Hospital Outpatient Prospective Payment Reimbursement Methodology/ASC

The 2016 Florida Legislature has mandated that the Agency for Health Care Administration (AHCA) implement a new outpatient payment method utilizing Enhanced Ambulatory Patient Groups (EAPGs) for Florida Medicaid on July 1, 2017.

Note: Based on SB 2500, SFY 2017-18 General Appropriations Act

Provider Specific Results, [128KB Microsoft Excel] Updated 5/23/2017
Florida EAPG Calculator [291KB Microsoft Excel] Updated 6/26/2017

Note: Based on PCB APC 17-01, SFY 2017-18 General Appropriations Act

Provider Specific Results, [77KB Microsoft Excel] Updated 4/3/2017


The Agency was required to contract with an independent consultant to develop a plan to convert Medicaid payments for outpatient services from a cost based reimbursement methodology to a prospective payment system. The study is required to identify steps necessary for the transition to be completed in a budget neutral manner.  As required by Specific Appropriation 181 of the 2015 General Appropriations Act, the report was submitted to the Governor, the President of the Senate, and the Speaker of the House of Representatives on November 30, 2015.

Outpatient Prospective Payment System Design for Florida Medicaid [2MB PDF]

Note: Rerun of Simulation 08 that was included in the report

Simulation 11 - Provider Specific Results [113KB MS Excel] Updated 1/21/2016

Note: Based on Simulation 11

Florida EAPG Calculator [307KB Microsoft Excel] Updated 2/9/2016

Note: Based on HB 5001, General Appropriations Act

Simulation 14 – Provider Specific Results [113KB Microsoft Excel] Updated 2/16/2016

Public Meetings

The Agency for Health Care Administration (Agency) is hosting a public meeting regarding Hospital Outpatient Prospective Payment Reimbursement Methodology for use in determining payment for hospital outpatient services.

Location Date Time Meeting Materials
Agency for Health Care Administration
2727 Mahan Drive
Bldg. 3, Conference Room B
Tallahassee, FL 32308

Dial-in Number: 1 (888) 670-3525
Conference Code 906-716-2866
November 20, 2015 1:30 p.m. - 3:30 p.m.

FAR Notice

Agenda [175KB PDF]
Presentation [1.08MB PDF]

Audio of Meeting [20.52MB MP3]

Simulation 07 ASC Results [72KB MS Excel]
Simulation 07 Hospital Results [74KB MS Excel]

Link to Webinar

11/06 Governance Meeting Summary [89KB PDF]
11/18 Governance Meeting Summary [87KB PDF]

Agency for Health Care Administration
2727 Mahan Drive
Bldg. 3, Conference Room A
Tallahassee, FL 32308

Dial-in Number: 1 (888) 670-3525
Conference Code 906-716-2866
October 20, 2015 1:00 p.m. - 3:00 p.m.

FAR Notice

Agenda [80KB PDF]
Presentation [915KB PDF]

Audio of Meeting [13.29MB MP3]

Simulation 06 ASC Results [68KB MS Excell]
Simulation 06 Hospital Results [68KB MS Excel]

Governance Meeting Summary [87KB PDF]

Agency for Health Care Administration
2727 Mahan Drive
Bldg. 3, Conference Room A
Tallahassee, FL 32308.

Dial-in Number: 1 (888) 670-3525
Conference Code 906-716-2866
September 17, 2015 3:00 p.m. - 5:00 p.m.

FAR Notice

Agenda [80KB PDF]
Presentation [550KB PDF]

Audio of Meeting [13.01MB MP3]

Governance Meeting Summary [333KB PDF]

Agency for Health Care Administration
2727 Mahan Drive
Bldg. 3, Conference Room A
Tallahassee, FL 32308.

Dial-in Number: 1 (888) 670-3525
Conference Code 906-716-2866
August 19, 2015 12:30 p.m. - 3:30 p.m.

FAR Notice

Agenda [80KB PDF]
Presentation [503KB PDF]

Audio of Meeting [12.64MB MP3]

Governance Meeting Summary [87KB PDF]