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

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…

Regulations of Connecticut State AgenciesSec. 17b-262-725. DefinitionsAs used in section 17b-262-724 to section 17b-262-735, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Activity of daily living\" or \"ADL\" means any activity necessary for self care includi…

Regulations of Connecticut State AgenciesSec. 17b-262-726. Provider participationTo enroll in Medicaid and receive payment from the department, providers shall comply with sections 17b-262-522 to 17b-262-533, inclusive, and sections 17b-262-1 to 17b-262-9, inclusive, of the Regul…

Regulations of Connecticut State AgenciesSec. 17b-262-727. EligibilityPayment for home health care services provided to persons eligible for Medicaid shall be available subject to the conditions and limitations that apply to these services as identified in sections 17b-262-724 to…

Regulations of Connecticut State AgenciesSec. 17b-262-728. Services covered and limitations(a) Subject to the limitations and exclusions identified in sections 17b-262-724 to 17b-262-735, inclusive, of the Regulations of Connecticut State Agencies, the department shall pay for me…

Regulations of Connecticut State AgenciesSec. 17b-262-729. Services not coveredThe department shall not pay a home health care agency:(1) for services provided to a client who is receiving the same service concurrently from an individual therapist, clinic, hospital, practitioner,…

Regulations of Connecticut State AgenciesSec. 17b-262-730. Cost effectiveness test(a) The department shall apply a cost effectiveness test for all prior authorization requests for: (1) home health aide services in excess of fourteen hours per week; and (2) all extended nursing se…

Regulations of Connecticut State AgenciesSec. 17b-262-731. Need for service(a) The department shall pay for medically necessary and medically appropriate home health care services only under orders of a licensed practitioner as part of a care plan. (b) The department shall pay fo…

Regulations of Connecticut State AgenciesSec. 17b-262-732. Prior authorization(a) To receive payment from the department the provider shall comply with the prior authorization requirements described in section 17b-262-528 of the Regulations of Connecticut State Agencies and this …

Regulations of Connecticut State AgenciesSec. 17b-262-733. Billing procedures(a) Claims from home health care agencies shall be submitted on the department's designated form or electronically transmitted to the department or its agent, in a form and manner as specified by the dep…

Regulations of Connecticut State AgenciesSec. 17b-262-734. Payment(a) Payment(1) The commissioner shall establish the fees for home health care services in the department's fee schedule pursuant to section 17b-242 of the Connecticut General Statutes. (2) The department shall pay …

Regulations of Connecticut State AgenciesSec. 17b-262-735. Documentation(a) All required documentation shall be maintained for at least five years, or longer by the provider in accordance with statute or regulation, subject to review by the department. Documentation as set forth …

Regulations of Connecticut State AgenciesSec. 17b-262-736. ScopeSections 17b-262-736 to 17b-262-746, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment to providers of orthotic and prosthetic devices th…

Regulations of Connecticut State AgenciesSec. 17b-262-737. DefinitionsAs used in sections 17b-262-736 to 17b-262-746, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Chronic disease hospital\" means a \"chronic disease hosp…

Regulations of Connecticut State AgenciesSec. 17b-262-738. Provider participationTo 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 Agencies…

Regulations of Connecticut State AgenciesSec. 17b-262-739. EligibilityA provider may receive reimbursement from the department for the provision of an orthotic and prosthetic device to a client. No reimbursement shall be made unless a licensed practitioner has prescribed the orth…

Regulations of Connecticut State AgenciesSec. 17b-262-740. Services covered and limitations(a) Services Covered(1) The department shall pay for the purchase or repair of a medically necessary and medically appropriate orthotic or prosthetic device, except as limited by sections 1…

Regulations of Connecticut State AgenciesSec. 17b-262-741. Goods and services not coveredThe department shall not pay providers for:(1) any orthotic or prosthetic device that is of an unproven, experimental or research nature or for services in excess of those deemed medically ne…

Regulations of Connecticut State AgenciesSec. 17b-262-742. Prior authorization(a) The department shall require PA for any orthotic or prosthetic device identified on the department's published fee schedule as requiring PA. (b) To receive reimbursement from the department a provid…

Regulations of Connecticut State AgenciesSec. 17b-262-743. 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 in a manner specified by the department and shall include all…

Regulations of Connecticut State AgenciesSec. 17b-262-744. Payment limitations(a) The department shall reimburse a provider when all requirements of sections 17b-262-736 to 17b-262-746, inclusive, of the Regulations of Connecticut State Agencies have been met. (b) The department …

Regulations of Connecticut State AgenciesSec. 17b-262-745. Documentation(a) All required documentation shall be maintained for at least five (5) years in the provider's primary place of business and shall be subject to review by the department. In the event of a dispute concernin…

Regulations of Connecticut State AgenciesSec. 17b-262-746. Other(a) Where brand names or stock or model 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 clie…

Regulations of Connecticut State AgenciesSec. 17b-262-747. ScopeSections 17b-262-747 to 17b-262-757, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of rehabilitative services provided by private no…

Regulations of Connecticut State AgenciesSec. 17b-262-748. DefinitionsAs used in sections 17b-262-747 through 17b-262-757, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Billing provider\" means the Connecticut Department …

Regulations of Connecticut State AgenciesSec. 17b-262-749. Provider and billing provider requirementsTo participate in the Medicaid program and provide PNMI rehabilitative services that are eligible for Medicaid reimbursement from the department, the following requirements shall …

Regulations of Connecticut State AgenciesSec. 17b-262-750. EligibilityPayment for PNMI rehabilitative services shall be subject to available appropriations and shall be available for services rendered to PNMI clients under the conditions and limitations that are set forth in sect…

Regulations of Connecticut State AgenciesSec. 17b-262-751. Need for servicesPayment for PNMI rehabilitative services shall be made by the department only if all of the following conditions are met: (1) The client shall be assessed by the billing provider or its agent to determine…

Regulations of Connecticut State AgenciesSec. 17b-262-752. Covered servicesPNMI rehabilitative services shall include the following services:(1) Assessment, treatment planning and support activities that assist the client in gaining access to authorized services. These services i…

Regulations of Connecticut State AgenciesSec. 17b-262-753. LimitationsCoverage of PNMI rehabilitative services shall be subject to the following limitations:(1) PNMI rehabilitative services shall be pre-authorized by DCF based on a written service recommendation. (2) The PNMI reh…

Regulations of Connecticut State AgenciesSec. 17b-262-754. Documentation and record retention requirementsPNMI rehabilitative services shall be reimbursed by the department when documentation of compliance with the following requirements is on file with the billing provider or th…