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

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-262-7. 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-262-701. 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)

Regulations of Connecticut State AgenciesSec. 17b-262-705. Services covered and limitationsThe 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 17-311-120, inclusive, and …

Regulations of Connecticut State AgenciesSec. 17b-262-706. Service limitations(a) the department shall pay to reserve a bed in a nursing facility for a Medicaid resident during a temporary absence in a hospital or a temporary absence for home leave in accordance with the provisio…

Regulations of Connecticut State AgenciesSec. 17b-262-707. Need for service and authorization process(a) The department shall pay for an admission that is medically necessary and medically appropriate as evidenced by the following: (1) certification by a licensed practitioner tha…

Regulations of Connecticut State AgenciesSec. 17b-262-708. Applied income(a) The department is responsible for calculating the applied income. The department shall notify the nursing facility of the amount of any applied income that the nursing facility is responsible for collect…

Regulations of Connecticut State AgenciesSec. 17b-262-709. Billing and payment procedures(a) The nursing facility 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 nu…

Regulations of Connecticut State AgenciesSec. 17b-262-710. Rates(a) The per diem rates for nursing facilities services are determined annually pursuant to section 17b-340 of the Connecticut general statutes and sections 17-311-1 to 17-311-209, inclusive, of the Regulations of Con…

Regulations of Connecticut State AgenciesSec. 17b-262-711. Documentation(a) The nursing facility shall maintain all documentation required for rate setting purposes in accordance with section 17-311-56 of the Regulations of Connecticut State Agencies, including all documentation …

Regulations of Connecticut State AgenciesSec. 17b-262-712. ScopeSections 17b-262-712 to 17b-262-722, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment to providers of medical and surgical supplies pro…

Regulations of Connecticut State AgenciesSec. 17b-262-713. DefinitionsAs used in sections 17b-262-712 to 17b-262-722, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Chronic disease hospital\" means \"chronic disease hospital\" as defined in section 19-13-D1 of…

Regulations of Connecticut State AgenciesSec. 17b-262-714. 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-262-715. EligibilityPayment for medical and surgical supplies is available for clients who have a medical necessity for such supplies, when the supplies are prescribed by a licensed practitioner, subject to the conditions and limi…

Regulations of Connecticut State AgenciesSec. 17b-262-716. Supplies covered and limitations(a) Supplies covered(1) The department shall pay for the purchase of medical and surgical supplies, except as limited by sections 17b-262-712 to 17b-262-722, inclusive, of the Regulations o…

Regulations of Connecticut State AgenciesSec. 17b-262-717. Supplies not coveredThe department shall not pay providers for:(1) standard or stock medical and surgical supplies prescribed and ordered for a client who: (A) dies prior to delivery of the supply; or(B) is not otherwise …

Regulations of Connecticut State AgenciesSec. 17b-262-718. Prior authorization(a) To receive payment from the department, providers shall comply with all prior authorization requirements. The department in its sole discretion determines what information is necessary in order to a…

Regulations of Connecticut State AgenciesSec. 17b-262-719. Billing procedure(a) Claims from providers shall be submitted on a hard copy invoice or electronically transmitted to the department or its agent, in a form and manner that the department shall specify and shall include a…

Regulations of Connecticut State AgenciesSec. 17b-262-720. Payment limitationsThe price for any supply listed in the fee schedule published by the department shall include and the department shall pay the lowest: (1) fees for initial measurements, fittings and adjustments and rel…

Regulations of Connecticut State AgenciesSec. 17b-262-721. Documentation(a) All required documentation shall be maintained for at least five years or the length of time required by statute in the provider's file subject to review by the department. In the event of a dispute conce…

Regulations of Connecticut State AgenciesSec. 17b-262-722. Other(a) Where brand names or stock numbers are specified on the prescription or the PA, no substitution shall be permitted without the written approval of the department. (b) The provider shall instruct the client or his…

Regulations of Connecticut State AgenciesSec. 17b-262-723. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-724. ScopeSections 17b-262-724 to 17b-262-735, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the payment of home health care services on behalf of clie…