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

Regulations of Connecticut State AgenciesSec. 17b-262-5. PolicyNo home health care agency enrolled as a Medicaid provider shall select a service area, or refuse to serve any person, based on the geographical location of the service to be provided unless the home health care agenc…

Regulations of Connecticut State AgenciesSec. 17b-262-500. DefinitionsFor the purposes of sections 17b-262-499 through 17b-262-510 the following definitions shall apply: (1) \"Active Treatment\" means the definition contained in 42 Code of Federal Regulations (CFR), Part 441, sec…

Regulations of Connecticut State AgenciesSec. 17b-262-501. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, providers shall meet the following requirements: (a) General:(1) meet and maintain all applicable licensi…

Regulations of Connecticut State AgenciesSec. 17b-262-502. EligibilityPayment for inpatient psychiatric hospital services shall be available on behalf of Medical Assistance Program clients under age twenty-one and age sixty-five or over under the conditions and limitations which …

Regulations of Connecticut State AgenciesSec. 17b-262-503. Services coveredThe department shall pay for the following:(a) medically necessary and medically appropriate inpatient psychiatric services for clients under age twenty-one or age sixty-five or over when the need for serv…

Regulations of Connecticut State AgenciesSec. 17b-262-504. Services not coveredThe department shall not pay for the following inpatient psychiatric hospital services which are not covered under the Medical Assistance Program: (a) procedures or services of an unproven, educational…

Regulations of Connecticut State AgenciesSec. 17b-262-505. Certification of need review requirements for inpatient psychiatric services for a client under age twenty-one in a psychiatric hospital(a) In order to receive payment for inpatient psychiatric hospital services for indiv…

Regulations of Connecticut State AgenciesSec. 17b-262-506. Individual plan of care requirements for inpatient psychiatric services for a client under age twenty-one in a psychiatric hospital(a) Inpatient psychiatric services for clients under age twenty-one shall constitute activ…

Regulations of Connecticut State AgenciesSec. 17b-262-507. Individual plan of care for a client age sixty-five or over in a psychiatric hospital(a) A written, individual plan of care shall be developed to ensure that institutional care maintains the client at, or restores them to…

Regulations of Connecticut State AgenciesSec. 17b-262-508. Utilization review program for inpatient psychiatric services for clients under age twenty-one or age sixty-five or over(a) The department's Utilization Review Program conducts utilization review activities for services d…

Regulations of Connecticut State AgenciesSec. 17b-262-509. Billing proceduresClaims from inpatient psychiatric providers shall be submitted on the department's uniform billing form or electronically transmitted to the department's fiscal agent and shall include all information re…

Regulations of Connecticut State AgenciesSec. 17b-262-510. Documentation and record retention(a) A provider shall meet the special medical record requirements for a psychiatric hospital and shall maintain records to support claims made for payment. All documentation shall be made…

Regulations of Connecticut State AgenciesSec. 17b-262-511. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-512. ScopeSections 17b-262-512 through 17b-262-520 inclusive set forth the Department of Social Services requirements for the payment of radiology services performed by an independent radiology or ultrasound center provided in…

Regulations of Connecticut State AgenciesSec. 17b-262-513. DefinitionsFor the purposes of sections 17b-262-512 through 17b-262-520 the following definitions shall apply: (1) \"Acute\" means having rapid onset, severe symptoms, and a short course.(2) \"Client\" means a person elig…

Regulations of Connecticut State AgenciesSec. 17b-262-514. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, providers shall: (a) meet and maintain all applicable licensing, accreditation, and certification require…

Regulations of Connecticut State AgenciesSec. 17b-262-515. EligibilityPayment for radiology or ultrasound center services shall be available on behalf of all persons eligible for the Medical Assistance Program subject to the conditions and limitations which apply to these service…

Regulations of Connecticut State AgenciesSec. 17b-262-516. Services coveredThe department shall pay for:(a) medically appropriate and medically necessary radiology or ultrasound center services as published in the department's fee schedule when ordered by a licensed physician or …

Regulations of Connecticut State AgenciesSec. 17b-262-517. Need for service and authorization process(a) Need for ServiceThe department shall pay for independent radiology and ultrasound center services which are ordered by a duly licensed physician or other licensed practitioner…

Regulations of Connecticut State AgenciesSec. 17b-262-518. Billing procedures(a) Claims from independent radiology or ultrasound center providers shall be submitted on the department's designated form or electronically transmitted to the department's fiscal agent and shall includ…

Regulations of Connecticut State AgenciesSec. 17b-262-519. Payment rate and limitations(a) The commissioner shall establish the fees contained in the department's published fee schedule for independent radiology and ultrasound centers pursuant to section 4-67c of the Connecticut …

Regulations of Connecticut State AgenciesSec. 17b-262-520. Documentation(a) Independent radiology or ultrasound center providers shall maintain a specific record for each client eligible for Medical Assistance Program payment including, but not limited to: name, address, birth da…

Regulations of Connecticut State AgenciesSec. 17b-262-521. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-522. ScopeSections 17b-262-522 through 17b-262-532, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services general requirements to which providers of Medical Assistance Program …

Regulations of Connecticut State AgenciesSec. 17b-262-523. DefinitionsFor the purposes of sections 17b-262-522 through 17b-262-532, inclusive, of the Regulations of Connecticut State Agencies the following definitions apply: (1) \"Acute\" means symptoms that are severe and have a…

Regulations of Connecticut State AgenciesSec. 17b-262-524. Provider participation(a) To enroll in the Medical Assistance Program and receive payment from the department for the provision of goods or services to Medical Assistance Program clients, providers shall: (1) Meet and mai…

Regulations of Connecticut State AgenciesSec. 17b-262-525. Termination or suspension of provider agreement(a) Providers shall be subject to all of the conditions contained in section 17b-99 of the Connecticut General Statutes and sections 17-83k-1 through 17-83k-7 of the Regulati…

Regulations of Connecticut State AgenciesSec. 17b-262-526. General provider requirementsTo maintain enrollment in the Connecticut Medical Assistance Program, a provider shall abide by all federal and state statutes regulations and operational procedures promulgated by the departm…

Regulations of Connecticut State AgenciesSec. 17b-262-527. Need for goods or servicesThe department shall review the medical appropriateness and medical necessity of medical goods and services provided to Medical Assistance Program clients both before and after making payment for…

Regulations of Connecticut State AgenciesSec. 17b-262-528. Prior authorization(a) Prior authorization, to determine medical appropriateness and medical necessity, shall be required as a condition of payment for certain Medical Assistance Program goods or services as set forth in …

Regulations of Connecticut State AgenciesSec. 17b-262-529. Billing procedures(a) Claims from providers shall be submitted on the department's designated form or electronically transmitted to the department's fiscal agent within twelve months of the date the service was provided o…

Regulations of Connecticut State AgenciesSec. 17b-262-530. Payment rates(a) All schedules of payment for coverable Medical Assistance Program goods and services shall be established by the commissioner and paid by the department in accordance with all applicable federal and state…

Regulations of Connecticut State AgenciesSec. 17b-262-531. Payment limitationsPayment, by the department, to all providers shall be limited to medically appropriate and medically necessary goods or services furnished to Medical Assistance Program clients. The following payment li…

Regulations of Connecticut State AgenciesSec. 17b-262-532. Payment for out-of-state goods or services(a) Pursuant to 42 CFR 431.52, payment for Medical Assistance Program goods or services furnished to clients while they are out-of-state shall be made by the department to the sam…

Regulations of Connecticut State AgenciesSec. 17b-262-533. Sums paid in excess of the authorized schedules of payment or for other reasons of ineligibility for paymentAny payment, or part thereof, for Medical Assistance Program goods or services which represents an excess over th…

Regulations of Connecticut State AgenciesSec. 17b-262-534. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-535. ScopeSections 17b-262-535 through 17b-262-545 inclusive set forth the Department of Social Services requirements for payment of chiropractic services, performed by licensed practitioners of chiropractic in private or grou…

Regulations of Connecticut State AgenciesSec. 17b-262-536. DefinitionsFor the purposes of sections 17b-262-535 through 17b-262-545 the following definitions shall apply: (1) \"Acute\" means having rapid onset, severe symptoms, and a short course.(2) \"Chiropractic\" means the ser…

Regulations of Connecticut State AgenciesSec. 17b-262-537. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, providers shall: (a) meet and maintain all applicable licensing, accreditation, and certification require…

Regulations of Connecticut State AgenciesSec. 17b-262-538. EligibilityPayment for chiropractic services shall be available on behalf of all persons eligible for the Medical Assistance Program subject to the conditions and limitations which apply to these services. (Adopted effect…

Regulations of Connecticut State AgenciesSec. 17b-262-539. Services covered and limitations(a) Except for the limitations and exclusions listed below, the department shall pay for the following: (1) the manual manipulation of the spine, but not for any procedures or services of a…

Regulations of Connecticut State AgenciesSec. 17b-262-540. Services not coveredThe department shall not pay for the following chiropractic services which are not covered under the Medical Assistance Program:(1) chiropractic practice does not include the prescription or administra…

Regulations of Connecticut State AgenciesSec. 17b-262-541. Need for serviceThe department shall pay for medically necessary and medically appropriate treatment only when: (a) provided by a licensed practitioner of chiropractic and the services are within the scope of practice of …

Regulations of Connecticut State AgenciesSec. 17b-262-542. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for: (1) manipulation of the spine in excess of five per client per provider per month; and(2) HealthTrack S…

Regulations of Connecticut State AgenciesSec. 17b-262-543. Billing procedures(a) The amount billed to the department shall represent the practitioner of chiropractic's usual and customary charge for the services delivered. (b) Claims from practitioners of chiropractic shall be su…

Regulations of Connecticut State AgenciesSec. 17b-262-544. Payment(a) Payment shall be made at the lowest of: (1) the provider's usual and customary charge to the general public;(2) the lowest Medicare rate;(3) the amount in the applicable fee schedule as published by the departm…

Regulations of Connecticut State AgenciesSec. 17b-262-545. Documentation(a) Practitioners of chiropractic shall maintain a specific record for all services received for each client eligible for Medical Assistance Program payment including, but not limited to: name, address, birth…

Regulations of Connecticut State AgenciesSec. 17b-262-546. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-547. ScopeSections 17b-262-547 through 17b-262-557 inclusive set forth the Department of Social Services requirements for payment of natureopathic services provided by licensed natureopaths for clients who are determined eligi…

Regulations of Connecticut State AgenciesSec. 17b-262-548. DefinitionsFor the purposes of sections 17b-262-547 through 17b-262-557 the following definitions shall apply: (1) \"Acute\" means having rapid onset, severe symptoms, and a short course.(2) \"Client\" means a person elig…