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, 2024
Note: Based on HB 5001, SFY 2024-25 General Appropriations Act

Florida EAPG Calculator [ 184.4 kB ]   7/1/2024
Provider Specific EAPG Results [ 123.2 kB ]  7/1/2024
EAPG Rate Worksheet FY 2024-25 [ 85.4 kB ]  7/1/2024
Provider EAPG Rate Worksheet FY 2024-25 [ 55 kB ]  7/1/2024

Enhanced Ambulatory Patient Grouping (EAPG) Payment System Educational Session
February 27, 2024
Florida EAPG Educational Training Session [ 642.9 kB ]

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

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

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

Florida EAPG Calculator [ 177.7 kB ]   Updated 6/8/2023
Provider Specific EAPG Results [ 159.1 kB ] Updated 7/15/2022
EAPG Rate Worksheet FY 2022-23 [ 87.1 kB ]  7/1/2022
Provider EAPG Rate Worksheet FY 2022-23 [ 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 [ 171.3 kB ]   Updated 6/8/2023
Provider Specific EAPG Results [ 159.1 kB ]  Updated 5/24/2021
EAPG Rate Worksheet FY 2021-22 [ 70.9 kB ]  Updated November 22, 2024
Provider EAPG Rate Worksheet FY 2021-22 [ 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 [ 288.3 kB ]    Updated 7/15/2022
Provider EAPG Rate Worksheet FY 2020-21 [ 58.5 kB ] October 1, 2020

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

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

Effective July 1, 2019

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

Florida EAPG Calculator [ 281.9 kB ] Updated 6/1/2020
Provider Specific Results [ 123.7 kB ]  Updated 10/7/2019
EAPG Rate Worksheet FY 2019-20 [ 46.1 kB ]  Updated November 22, 2024
Provider EAPG Rate Worksheet FY 2019-20 [ 46.1 kB ] July 1, 2019

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

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

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

Florida EAPG Calculator [ 277.1 kB ] Updated 3/13/2020
Provider EAPG Rate Worksheet FY2019-20, Effective July 1, 2018 [ 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 [ 276.1 kB ]  Updated 6/13/2018
Provider Specific Results of Reconciliation Calculation [ 114.5 kB ]  Updated 5/31/2018
5 Percent Cap on Gains and Losses Reconciliation calculation [ 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 [ 127.6 kB ]  Updated 5/23/2017
Florida EAPG Calculator [ 275.6 kB ]   Updated 1/23/2018

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

Provider Specific Results [ 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 [ 2 MB ]

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

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

Note: Based on Simulation 11

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

Note: Based on HB 5001, General Appropriations Act

Simulation 14 – Provider Specific Results [ 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.

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 [ 174.5 kB ] Audio of Meeting [ 20.5 MB ] Simulation 07 ASC Results [ 71.4 kB ] Link to Webinar 11/06 Governance Meeting Summary [ 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, 2015	1:00 p.m. - 3:00 p.m.	FAR Notice Agenda [ 79.3 kB ] Audio of Meeting [ 13.3 MB ] Simulation 06 ASC Results [ 67.9 kB ] Governance Meeting Summary [ 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, 2015	3:00 p.m. - 5:00 p.m.	FAR Notice Agenda [ 79.4 kB ] Audio of Meeting [ 13 MB ] Governance Meeting Summary [ 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, 2015	12:30 p.m. - 3:30 p.m.	FAR Notice Agenda [ 79.5 kB ] Audio of Meeting [ 12.6 MB ] Governance Meeting Summary [ 86.9 kB ]