Florida Medicaid Providers: New $15 Minimum Wage Requirements | Bass, Berry & Sims APIs

Starting October 1, 2022, some providers participating in the Florida Medicaid program will be required to pay direct care workers a minimum of $15 per hour. Below, we’ve outlined the organizations subject to this new requirement and other relevant implementation details.

What is the new requirement?

Effective October 1, 2022, Florida Medicaid providers will be required to pay some of their employees a minimum wage of $15 per hour. The minimum wage requirement applies to the following groups:

  • Direct care workers, whether employees or independent contractors, of entities other than nursing homes paid according to the fee schedules described below.
  • All nursing home workers, whether employees or independent contractors.

A “direct care worker” means a person who has direct contact with a Medicaid beneficiary to provide a Medicaid reimbursable service. Direct care workers do not include people who do not provide a service reimbursable by Medicaid, such as maintenance or administrative staff.

Which service providers are affected by this new requirement?

The new rule covers all Medicaid providers who receive reimbursement under any of the affected fee-for-service schedules. The Florida Agency for Healthcare Administration (AHCA) has posted a list of affected fee schedules on its website, which includes, but is not limited to, the Practitioner’s Fee Schedule, the radiology costs, hospital services and ASC for inpatients and outpatients. Fees, Fee Schedule for Home Visiting Services and Nursing Home Fee-for-Service Fees. Suppliers that charge under an impacted fee schedule must implement the minimum wage increase. A supplier cannot “opt-out” of this requirement.

Are there exceptions?

The suppliers who exclusively invoice according to the following fee schedules will not be required to comply with the new minimum wage requirement:

  • Behavioral analysis
  • County Community Match for Drug Abuse
  • County Health Department Certified Matching Program
  • Fee Schedule for Service Providers of Durable Medical Equipment and Medical Supplies for All Medicaid Beneficiaries
  • Early Intervention Services
  • Medicaid Certified School Matching Program
  • Doctor Pediatric surgery
  • Prescribed drugs Immunization
  • Prescribed Drugs Physician Administered Billing Codes
  • Neonatal Services of the Regional Perinatal Intensive Care Center
  • Obstetrical Services of the Regional Perinatal Intensive Care Center
  • Targeted case management for children at risk of abuse and neglect

How will the salary increase be paid?

Funding to support the $15 minimum wage will be distributed to Medicaid providers through increased fee-for-service fee schedules and managed care rates.

The AHCA is currently finalizing the impacted fee schedule increases and anticipates completion of all fee schedule increases by October 1, 2022. The fee increase for nursing homes, licensed health centers by the federal government and rural health clinics will be effective October 1, 2022. All other fee schedule increases will be retroactive to July 1, 2022.

What should a Medicaid provider do before October 1, 2022?

Prior to October 1, 2022, each Medicaid provider who is required to implement the $15 minimum wage must sign a supplemental wage agreement located on the Medicaid provider’s secure web portal, certifying that each provider’s direct care worker ( and all nursing home workers), will be paid at least $15 an hour, starting October 1.

What are the penalties for non-compliance?

Claimants who do not sign the Supplemental Wage Agreement will be subject to clawback of funds associated with the minimum wage requirement. Additionally, starting January 1, 2023, suppliers will be at increased risk of litigation if they fail to comply with the requirement to pay workers at least $15 per hour. Any staff member of a vendor who should be paid at least $15 an hour but isn’t will be able to bring a civil action against the allegedly non-compliant vendor from that date.

Next steps?

Suppliers should consider the following next steps:

  1. Determine if the new minimum wage requirements apply to the supplier.
  2. Determine which workers are subject to the minimum wage increase.
  3. Submit the supplemental wage agreement certifying that all eligible workers will be paid at least $15 per hour beginning October 1, 2022 and implement any internal changes necessary to comply with the requirements by the October 1 deadline .
  4. Implement the new minimum wage increase for eligible workers by October 1, 2022.
  5. Make sure the increased rates are reflected in the reimbursement received from Medicaid.

The AHCA portal has an FAQ page with useful information. Please contact the authors with any questions regarding this new minimum wage increase requirement.

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