Hospital Rates

Medicaid Reimbursement Rates

These are rates which Medicaid reimburses Medicaid participating hospitals for services provided on a fee for service basis to Medicaid recipients. This includes rates based on Legislative directions provided in the General Appropriations Act for each state fiscal year, which may exempt certain hospitals from rate reimbursement ceilings.

Effective July 1, 2005, the cost of exempting certain hospitals from reimbursement ceilings is included in the capitation rates paid to Medicaid managed care organizations.

Rates published are effective as of the first day of the rate semester (January 1st/July 1st). Effective July 1, 2011, rates are to be set once a year every July 1st. This Web site is not updated for increases or decreases in rates due to revisions to cost data (such as amended cost reports or audits).

Effective July 1, 2013, the Agency will be implementing a new hospital inpatient payment method utilizing Diagnosis-Related Groups (DRG) for Florida Medicaid.  With this reimbursement change, there will no longer be any hospital inpatient per diem rates posted.  The only exception is for the State Mental Health Hospitals which will continue to be reimbursed per diem.  Hospital inpatient DRG rate worksheets will be posted instead of per diems.  Hospital outpatient per diem rates will continue to be posted.

For individual updated hospital rates, please contact your local Medicaid field offices or AHCA Medicaid Cost Reimbursement at (850) 412-4103.

Reimbursement Plans

SFY 2012-13 Self-Funded Buyback and Exemption Adjustments

Summary of SFY 2012-13 Self funded Buybacks and Exemptions [84KB PDF]

Notice of Rate Setting Letter [114KB PDF]

Outpatient Rates

2015

Out-of-State Outpatient Hospital Rates

Effective July 1, 2015

Hospital Outpatient Prospective Payment Reimbursement Methodology

During the 2015 Legislative Session (Special Session A), the Agency was directed to contract with a vendor to develop a plan to convert to a prospective payment system for outpatient hospital reimbursement.

Diagnosis Related Group (DRG) Inpatient Payment Review

The 2012 Florida Legislature has mandated that the Agency for Health Care Administration (AHCA) implement a new inpatient payment method utilizing Diagnosis-Related Groups (DRG) for Florida Medicaid on July 1, 2013. The DRG pricing conversion process and simulation results on located on the DRG web pages. For more information about this transition, please visit the DRG Pricing web page on the provider web portal.

DRG Inpatient Hospitals

2015

Archive 2014 - 2010

Medicaid Rates/County Billing Purposes Only Archive