Institutional Reimbursement

The Institutional Provider Reimbursement section calculates the Medicaid reimbursement rates for institutional providers. These providers include inpatient and outpatient hospitals, nursing homes, Federally Qualified Health Centers (FQHCs), County Health Departments (CHDs), and Intermediate Care Facilities (ICFs). This section is also responsible for processing rate changes based on audit adjustments, interim rate calculations, and all other retroactive rate adjustments.

The methodology used to calculate the reimbursement rates for institutional providers is established in the Title XIX institutional provider reimbursement plans for each institutional provider these reimbursement plans are adopted by rule.

The Institutional Provider Reimbursement section also oversees the Medicaid School District Administrative Claiming (SDAC) program which is a federally funded program administered by AHCA in coordination with DOE. 

Hospitals

Rates for inpatient and outpatient hospitals.

CHD

Rates for County Health Departments.

ICF

Rates for Intermediate Care Facilities.

Hospice

Rates for Hospice Room and Board

FQHC/RHC

Rates for Federally Qualified Health Centers and Rural Health Clinics.

Skilled Nursing Unit Rate

Rates for Skilled Nursing Units.

Swing Beds

Rates for swing beds.