Nursing Home Supplemental Payments

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 and recipients with AIDS.

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:

1. Have a medical condition that causes the recipient to be technologically dependent on medical apparatus or procedures to sustain life; and
2. Could expire without warning unless continually under observation.

Prior to billing Medicaid, the provider must obtain:

1. Prior authorization from the Children’s Multidisciplinary Assessment Team (CMAT) to receive a supplemental payment for a medically-fragile recipient under 21; and
2. The Medicaid area office service authorization nurse must approve the Children’s Multidisciplinary Assessment Team (CMAT) for the level of care decision.

Refer to Appendix D of the Florida Medicaid Provider General Handbook for the definition of medically fragile. You may access the Florida Medicaid handbook from the Medicaid fiscal agent's Provider Web Portal. Once inside the site, look to the left of the screen and choose “Provider Support”, then ”Provider Handbooks”.

Nursing Home Supplemental Payment for Recipients with Acquired Immune Deficiency Syndrome (AIDS)

Medicaid pays a supplemental payment to nursing facilities for the care of recipients with Acquired Immune Deficiency Syndrome (AIDS). Nursing facilities must obtain prior authorization from the Agency for Health Care Administration (AHCA) to receive the additional funds for the care of AIDS patients.

Refer to Chapter 2 of the Florida Medicaid Provider Reimbursement Handbook, Institutional 021 for prior authorization procedures. You may access the Florida Medicaid handbook from the Medicaid fiscal agent's Provider Web Portal. Once inside the site, look to the left of the screen and choose “Provider Support”, then ”Provider Handbooks”.