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Medicaid Hospital Reimbursement

Overview

Please Note:

DSS Order Extending Specified Deadline – Posted 03-26-20

Coronavirus Relief Fund (CRF) Payments to General Hospitals

To apply to DSS for federal Coronavirus Relief Fund (CRF) payments.  Please download and review each of the seven documents below. The cover letter will specify the requirements that each hospital must follow when completing the documents. In order to apply for the CRF payment, you must complete, sign and send both the Agreement and Cost Report back to the Department by February 18, 2021.

Please contact con-ratesetting.dss@ct.gov with any questions.

  1. Summary
  2. CRF Cover Letter
  3. CRF Agreement
  4. CRF Payment Amounts by Hospital
  5. CRF Cost Report
  6. Federal Funding Cover Letter
  7. Federal Funding Report Form
 

The Office of Reimbursement and Certificate of Need (CON) is responsible for establishing Medicaid reimbursement methodologies for inpatient services, outpatient hospital services, Disproportionate Share Hospital (DSH) payments and hospital supplemental payments. Reimbursement and CON is responsible for Medicaid State Plan Amendments that are necessary to obtain Federal matching funds.

Key Areas of Focus

  • Effective for admissions on or after January 1, 2015, Connecticut Medicaid, working with consultants at Mercer, Myers & Stauffer, and Hewlett Packard (HP), moved from an inpatient hospital reimbursement system based on interim per diem rates and cost settlement to a diagnosis-related group (DRG) system where hospital payments are established prospectively.
  • Effective for services provided on or after July 1, 2016, Connecticut Medicaid moved from an outpatient hospital reimbursement system based on Revenue Center Codes (some paid based on fixed fees, some based on a ratio of costs to charges) to an ambulatory payment classification (APC) prospective payment system based on the complexity of the services performed. Refer to the Reimbursement Modernization page for further information.