Florida State flag

An official website of the Florida State government.

Hospital Outpatient Prospective Payment Reimbursement Methodology/ASC

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.

Effective July 1, 2023
Note: Based on SB 2500, SFY 2023-24 General Appropriations Act

Florida EAPG Calculator [ excel 181.9 kB ]   Updated 6/14/2023
Provider Specific EAPG Results [ excel 138.2 kB ]   5/05/2023
EAPG Rate Worksheet FY 2023-24 [ excel 78.7 kB ]  6/14/2023
Provider EAPG Rate Worksheet FY 2023-24 [ excel 54 kB ]  Updated 6/14/2023

Effective July 1, 2022
Note: Based on SB 2500, SFY 2022-23 General Appropriations Act

Florida EAPG Calculator [ excel 177.7 kB ]   Updated 6/8/2023
Provider Specific EAPG Results [ excel 159.1 kB ] Updated 7/15/2022
EAPG Rate Worksheet FY 2022-23 [ excel 87.1 kB ]  7/1/2022
Provider EAPG Rate Worksheet FY 2022-23 [ excel 79.9 kB ]  Updated 6/8/2023

Effective July 1, 2021
Note: Based on SB 2500, SFY 2021-22 General Appropriations Act

Florida EAPG Calculator [ excel 171.3 kB ]   Updated 6/8/2023
Provider Specific EAPG Results [ excel 159.1 kB ]  Updated 5/24/2021
EAPG Rate Worksheet FY 2021-22 [ excel 50.3 kB ]  7/01/2021
Provider EAPG Rate Worksheet FY 2021-22 [ excel 50.8 kB ]  Updated 6/8/2023

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

Florida EAPG Calculator [ excel 288.3 kB ]    Updated 7/15/2022
Provider EAPG Rate Worksheet FY 2020-21 [ excel 58.5 kB ] October 1, 2020

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

Florida EAPG Calculator [ excel 284.1 kB ] Updated 9/8/2020
Provider Specific Results [ excel 129.3 kB ] Updated 4/1/2020
EAPG Rate Worksheet FY 2020-21 [ excel 48.2 kB ] September 8, 2020
Provider EAPG Rate Worksheet FY 2020-21 [ excel 61.8 kB ] July 1, 2020

Effective July 1, 2019

Note: Based on SB 2500, SFY 2019-20 General Appropriations Act

Florida EAPG Calculator [ excel 281.9 kB ] Updated 6/1/2020
Provider Specific Results [ excel 123.7 kB ]  Updated 10/7/2019
EAPG Rate Worksheet FY 2019-20 [ excel 56.4 kB ] July 1, 2019
Provider EAPG Rate Worksheet FY 2019-20 [ excel 56.4 kB ] July 1, 2019

Effective April 1, 2019
Note: Based on HB 5001, SFY 2018-19 General Appropriations Act

Florida EAPG Calculator [ excel 286 kB ] Updated 3/13/2020
Provider EAPG Rate Worksheet FY2019-20, Effective April 1, 2019 [ excel 57.3 kB ]  Updated 3/13/2020
Provider EAPG Rate Worksheet FY 2018-19 Reconciliation [ excel 55.2 kB ] , April 1, 2019

Effective July 1, 2018
Note: Based on HB 5001, SFY 2018-19 General Appropriations Act

Florida EAPG Calculator [ excel 277.1 kB ] Updated 3/13/2020
Provider EAPG Rate Worksheet FY2019-20, Effective July 1, 2018 [ excel 56.4 kB ]  Updated 3/13/2020

Effective April 1, 2018
Note: Based on HB 5001, SFY 2018-19 General Appropriations Act

Florida EAPG Calculator [ excel 276.1 kB ]  Updated 6/13/2018
Provider Specific Results of Reconciliation Calculation [ excel 114.5 kB ]  Updated 5/31/2018
5 Percent Cap on Gains and Losses Reconciliation calculation [ excel 73.4 kB ]  Updated 5/31/2018

Effective July 1, 2017
Note: Based on SB 2500, SFY 2017-18 General Appropriations Act

Provider Specific Results [ excel 127.6 kB ]  Updated 5/23/2017
Florida EAPG Calculator [ excel 275.6 kB ]   Updated 1/23/2018

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

Provider Specific Results [ excel 76.8 kB ]  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 [ pdf 2 MB ]

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

Simulation 11 - Provider Specific Results [ excel 112.7 kB ] Updated 1/21/2016

Note: Based on Simulation 11

Florida EAPG Calculator [ excel 1.1 MB ] Updated 2/9/2016

Note: Based on HB 5001, General Appropriations Act

Simulation 14 – Provider Specific Results [ excel 112.1 kB ] 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.

LocationDateTimeMeeting 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, 20151:30 p.m. - 3:30 p.m.FAR Notice
Agenda [ pdf 174.5 kB ]
Audio of Meeting [ sound 20.5 MB ]
Simulation 07 ASC Results [ excel 71.4 kB ]
Link to Webinar
11/06 Governance Meeting Summary [ pdf 88.8 kB ]
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, 20151:00 p.m. - 3:00 p.m.FAR Notice
Agenda [ pdf 79.3 kB ]
Audio of Meeting [ sound 13.3 MB ]
Simulation 06 ASC Results [ excel 67.9 kB ]
Governance Meeting Summary [ pdf 86.4 kB ]
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, 20153:00 p.m. - 5:00 p.m.FAR Notice
Agenda [ pdf 79.4 kB ]
Audio of Meeting [ sound 13 MB ]
Governance Meeting Summary [ pdf 332.5 kB ]
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, 201512:30 p.m. - 3:30 p.m.FAR Notice
Agenda [ pdf 79.5 kB ]
Audio of Meeting [ sound 12.6 MB ]
Governance Meeting Summary [ pdf 86.9 kB ]