Important Update: Rate Changes for Medicaid in Florida
As you may have heard, the State of Florida is implementing changes to the Medicaid health plan rates effective October 1st, 2024. While we received this news with less than 3 days’ notice, let’s look on the bright side—after all, higher rates mean more funding to support our vital services! It’s almost like getting a surprise party, but instead of cake, we get… rates!
At Office Puzzle, we want to make sure you have the tools you need to navigate this transition smoothly.
We recommend a straightforward approach: only change the rates once you have finalized billing for the previous month, which includes everything up until September 30th.
And if you’re thinking about updating the rates early, here’s the funny part: even if you do it today, Medicaid won’t pay you the higher rate just yet! So if you want, you can update the rates right now and you will be fine. They will adjust to the correct rates.
To avoid any issues, check out our step-by-step guide on how to manually update your rates by following the instructions below or the quick video tutorial we’ll be providing. This will ensure everything runs smoothly without any surprises!
- Go to the Agency Dashboard
- Click Configuration
- Click Billing
- Click Payers
- Click on the Payer Name (STATE OF FLORIDA, MEDICAID, FLORIDA MEDICAID, etc)
- Look for the Health Plan, it’s on the right. Click on the green pencil right next to the name of the Health Plan (Default, Medicaid, etc)
- Click the Rates Tab
- Find the Billing code you would like to update the rate and enter the new amount (find the changes below)
- Repeat step #8 three times since we have 3 rate changes (97153, 97155, 97155-HN)
The video instruction is here:
In case you missed the changes here is a quick summary of them:
| Service Description | Procedure Code | 2022 Rate (Per Unit) | 2022 Rate (Per Hour) | 2024 Rate (Per Unit) | 2024 Rate (Per Hour) | Fee Change (Per Unit) | Fee Change (Per Hour) |
|---|---|---|---|---|---|---|---|
| Behavior identification – assessment | 97151 | $19.05 | $76.20 | $19.05 | $76.20 | No change | No change |
| Behavior identification – supporting assessment | 97152 | $12.19 | $48.76 | $12.19 | $48.76 | No change | No change |
| Behavior reassessment | 97151 TS | $12.19 | $76.20 | $12.19 | $48.76 | No change | No change |
| Behavior treatment with protocol modification (Lead) | 97155 | $19.05 | $76.20 | $19.17 | $76.68 | +$0.12 | +$0.48 |
| Behavior treatment with protocol modification (Assistant) | 97155 HN | $15.24 | $60.96 | $15.37 | $61.48 | +$0.13 | +$0.52 |
| Behavior treatment by protocol (RBT/BCaBA/Lead) | 97153 | $12.19 | $48.76 | $12.26 | $49.04 | +$0.07 | +$0.28 |
| Family training by Lead Analyst | 97156 | $19.05 | $76.20 | $19.05 | $76.20 | No change | No change |
| Family training via telemedicine (Lead Analyst) | 97156 GT | $19.05 | $76.20 | $19.05 | $76.68 | No change | No change |
| Family training by assistant | 97156 HN | $15.24 | $60.96 | $15.24 | $60.96 | No change | No change |
Thank you for your continued partnership as we work together through these changes!