Medicaid Institutional Provider Cost Reimbursement
Medicaid reimbursement for institutional providers is determined in the Medicaid Program Finance Bureau. These providers include inpatient and outpatient hospital, nursing homes and ICF/DDs. This page contains links to some commonly requested documentation regarding the reimbursement of institutional providers.
Questions regarding the information contained in these documents may be directed to (850) 412-4103.
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 following drop down menus provide information on the DRG pricing conversion process and simulation results. For more information about this transition, please visit the DRG Pricing web page on the provider web portal.
NOTE: Final DRG Conversion Implementation Plan as submitted to the Governor, the President of the Senate, and the Speaker of the House of Representatives.
DRG Conversion Implementation Plan [2.71MB PDF]
NOTE: Based on final rates implemented 11/1/2013 and effective July 1, 2013 (retrospective) for FY 2013-14.
Florida DRG Calculator [309KB Microsoft Excel] Updated 11/1/2013
Rough draft version as used for discussion purposes only at the August 27, 2013 rule development workshop.
DRG Reimbursement Plan Rough Draft [1.23MB PDF]
NOTE: This inpatient hospital reimbursement plan was submitted to the Centers for Medicare and Medicaid Services (CMS) as State Plan Amendment (SPA) 2013-011 on September 30, 2013. The language contained in the reimbursement plan may be revised several times during the CMS review and approval process and is not considered final until AHCA receives written approval of the reimbursement plan from CMS.
DRG Reimbursement Plan [885MB PDF]
NOTE: Based on the FY 2013-14 General Appropriations Act
Florida DRG Calculator [314KB Microsoft Excel]
Summary of DRG Simulation Based on FY 2013-14 GAA Results by Provider [105KB Microsoft Excel]
DRG Payment Calculation Provider Training [951KB PDF] 6/6/2013
NOTE: Based on final DRG Conversion Implementation Plan as submitted to the Governor, the President of the Senate, and the Speaker of the House of Representatives.
Florida DRG Calculator [290KB Microsoft Excel]
Summary of DRG Simulation 28 Results by Provider [292KB PDF]
Summary of DRG Simulation 28 Results by Provider [92KB Microsoft Excel]
NOTE: Based on originally filed House budget bill, PCB APC 13-05 (GAA).
Summary of DRG Simulation as Proposed in PCB APC 13-05 (GAA) Results by Provider [127KB Microsoft Excel]
NOTE: Based on originally filed Senate budget bill, SPB 7040
Summary of DRG Simulation as Proposed in SPB 7040 Results by Provider [125KB Microsoft Excel]
DRG Payment Method Options Document [1MB PDF]
NOTE: The recommendations contained in the DRG payment method options document posted below are from the consultants and not from the Agency for Health Care Administration. The recommendations are preliminary and made prior to comparing the data analysis that would be required to finalize the recommendations. The Agency has not made its recommendations.
January 8, 2013
- Agenda [91KB PDF]
- Summary of DRG Simulation 17 Results by Provider [573KB PDF]
- Summary of DRG Simulation 17 Results by Provider [118KB Microsoft Excel]
- DRG Payment Implementation Presentation [3.41MB PDF]
November 15, 2012
- Agenda [90KB PDF]
- DRG Payment Implementation Presentation [1.04MB PDF]
- Summary of Provider DRG Payment Simulation 5 [576KB PDF]
- Summary of Provider DRG Payment Simulation 5 [87KB Microsoft Excel]
October 11, 2012
August 29, 2012
August 2, 2012
SFY 2012-13 Self-Funded Buyback and Exemption Adjustments
Notice of Rate Setting Letter [114KB PDF]
Average Interest Rates
Nursing Home Cost and Payment Rates
Medicaid Nursing Home Upper Payment Limit Fiscal Year 2011 – 2012 [2.20MB PDF] 4/15/2013
Florida Nursing Home Estimated Average Private Pay Rate for 2013 [301KB PDF] 4/26/2013
A Report to the Florida Legislature (2013) [1.63MB PDF]
A Report to the Florida Legislature (2012) [3.17MB PDF]
A Report to the Florida Legislature (2011) [2.39MB PDF]
A Report to the Florida Legislature (2010) [4.14MB PDF]
A Florida Medicaid Report (January 19, 2005) - In conjunction with the Florida Association of Homes for the Aging and the Florida Health Care Association [1.42MB PDF]