If you deliver Florida iBudget waiver services, almost everything you can and can't bill flows from a single chain: the consumer's individual budget, the cost plan built from it, and the service authorizations issued off that plan. Get the chain right and billing is routine. Misread where your authorized units end, and you deliver services the state won't pay for — or leave authorized care undelivered.
This is a plain-language walk through that chain — the iBudget amount, the cost plan, service authorizations, authorized units versus utilization, and service codes — and what each one asks of a provider. The authoritative source is the iBudget Handbook and Rule 65G-4, Florida Administrative Code; treat this as orientation and the current Handbook as the authority.
The individual budget: where the money starts
Every iBudget waiver consumer has an individual budget — the iBudget amount — that caps what the waiver will spend on their services in a plan year. That amount is not negotiated case by case; it is calculated by the allocation algorithm in Rule 65G-4.0214, F.A.C., using factors such as the consumer's age, living setting, and Questionnaire for Situational Information (QSI) scores. Where the algorithm doesn't cover a documented, medically necessary need, additional funding can be requested through the Significant Additional Needs (SAN) process.
As a provider you don't see the algorithm math, but you feel its result: the iBudget amount is the ceiling everything downstream has to fit under. Services can't be authorized beyond what the budget holds.
The cost plan: the annual spending map
The consumer's Waiver Support Coordinator (WSC) works with the consumer and their planning team to turn the iBudget amount into a cost plan — an annual document that lists the waiver services the consumer will receive, the anticipated cost of each, and the approved provider of each. It is built from person-centered planning and the consumer's support plan, and it has to balance within the iBudget amount.
The cost plan is the WSC's document, not the provider's. You are named in it as the approved provider for specific services, but you don't write it, price it, or change it. When a consumer's needs change mid-year, the WSC revises the cost plan and moves it back through APD for approval — a provider requests changes through the WSC, never around them.
From cost plan to service authorization
A cost plan being approved is not, by itself, your permission to deliver. For a specific service to begin, that service must be listed in an approved cost plan and a service authorization must be issued to the provider before the service is delivered. The service authorization is the operative document for a provider: it names the provider, the service, the authorized units, and the effective and end dates, and it reflects the scope, frequency, and intensity approved for that consumer.
Service authorizations live in APD iConnect, the state's mandated system, where the WSC creates and transmits them. APDHQ runs alongside iConnect and never replaces it — the authorization originates from the WSC and iConnect, and that is where your billing has to line up. If there's no active authorization for a service and date, there is nothing to bill against, no matter what the cost plan says.
Authorized units vs. utilization, and service codes
Each waiver service is measured in a service billing unit defined by the Handbook — commonly a 15-minute increment, but also hourly, per day, per month, per trip, or per visit, depending on the service. The authorization grants a number of those units over the authorization period. That granted number is your authorized units; what you've actually delivered and billed against them is your utilization. The gap between the two is what you have to manage all year.
Each service also carries its own service code (procedure code) that identifies it on claims, so the units you bill attach to the right authorized service. Two rules follow directly: you can only bill for service dates that fall between the authorization's effective and end dates, and you can't bill more units than are authorized. If you over-bill, the correction is painful — a paid claim generally has to be voided before an updated authorization can be retransmitted for payment. Under-delivering is a quieter problem: authorized care the consumer needed but didn't receive, which surfaces in monitoring.
What a provider must do
The provider's obligations reduce to a short, strict list. Deliver a service only after its authorization has been issued, and only within the authorized units and effective-to-end dates. Bill under the correct service code, against the right authorization. Document every unit you deliver so the record supports what you billed — service logs and notes entered per the Handbook's requirements for that service, in iConnect. Watch utilization against authorized units throughout the plan year so you neither run past the authorization nor leave authorized care undelivered. And when the consumer's needs change, route it through the WSC to revise the cost plan and reissue the authorization before you act on it.
Unit types, documentation formats, and limits vary by service and are set per authorization, so confirm the specifics for each service you're enrolled to deliver against the current iBudget Handbook.
Where APDHQ fits
The hardest part of authorizations isn't understanding them — it's tracking dozens at once, each with its own units, dates, and service code, across every consumer you serve. APDHQ is the EHR for Florida APD iBudget agencies that keeps that visible: it tracks each consumer's authorizations and your utilization against them, so your team can see remaining units and end dates before they deliver — avoiding both over-delivery you can't bill and under-delivery that shows up in monitoring. The authorizations themselves still originate from the WSC and live in iConnect; APDHQ doesn't issue them and doesn't replace iConnect. It keeps your agency's copy of the picture organized alongside it, tied to the waiver services you deliver and the records a Provider Discovery Review examines.
Frequently asked questions
What is an iBudget cost plan?
It's the annual planning document your consumer's Waiver Support Coordinator builds from the consumer's individual budget (iBudget amount). It lists the waiver services the consumer will receive, the anticipated cost of each, and the approved provider of each, and it must balance within the iBudget amount. It's developed through person-centered planning and approved by APD.
What's the difference between a cost plan and a service authorization?
The cost plan is the overall annual spending map for the consumer. A service authorization is the specific, provider-facing document issued off that plan for one service — naming the provider, the authorized units, and the effective and end dates. A service must be listed in an approved cost plan and have a service authorization issued to the provider before it can be delivered.
What are authorized units, and how do they relate to utilization?
Authorized units are the quantity of a service the authorization grants over its period, measured in that service's billing unit (for example 15-minute increments, per day, per month, per trip, or per visit). Utilization is what you've actually delivered and billed against them. You can't bill more than the authorized units, or for dates outside the authorization's effective and end dates.
Can a provider deliver a service if it's in the cost plan but not yet authorized?
No. An approved cost plan isn't your permission to deliver. The service authorization must be issued to the provider before the service is delivered. Without an active authorization for that service and date, there's nothing to bill against.
Who issues and changes service authorizations?
The Waiver Support Coordinator creates and transmits service authorizations in APD iConnect, off the approved cost plan. Providers don't issue or edit them. If a consumer's needs change, the provider raises it with the WSC, who revises the cost plan and reissues the authorization — providers deliver to what's authorized, not around it.