MedicaidReimbursementHigh impact
Update Regarding Outpatient Hospital Modernization - Outpatient Prospective Payment System (OPPS)
Connecticut Medicaid (HUSKY Health)·CT·Reimbursement
Effective date
Jul 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut is transitioning from its current outpatient hospital reimbursement model to an Outpatient Prospective Payment System (OPPS) similar to Medicare, which will use both revenue center codes and procedure codes to determine payment levels. This change affects all outpatient hospital billing and rescinds 14 previous provider bulletins.
Action Required
By July 1, 2016: Hospital billing teams must transition to the new OPPS system by accessing CMAP's Addendum B at www.ctdssmap.com to determine payment methods for each service. Update billing workflows to follow new outpatient hospital regulations instead of the 14 rescinded provider bulletins. Ensure professional fees are billed separately via professional claim forms as they are excluded from APC pricing. Review Hospital Modernization claim submission instructions in provider manual chapter 8.