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

Regulations of Connecticut State AgenciesSec. 17b-262-808. Services covered(a) The department shall pay a per diem rate, which is an inclusive payment for all services that are required to be provided by the facility as a condition for participation as a PRTF, including, but not …

Regulations of Connecticut State AgenciesSec. 17b-262-809. Services not coveredThe department shall not pay for the following PRTF services that are not covered under Medicaid: (a) procedures or services of an unproven, educational, social, research, experimental or cosmetic natu…

Regulations of Connecticut State AgenciesSec. 17b-262-810. Certification of need requirements(a) In order to receive payment for PRTF services for an individual, admissions shall have a certification of need as required in 42 CFR 441 Subpart D, as amended from time to time. (b) T…

Regulations of Connecticut State AgenciesSec. 17b-262-811. Individual plan of care requirements(a) PRTF services for clients shall involve active treatment, as documented in the professionally developed and supervised individual plan of care. (b) A physician shall: (1) assume pro…

Regulations of Connecticut State AgenciesSec. 17b-262-812. Utilization review program(a) The department conducts utilization review activities for services delivered by the PRTF for clients where Medicaid has been determined to be the appropriate payer. (b) To determine whether a…

Regulations of Connecticut State AgenciesSec. 17b-262-813. Billing proceduresClaims from providers shall be submitted on the department's uniform billing form or electronically transmitted to the department's fiscal agent and shall include all information required by the departme…

Regulations of Connecticut State AgenciesSec. 17b-262-814. Documentation and record retention(a) A provider shall meet the medical record requirements for a PRTF and shall maintain records to support claims made for payment. All documentation shall be made available upon request …

Regulations of Connecticut State AgenciesSec. 17b-262-815. PaymentThe Department shall reimburse PRTFs at a negotiated per diem rate.(Adopted effective September 4, 2009)

Regulations of Connecticut State AgenciesSec. 17b-262-816. Audit and compliance reviewAll supporting accounting and business records, statistical data and all other records relating to the provision of PRTF services paid for by the department shall be subject to audit or complian…

Regulations of Connecticut State AgenciesSec. 17b-262-817. ScopeSections 17b-262-817 to 17b-262-828, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services’ requirements for payment of accepted methods of treatment performed by beh…

Regulations of Connecticut State AgenciesSec. 17b-262-818. DefinitionsFor the purposes of sections 17b-262-817 to 17b-262-828, inclusive, of the Regulations of Connecticut State Agencies, the following definitions shall apply: (1) “Allied Health Professional” or “AHP” means: (A) …

Regulations of Connecticut State AgenciesSec. 17b-262-819. Provider participation(a) Providers shall meet and maintain all department enrollment requirements, as described in sections 17b-262-522 to 17b-262-533, inclusive, of the Regulations of Connecticut State Agencies, to rece…

Regulations of Connecticut State AgenciesSec. 17b-262-820. EligibilityPayment for behavioral health clinic services shall be available to all clients eligible for Medicaid subject to the conditions and limitations that apply to provision of the services. (Effective October 9, 201…

Regulations of Connecticut State AgenciesSec. 17b-262-821. Services covered(a) The department shall pay providers for those procedures listed in the department’s behavioral health clinic fee schedule, provided such services are: (1) Within the clinic’s scope of practice as descri…

Regulations of Connecticut State AgenciesSec. 17b-262-822. Service limitations(a) General (1) Payment for individual, group, family or multiple-family psychotherapy is limited to one visit of each type per day, per provider, per client. (2) Family and group psychotherapy sessions…

Regulations of Connecticut State AgenciesSec. 17b-262-823. Services not coveredThe department shall not pay for the following:(1) Information or services provided to a client over the telephone;(2) Cancelled services and appointments not kept;(3) Any services, treatment or items …

Regulations of Connecticut State AgenciesSec. 17b-262-824. Need for service(a) Each client’s care shall be under the direction of a physician directly employed by or under contract with the clinic. The physician shall authorize the care provided and periodically review the need f…

Regulations of Connecticut State AgenciesSec. 17b-262-825. Authorization(a) Behavioral health clinic services for clients with psychiatric and substance abuse disorders shall be subject to authorization requirements to the extent required by this section. Where a service is subje…

Regulations of Connecticut State AgenciesSec. 17b-262-826. Billing requirements(a) Claims shall be submitted by the providers on the department's designated form or electronically transmitted to the department's fiscal agent and shall include all information required by the depar…

Regulations of Connecticut State AgenciesSec. 17b-262-827. Payment(a) The commissioner shall establish fees in accordance with section 4-67c of the Connecticut General Statutes. Fees shall be the same for in-state, border and out-of-state providers. (b) If the client is present f…

Regulations of Connecticut State AgenciesSec. 17b-262-828. Documentation and audit requirements(a) Providers shall maintain a specific record for all services rendered for each client eligible for Medicaid payment including, but not limited to: (1) Client’s name, address, birth d…

Regulations of Connecticut State AgenciesSec. 17b-262-829. ScopeSections 17b-262-829 to 17b-262-848, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the payment of hospice services on behalf of clients who a…

Regulations of Connecticut State AgenciesSec. 17b-262-830. DefinitionsAs used in section 17b-262-829 to section 17b-262-848, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Advanced practice registered nurse\" or \"APRN\" means an advanced practice registered n…

Regulations of Connecticut State AgenciesSec. 17b-262-831. 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, shall be c…

Regulations of Connecticut State AgenciesSec. 17b-262-832. EligibilityPayment for hospice services is provided to persons who meet all of the following conditions: (1) the individual is eligible for Medicaid; and(2) the individual is certified by a physician as being terminally i…

Regulations of Connecticut State AgenciesSec. 17b-262-833. Refusal to serveNo hospice enrolled as a Medicaid provider shall select a service area or refuse to serve any person, based on the geographical location of the service to be provided unless the hospice has a legitimate, n…

Regulations of Connecticut State AgenciesSec. 17b-262-834. Certification of terminal illness(a) The provider shall obtain an initial certification of the client's terminal illness jointly from the medical director of the hospice or a physician member of the hospice interdisciplin…

Regulations of Connecticut State AgenciesSec. 17b-262-835. Plan of care(a) The interdisciplinary team in conjunction with the attending physician shall establish an initial written plan of care for each client within 48 hours of the client's election of hospice. Services may not …

Regulations of Connecticut State AgenciesSec. 17b-262-836. Election of hospice(a) A client who meets the eligibility requirement of 42 CFR 418.20 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her legal …

Regulations of Connecticut State AgenciesSec. 17b-262-837. Discharge from hospice(a) The provider may discharge a client if: (1) the client moves out of the provider's service area or transfers to another hospice;(2) the client is no longer terminally ill;(3) the client revokes t…

Regulations of Connecticut State AgenciesSec. 17b-262-838. Services covered(a) The following documents shall be in place prior to the provision of hospice services: (1) certification of terminal illness for the applicable election period. The certification may be in writing, elec…

Regulations of Connecticut State AgenciesSec. 17b-262-839. Coordination of hospice and waiver services(a) For clients who receive waiver services prior to electing the hospice benefit under Medicaid, waiver services shall continue to be available. (b) It is the responsibility of …

Regulations of Connecticut State AgenciesSec. 17b-262-840. VolunteersThe provider shall maintain a volunteer program consistent with 42 CFR 418.78.(Adopted effective July 7, 2009)

Regulations of Connecticut State AgenciesSec. 17b-262-841. Service limitations(a) The department shall pay only for services listed in its fee schedule.(b) the department shall not pay separately for any services that are related to the treatment of the terminal condition for whi…

Regulations of Connecticut State AgenciesSec. 17b-262-842. Services not covered(a) When a client elects the hospice benefit, the client waives his or her right to receive the following services under Medicaid: (1) treatment intended to cure the terminal illness;(2) treatment rela…

Regulations of Connecticut State AgenciesSec. 17b-262-843. Prior authorization(a) Prior authorization, on forms and in the manner specified by the department shall be required for: (1) general inpatient days beyond the fifth day; and(2) any service which the department indicates …

Regulations of Connecticut State AgenciesSec. 17b-262-844. Billing procedures(a) Claims from providers 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 all…

Regulations of Connecticut State AgenciesSec. 17b-262-845. Payment(a) The Commissioner shall establish fees that are consistent with section 1902(a)(13)(B) of the Social Security Act. (b) the Commissioner may increase any fee payable to a hospice upon the application of such an a…

Regulations of Connecticut State AgenciesSec. 17b-262-846. Payment limitations(a) It is expected that the provider shall provide bereavement counseling to the client's family after the client's death; however the department shall not pay the provider for such bereavement counseli…

Regulations of Connecticut State AgenciesSec. 17b-262-847. Review process(a) a client or client representative may request a review with the hospice whenever a requested good or service is denied. (b) Review Process:(1) The hospice shall have a timely and organized review process…

Regulations of Connecticut State AgenciesSec. 17b-262-848. 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. In the event of a dispute …

Regulations of Connecticut State AgenciesSec. 17b-262-849. ScopeSections 17b-262-849 to 17b-262-861, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for Medicaid coverage of rehabilitation services for individu…

Regulations of Connecticut State AgenciesSec. 17b-262-850. DefinitionsAs used in sections 17b-262-849 to 17b-262-861, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Admission\" means an individual's initial participation in a rehabilitation services program; (…

Regulations of Connecticut State AgenciesSec. 17b-262-851. Provider participationIn order to participate in the Medicaid program and provide rehabilitation services that are eligible for Medicaid reimbursement from the department, the provider shall: (1) Enroll with the departmen…

Regulations of Connecticut State AgenciesSec. 17b-262-852. EligibilityMedicaid coverage for the cost of rehabilitation services is available for individuals with behavioral health conditions when the service is medically necessary and is provided by a provider to an individual wi…

Regulations of Connecticut State AgenciesSec. 17b-262-853. Need for servicesPayment for rehabilitation services shall be made by the department only if all of the following conditions are met: (1) Medicaid payment for rehabilitation services may be made only to the extent that a …

Regulations of Connecticut State AgenciesSec. 17b-262-854. Covered services(a) Rehabilitation services shall be recommended by a physician or other licensed clinician operating within his or her scope of practice. (b) Rehabilitation services are services designed to assist indivi…

Regulations of Connecticut State AgenciesSec. 17b-262-855. Coverage limitations(a) Coverage of services shall be subject to the following limitations: (1) Services that do not meet medical necessity requirements or any applicable authorization or certification requirements are no…

Regulations of Connecticut State AgenciesSec. 17b-262-856. Non-billable activitiesThe following activities are not billable:(1) Telephone contact with the department for the purpose of requesting or reviewing authorization; (2) documentation of progress notes or billing documenta…

Regulations of Connecticut State AgenciesSec. 17b-262-857. Authorization(1) Services are subject to prior authorization or registration requirements to the extent required by this section. Where a service is subject to authorization or registration requirements, Medicaid payment …