Health Care Responsibility Act (HCRA)
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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Additional Information and HCRA Related Forms
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.
- Notification of Eligibility [108KB,PDF] AHCA Form 5220-0002
- Participating Hospital List [354KB, XLS] Updated: 11/10/2016
- Participating Hospital Contact List [522KB, XLS] Updated: 8/29/2016
- APR-DRG Inpatient and Outpatient Hospital Reimbursement Rates Instructions [204KB, PDF]
- APR-DRG Inpatient Hospital Reimbursement Calculator
- Hospital Outpatient Per Diem Rates [174KB, PDF] – Effective July 1, 2015
Note: Effective for claims with dates of service or treatment PRIOR to July 1, 2016
- Hospital Outpatient Per Diem Rates [57KB, XLS] – Effective July 1, 2016
Note: Hospital Outpatient Per Diem Rates [21KB, XLS] - Effective July 1, 2016 may also be found at: http://www.ahca.myflorida.com/medicaid/cost_reim/hospital_rates.shtml
- Outpatient Revenue Center Codes
- Pathology/Laboratory Fees [253KB, PDF]
- County Population and HCRA Liability[256KB, XLS] 2015-2016
- County Population and HCRA Liability [256KB, XLS] 2016-2017
- 100% Federal Poverty Income Limits [140KB, PDF] Effective: 3/1/2016
- Spend-down Provision Income Limits [140KB, PDF] Effective: 3/1/2016
- Asset Limits - Medically Needy [6KB, PDF] Effective: 9/18/2013
- Monthly Caseload and Appeals Automated Template [267KB, XLS] 2015-2016
- Monthly Caseload and Appeals Automated Template [265KB, XLS] 2016-2017
- Quarterly Expense Automated Template [43KB, XLS] 2015-2016
- Quarterly Expense Automated Template [52KB, XLS] 2016-2017
- County Contact Change Form [124KB, PDF]
- Monthly Household Expense Calculation Form [14.5KB, PDF]