I don’t know about you, but whenever I hear the words “Special Session,” my coffee intake automatically doubles. It sounds so official. It sounds intense. And let’s be honest, for most practice owners I talk to, it sounds like a giant “Necessary Evil” that we have to navigate.
But here we are. It is Friday, April 17th. We are just three days away from the big show in Tallahassee starting on Monday, April 20th. If you’ve been following along with our recent posts, you know things have been a bit… well, dramatic. The regular session ended in March without a finished budget. Now, our lawmakers are heading back to the capital to figure out how to bridge a massive gap.
I’ve spent the last week digging through legislative notes and talking to my colleagues in the billing world. I wanted to give you a clear picture of what is actually happening. No fluff. Just the facts that will affect your clinic’s bottom line.
Are you ready? Let’s dive in. Sound familiar? It’s the Florida legislative rollercoaster we all know and love (or tolerate).
The $1.4 Billion Question
The biggest elephant in the room is the budget. I talk to therapists every day who are worried about their rates. And they should be! The House and the Senate are currently staring at each other across a $1.4 billion gap.
The House has proposed a $113.6 billion plan. The Senate is aiming higher at $115 billion. That sounds like a lot of zeros, right? But in state government terms, that $1.4 billion difference is where the “real” decisions happen. This is where programs get funded, or where they get trimmed.
I realized a long time ago that when lawmakers argue over a billion dollars, healthcare often becomes the target. Why? Because Health and Human Services is one of the biggest slices of the pie. If they can’t agree on where to get the money, they start looking at administrative costs and provider rates.
Why the Medicaid Match Shift Matters to You
Wait! What? Yep, there is another layer to this budget onion. The federal match for Florida Medicaid has dropped slightly to 55.4%. Now, at a high level, this might seem like a tiny decimal change. But for the state of Florida, it’s a big deal.
It means the federal government is picking up a smaller portion of the bill. Florida has to pick up the rest. When the state has to reach deeper into its own pockets, they get very protective of every dollar.
I’m going to give a quick overview of what this usually leads to. In my experience, a lower federal match leads to “tighter” administration. We are already seeing a push for more frequent Medicaid redeterminations. They want to make sure everyone on the rolls actually belongs there. For your practice, this means you need to be double-checking eligibility every single time a patient walks through the door.
Don’t wait until the claim is denied to find out a family lost their coverage. I’ve seen practices lose thousands of dollars because they assumed a patient was still eligible. In this environment, “assuming” is a very expensive hobby.
The DMEPOS Moratorium: Still in Play
I have to mention this because it is catching a few of our providers off guard. The Medicaid DMEPOS moratorium for Provider Type 90 is still very much active. If you are a therapy practice that also supplies equipment, like orthotics, splints, or specialized seating, you need to pay attention.
Enrollment for new Provider Type 90 spots is essentially on pause. If you were planning on expanding that side of your business this month, you might hit a brick wall. It’s frustrating. I know. I’ve heard the frustration in your voices when we talk on the phone.
But staying informed is half the battle. If you know the wall is there, you won’t waste energy trying to run through it. We are keeping a close eye on when this moratorium might lift, but for now, it’s a “wait and see” situation.
We Are Eyes and Ears in Tallahassee
I don’t know about you, but I find the legislative process to be a mix of “Scary, Boring, and Necessary.” It’s a “Necessary Evil” that we have to track so you don’t have to.
Next week is going to be big. During the special session, the discussions around Early Steps and general therapy rate increases will be front and center. These are the things that keep your doors open. These are the rates that allow you to hire more therapists and serve more kids.
I talk to so many owners who feel like they have no voice in this. But you do! Knowing what is happening is the first step. The second step is having a team that knows how to pivot when the rules change. That is exactly what we do here at Extra Mile Billing.
How to Prepare Your Practice This Weekend
So, what should you do while the lawmakers are packing their bags for Tallahassee? I have a few suggestions that will help you sleep better on Sunday night.
First, take a look at your current Medicaid caseload. Are you noticing more denials related to eligibility? If so, that is a red flag that the redetermination “tightening” is hitting your area.
Second, check your enrollment status for all your providers. If you have a new therapist starting soon, get that paperwork in now. Don’t wait to see if the session changes the requirements.
Third, take a breath. It’s easy to get overwhelmed by the $1.4 billion gaps and the legislative drama. But remember, you are a clinician first. Your job is to help kids. Our job is to handle the noise so you can focus on the heart of your practice.
We’re in this together.
Feel free to ask us any questions about how the FMAP shift might affect your specific billing cycle. We’ve seen it all before, and we know how to navigate it. It feels GREAT to have a plan in place, doesn’t it?
Aaron and the Extra Mile Team