Medicaid Reimbursement Rates
These are rates which Medicaid reimburses Medicaid participating hospitals for services provided on a fee for service basis to Medicaid recipients. This includes rates based on Legislative directions provided in the General Appropriations Act for each state fiscal year, which may exempt certain hospitals from rate reimbursement ceilings.
Effective July 1, 2005, the cost of exempting certain hospitals from reimbursement ceilings is included in the capitation rates paid to Medicaid managed care organizations.
Rates published are effective as of the first day of the rate semester (January 1st/July 1st). Effective July 1, 2011, rates are to be set once a year every July 1st. This Web site is not updated for increases or decreases in rates due to revisions to cost data (such as amended cost reports or audits).
Effective July 1, 2013, the Agency will be implementing a new hospital inpatient payment method utilizing Diagnosis-Related Groups (DRG) for Florida Medicaid. With this reimbursement change, there will no longer be any hospital inpatient per diem rates posted. The only exception is for the State Mental Health Hospitals which will continue to be reimbursed per diem. Hospital inpatient DRG rate worksheets will be posted instead of per diems.
Effective July 1, 2017, the Agency will be implementing a new hospital outpatient payment method utilizing Enhanced Ambulatory Patient Groups (EAPGs) for Florida Medicaid. With this reimbursement change, there will no longer be any hospital outpatient per diem rates posted. The only exception is for the State Mental Health Hospitals which will continue to be reimbursed per diem. Hospital outpatient EAPG rate worksheets will be posted instead of per diems.
For individual updated hospital rates, please contact your local Medicaid field offices or AHCA Medicaid Cost Reimbursement at (850) 412-4101.
Reimbursement Plans
- Inpatient Hospital
Florida Title XIX Inpatient Hospital Reimbursement Plan Version XXLII [
1022.4 kB
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Effective Date: July 1, 2023
Posted September 3, 2024
- Outpatient Hospital
Florida Title XIX Outpatient Hospital Reimbursement Plan Version XXXV [
326.7 kB
]
Effective Date: July 1, 2023
Posted September 3, 2024
Payment to Out-of-State and Non-Medicaid Providers During 2017 Hurricane Irma Disaster Grace Period
Hospital Outpatient Prospective Payment Reimbursement Methodology/ASC
During the 2015 Legislative Session (Special Session A), the Agency was directed to contract with a vendor to develop a plan to convert to a prospective payment system for outpatient hospital reimbursement. Pricing conversion and simulation results are located on the EAPG web pages. For more information about this transition, please visit the EAPG Pricing web page on the provider web portal.
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.
Statewide Inpatient Psychiatric Program (SIPP) Rates
Effective October 2024
$657.79
State Mental Health Hospital Program
2024
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Hospital Rates
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, Effective July 1, 2024 Posted 6/20/2024 -
Calculation Worksheets
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50.8 kB
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, Effective July 1, 2024 Posted 6/20/2024
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Rate Letters
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851 kB
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, Effective July 1, 2024 Posted 6/20/2024
Vagus Nerve Stimulator (VNS) Reimbursement
The Agency has developed a Vagus Nerve Stimulator reimbursement fact sheet. Please click on the link below to view the fact sheet.
