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

Regulations of Connecticut State AgenciesSec. 17b-262-755. Billing requirements(a) Claims for payment of PNMI rehabilitation services shall be submitted by the billing provider on the department's uniform billing form or electronically transmitted to the Department's fiscal agent…

Regulations of Connecticut State AgenciesSec. 17b-262-756. PaymentPayment by the department for PNMI rehabilitative services shall be made in accordance with the following provisions. (1) The department shall make payments on the basis of monthly rates for each of three types of …

Regulations of Connecticut State AgenciesSec. 17b-262-757. Audit and compliance reviewAll supporting accounting and business records, statistical data and all other records relating to the provision of PNMI rehabilitative services paid for by the department shall be subject to au…

Regulations of Connecticut State AgenciesSec. 17b-262-758. ScopeSections 17b-262-758 to 17b-262-769, 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-262-759. DefinitionsAs used in sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Adult\" means a person who is 18 years of age or older;(2) \"Department\" or \"DSS\" means the …

Regulations of Connecticut State AgenciesSec. 17b-262-760. Provider participationIn order to participate in the Medicaid program and provide PNMI rehabilitative services that are eligible for Medicaid reimbursement from the department, the provider shall: (1) Enroll with the depa…

Regulations of Connecticut State AgenciesSec. 17b-262-761. EligibilityPayment for PNMI rehabilitative services shall be available for services rendered to PNMI clients under the conditions and limitations that are set forth in sections 17b-262-758 to 17b-262-769, inclusive, of th…

Regulations of Connecticut State AgenciesSec. 17b-262-762. Need for servicesPayment for PNMI rehabilitative services shall be made by the department only if all of the following conditions are met: (1) For up to thirty days of a PNMI client's initial stay in a PNMI program, the P…

Regulations of Connecticut State AgenciesSec. 17b-262-763. Covered servicesPNMI rehabilitative services are services designed to assist individuals with a serious and persistent mental illness to achieve their highest degree of independent functioning and recovery. These services…

Regulations of Connecticut State AgenciesSec. 17b-262-764. LimitationsCoverage of PNMI rehabilitative services shall be subject to the following limitations:(1) PNMI rehabilitative services shall be pre-authorized by the department or its agent based on a written service recommen…

Regulations of Connecticut State AgenciesSec. 17b-262-765. Prior authorization(a) Prior authorization of the need for PNMI adult rehabilitative services is required in order for Medicaid payment to be available for the services. Prior authorization shall be obtained on forms and …

Regulations of Connecticut State AgenciesSec. 17b-262-766. Documentation and record retention requirementsProviders shall comply with the following documentation and record retention requirements:(1) An initial residential rehabilitation plan and all updated versions, including t…

Regulations of Connecticut State AgenciesSec. 17b-262-767. Billing requirements(a) Claims for payment of PNMI rehabilitation services shall be on the department's uniform billing form or electronically transmitted to the department's fiscal agent and shall include all information…

Regulations of Connecticut State AgenciesSec. 17b-262-768. PaymentPayment by the department for PNMI rehabilitative services shall be made in accordance with the following provisions. (a) The department shall make payments on the basis of monthly rates for PNMI programs.(b) A sta…

Regulations of Connecticut State AgenciesSec. 17b-262-769. Audit and compliance reviewAll supporting accounting and business records, statistical data and all other records relating to the provision of PNMI rehabilitative services paid for by the department shall be subject to au…

Regulations of Connecticut State AgenciesSec. 17b-262-770. ScopeSections 17b-262-770 to 17b-262-773, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the establishment by Medicaid entities of policies and pro…

Regulations of Connecticut State AgenciesSec. 17b-262-771. DefinitionsAs used in sections 17b-262-770 to 17b-262-773, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Entity\" means a government agency, organization, unit, corporation, partnership, or other busi…

Regulations of Connecticut State AgenciesSec. 17b-262-772. Provider participationTo receive payment from the Department for the provision of goods or services to Medicaid clients, entities shall comply with sections 17b-262-770 to 17b-262-773, inclusive, of the Regulations of Con…

Regulations of Connecticut State AgenciesSec. 17b-262-773. Establishment and dissemination of written policies(a) An entity shall establish and disseminate written policies, which shall also be adopted by its contractors or agents. Written policies may be on paper or in electroni…

Regulations of Connecticut State AgenciesSec. 17b-262-774—17b-262-778. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-779. ScopeSections 17b-262-779 to 17b-262-791, inclusive, of the Regulations of Connecticut State Agencies, set forth the department of social services' requirements for payment to chronic disease hospitals for services to cli…

Regulations of Connecticut State AgenciesSec. 17b-262-780. DefinitionsAs used in sections 17b-262- 779 to 17b-262- 791, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Applied income\" means the amount of income that each client receiving chronic disease hospit…

Regulations of Connecticut State AgenciesSec. 17b-262-781. Provider participation(a) To enroll in Medicaid and receive payment from the department, a chronic disease hospital shall comply with the provider participation requirements of sections 17b-262-522 through 17b-262-533, in…

Regulations of Connecticut State AgenciesSec. 17b-262-782. EligibilityPayment for chronic disease hospital services is available on behalf of all clients subject to the conditions and limitations that apply to these services. (Adopted effective October 6, 2009)

Regulations of Connecticut State AgenciesSec. 17b-262-783. Need for serviceIn order for a client to be approved for admission to a chronic disease hospital, the client shall meet the criteria for admission as either a chronic disease client or a rehabilitation client. All care sh…

Regulations of Connecticut State AgenciesSec. 17b-262-784. Services coveredThe department shall pay an all-inclusive per diem rate to the provider for each resident for whom payment has been authorized pursuant to section 17b-262-783 of the Regulations of Connecticut State Agenci…

Regulations of Connecticut State AgenciesSec. 17b-262-785. Service limitationsPayment shall be made for the date of admission but not for the date of discharge. Exceptions to this are: (a) payment shall be made for the date of death when the resident dies in the chronic disease h…

Regulations of Connecticut State AgenciesSec. 17b-262-786. Services not covered(a) The department shall not pay a chronic disease hospital that is characterized as an institution for mental diseases except for services to clients aged 65 and older or under age 22 in accordance wi…

Regulations of Connecticut State AgenciesSec. 17b-262-787. Authorization process(a) The department shall pay a provider only when the department has authorized payment for the client's admission to that chronic disease hospital. (b) The provider shall comply with the authorizatio…

Regulations of Connecticut State AgenciesSec. 17b-262-788. Applied income(a) A client who receives chronic disease hospital services is responsible for paying applied income to the chronic disease hospital. (b) The department shall calculate the applied income. The department sha…

Regulations of Connecticut State AgenciesSec. 17b-262-789. Billing and payment 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 t…

Regulations of Connecticut State AgenciesSec. 17b-262-790. Rates(a) The per diem rate for a chronic disease hospital is determined annually pursuant to section 17b-239 of the Connecticut General Statutes for freestanding chronic disease hospitals or section 17b-340 of the Connect…

Regulations of Connecticut State AgenciesSec. 17b-262-791. Documentation(a) The chronic disease hospital shall maintain all documentation required for rate setting purposes in accordance with section 17-311-56 of the Regulations of Connecticut State Agencies. This documentation i…

Regulations of Connecticut State AgenciesSec. 17b-262-792. ScopeSections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment to providers of hearing aids and supplies that are…

Regulations of Connecticut State AgenciesSec. 17b-262-793. DefinitionsAs used in sections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Actual acquisition cost\" means the price paid to a manufacturer by a hearing aid provider for …

Regulations of Connecticut State AgenciesSec. 17b-262-794. Provider participationTo enroll in the Medicaid program and receive payment from the department, providers shall comply with sections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies…

Regulations of Connecticut State AgenciesSec. 17b-262-795. Need for service(a) The department shall pay for the purchase or repair of a medically necessary hearing aid or supply, subject to the conditions and limitations described in sections 17b-262-792 to 17b-262-803, inclusive…

Regulations of Connecticut State AgenciesSec. 17b-262-796. EligibilityPayment to a provider for hearing aids and related supplies is available for clients who have a need for such products and services which meets the department's definition of a hearing aid when the items are me…

Regulations of Connecticut State AgenciesSec. 17b-262-797. Services covered and limitations(a) The department shall maintain a fee schedule for hearing aids and supplies, subject to the conditions and limitations set forth in sections 17b-262-792 to 17b-262-803, inclusive, of the…

Regulations of Connecticut State AgenciesSec. 17b-262-798. Goods and services not coveredThe department shall not pay providers for:(a) Any hearing aid that is of an unproven, experimental or research nature or for services in excess of those deemed medically necessary by the dep…

Regulations of Connecticut State AgenciesSec. 17b-262-799. Payment and payment limitations(a) Fees shall be the same for in-state, border-state 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 Medi…

Regulations of Connecticut State AgenciesSec. 17b-262-8. Legitimate non-discriminatory reason(a) In any case in which a home health care agency is required to provide written justification based upon legitimate non-discriminatory reasons in accordance with this section, the home …

Regulations of Connecticut State AgenciesSec. 17b-262-800. Prior authorization(a) The department shall require PA for: (1) Any hearing aid that is identified on the department's fee schedule as requiring PA;(2) EPSDT special services; and(3) any service or device that is not on t…

Regulations of Connecticut State AgenciesSec. 17b-262-801. Billing procedure(a) Claims from providers shall be submitted on a hard copy invoice or electronically transmitted to the department in a form and in a manner specified by the department and shall include all information …

Regulations of Connecticut State AgenciesSec. 17b-262-802. Documentation(a) Providers shall maintain all fiscal and medical records related to services and goods rendered or delivered to clients. (b) All required documentation, including evidence of a medical evaluation for a hea…

Regulations of Connecticut State AgenciesSec. 17b-262-803. 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-262-804. ScopeSections 17b-262-804 to 17b-262-816, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment for Psychiatric Residential Treatment Facilities …

Regulations of Connecticut State AgenciesSec. 17b-262-805. DefinitionsAs used in section 17b-262-804 to section 17b-262-816, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Active treatment\" means \"active treatment\" as defined in 42 CFR, Part 441, section 44…

Regulations of Connecticut State AgenciesSec. 17b-262-806. Provider participationIn order to enroll in Medicaid and receive payment from the department, a provider shall meet the following requirements: (a) General:(1) meet and maintain all applicable licensing, accreditation and…

Regulations of Connecticut State AgenciesSec. 17b-262-807. EligibilityPayment for PRTF services shall be available, subject to the conditions and limitations set forth in sections 17b-262-804 to17b-262-816, inclusive, of the Regulations of Connecticut State Agencies, for services…