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.
Diagnosis Related Group (DRG) Inpatient Payment Review
DRG Conversion Implementation Plan [2.71MB PDF]
NOTE: 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 [440KB PDF]
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 [662KB PDF] 4/4/2013
Summary of DRG Simulation as Proposed in SPB 7040 Results by Provider [125KB Microsoft Excel] 4/4/2013
DRG Payment Options
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.
DRG Payment Method Options (with Navigant's preliminary recommendations) [802KB PDF]
Governance Meeting Summaries
August 29, 2012 [38KB PDF]
September 18, 2012 [43KB PDF]
October 9, 2012 [36KB PDF]
November 6, 2012 [35KB PDF]
December 12, 2012 [35KB PDF]
Public Meetings
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
- Agenda [93KB PDF]
- DRG Payment Implementation [1.70MB PDF]
August 29, 2012
- August 29, 2012 Meeting Agenda [35KB PDF]
- DRG Payment Implementation Project Status [497KB PDF]
August 2, 2012
SFY 2012-13 Self-Funded Buyback and Exemption Adjustments
Summary of SFY 2012-13 Self funded Buybacks and Exemptions [84KB PDF]
Notice of Rate Setting Letter [114KB PDF]
Average Interest Rates
Reimbursement Plans
Reimbursement Rates
Hospice Recipient Log Reporting
Nursing Home Retroactive Rate Adjustments
Nursing Home Cost and Payment Rates
Medicaid Nursing Home Upper Payment Limit Fiscal Year 2011 – 2012 [2.20MB PDF] 4/15/2013
Medicaid Nursing Home Upper Payment Limit Fiscal Year 2010 – 2011 [2.47MB PDF ]
Florida Nursing Home Estimated Average Private Pay Rate for 2013 [301KB PDF] 4/26/2013
Florida Nursing Home Estimated Average Private Pay Rate for 2012 [1.55MB PDF]
Florida Nursing Home Estimated Average Private Pay Rate for 2011 [64KB 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]
