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

Regulations of Connecticut State AgenciesSec. 17b-262-549. Provider participationIn order to participate in the Medical Assistance Program and receive payment from the department, providers shall: (a) meet and maintain all applicable licensing, accreditation, and certification re…

Regulations of Connecticut State AgenciesSec. 17b-262-550. EligibilityPayment for natureopathic 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 effec…

Regulations of Connecticut State AgenciesSec. 17b-262-551. Services covered and limitationsExcept for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed natureopath which conform to accepted methods of diagnosis and t…

Regulations of Connecticut State AgenciesSec. 17b-262-552. Services not coveredThe department shall not pay for the following natureopathic services:(a) the administration of internal medication or substances simulating medicine, or the form of medicine; (b) the administration of…

Regulations of Connecticut State AgenciesSec. 17b-262-553. Need for serviceThe department shall pay for medically necessary and medically appropriate treatment only when: (a) provided by a licensed natureopath and the services are within the scope of the natureopath's scope of pr…

Regulations of Connecticut State AgenciesSec. 17b-262-554. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, shall be required for: (1) professional office or home visits in excess of five per client per provider per month, and (…

Regulations of Connecticut State AgenciesSec. 17b-262-555. Billing procedures(a) Claims for natureopathic services shall be submitted on hard copy invoice or electronically transmitted to the department's fiscal agent, in a form and manner as specified by the department, and shal…

Regulations of Connecticut State AgenciesSec. 17b-262-556. 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-262-557. Documentation(a) Natureopathic care providers 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-262-558. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-559. ScopeSections 17b-262-559 through 17b-262-571, inclusive, set forth the Department of Social Services requirements for payment of accepted methods of treatment provided by an ophthalmologist, optometrist, or optician for …

Regulations of Connecticut State AgenciesSec. 17b-262-560. DefinitionsFor the purposes of sections 17b-262-559 through 17b-262-571 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-262-561. 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-262-562. EligibilityPayment for vision care 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 effecti…

Regulations of Connecticut State AgenciesSec. 17b-262-563. Services covered and limitations(a) Except for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed ophthalmologist, optometrist, or optician which conform to a…

Regulations of Connecticut State AgenciesSec. 17b-262-564. Services not coveredThe department shall not pay for the following:(a) information or services provided to a client by a provider over the telephone;(b) cancelled office visits and appointments not kept;(c) a spare pair o…

Regulations of Connecticut State AgenciesSec. 17b-262-565. Need for serviceThe department shall pay for medically necessary and medically appropriate vision care services for Medical Assistance Program eligible clients, in relation to the diagnosis for which care is required, pro…

Regulations of Connecticut State AgenciesSec. 17b-262-566. Early periodic screening, diagnostic and treatment services(a) Prior authorization for EPSDT services not on the Vision Care fee schedule or which are on such fee schedule but for which there are limitations in the amount…

Regulations of Connecticut State AgenciesSec. 17b-262-567. Billing procedures(a) Claims from providers shall be submitted on the department's designated form or electronically submitted to the department's fiscal agent and shall include all information required by the department …

Regulations of Connecticut State AgenciesSec. 17b-262-568. Payment(a) Payment rates shall be the same for in-state and out-of-state providers.(b) Payment for professional services shall be made at the lowest of: (1) the provider's usual and customary charge;(2) the lowest Medicar…

Regulations of Connecticut State AgenciesSec. 17b-262-569. Payment rateThe commissioner establishes the fees contained in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (Adopted effective March 6, 1998; Amended June 11, 2003)

Regulations of Connecticut State AgenciesSec. 17b-262-570. Payment limitations(a) Contact lenses shall be covered, when such lenses provide better management of a visual or ocular condition than can be achieved with spectacle lenses, including, but not limited to the diagnosis of…

Regulations of Connecticut State AgenciesSec. 17b-262-571. Documentation(a) Vision care providers shall maintain a specific record for all services and supplies received for each client eligible for Medical Assistance Program payment including, but not limited to: name, address, …

Regulations of Connecticut State AgenciesSec. 17b-262-572. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-573. ScopeSections 17b-262-573 through 17b-262-585 inclusive set forth the Department of Social Services requirements for payment of nurse-midwifery services performed by licensed nurse-midwifes for clients who are determined …

Regulations of Connecticut State AgenciesSec. 17b-262-574. Definitions.For the purposes of sections 17b-262-573 to 17b-262-585, inclusive, of the Regulations of Connecticut State Agencies, the following definitions apply:(1) “Accountable provider” means the maternity billing prov…

Regulations of Connecticut State AgenciesSec. 17b-262-575. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, a nurse-midwife shall: (a) meet all applicable licensing, accreditation, and certification requirements;(…

Regulations of Connecticut State AgenciesSec. 17b-262-576. EligibilityPayment for nurse-midwifery services shall be available on behalf of all women and newborns, only throughout the maternity cycle, eligible for the Medical Assistance program subject to the conditions and limita…

Regulations of Connecticut State AgenciesSec. 17b-262-577. Services covered and limitationsExcept for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed and certified nurse-midwife which conform to accepted methods of…

Regulations of Connecticut State AgenciesSec. 17b-262-578. Services not coveredThe department shall not pay for the following:(a) nurse-midwifery services to newborns occurring beyond the maternity cycle;(b) any examinations, laboratory tests, biological products, immunizations, …

Regulations of Connecticut State AgenciesSec. 17b-262-579. Need for serviceThe department shall pay for medically necessary and appropriate nurse-midwifery services for Medical Assistance Program eligible clients: (a) requiring care during an essentially normal maternity cycle or…

Regulations of Connecticut State AgenciesSec. 17b-262-580. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for: (1) more than one visit per day per client; and(2) HealthTrack Special Services. (A) HealthTrack Specia…

Regulations of Connecticut State AgenciesSec. 17b-262-581. Billing procedures(a) Claims from nurse-midwifes shall be submitted on the department's designated form or electronically transmitted to the department's fiscal agent and shall include all information required by the depa…

Regulations of Connecticut State AgenciesSec. 17b-262-582. PaymentPayment shall be made at the lowest of:(a) the provider's usual and customary charge to the general public;(b) the lowest Medicare rate;(c) the amount in the applicable fee schedule as published by the department;(…

Regulations of Connecticut State AgenciesSec. 17b-262-583. Payment rate(a) The commissioner establishes the fees contained in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (b) Payment rates shall be the same for in-state and out-of-s…

Regulations of Connecticut State AgenciesSec. 17b-262-584. Payment limitations(a) The department shall pay for an initial visit by a nurse-midwife only once per client. Initial visits refer to the nurse-midwife's first contact with the client and reflect higher fees for the addit…

Regulations of Connecticut State AgenciesSec. 17b-262-585. Documentation(a) Nurse-midwifes shall maintain a specific medical record for all services rendered to each client eligible for Medical Assistance Program payment including, but not limited to: name, address, birth date, M…

Regulations of Connecticut State AgenciesSec. 17b-262-586. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-587. Purpose and scopeSections 17b-262-587 through 17b-262-596b, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of personal care assistance ser…

Regulations of Connecticut State AgenciesSec. 17b-262-588. DefinitionsFor the purposes of sections 17b-262-587 through 17b-262-596b, inclusive, of the Regulations of Connecticut State Agencies, the following definitions shall apply: (1) \"Activities of Daily Living\" means hands-…

Regulations of Connecticut State AgenciesSec. 17b-262-589. Eligibility and determination of need(a) In order to be eligible to receive coverage for the cost of personal care assistance services under the Department's Personal Care Assistance Waiver Program, an individual shall ei…

Regulations of Connecticut State AgenciesSec. 17b-262-590. Application process(a) The application process consists of: (1) a financial eligibility determination by the Department in accordance with the eligibility standards for participation in the Department's Title XIX medical …

Regulations of Connecticut State AgenciesSec. 17b-262-591. Waiting list(a) As a result of the limitation of the number of slots and/or funding, the Department shall establish and maintain a statewide waiting list for the Personal Care Assistance Waiver program when the Department…

Regulations of Connecticut State AgenciesSec. 17b-262-592. Limitations(a) The Department does not offer Personal Care Assistance Waiver services to more than the number of consumers specified in the federally approved Personal Care Assistance Waiver or to more than the number of …

Regulations of Connecticut State AgenciesSec. 17b-262-593. Services covered(a) Services covered are: (1) personal care assistance services provided in accordance with a personal care services plan which enable the consumer to carry out activities of daily living and instrumental …

Regulations of Connecticut State AgenciesSec. 17b-262-594. Determining the cost effectiveness of the service planIn order to determine the cost effectiveness of the consumer's service plan, the Department shall do all of the following: (1) Obtain the monthly average nursing facil…

Regulations of Connecticut State AgenciesSec. 17b-262-595. Payment(a) Payment for personal care assistance services for adults is made at the lowest of: (1) the maximum rate determined by the department for personal care assistance services;(2) a rate below the maximum based on a…

Regulations of Connecticut State AgenciesSec. 17b-262-596. Personal care assistant qualifications(a) The consumer is responsible for ensuring that his or her personal care assistants meet all of the following qualifications: (1) be at least 16 years of age except that, if the con…

Regulations of Connecticut State AgenciesSec. 17b-262-596a. Fair hearingsApplicants for and recipients of services under the Personal Care Assistance program may request and receive a fair hearing, in accordance with the rules of the Department's Medicaid program when the Departm…

Regulations of Connecticut State AgenciesSec. 17b-262-596b. (Repealed) Repealed March 9, 2006.