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

The 2012 Florida Legislature has mandated that the Agency for Health Care Administration (AHCA) implement a new inpatient payment method utilizing Diagnosis-Related Groups (DRG) for Florida Medicaid on July 1, 2013. The DRG pricing conversion process and simulation results on located on the DRG web pages. For more information about this transition, please visit the DRG Pricing web page on the provider web portal.

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]

Reimbursement Plans

Reimbursement Rates

Nursing Home Requirements

For a list of the required documents and other information, please go to the Nursing Home Requirements web page.