of an hourly billing unit equals 1 hour) can be found in the handbook. This handbook can be found at. Some service rates are different, depending on geographical location. The term 'Geographical' refers to a group of counties (Palm Beach, Broward, and Dade Counties) that use separate rates associated with that geographical region, with Monroe County having another separate distinct rate for services. All other counties use rates listed under Non-geographical. For informational purposes. Shows the maximum number of billing units a day for services that have a daily rate (e.g. quarter hours, hours or day rate). Shows the maximum number of billing units for a designated time frame or specific limitation (e.g. visits in a week, hours per month). Shows the maximum number of billing units for the year. An acronym that stands for Medicaid State Plan. Some waiver services are now using the same rate for comparable services in the Medicaid State Plan. For general information about Florida Medicaid, visit (select Medicaid). Some service rates allow for a negotiated rate between the provider and the for Persons with Disabilities (APD). A negotiated rate will be an amount that will fall between published rates within a category or group of services, but will never exceed the maximum amount of the service category or group. Providers can only negotiate rates for individual customers to best serve the needs of the customer. Non-Standard Supports Level and Frequencies Usual and Customary Rate & Maximum Allowable Residential Habilitation Services provided in an Assisted Living Facility (ALF) will incorporate a non-standard rate to avoid duplication of services for daily Assistive Care Services (ACS) billed through the Medicaid State Plan. The residential habilitation rate determined for use by the facility for an APD customer in an ALF will be reduced by the ACS rate before billing the waiver. Provides additional information relative to the use of the service, combination of services, and other limitations beyond rate and unit. All providers are to be in compliance with the Developmental Disabilities Individual Budgeting Medicaid Waiver Services Coverage and Limitations Handbook (Draft). Guidelines on limitations such as age, non-duplication of services between state agencies or other entities, and other restrictions or requirements can be found in the handbook. This handbook can be found at. A code to identify the procedure, service or commodity provided. Can be as short as 5 characters, and up to 9 characters. These codes are used by providers to bill in FMMIS (Florida Medicaid Management Information System). describes when a service can be delivered to one or more than one individual at a time. Each ratio is given a rate based on the number of individuals served and each individual is charged that rate. 1:1, 1:2, or 1:3 are examples of individuals served by a ratio of 1 staff to 1 customer, 1 staff to 2 customers, or 1 staff to 3 customers. A ratio of 1:6-10 indicates the rate applies to a staff member serving 6 to 10 individuals. Describes service rendered; provides title of service (Please refer to draft handbook found at.). Represents rates for individual providers that are self employed or independent vendors, and has 2 or fewer employees. Supports Level is in relation to the level of care (e.g. basic, minimal, moderate, extensive, intensive) that best describes the individual and their primary area of support needs for Residential Habilitation services (Please refer to the Level of Supports Rate Descriptors following the provider rate tables.). Describes how many units are allowed at a given frequency per day, per month, per year, per visit, etc. Some service rates allow for a charge within an allowable range. The Usual and Customary Rate represents the most common charge for the service, and the Maximum Allowable Rate is the highest charge allowed. Charges above the norm require explanation or justification of higher cost. Please refer to LEGEND at the end of each provider rate table for definitions of column headings and specific terms. 10 of 10 For Residential Habilitation Services, refer to Level of Supports Rate Descriptors following tables.