MedicaidReimbursementHigh impact
Outpatient Hospital Modernization – Outpatient Prospective Payment System (OPPS)
Connecticut Medicaid (HUSKY Health)·CT·Reimbursement
Effective date
Mar 1, 2016
We identified it
Jun 20, 2026
Summary
Connecticut Medicaid is transitioning from current outpatient hospital reimbursement to an Outpatient Prospective Payment System (OPPS) similar to Medicare, using APC grouper software and procedure codes to determine payment levels. This affects all outpatient hospital services including general acute care, chronic disease, psychiatric, and children's hospitals.
Action Required
By March 1, 2016: Billing teams at hospitals must update systems to process claims using CMAP OPPS methodology including APC grouper software, OCE and NCCI edits. Update billing workflows to use CMAP's Addendum B for status indicators and payment methods. Ensure professional services are billed separately via professional claim forms. Implement three-day rule for inpatient admissions requiring outpatient services within 3 days to be bundled with inpatient stay unless clinically distinct.