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.

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:

  1. 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
  2. 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

Recipients Acquired Immune Deficiency Syndrome (AIDS) Supplemental Payment

Forms

AIDS Supplemental Payment Authorization Form [44KB]