2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-239. (Formerly Sec. 17-312). - Payments to hospitals, emergency department physicians. Value-based methodologies. Readmission penalties. Compliance with federal law. Regulations.

(a) Medicaid rates paid to acute care hospitals, including children's hospitals, shall be based on diagnosis-related groups established and periodically rebased by the Commissioner of Social Services in accordance with 42 USC 1396a(a)(30)(A), provided the Department of Social Services completes a fiscal analysis of the impact of such rate payment system on each hospital. The commissioner shall, in accordance with the provisions of section 11-4a, file a report on the results of the fiscal analysis not later than six months after implementing the rate payment system with the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies. Within available appropriations, the commissioner shall annually determine in-patient payments for each hospital by multiplying diagnosis-related group relative weights by a base rate. Over a period of up to four years beginning on or after January 1, 2016, within available appropriations and at the discretion of the commissioner, the Department of Social Services shall transition hospital-specific, diagnosis-related group base rates to state-wide diagnosis-related group base rates by peer groups determined by the commissioner. For the purposes of this subsection and subsection (c) of this section, “peer group” means a group comprised of one of the following categories of acute care hospitals: Privately operated acute care hospitals, publicly operated acute care hospitals, or acute care children's hospitals licensed by the Department of Public Health. At the discretion of the Commissioner of Social Services, the peer group for privately operated acute care hospitals may be further subdivided into peer groups for privately operated acute care hospitals. For inpatient hospital services that the Commissioner of Social Services determines are not appropriate for reimbursement based on diagnosis-related groups, the commissioner shall reimburse for such services using any other methodology that complies with 42 USC 1396a(a)(30)(A). Within available appropriations, the commissioner may, in his or her discretion, make additional payments to hospitals based on criteria to be determined by the commissioner. Upon the conversion to a hospital payment methodology based on diagnosis-related groups, the commissioner shall evaluate payments for all hospital services, including, but not limited to, a review of pediatric psychiatric inpatient units within hospitals. The commissioner may, within available appropriations, implement a pay-for-performance program for pediatric psychiatric inpatient care. Nothing contained in this section shall authorize Medicaid payment by the state to any such hospital in excess of the charges made by such hospital for comparable services to the general public.
(b) Effective October 1, 1991, the rate to be paid by the state for the cost of special services rendered by such hospitals shall be established annually by the commissioner for each such hospital pursuant to 42 USC 1396a(a)(30)(A) and within available appropriations. Nothing contained in this subsection shall authorize a payment by the state for such services to any such hospital in excess of the charges made by such hospital for comparable services to the general public.
(c) (1) Until such time as subdivision (2) of this subsection is effective, the state shall also pay to such hospitals for each outpatient clinic and emergency room visit a rate established by the commissioner for each hospital pursuant to 42 USC 1396a(a)(30)(A) and within available appropriations.
(2) On or after July 1, 2016, with the exception of publicly operated psychiatric hospitals, hospitals shall be paid for outpatient and emergency room services based on prospective rates established by the commissioner within available appropriations and in accordance with an ambulatory payment classification system, provided the Department of Social Services completes a fiscal analysis of the impact of such rate payment system on each hospital. Such ambulatory payment classification system may include one or more peer groups established by the Department of Social Services. The Commissioner of Social Services shall, in accordance with the provisions of section 11-4a, file a report on the results of the fiscal analysis not later than six months after implementing the rate payment system with the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies. Nothing contained in this subsection shall authorize a payment by the state for such services to any hospital in excess of the charges made by such hospital for comparable services to the general public. Effective upon implementation of the ambulatory payment classification system, a covered outpatient hospital service that is not being reimbursed using such ambulatory payment classification system shall be paid in accordance with a fee schedule or an alternative payment methodology, as determined by the commissioner. The commissioner may, within available funding for implementation of the ambulatory payment classification methodology, establish a supplemental pool to provide payments to offset losses incurred, if any, by publicly operated acute care hospitals and acute care children's hospitals licensed by the Department of Public Health as a result of the implementation of the ambulatory payment classification system. Prior to the implementation of the ambulatory payment classification system, each hospital's charges shall be based on the charge master in effect as of June 1, 2015. After implementation of such system, annual increases in each hospital's charge master shall not exceed, in the aggregate, the annual increase in the Medicare economic index.
(d) Concurrent with the implementation of the ambulatory payment classification methodology of payment to hospitals, an emergency department physician may enroll separately as a Medicaid provider and qualify for direct reimbursement for professional services provided in the emergency department of a hospital to a Medicaid recipient, including services provided on the same day the Medicaid recipient is admitted to the hospital. The commissioner shall pay to any such emergency department physician the Medicaid rate for physicians in accordance with the applicable physician fee schedule in effect at that time. If the commissioner determines that payment to an emergency department physician pursuant to this subsection results in an additional cost to the state, the commissioner shall adjust such rate in consultation with the Connecticut Hospital Association and the Connecticut College of Emergency Physicians to ensure budget neutrality.
(e) The commissioner may adopt regulations, in accordance with the provisions of chapter 54, establishing criteria for defining emergency and nonemergency visits to hospital emergency rooms. All nonemergency visits to hospital emergency rooms shall be paid in accordance with subsection (c) of this section. Nothing contained in this subsection or the regulations adopted under this section shall authorize a payment by the state for such services to any hospital in excess of the charges made by such hospital for comparable services to the general public. To the extent permitted by federal law, the Commissioner of Social Services may impose cost-sharing requirements under the medical assistance program for nonemergency use of hospital emergency room services.
(f) The commissioner shall establish rates to be paid to freestanding chronic disease hospitals within available appropriations.
(g) The Commissioner of Social Services may implement policies and procedures as necessary to carry out the provisions of this section while in the process of adopting the policies and procedures as regulations, provided notice of intent to adopt the regulations is published in accordance with the provisions of section 17b-10 not later than twenty days after the date of implementation.
(h) In the event the commissioner is unable to implement the provisions of subsection (d) of this section by January 1, 2015, the commissioner shall submit written notice, not later than thirty-five days prior to January 1, 2015, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies indicating that the department will not be able to implement such provisions on or before such date. The commissioner shall include in such notice (1) the reasons why the department will not be able to implement such provisions by such date, and (2) the date by which the department will be able to implement such provisions.
(i) (1) Subject to federal approval, the commissioner shall increase rates effective January 1, 2018, for hospitals, implementing those increases on the earliest available date, as follows: (A) The diagnosis-related group base rate for inpatient hospital services provided by nongovernmental licensed short-term general hospitals shall be increased by thirty-one and sixty-five-hundredths per cent from the level in effect on July 1, 2017, and (B) the ambulatory payment classification base conversion factor for outpatient hospital services provided by licensed short-term general hospitals shall be increased by six and one-half per cent from the level in effect on July 1, 2017.
(2) (A) For the purposes of this subsection and subsection (k) of this section, “settlement agreement” has the same meaning as provided in section 12-263z.
(B) To the extent required by the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z, for dates of service from January 1, 2020, through June 30, 2026, applicable payments to nongovernmental licensed short-term general hospitals located in the state shall be made in accordance with the relevant requirements of said agreement regarding wage index values, the inpatient hospital all-patient refined diagnosis-related group base rate and the outpatient hospital ambulatory payment classification conversion factor.
(3) (A) To the extent required by the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z, effective January 1, 2020, and each January first thereafter until and including January 1, 2026, the commissioner shall increase annually the Medicaid rates payable to nongovernmental licensed short-term general hospitals located in the state as follows: (i) The inpatient hospital all-patient refined diagnosis-related group base rate by two per cent; (ii) the inpatient hospital behavioral health per diem rate, the inpatient psychiatric services and rehabilitation per diem rates and the inpatient behavioral health child discharge delay per diem rate, each by two per cent; (iii) the outpatient hospital ambulatory payment classification conversion factor by two and two-tenths per cent; and (iv) the revenue center codes listed on the hospital outpatient flat fee schedule by two and two-tenths per cent. Each such annual increase shall be calculated against the rates in effect for the calendar year immediately preceding such rate increase.
(B) As soon as practicable after December 19, 2019, the commissioner shall publish public notice of the intent to submit the Medicaid state plan amendments necessary to provide for the rate increases set forth in subparagraph (A) of this subdivision. Not later than fifteen days after the expiration of the thirty-day comment period for such state plan amendments, the commissioner shall submit such state plan amendments to the Centers for Medicare and Medicaid Services for approval. The commissioner shall diligently pursue the federal approvals required for such rate increases. The commissioner shall implement such rate increases for the dates of service set forth in subparagraph (A) of this subdivision even if federal approvals are received after such dates of service, provided the implementation of such rate increases remains subject to federal approval to the extent required by the terms of the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z. If federal approvals of such rate increases are not obtained, the payment of such rate increases may later be recovered by the commissioner by recoupment against other Medicaid payments due to a hospital or in any manner authorized by law.
(4) To the extent required by the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z, from July 1, 2019, through June 30, 2026, the commissioner shall not remove, repeal or reduce the rate increases set forth in this subsection and appropriations for any payments to nongovernmental licensed short-term general hospitals based on such rates shall not be subject to rescissions or holdbacks.
(5) Nothing in this section shall affect the authority of the state to recover overpayments and collect unpaid liabilities, as authorized by law. No provision of this subsection shall affect implementation of state-wide diagnosis-related group base rates in accordance with subsection (a) of this section.
(j) Except as otherwise specifically required in subsection (i) of this section, (1) notwithstanding the provisions of this chapter or regulations adopted thereunder, the Department of Social Services is not required to increase rates paid, or to set any rates to be paid to or adjust upward any method of payment to, any hospital based on inflation or based on any inflationary factor, including, but not limited to, any current payments or adjustments that are being made based on dates of service in previous years, and (2) the Department of Social Services shall not increase or adjust upward any rates or method of payment to hospitals based on inflation or based on any inflationary factor unless the approved state budget includes appropriations for such increases or upward adjustments.
(k) (1) Subject to any court order issued in accordance with the provisions of section 12-263z, the Department of Social Services shall make payments to nongovernmental licensed short-term general hospitals to the extent required by the settlement agreement, including, to the extent applicable, portions of payments for which the federal financial participation may not be available, such as one-time payments and payments using state-only funds above the upper payment limit. For the purposes of this subsection, “upper payment limit” means the limit on aggregate Medicaid payments to specified groups of facilities for which Medicaid federal financial participation is available, in accordance with 42 CFR 447.72 and 42 CFR 447.321, as applicable, each as amended from time to time.
(2) To the extent required by the settlement agreement, including any court order issued in accordance with the provisions of section 12-263z, from July 1, 2019, through June 30, 2026, for nongovernmental licensed short-term general hospitals located in the state, the Department of Social Services shall continue to set Medicaid rates for inpatient hospital services and outpatient hospital services in accordance with the rate-setting rules and methodologies established in the Medicaid state plan in effect as of December 19, 2019, and incorporating changes to said plan as required by the settlement agreement.
(1949, 1953, S. 1586d; 1961, P.A. 474, S. 2; 1967, P.A. 726, S. 1; 1969, P.A. 339, S. 1; P.A. 73-117, S. 23, 31; P.A. 77-574, S. 4, 6; P.A. 79-560, S. 26, 39; P.A. 81-472, S. 111, 159; P.A. 84-367, S. 1, 3; P.A. 85-482, S. 1, 2; P.A. 87-27, S. 1; 87-516, S. 1, 5; P.A. 88-156, S. 19; P.A. 89-296, S. 6, 9; June Sp. Sess. P.A. 91-8, S. 13, 43, 63; May Sp. Sess. P.A. 92-16, S. 25, 89; P.A. 93-262, S. 1, 87; May Sp. Sess. P.A. 94-5, S. 2, 30; P.A. 95-160, S. 25, 69; 95-306, S. 1, 7; 95-351, S. 28, 30; P.A. 96-139, S. 12, 13; P.A. 98-131, S. 1, 2; P.A. 99-279, S. 13, 14, 45; June Sp. Sess. P.A. 00-2, S. 15, 53; June Sp. Sess. P.A. 01-2, S. 11, 66, 69; June Sp. Sess. P.A. 01-3, S. 1, 2, 6; June Sp. Sess. P.A. 01-9, S. 119, 120, 121, 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 57; June 30 Sp. Sess. P.A. 03-3, S. 67, 68; P.A. 04-258, S. 1, 3; May Sp. Sess. P.A. 04-2, S. 34; P.A. 05-280, S. 6; P.A. 06-188, S. 21; June Sp. Sess. P.A. 07-2, S. 27; P.A. 11-44, S. 113; 11-61, S. 122; June 12 Sp. Sess. P.A. 12-1, S. 265; Dec. Sp. Sess. P.A. 12-1, S. 4; P.A. 13-234, S. 76; 13-247, S. 91; P.A. 14-116, S. 6; 14-160, S. 1; 14-217, S. 194; June Sp. Sess. P.A. 15-5, S. 393; May Sp. Sess. P.A. 16-3, S. 87; June Sp. Sess. P.A. 17-2, S. 619; June Sp. Sess. P.A. 17-4, S. 12; P.A. 19-117, S. 306; Dec. Sp. Sess. P.A. 19-1, S. 5.)
History: 1961 act changed technical language, added standard of comparable charges to Subsec. (a), deleted requirement of Subsec. (b) that special services be professional and added Subsec. (c); 1967 act changed term “welfare” to “state” patients, restricted standard of comparable charges in Subsec. (a), made allowances for unpaid bills, working capital requirements and services development costs in determination of “actual cost” in Subsec. (c) and added Subsec. (d); 1969 act allowed alternative rates in Subsec. (a) based on charges for ward or semiprivate facilities and placed limit on rate for outpatient clinic visit in Subsec. (d); P.A. 73-117 replaced hospital cost commission with committee established in accordance with Sec. 17-311; P.A. 77-574 included allowances for costs associated with collective bargaining agreements in Subsec. (c); P.A. 79-560 replaced committee with commissioner of income maintenance; P.A. 81-472 made technical changes; P.A. 84-367 changed the basis of the rate from “actual” to “reasonable” cost and added Subsec. (e) setting rates for the inpatient care of patients who no longer require acute care; P.A. 85-482 amended Subsec. (d) by substituting 116% for 150% of combined average fee of general practitioner and specialist for office visit as maximum rate for an outpatient clinic visit; P.A. 87-27 amended Subsec. (c) to exclude from “reasonable cost” amounts paid to employees, attorneys or consultants due to unionization disputes; P.A. 87-516 allowed the commissioner to establish a rate cap if he receives approval for a disproportionate share exemption pursuant to federal regulations; P.A. 88-156 added freestanding chronic disease hospitals providing services to persons aided or cared for by the state for routine services furnished to state patients and gave the commissioner the discretion to set a higher rate for hospitals serving a disproportionate share of indigent patients; P.A. 89-296 amended Subsec. (d) to prohibit the state from paying a hospital for services in excess of the charges made by the hospital for comparable services to the public, added a new Subsec. (e) requiring the commissioner to adopt regulations establishing criteria for defining emergency and nonemergency visits to hospital emergency rooms and relettered former Subsec. (e) as Subsec. (f); June Sp. Sess. P.A. 91-8 amended Subsec. (b) to add a provision re payment by the state of charges in excess of charges made when comparable service is rendered to the general public and amended Subsec. (d) re rates paid by the state for outpatient clinic, services, emergency room visits and outpatient hospital services paid on the basis of a ratio of cost to charges; May Sp. Sess. P.A. 92-16 amended Subsec. (d) by providing that emergency room visit rates in effect on June 30, 1991, shall remain in effect through June 30, 1993, except that those which would decrease on July 1, 1992, shall decrease; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; May Sp. Sess. P.A. 94-5 amended Subsec. (d) to add a formula concerning outpatient hospital services paid on the basis of a ratio of cost to charges and required the commissioner to establish a fee schedule for outpatient hospital services, effective July 1, 1994; Sec. 17-312 transferred to Sec. 17b-239 in 1995; P.A. 95-160 amended Subsec. (a) by adding a provision for rates to be paid to freestanding chronic disease hospitals, effective July 1, 1995; P.A. 95-306 amended Subsec. (f) by prohibiting payment to an acute care general hospital for inpatient care of a patient if such patient is no longer in need of such care and is eligible for Medicare, unless Medicare reimbursement is not received for such care, effective July 1, 1995; P.A. 95-351 amended Subsec. (a) by providing that the commissioner use the “actual charge based on utilized service” instead of the “cost of service” when determining rates paid to freestanding chronic disease hospitals, effective July 1, 1995; P.A. 96-139 changed effective date of P.A. 95-160 but without affecting this section; P.A. 98-131 added new Subsec. (g) requiring commissioner to establish hospital inpatient rates, effective July 1, 1998; P.A. 99-279 amended Subsec. (d) to eliminate annual increases in the fee schedule for outpatient hospital services for the rate periods beginning July 1, 1999, and July 1, 2000, and amended Subsec. (g) to provide an exception for the rate period beginning October 1, 1998, from the application of the 3% annual adjustment factor to the target amount per discharge, to prohibit the commissioner from applying an annual adjustment factor for succeeding rate periods, and to make a technical change, effective July 1, 1999; June Sp. Sess. P.A. 00-2 amended Subsec. (a) by deleting provisions re rates paid to freestanding chronic disease hospitals on and after July 1, 1995, and inserting provisions re rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals, beginning July 1, 2000, and thereafter, effective July 1, 2000; June Sp. Sess. P.A. 01-2 amended Subsec. (a) to make a technical change for the purpose of gender neutrality, to require commissioner to use the rate of the highest-paid freestanding chronic disease hospital for any freestanding chronic disease hospital having more than an average of 15% of its inpatient days utilized as long-term ventilator patient days beginning for the rate period ending in 2001, in lieu of rate paid for period when determining rates paid on and after July 1, 2001, notwithstanding provisions of subsection, and to define term “long-term ventilator patient”, effective July 1, 2001, and further amended Subsec. (a) to remove discretion of commissioner re determination of appropriate amount in the case of hospitals serving a disproportionate number share of indigent patients and to replace provisions re rates paid to freestanding chronic disease hospitals and freestanding psychiatric hospitals for rate period beginning July 1, 2001, effective July 2, 2001; June Sp. Sess. P.A. 01-3 amended Subsec. (d) by deleting provisions re rate for outpatient clinic visit and rate cap for outpatient clinics upon approval of disproportionate share exemption and adding provision re increase of fee schedule for rate period beginning July 1, 2001, and amended Subsec. (g) by deleting former provisions and adding provisions re establishment of inpatient hospital rates, effective July 1, 2001; June Sp. Sess. P.A. 01-9 amended Subsec. (d) to make 10.5% increase applicable to rate period beginning July 1, 2000, and effective June 1, 2001, and amended Subsec. (g) to make June 1, 2001, the date by which the commissioner is to establish inpatient hospital rates, effective July 1, 2001, and revised effective date of June Sp. Sess. P.A. 01-2 but without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended Subsec. (a) by delaying from July 1, 2002, to January 1, 2003, a 2% rate increase to a free standing chronic disease hospital and a free standing psychiatric hospital and maintaining effectiveness of existing rate until December 31, 2002, effective August 15, 2002; June 30 Sp. Sess. P.A. 03-3 amended Subsec. (d) to provide that outpatient rates in effect as of June 30, 2003, shall remain in effect through June 30, 2005, and amended Subsec. (g) by replacing “and October 1, 2002,” with “through September 30, 2005,” re period of time during which commissioner shall not apply an annual adjustment factor to target amount per discharge, effective August 20, 2003; P.A. 04-258 amended Subsec. (a) by providing that each freestanding chronic disease hospital shall receive a rate that is 2% more than the rate it received in the prior fiscal year and amended Subsec. (g) by substituting September 30, 2004, for September 30, 2005, re time period during which the commissioner shall not apply an annual adjustment factor to the target amount per discharge and adding provisions re revised target amount per discharge for the periods commencing April 1, 2005, April 1, 2006, and April 1, 2007, effective July 1, 2004; May Sp. Sess. P.A. 04-2 amended Subsec. (g) by substituting March 31, 2008, for September 30, 2004, effective July 1, 2004; P.A. 05-280 amended Subsec. (g) by changing effective date for the $4,000 revised target amount per discharge from April 1, 2006, to October 1, 2006, and changing effective date for the $4,250 revised target amount per discharge from April 1, 2007, to October 1, 2007, effective July 1, 2005; P.A. 06-188 amended Subsec. (a) to make a technical change, amended Subsec. (d) to allow commissioner, within available appropriations, to increase outpatient service fees for services that include clinic, emergency room, magnetic resonance imaging and computerized axial tomography and thereafter report to the General Assembly on such fee increases and the associated cost increase estimates, and amended Subsec. (g) to substitute “September 30, 2006” for “March 31, 2008” re time period during which commissioner shall not apply annual adjustment factor to target amount per discharge, and to substitute former provisions re target amount per discharge that were to take effect October 1, 2006, and October 1, 2007, with new language re target amount per discharge to take effect on October 1, 2006, and reporting requirement on cost estimates for new target amount per discharge, effective July 1, 2006; June Sp. Sess. P.A. 07-2 amended Subsec. (a) by replacing “July 1, 2004” with “July 1, 2007” and “two” with “four” re percentage increase in the rate provided to freestanding chronic disease hospitals over the rate provided in prior fiscal year and amended Subsec. (g) by replacing provisions re increased target amount per discharge effective October 1, 2006, with provisions requiring commissioner to establish increased target amount per discharge effective October 1, 2007, and to report to the General Assembly on the costs associated with such action, effective July 1, 2007; P.A. 11-44 amended Subsec. (d) by adding provision allowing commissioner to modify fee schedule for outpatient hospital services and deleting provision re submission of report, effective July 1, 2011; P.A. 11-61 amended Subsec. (d) by adding provision excluding utilization as factor in determining cost neutrality, effective July 1, 2011; June 12 Sp. Sess. P.A. 12-1 amended Subsecs. (b) and (d) by making technical changes and deleted former Subsec. (g) re establishment of inpatient hospital rates by commissioner, effective June 15, 2012; Dec. Sp. Sess. P.A. 12-1 amended Subsec. (d) to replace “shall not” with “may” and add “for the fiscal year ending June 30, 2013” re utilization as a factor in determining cost neutrality, effective December 21, 2012; P.A. 13-234 amended Subsec. (a) to replace former provisions re rates with provisions re acute care and children's hospital Medicaid rates to be based on diagnosis-related groups and re determination of in-patient rates and to delete provisions re payments to freestanding chronic disease hospitals and psychiatric hospitals, amended Subsec. (d) to add provisions re outpatient and emergency care payments to be based on prospective rates in accordance with the Medicare Ambulatory Payment Classification system, amended Subsec. (e) to add provision re cost-sharing requirements for nonemergency use of hospital emergency room services, added Subsec. (g) re policies and procedures while adopting regulations, and made conforming and technical changes, effective July 1, 2013; P.A. 13-247 amended Subsec. (a) to add Subdiv. (1) re rates to be based on reasonable cost, charge to general public or lowest charge and to designate existing provisions as Subdiv. (2), amended Subsec. (d) to add Subdiv. (1) re rates to be determined by reasonable cost of services and to designate existing provisions as Subdiv. (2), added new Subsec. (g) re rates for freestanding chronic disease hospitals, and redesignated existing Subsec. (g) as Subsec. (h), effective July 1, 2013; P.A. 14-116 deleted former Subsec. (f) re payment for inpatient care of patient who no longer requires acute care and is eligible for Medicare, redesignated existing Subsecs. (g) and (h) as Subsecs. (f) and (g) and amended redesignated Subsec. (g) by replacing reference to Connecticut Law Journal with reference to Sec. 17b-10, effective July 1, 2014; P.A. 14-160 added new Subsecs. (e) and (j) re Medicaid reimbursement for emergency department physicians, redesignated existing Subsecs. (e) to (h) as Subsecs. (f) to (i), and amended redesignated Subsec. (i) by replacing reference to Connecticut Law Journal with reference to Sec. 17b-10, effective July 1, 2014 (Revisor's note: Subsecs. (h) to (j) were redesignated editorially by the Revisors as Subsecs. (g) to (i) to conform with changes made by P.A. 14-116, S. 6); P.A. 14-217 amended Subsec. (a)(2) to add provision re evaluation of payments for hospital services and pay-for-performance program for pediatric psychiatric inpatient care and make technical changes, effective July 1, 2014; June Sp. Sess. P.A. 15-5 added “within available appropriations” throughout, amended Subsec. (a)(2) by adding provision re transition to state-wide diagnosis-related group base rates by peer groups, provision re subdivision of peer groups for privately operated acute care hospitals and definition of “peer group”, amended Subsec. (d)(2) by adding exception re publicly operated psychiatric hospitals, replacing “pediatric, obstetric, neonatal and perinatal services” with “mammograms, durable medical equipment, physical, occupational and speech therapy”, and replacing former provision re payment for outpatient hospital services that do not have an established classification code with provisions re payments prior to and after implementation of Ambulatory Payment Classification system, added Subsec. (j) re rates not required to be based on inflation, and made technical and conforming changes, effective July 1, 2015; May Sp. Sess. P.A. 16-3 deleted former Subsec. (a)(1) re rate to be paid by state to certain hospitals, redesignated existing Subsec. (a)(2) re Medicaid rates paid to acute care hospitals as new Subsec. (a) and amended same to add reference to 42 USC 1396a(a)(30)(A) and add provision re inpatient hospital services commissioner determines not appropriate for reimbursement based on diagnosis-related groups, amended Subsec. (b) to replace reference to reasonable cost of services to hospital with reference to 42 USC 1396a(a)(30)(A), deleted former Subsec. (c) re reasonable cost and adjustment of rate of payment, redesignated existing Subsec. (d) re rate state is to pay hospitals for outpatient clinic and emergency room visit as Subsec. (c) and amended same to delete “annually” and replace reference to reasonable cost of services with reference to 42 USC 1396a(a)(30)(A) in Subdiv. (1) and to replace “July 1, 2013” with “July 1, 2016”, replace “episodes of care” with “services”, replace “Medicare Ambulatory Payment Classification system” with “ambulatory payment classification system”, add provision re ambulatory payment classification system may include peer groups, add provision re establishment of supplemental pool and delete provision re commissioner to establish fee schedule for outpatient hospital services in Subdiv. (2), redesignated existing Subsec. (e) as Subsec. (d) and amended same to delete “On and after January 1, 2015” and replace “diagnosis-related group” with “ambulatory payment classification”, redesignated existing Subsec. (f) as Subsec. (e) and amended same to replace “shall” with “may” in provision re adoption of regulations and replace “shall” with “may” in provision re imposing cost-sharing requirements for nonemergency use of hospital emergency room services, redesignated existing Subsecs. (g) to (i) as Subsecs. (f) to (h), redesignated existing Subsec. (j) re increase of rates as Subsec. (i) and amended same to add provision re notwithstanding provisions of chapter or regulations adopted thereunder and add provisions re department not to increase or adjust upward rates or method of payment to hospitals based on inflation unless state budget includes appropriations, and made technical and conforming changes, effective June 2, 2016; June Sp. Sess. P.A. 17-2 added new Subsec. (i) re increase in rates for certain hospital, redesignated existing Subsec. (i) as Subsec. (j), and made a conforming change, effective October 31, 2017; June Sp. Sess. P.A. 17-4 amended Subsec. (i) to replace provision re increase in rates for certain hospitals with provisions re Medicaid state plan amendment submission and approval for rate increases and made technical and conforming changes in Subsec. (j), effective November 21, 2017; P.A. 19-117 added Subsecs. (k) and (l) re value-based payment methodologies and Medicaid payments to be made in compliance with federal law, respectively, effective July 1, 2019; Dec. Sp. Sess. P.A. 19-1 substantially revised Subsec. (i) re making certain payments to nongovernmental licensed short-term hospitals, amended Subsec. (j) to add Subdiv. designators (1) and (2) and make conforming changes, deleted former Subsec. (k) re value-based payment methodologies and reductions for hospital readmissions, deleted former Subsec. (l) re Medicaid payments to hospitals, and added new Subsec. (k) re payments to nongovernmental licensed short-term general hospitals by the Department of Social Services, effective December 19, 2019.
Annotations to former section 17-312:
Cited. 175 C. 49; 181 C. 130.