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

Regulations of Connecticut State AgenciesSec. 17b-262-602. Billing proceduresAll claims submitted to the department for payment of evaluation and early intervention services including assessments and assistive technology devices, shall be substantiated by documentation in the Bir…

Regulations of Connecticut State AgenciesSec. 17b-262-603. Payment(a) The department shall establish payment rates effective July 1, 1996.(b) The rate period shall be the state fiscal year.(c) Interim rates shall be issued for each rate period and such rates shall be replaced by …

Regulations of Connecticut State AgenciesSec. 17b-262-604. Documentation requirementsEarly intervention services shall be paid by the department only when the lead agency ensures compliance of the following documentation requirements on file with the performing provider, as appro…

Regulations of Connecticut State AgenciesSec. 17b-262-605. Audit and record retention(a) All supporting accounting and business records, statistical data, early intervention records, and other records relating to the provision of evaluation, assessment, service coordination, and …

Regulations of Connecticut State AgenciesSec. 17b-262-606. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-607. ScopeSections 17b-262-607 through 17b-262-618 inclusive set forth the Department of Social Services requirements for payment of nurse practitioner services provided by licensed advanced practice registered nurses for clie…

Regulations of Connecticut State AgenciesSec. 17b-262-608. Definitions.For the purposes of sections 17b-262-607 to 17b-262-618, 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-262-609. 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-262-610. EligibilityPayment for nurse practitioner 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. (Effectiv…

Regulations of Connecticut State AgenciesSec. 17b-262-611. Services covered and limitations(a) Except for the limitations and exclusions listed below, the department shall pay for: (1) medically necessary and medically appropriate professional services of a nurse practitioner whi…

Regulations of Connecticut State AgenciesSec. 17b-262-612. Services not coveredThe department shall not pay for the following:(a) Any procedures or services of an unproven, educational, social, research, experimental or cosmetic nature; for any diagnostic, therapeutic or treatmen…

Regulations of Connecticut State AgenciesSec. 17b-262-613. Need for serviceThe department shall pay for an initial office visit and continuing services which the department deems are medically necessary and medically appropriate, in relation to the diagnosis for which care is req…

Regulations of Connecticut State AgenciesSec. 17b-262-614. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for the following services: (1) more than one visit on the same day for the same client by the same provider…

Regulations of Connecticut State AgenciesSec. 17b-262-615. Billing procedures(a) Claims from nurse practitioners 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…

Regulations of Connecticut State AgenciesSec. 17b-262-616. Payment(a) Payment rates shall be the same for in-state and out-of-state providers.(b) Payment shall be made at the lowest of: (1) the provider's usual and customary charge to the general public;(2) the lowest Medicare ra…

Regulations of Connecticut State AgenciesSec. 17b-262-617. Payment rate and limitations(a) The commissioner establishes the fees contained in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes.(b) Nurse practitioner rates for each procedur…

Regulations of Connecticut State AgenciesSec. 17b-262-618. Documentation(a) Nurse Practitioners shall maintain a specific record for all services rendered for each client eligible for Medical Assistance Program payment including, but not limited to: name, address, birth date, Med…

Regulations of Connecticut State AgenciesSec. 17b-262-619. ScopeSections 17b-262-619 to 17b-262-629, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment of podiatric services on behalf of clients who are…

Regulations of Connecticut State AgenciesSec. 17b-262-620. DefinitionsAs used in section 17b-262-619 to section 17b-262-629, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Acute\" means symptoms that are severe and have a rapid onset and short course;(2) \"Adm…

Regulations of Connecticut State AgenciesSec. 17b-262-621. Provider participationTo 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. (Adopted e…

Regulations of Connecticut State AgenciesSec. 17b-262-622. EligibilityPayment for podiatric services shall be available on behalf of all persons eligible for Medicaid subject to the conditions and limitations that apply to these services. (Adopted effective February 11, 2009)

Regulations of Connecticut State AgenciesSec. 17b-262-623. Services covered and limitationsSubject to the limitations and exclusions identified in sections 17b-262-619 to 17b-262-629, inclusive, of the Regulations of Connecticut State Agencies, the department shall pay providers …

Regulations of Connecticut State AgenciesSec. 17b-262-624. Services not coveredThe department shall not pay a podiatrist:(1) for information or services provided to a client by a podiatrist over the telephone;(2) for any product available to podiatrists free of charge;(3) for mor…

Regulations of Connecticut State AgenciesSec. 17b-262-625. Need for servicePayment for an initial office visit and continuing services which the department deems medically necessary and medically appropriate, in relation to the diagnosis for which care is required, is available p…

Regulations of Connecticut State AgenciesSec. 17b-262-626. Prior authorization(a) To receive payment from the department, a podiatrist shall comply with the prior authorization requirements described in section 17b-262-528 of the Regulations of Connecticut State Agencies. The dep…

Regulations of Connecticut State AgenciesSec. 17b-262-627. Billing procedures(a) Claims from podiatrists shall be submitted on the department's designated form or electronically transmitted to the department, in a form and manner as specified by the department, and shall include …

Regulations of Connecticut State AgenciesSec. 17b-262-628. Payment(a) The commissioner shall establish, and may periodically update, the fees for covered services in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (b) Fees shall be the…

Regulations of Connecticut State AgenciesSec. 17b-262-629. Documentation and audit requirements(a) Podiatrists shall maintain a specific record for all services received by each client eligible for Medicaid payment including, but not limited to: name, address, birth date, Medicai…

Regulations of Connecticut State AgenciesSec. 17b-262-630. ScopeSections 17b-262-630 to 17b-262-640, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment of services provided by independent licensed audio…

Regulations of Connecticut State AgenciesSec. 17b-262-631. DefinitionsFor the purposes of sections 17b-262-630 to 17b-262-640, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Advanced practice registered nurse\" or \"APRN\"…

Regulations of Connecticut State AgenciesSec. 17b-262-632. Provider participationIn order to participate in Medicaid and receive payment from the department, providers shall: (a) Comply with all applicable licensing, accreditation and certification requirements;(b) comply with al…

Regulations of Connecticut State AgenciesSec. 17b-262-633. EligibilityPayment for independent therapy services prescribed by a licensed practitioner is available on behalf of all clients who have a need for such services and which are medically necessary subject to the conditions…

Regulations of Connecticut State AgenciesSec. 17b-262-634. Services covered and limitationsSubject to the limitations and exclusions in this section, the department shall pay for independent therapy which conforms to accepted methods of diagnosis and treatment, but shall not pay …

Regulations of Connecticut State AgenciesSec. 17b-262-635. Need for service(a) The department shall pay for independent therapy that is medically necessary when a licensed practitioner prescribes the client's need for the service. (b) A licensed practitioner shall reestablish the…

Regulations of Connecticut State AgenciesSec. 17b-262-636. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for: (1) All audiology, physical therapy, occupational therapy and speech pathology evaluation services in e…

Regulations of Connecticut State AgenciesSec. 17b-262-637. Billing proceduresProviders shall submit claims on a hard copy invoice or by electronic transmission to the department in a form and manner specified by the department, together with all information required by the depart…

Regulations of Connecticut State AgenciesSec. 17b-262-638. Payment(a) Payment rates shall be the same for in-state, border and out-of-state providers.(b) Payment shall be made at the lowest of: (1) The provider's usual and customary charge;(2) the lowest Medicare rate;(3) the amo…

Regulations of Connecticut State AgenciesSec. 17b-262-639. Payment ratesThe commissioner shall establish the fees contained in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (Adopted effective December 1, 2000; Amended September 6, 20…

Regulations of Connecticut State AgenciesSec. 17b-262-640. Documentation(a) Providers shall maintain a specific record for all services provided to each client including, but not limited to: name, address, birth date, Medicaid identification number, pertinent diagnostic informati…

Regulations of Connecticut State AgenciesSec. 17b-262-641. ScopeSections 17b-262-641 through 17b-262-650, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment of laboratory services provided by licensed c…

Regulations of Connecticut State AgenciesSec. 17b-262-642. DefinitionsFor the purposes of sections 17b-262-641 through 17b-262-650, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Client\" means a person eligible for goods …

Regulations of Connecticut State AgenciesSec. 17b-262-643. Provider participationIn order to enroll in the Medicaid Program and receive payment from the department, providers shall: (1) be in compliance with the provisions of the Clinical Laboratories Improvement Amendments (CLIA…

Regulations of Connecticut State AgenciesSec. 17b-262-644. EligibilityPayment for independent clinical laboratory services shall be available on behalf of all persons eligible for the Medicaid Program subject to the conditions and limitations which apply to these services. (Adopt…

Regulations of Connecticut State AgenciesSec. 17b-262-645. Services covered and limitations(a) The department shall pay for the following: (1) medically appropriate and medically necessary clinical laboratory services, for which the laboratory holds certification according to the…

Regulations of Connecticut State AgenciesSec. 17b-262-646. Need for serviceThe department shall pay for medically necessary and medically appropriate testing and analysis services only when ordered by a licensed physician or other licensed practitioner of the healing arts. (Adopt…

Regulations of Connecticut State AgenciesSec. 17b-262-647. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for HealthTrack Special Services. HealthTrack Special Services are determined medically necessary and medica…

Regulations of Connecticut State AgenciesSec. 17b-262-648. Billing procedures(a) Claims from providers 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 departmen…