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. For more information about this transition, please visit the DRG Pricing web page on the provider web portal.

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

Provider Specific Results, [89KB Microsoft Excel] Updated 5/24/2017
Florida DRG Calculator [297KB Microsoft Excel] Updated 1/23/2018

Previous DRG Simulations

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

Provider Specific Results, [104KB Microsoft Excel] Updated 4/3/2017

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

Provider Specific Results, [103KB Microsoft Excel] Updated 4/3/2017

Note: Based on FY 2016-17 General Appropriations Act

Florida DRG Calculator SFY 2016-2017, Effective July 1, 2016 [284KB Microsoft Excel]

Note: Based on FY 2015-16 Casemix Reconciliation

Florida DRG Calculator SFY 2015-2016, Effective March 1, 2016 [292KB Microsoft Excel]

Note: Based on FY 2015-16 General Appropriations Act

Florida DRG Calculator SFY 2015-2016, Effective July 1, 2015 [307KB Microsoft Excel]

Note: Based on FY 2014-15 General Appropriations Act

Florida DRG Calculator SFY 2014-2015 [324KB Microsoft Excel] Updated 7/21/2014

Note: Based on FY 2014-15 Casemix Reconciliation

Florida DRG Calculator SFY 2014-15 Effective March 1, 2015 [322KB Microsoft Excel] Updated 3/6/2015

NOTE: Based on final rates implemented 11/1/2013 and effective July 1, 2013 (retrospective) for FY 2013-14.

Florida DRG Calculator [308KB Microsoft Excel]
Summary Comparison of DRG July 1, 2013 GAA Simulation vs. November 1, 2013 FINAL Simulation by Provider [61KB MS Excel]
Summary Comparison of DRG July 1, 2013 GAA Simulation vs. November 1, 2013 FINAL Simulation by Provider [557KB PDF]

NOTE: Based on 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]
Summary of DRG Simulation as Proposed in SPB 7040 Results by Provider [125KB Microsoft Excel]

DRG Transitional Payments

DRG Transitional Payments Report, June 30, 2014 [4.52MB PDF]
DRG Transitional Payments Report, March 1, 2014 [4.06MB PDF]

DRG Payment Options

NOTE: Final DRG Conversion Implementation Plan as submitted to the Governor, the President of the Senate, and the Speaker of the House of Representatives.

DRG Conversion Implementation Plan [2.71MB 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]

Reimbursement Plans

Rough draft version as used for discussion purposes only  at the August 27, 2013 rule development workshop.

DRG Reimbursement Plan Rough Draft [1.23MB PDF]

NOTE: This inpatient hospital reimbursement plan was submitted to the Centers for Medicare and Medicaid Services (CMS) as State Plan Amendment (SPA) 2013-011 on September 30, 2013.  The language contained in the reimbursement plan may be revised several times during the CMS review and approval process and is not considered final until AHCA receives written approval of the reimbursement plan from CMS.

DRG Reimbursement Plan [885KB PDF]

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