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.

Effective October 1, 2020
Note: Based on HB 5001, SFY 2020-21 General Appropriations Act

Florida DRG Calculator, [311KB MS Excel] Updated 9/14/2020

Effective July 1, 2020
Note: Based on SB 5001, SFY 2020-21 General Appropriations Act

Florida DRG Calculator, [311KB MS Excel] Updated 6/1/2020
Provider Specific Results, [83KB MS Excel] Updated 3/27/2020

Previous DRG Simulations

Note: The SFY 2019-20 Provider Specific Results have been updated with data reflecting the impact of changes to projected hospital inpatient reimbursement, by hospital and in the aggregate, resulting from final parameters adopted by the Legislature in SFY 2020-21 HB 5001 back of the bill proviso language.

Florida DRG Calculator [306KB MS Excel] Updated 6/1/2020
Provider Specific Results, [81KB Microsoft Excel] Updated 3/27/2020

Note: Based on HB 5001, SFY 2018-19 General Appropriations Act

Florida DRG Calculator [299KB MS Excel] Updated 8/27/2018
Provider Specific Results [78KB MS Excel] Updated 6/29/2018

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

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

Note: Based on FY 2014-15 Casemix Reconciliation

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

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.

NOTE: Based on originally filed House budget bill, PCB APC 13-05 (GAA).

NOTE: Based on originally filed Senate budget bill, SPB 7040

DRG Transitional Payments

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.

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. 

Reimbursement Plans

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

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.

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