The Health Care Responsibility Act (HCRA) was enacted in order to assure that adequate and affordable health care is available to all Floridians. HCRA places the ultimate financial obligation for a qualified indigent's out-of-county emergency care at a participating HCRA hospital on the county in which the qualified indigent patient resides.
Effective July 1, 2013, the Agency implemented a new hospital inpatient payment method utilizing Diagnosis-Related Groups (DRG) for Florida Medicaid. DRG transitions hospital inpatient reimbursement from a cost-based per diem to a per discharge, diagnosis-code payment. If the DRG code provided in field 71 on the UB 04 claim form is not a four-digit code from the DRG Table tab of the DRG Pricing Calculator, it is not reimbursable through HCRA. Effective July 1, 2017, the Agency implemented a new hospital outpatient payment method utilizing Enhanced Ambulatory Patient Grouping (EAPG) for Florida Medicaid. EAPG classifies claim lines for outpatient visits by assigning a separate EAPG code to each line item on the UB 04 claim form. If the revenue code provided on the UB 04 claim form is not a four-digit code from the Covered Rev Codes tab of the EAPG Pricing Calculator, it is not reimbursable through HCRA. The county shall not be liable for payment of treatment of a certified resident who is a qualified indigent patient or spend-down provision eligible patient, unless the participating hospital is able to provide the necessary information to the counties required to calculate the rate of reimbursement.
Please review this HCRA Overview Presentation [540KB, PDF] for the most up to date information concerning the HCRA program. If you do not find the answer to your question(s) or for county or hospital training, please email the HCRA liaison at HCRA@ahca.myflorida.com.
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The following HCRA Information and Forms are intended for use only by HCRA Participating Hospitals and counties in Florida. * Any modifications to these forms/templates are prohibited.