Medicaid Hospital Reimbursement

Fees/Payment

Hospital Rates

Outpatient Rates                     

January 1, 2017
In-State Hospital APC Rate Letter 

View the calculations in Excel format  

View the calculations in PDF format  

Out-of-State Hospital APC Rate Letter  

July 1, 2016 

DSS issued outpatient rates effective for dates of service on and after July 1, 2016 using the Ambulatory Payment Classification (APC) methodology.

In-State Hospital APC Rate Letters   

Out-of-State Hospital APC Rate Letter   

Visit Outpatient Hospital Payment Modernization for more information on APC rate development.

July 1, 2015 - DSS issued outpatient rates for FY16.

Hospital Outpatient Rate Letters 

General Hospital Outpatient Rates   

RCC 901 - Outpatient Fee Change  

Inpatient Rates

January 1, 2017

In-State Hospital DRG Rate Letter  

View the calculations in Excel format  

View the calculations in PDF format  

Weights and Outlier Thresholds Under APR-DRG V33 and V34 System 

Out-of-State Hospital DRG Rate Letter  

January 1, 2015 - DSS issued inpatient rates on December 8, 2014 for admissions on or after January 1, 2015. The letters list the APR-DRG base rates as well as per diem rates for behavioral health and rehabilitation. See the Hospital Payment Modernization webpage for more information on the development of these rates.

Hospital Inpatient Rate Letters 

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View the calculations in pdf format  

Rate letters for border and out-of-state general acute care hospitals  

Out-of State and Border Psychiatric Hospital Rate Letter  

DRG Payment Calculator Opens in a new window- All general acute care hospitals, including border and out-of-state, are now reimbursed using the All Patient Refined Diagnosis Related Groups (APR-DRG) methodology. A hospital can estimate its payment for a claim using the DRG payment calculator. The calculator contains detailed instructions regarding the data to be entered, including a link to 3M's site that must be used to calculate the DRG assignment to be entered in the calculator.

Organ Acquisition Reimbursement 

The list below will be used to reimburse hospitals for organ acquisition. Rates are effective for all inpatient claims for admissions on or after July 1, 2016. Rates are for both in- and out-of-state hospitals. Acquisition of the heart, liver, kidneys, and lungs will be manually priced based on the submission of RCC 81X. For lung acquisition, hospitals must submit most recent Medicare cost reports submitted to CMS. Additional information can be found on Provider Bulletin 2014-79

Organ

In-State

Out-of-State

Kidney

$70,192

$70,192

Heart

$81,102

$81,102

Liver

$119,107

$119,107

Pancreas

$7,121

$7,121

Lung

TBD*

TBD*

*Lung acquisition - Hospitals must submit most recent Medicare cost reports submitted to CMS.  

To view prior year organ acquisition reimbursement rates, please follow this link Opens in a new window.

The organ acquisition fee schedule is also featured on the Connecticut Medical Assistance Program (CMAP) webpage. In order to access the fee schedule, please follow this link Opens in a new window to the CMAP webpage. Once at the CMAP webpage, click "Provider" in the upper left, and then select "Provider Fee Schedule Download". Once you have selected "Provider Fee Schedule Download", it is necessary to read and accept the CMAP End User License Agreement. Acceptance is indicated by clicking on the “I Accept” button at the bottom of the page. After the license agreement has been accepted, the Provider Fee Schedule Download panel will display. You may then select "Hospital DRG Organ Acquisition" to view the fee schedule.

DSH, Supplemental, and Direct GME Payments

See files below which contain Disproportionate Share Hospital (DSH), Supplemental, and Direct Graduate Medical Education (GME) payments.

Spreadsheet with Calculations - SFY14   (Excel) 

Spreadsheet with Calculations - SFY15   (Excel) 

Spreadsheet with Calculations - FFY 16 DSH/SFY 16 GME  (Excel) 

File was revised 9/21/15 to correct the GME calculation for SFY15 and SFY16

Spreadsheet with Calculations - SFY16 Inpatient Supplemental Payments (Excel) 

Spreadsheet with Calculations - SFY17 GME Payments (Excel) 

Q1 payments were wired on 8/26/2016.

Q2 payments were wired on 10/24/2016.

Q3 payments were wired on 1/24/2017.

Q4 payments were wired on 5/10/2017.

 

Spreadsheet with Calculations - SFY17 Inpatient Supplemental Payments (Excel) 

Q1 State share payments were wired on 9/20/2016.

Q2 State share payments were wired on 10/24/2016.

Q3 State share payments were wired on 1/24/2017.

Q1 through Q3 federal share payments were wired on 3/31/17.

Q4 payments were wired on 6/9/2017.

Spreadsheet with Calculations - FFY 2017 DSH 

Archive - Organ Acquisition Costs

Reimbursement for Organ Acquisition Costs 

1/1/2015 - 6/30/2015

7/1/2015 - 6/30/2016

Organ

In-State

Out-State

In-State

Out-of-State

Kidney

$71,715

$71,715

$64,324

$64,324

Heart

$81,352

$81,352

$96,667

$96,667

Liver

$86,032

$86,032

$93,691

$93,691

Pancreas

$174,121

$174,121

$50,913

$50,913

Lung

TBD*

TBD*

TBD*

TBD*

 *For lung acquisition, hospitals must submit most recent Medicare cost reports as submitted to CMS.