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

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…

Regulations of Connecticut State AgenciesSec. 17b-262-649. 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-262-650. Documentation(a) Independent clinical laboratory providers shall maintain a specific record for all services received for each client eligible for Medicaid Program payment including, but not limited to: name, address, bir…

Regulations of Connecticut State AgenciesSec. 17b-262-651. ScopeSections 17b-262-651 through 17b-262-660, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment of dialysis services provided by physicians, …

Regulations of Connecticut State AgenciesSec. 17b-262-652. DefinitionsFor the purposes of sections 17b-262-651 through 17b-262-660, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Border Hospital\" means an out-of-state gen…

Regulations of Connecticut State AgenciesSec. 17b-262-653. Provider participationIn order to enroll in the Medicaid Program and receive payment from the department, providers shall: (1) meet and maintain all applicable licensing, accreditation, and certification requirements;(2) …

Regulations of Connecticut State AgenciesSec. 17b-262-654. EligibilityPayment for dialysis 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. (Adopted effective May 10, 20…

Regulations of Connecticut State AgenciesSec. 17b-262-655. Services covered and limitationsSubject to the limitations and exclusions listed below and those set forth in the Regulations of Connecticut State Agencies dealing with physicians, general hospitals, and freestanding dial…

Regulations of Connecticut State AgenciesSec. 17b-262-656. Need for service and authorization process(a) The department shall pay for medically necessary and medically appropriate dialysis services for Medicaid Program clients, in relation to the diagnosis for which care is requi…

Regulations of Connecticut State AgenciesSec. 17b-262-657. Billing proceduresClaims 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 department to…

Regulations of Connecticut State AgenciesSec. 17b-262-658. 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-262-659. Payment rate(a) The commissioner establishes the fees contained in the provider's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (b) Payment rates for physicians and physician groups are found…

Regulations of Connecticut State AgenciesSec. 17b-262-660. Documentation(a) Providers shall maintain a specific medical record for all services received for each client eligible for Medicaid Program payment including, but not limited to: name, address, birth date, Medicaid identi…

Regulations of Connecticut State AgenciesSec. 17b-262-661—17b-262-671. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-672. ScopeSections 17b-262-672 through 17b-262-682 of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the payment of durable medical equipment (DME) to providers, for …

Regulations of Connecticut State AgenciesSec. 17b-262-673. DefinitionsFor the purposes of sections 17b-262-672 through 17b-262-682 of the Regulations of Connecticut State Agencies, the following definitions shall apply: (1) \"Chronic disease hospital\" means an institution as def…

Regulations of Connecticut State AgenciesSec. 17b-262-674. Provider participationIn order to enroll in the Medicaid program 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…

Regulations of Connecticut State AgenciesSec. 17b-262-675. EligibilityPayment for DME and related equipment is available for Medicaid clients who have a medical need for such equipment which meets the department's definition of DME when the item is prescribed by a licensed practi…

Regulations of Connecticut State AgenciesSec. 17b-262-676. Services covered and limitations(a) Services Covered(1) The department shall pay for the purchase or rental and the repair of DME, except as limited by sections 17b-262-672 to 17b-262-682, inclusive, of the Regulations of…

Regulations of Connecticut State AgenciesSec. 17b-262-677. Services not coveredThe Department shall not pay DME providers for:(1) standard or stock DME items prescribed and ordered for a client who:(A) dies prior to delivery of the item, or(B) is not otherwise eligible on the dat…

Regulations of Connecticut State AgenciesSec. 17b-262-678. Prior authorization(a) In order to receive reimbursement from the department a provider shall comply with all prior authorization requirements. The department in its sole discretion determines what information is necessar…

Regulations of Connecticut State AgenciesSec. 17b-262-679. Billing procedure(a) Claims from DME providers shall be submitted on a hard copy invoice or electronically transmitted to the department or its agent, in a form and manner as specified by the department, and shall include…

Regulations of Connecticut State AgenciesSec. 17b-262-680. Payment limitations(a) Payment shall be made for customized DME for a client who dies or is not otherwise eligible on the date of delivery providing the client was eligible: (1) on the date prior authorization was given b…

Regulations of Connecticut State AgenciesSec. 17b-262-681. Documentation(a) All required documentation shall be maintained for at least five (5) years in the DME provider's file subject to review by the department. In the event of a dispute concerning a service or an item provide…

Regulations of Connecticut State AgenciesSec. 17b-262-682. Other(a) All equipment or devices purchased by the department shall be new and shall become the property of the client as of the date of delivery to the client. (b) Where brand names or stock or model numbers are specifie…

Regulations of Connecticut State AgenciesSec. 17b-262-683. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-684. Scope (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-685. Definitions (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-686. Provider participation (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-687. Eligibility (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-688. Services covered and limitations (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-689. Services not covered (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-690. Payment rate (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-691. Documentation (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-692. Manufacturer rebate program (Repealed) Repealed June 11, 2014.(Adopted effective January 1, 2002; Repealed June 11, 2014)Notes: For 2014 repeal, see Sec. 54 of Public Act 14-187. (June 11, 2014)

Regulations of Connecticut State AgenciesSec. 17b-262-693. Scope (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-694. Definitions (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-695. Provider participation (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-696. Eligibility (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-697. Services covered and limitations (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-698. Services not covered (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-699. Payment rate and billing procedure (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-7. Refusal to serve(a) All home health care agencies shall record each and every written or oral refusal to serve and suspension of service, including but not limited to discharges, including the date, the name and address of …

Regulations of Connecticut State AgenciesSec. 17b-262-700. Documentation (Repealed) Repealed July 9, 2025.(Adopted effective July 10, 2001; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-701. ScopeSections 17b-262-701 to 17b-262-711, inclusive, set forth the Department of Social Services requirements for payment to nursing facilities for services to clients eligible to receive such services under Connecticut's…

Regulations of Connecticut State AgenciesSec. 17b-262-702. DefinitionsFor the purposes of sections 17b-262-701 to 17b-262-711, inclusive, the following definitions shall apply: (1) \"Applied income\" means the amount of income that each client receiving nursing facility services …

Regulations of Connecticut State AgenciesSec. 17b-262-703. Provider participationIn order to enroll in the Medicaid program and receive payment from the department, a nursing facility shall comply with sections 17b-262-522 through 17b-262-533, inclusive, of the Regulations of Con…

Regulations of Connecticut State AgenciesSec. 17b-262-704. EligibilityPayment for nursing facility services is available to all persons eligible for the Medicaid program subject to the conditions and limitations that apply to these services. (Adopted effective March 1, 2002)