Department of Social Services › 17b-262 Requirements for Payment of Home Health Agencies

Regulations of Connecticut State AgenciesSec. 17b-262-1. ScopeSections 17b-262-2 to 17b-262-9 inclusive set forth the requirements for payment of Home Health services provided to individuals who are determined eligible to receive services under Connecticut's Medical Assistance Pr…

Regulations of Connecticut State AgenciesSec. 17b-262-1000. Prior authorization requirements(a) In order to receive payment from the department, each FQHC shall comply with all prior authorization requirements. The department in its sole discretion determines what information is …

Regulations of Connecticut State AgenciesSec. 17b-262-1001. Change in scope of services(a) Each FQHC shall notify the department of any increase or decrease in the scope of services provided by the FQHC in accordance with section 17b-245d of the Connecticut General Statutes. If t…

Regulations of Connecticut State AgenciesSec. 17b-262-1002. Billing requirements(a) Each FQHC shall bill for FQHC services per encounter. Claims are limited to one all-inclusive encounter per day to include all services received by a client on the same day unless the client suffe…

Regulations of Connecticut State AgenciesSec. 17b-262-1003. Reimbursement(a) The department shall reimburse a FQHC an all-inclusive encounter rate per client encounter in accordance with a PPS as required by 42 USC 1396a (bb). (b) The department shall establish the baseline encou…

Regulations of Connecticut State AgenciesSec. 17b-262-1004. Documentation and audit requirements(a) Each FQHC shall maintain a specific record for all services provided to each client including, but not limited to: name, address, birth date, Medicaid Identification Number, pertin…

Regulations of Connecticut State AgenciesSec. 17b-262-1006. ScopeSections 17b-262-1006 to 17b-262-1017, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the payment of dental services for clients who are dete…

Regulations of Connecticut State AgenciesSec. 17b-262-1007. DefinitionsAs used in section 17b-262-1006 to section 17b-262-1017, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Adjunctive dental services\" means services that are not primarily dental in nature b…

Regulations of Connecticut State AgenciesSec. 17b-262-1008. Provider Participation (a) In order to participate in the Connecticut Medicaid program and provide dental services eligible for reimbursement from the department, each dental provider shall: (1) Comply with all applicabl…

Regulations of Connecticut State AgenciesSec. 17b-262-1009. EligibilityPayments for dental services shall be made available to CMAP providers for members enrolled in the CMAP. (Effective July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-1010. Administrative Services Organization (a) The department may contract with an administrative services organization, or ASO, to administer dental health services in accordance with a contract between the ASO and the depart…

Regulations of Connecticut State AgenciesSec. 17b-262-1011. Services covered and limitations Non-exhaustive coverage for dental services and limitations to such services are set forth in subsections (a) to (j), inclusive, of this section subject to the exception process through p…

Regulations of Connecticut State AgenciesSec. 17b-262-1012. Services not coveredThe following services are not covered by the CMAP: (a) Adjunctive dental services: General anesthesia and conscious sedation (1) For members over the age of twelve who do not have a cognitive impairm…

Regulations of Connecticut State AgenciesSec. 17b-262-1013. Documentation(a) The member's chart and dental records shall contain the following information: (1) The member's full name, including such member’s first, middle, and last name; (2) The member's residential and mailing a…

Regulations of Connecticut State AgenciesSec. 17b-262-1014. Need for Service and Authorization Process (a) The need for a dental service includes any services that are deemed by the department to be medically necessary and that: (1) Are within the scope of the dentist's practice;…

Regulations of Connecticut State AgenciesSec. 17b-262-1015. Payment(a) The Commissioner shall establish the fees contained in the dental fee schedule annually. The fees shall be based on moderate and reasonable rates prevailing in the respective communities where the services are…

Regulations of Connecticut State AgenciesSec. 17b-262-1016. Billing(a) All dental services performed on behalf of members that do not require prior authorization or post-procedure review shall be recorded in the member's permanent record and submitted to the department's claims p…

Regulations of Connecticut State AgenciesSec. 17b-262-1017. Marketing Guidelines (a) Prohibited marketing activities. Any dental provider, including a dentist, dental clinic, mobile dental clinic or SBHC, participating in the CMAP shall not engage in any marketing activity, inclu…

Regulations of Connecticut State AgenciesSec. 17b-262-10—17b-262-201. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-2. DefinitionsFor the purpose of Sections 17b-262-1 through 17b-262-9 the following definitions apply: (1) \"Commissioner\" means the Commissioner of the department of social services, or his representative. (2) \"Department\"…

Regulations of Connecticut State AgenciesSec. 17b-262-202—17b-262-211. (Repealed) Repealed August 28, 1998.

Regulations of Connecticut State AgenciesSec. 17b-262-212. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-213. ScopeSections 17b-262-213 to 17b-262-224 inclusive set forth the requirements for payment of school based child health services provided by or on behalf of Local Educational Agencies (LEAs) under section 10-76d of the Con…

Regulations of Connecticut State AgenciesSec. 17b-262-214. DefinitionsFor purposes of section 17b-262-213 through 17b-262-224 the following definitions shall apply: (1) \"Allied Health Professional\" means an individual who is licensed or certified by the Department of Public Hea…

Regulations of Connecticut State AgenciesSec. 17b-262-215. Provider participationIn order to participate in the Connecticut Medical Assistance Program and provide SBCH Services eligible for Medicaid reimbursement from the Department, the provider shall meet the following requirem…

Regulations of Connecticut State AgenciesSec. 17b-262-216. EligibilityMedicaid funding is available for SBCH Services under section 17b-262-218 below on behalf of all children who are Medicaid recipients. (Effective January 31, 1996; Amended May 10, 2000)

Regulations of Connecticut State AgenciesSec. 17b-262-217. Need for servicesMedicaid shall reimburse for SBCH Services provided the following requirements are met: (a) The diagnostic and evaluation services recommended by the PPT and a licensed practitioner of the healing arts in…

Regulations of Connecticut State AgenciesSec. 17b-262-218. Services coveredThe Department shall pay for the following services:(a) AudiologyAudiology services include, but are not limited to: (1) identification of children with hearing loss; (2) determination of the range, nature…

Regulations of Connecticut State AgenciesSec. 17b-262-219. Limitations(a) No payments shall be made by Medicaid: (1) directly to health professionals or organizations under contract to a LEA for medically appropriate and necessary services covered under section 17b-262-218 above;…

Regulations of Connecticut State AgenciesSec. 17b-262-220. Documentation and record retention requirements(a) A permanent service record documenting each SBCH Service provided to each medicaid eligible child shall be maintained by the LEA at which the child is enrolled at the tim…

Regulations of Connecticut State AgenciesSec. 17b-262-221. Billing requirements(a) All SBCH Services performed on behalf of Medicaid-eligible children shall be recorded on the required claim forms for the SBCH provider and submitted to the Department in accordance with the billin…

Regulations of Connecticut State AgenciesSec. 17b-262-222. Establishment of rates(a) The Department shall establish payment rates for three (3) types of service specific to type of placement for SBCH Services: (1) a per month per child unit rate for SBCH treatment services, speci…

Regulations of Connecticut State AgenciesSec. 17b-262-223. Audit/compliance reviewAll supporting accounting and business records, statistical data, the child's permanent service record and all other records relating to the provision of SBCH Services paid for by the Department sha…

Regulations of Connecticut State AgenciesSec. 17b-262-224—17b-262-298. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-299. ScopeSections 17b-262-299 to 17b-262-311, inclusive, of the Regulations of Connecticut State Agencies set forth the requirements for payment of services provided by Intermediate Care Facilities for the Mentally Retarded t…

Regulations of Connecticut State AgenciesSec. 17b-262-3. Provider participationIn order to receive payment from the department for home health services, all Home Health Care Agencies shall be licensed by the Department of Public Health and shall meet the requirements for particip…

Regulations of Connecticut State AgenciesSec. 17b-262-300. DefinitionsAs used in sections 17b-262-299 to 17b-262-311, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Active treatment\" means the treatment as described in 42…

Regulations of Connecticut State AgenciesSec. 17b-262-301. Provider participationIn order to enroll in Medicaid and receive payment from the department, providers shall comply with sections 17b-262-522 to 17b-262-533, inclusive, of the Regulations of Connecticut State Agencies an…

Regulations of Connecticut State AgenciesSec. 17b-262-302. EligibilityPayment to Intermediate Care Facilities for the Mentally Retarded is available on behalf of all clients who are determined to be in need of ICF/MR care by the Department of Mental Retardation and the Department…

Regulations of Connecticut State AgenciesSec. 17b-262-303. Services covered and limitations(a) Services Covered(1) The department shall pay an all-inclusive per diem rate, computed in accordance with section 17b-340 of the Connecticut General Statutes and sections 17-311-1 to 17-…

Regulations of Connecticut State AgenciesSec. 17b-262-304. Need for services and authorization process(a) The decision to admit and the subsequent admission to a facility must be made by the Department of Mental Retardation or the admitting ICF/MR in conjunction with the client's…

Regulations of Connecticut State AgenciesSec. 17b-262-305. Client's bill of rights(a) An ICF/MR shall protect and promote the rights of each client as described in 42 CFR 483.420, as amended from time to time. (b) Requirements for the administration of the patient's personal allo…

Regulations of Connecticut State AgenciesSec. 17b-262-306. Bed reserve for hospitalization(a) DSS shall pay to reserve a bed in an ICF/MR for a client during a temporary absence in a hospital for up to fifteen (15) days in accordance with subsection (e) of this section. (b) The I…

Regulations of Connecticut State AgenciesSec. 17b-262-307. Bed reserve for home leave(a) DSS shall pay to reserve a bed in an ICF/MR for a client during a temporary absence for home leave for up to thirty-six (36) days per calendar year. The ICF/MR shall not make the reserved bed…

Regulations of Connecticut State AgenciesSec. 17b-262-308. Applied income(a) DSS is responsible for calculating the applied income. DSS shall notify the ICF/MR of the amount of any applied income that the facility is responsible for collecting. Applied income shall be deducted fr…

Regulations of Connecticut State AgenciesSec. 17b-262-309. Billing and payment procedures(a) The ICF/MR shall submit claims to the department as described in section 17b-262-529 of the Regulations of Connecticut State Agencies and the billing instructions specific to ICFs/MR. (b)…

Regulations of Connecticut State AgenciesSec. 17b-262-310. RatesThe per diem rates for an ICF/MR shall be determined annually, pursuant to section 17b-340 of the Connecticut general statutes and sections 17-311-1 to 17-311-120, inclusive, of the Regulations of Connecticut State A…

Regulations of Connecticut State AgenciesSec. 17b-262-311. Documentation(a) The ICF/MR shall maintain all documentation required for rate setting purposes for a minimum of 10 years pursuant to section 17-311-56 of the Regulations of Connecticut State Agencies, including all docum…

Regulations of Connecticut State AgenciesSec. 17b-262-312—17b-262-336. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-337. ScopeSections 17b-262-337 to 17b-262-349, inclusive, of the Regulations of Connecticut State Agencies, set forth the Department of Social Services requirements for payment of accepted methods of treatment performed by or …