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. Participating hospitals must provide inpatient UB 04 claim forms to the HCRA eligible applicant's county of residence using the APR-DRG grouping method (not Medicare). If the DRG code provided in field 71 on the UB 04 claim form is not on the APR-DRG Inpatient Hospital Reimbursement Rates list posted on the HCRA website, it is not reimbursable through HCRA.
Please review this HCRA Overview Presentation [571KB, 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.