Medicaid Reimbursement for ARNP (Advanced Registered Nurse Practitioner) services

Florida Medicaid reimburses for services rendered by licensed, Medicaid-participating Advanced Registered Nurse Practitioners (ARNPs). The services must be rendered in collaboration with a physician. Reimbursement for anesthesia, obstetrical and psychiatric services is limited to ARNPs who have completed the educational program in the appropriate specialty and are authorized to provide these services.

Medicaid reimburses ARNPs who are Medicaid-participating independent providers with formal relationships with Florida licensed physicians.

LIMITATIONS:

Medicaid reimbursement for ARNP services is limited to:

• One ARNP-recipient contact per day (except for emergencies);

• One long-term care facility service, per ARNP, per month, per recipient (except for emergencies);

• Ten low-risk prenatal and two postpartum visits per pregnancy; and

• One new patient evaluation and management service, per ARNP, per recipient, every three years, if no services were rendered by the ARNP to the recipient during the three years. Subsequent encounters must be reimbursed as established patient evaluation and management services.

EXCEPTIONS:

The ARNP may request authorization for reimbursement for services in excess of the service limitations.

ELIGIBILITY:

Medicaid reimburses for ARNP services for all Medicaid recipients based on medical necessity.

REIMBURSEMENT:

Medicaid reimbursement for ARNP services is the maximum Medicaid fee or the provider’s customary fee, whichever is lower. ARNPs are reimbursed at 80 percent of the physician’s rate for services that are approved by the Centers for Medicare and Medicaid Services (CMS), formerly known as HCFA. If an ARNP is salaried by a hospital or other facility that is reimbursed on a cost-related basis, the ARNP cannot be paid on a fee-for-service basis if the costs for the ARNP’s salary are included in the facility’s cost report.

There is a $2 recipient copayment for ARNP services, per provider, per day, unless the recipient is exempt.