Medicaid Hospital Reimbursement

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Medicaid Hospital Reimbursement

Overview

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.