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

Regulations of Connecticut State AgenciesSec. 17b-262-858. Documentation and record retention requirements(a) Providers shall comply with the following documentation and record retention requirements: (1) An initial rehabilitation plan and all updated versions, including the curr…

Regulations of Connecticut State AgenciesSec. 17b-262-859. Billing requirements(a) Claims for office-based off-site rehabilitation services shall be billed with routine outpatient procedure codes and an off-site modifier or appropriate place of service code as designated by the d…

Regulations of Connecticut State AgenciesSec. 17b-262-860. Payment(a) In order to receive payment from the department, the provider shall be enrolled in the Connecticut Medical Assistance Program and comply with the requirements of sections 17b-262-522 through 17b-262-533, inclus…

Regulations of Connecticut State AgenciesSec. 17b-262-861. Audit and compliance reviewsAll supporting accounting and business records, statistical data and all other records relating to the provision of rehabilitation services paid for by the department shall be subject to audit …

Regulations of Connecticut State AgenciesSec. 17b-262-862. Scope (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-863. Definitions (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-864. Limitations on Coverage of Certain Non-emergency Dental Services (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-865. Services Not Covered (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-866. Prior Authorization Requirements (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-9. SanctionsIf the department determines, in accordance with sections 17b-262-1 through 17b-262-9, that these regulations have been violated, the department shall provide the home health care agency a written notice of violati…

Regulations of Connecticut State AgenciesSec. 17b-262-912. ScopeSections 17b-262-912 to 17b-262-925, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of services performed by licensed behavioral heal…

Regulations of Connecticut State AgenciesSec. 17b-262-913. DefinitionsAs used in sections 17b-262-912 to 17b-262-925, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Advanced practice registered nurse\" or \"APRN\" means an individual licensed pursuant to secti…

Regulations of Connecticut State AgenciesSec. 17b-262-914. Provider participationIn order to enroll in Medicaid and receive payment from the department, a provider shall: (1) Comply with all applicable licensing, accreditation and certification requirements;(2) comply with all de…

Regulations of Connecticut State AgenciesSec. 17b-262-915. EligibilityThe department shall pay for medically necessary behavioral health clinician services provided to clients eligible for such services, subject to the conditions and limitations that apply to these services. (Eff…

Regulations of Connecticut State AgenciesSec. 17b-262-916. Services coveredThe department shall pay only for behavioral health clinician services that are:(1) Within the licensed behavioral health clinician's scope of practice as defined by chapters 376b, 383a, 383b or 383c of th…

Regulations of Connecticut State AgenciesSec. 17b-262-917. Service limitationsThe department shall pay for covered services only in accordance with the treatment plan and with the following additional limits: (1) Only one diagnostic interview in any twelve-month period per licens…

Regulations of Connecticut State AgenciesSec. 17b-262-918. Services not coveredThe department shall not pay for the following behavioral health clinician services:(1) Information or services furnished by the licensed behavioral health clinician to the client electronically or ove…

Regulations of Connecticut State AgenciesSec. 17b-262-919. Need for service and treatment planThe department shall pay for medically necessary behavioral health clinician services. The provider shall establish a treatment plan for each client based on the initial diagnostic evalu…

Regulations of Connecticut State AgenciesSec. 17b-262-920. Prior authorization and registration(a) Where a service requires prior authorization or registration under this section, the department shall not pay for such service unless the provider complies with this section and all…

Regulations of Connecticut State AgenciesSec. 17b-262-921. Billing procedures(a) Providers shall submit claims on the department's designated form or by electronic transmission as established by the department and shall include all information required by the department to proces…

Regulations of Connecticut State AgenciesSec. 17b-262-922. Payment(a) Licensed behavioral health clinicians who are fully or partially compensated by a Medicaid participating general hospital, public or private institution, freestanding clinic or federally qualified health center…

Regulations of Connecticut State AgenciesSec. 17b-262-923. Payment rateThe commissioner shall establish, update and publish the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (Effective December 28, 2012)

Regulations of Connecticut State AgenciesSec. 17b-262-924. Payment limitations(a) The fees for a diagnostic interview examination, as stipulated in the department's applicable fee schedule, represent one unit of service. The provider shall bill for only one unit of service for a …

Regulations of Connecticut State AgenciesSec. 17b-262-925. Documentation(a) Providers shall maintain (1) a specific record for all services provided to each client including, but not limited to: name, address, birth date, Medicaid identification number, pertinent diagnostic infor…

Regulations of Connecticut State AgenciesSec. 17b-262-956. ScopeSections 17b-262-956 to 17b-262-965, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment to birth centers that are medically necessary and …

Regulations of Connecticut State AgenciesSec. 17b-262-957. DefinitionsAs used in sections 17b-262-956 to 17b-262-965, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Birth center\" means a free-standing, separately licensed health care facility that is not a ho…

Regulations of Connecticut State AgenciesSec. 17b-262-958. Provider participation(a) To enroll in Medicaid and receive payment from the department, a provider shall comply with sections 17b-262-956 to 17b-262-965, inclusive, of the Regulations of Connecticut State Agencies and se…

Regulations of Connecticut State AgenciesSec. 17b-262-959. Need for serviceService in a birth center shall be limited to maternal patients who have had a low-risk pregnancy and are likely to have a low-risk delivery, as determined by the maternal patient's licensed practitioner. …

Regulations of Connecticut State AgenciesSec. 17b-262-960. EligibilityPayment to a provider for birth center services is available for clients who have a need for such products and services when the items are medically necessary, subject to the conditions and limitations set fort…

Regulations of Connecticut State AgenciesSec. 17b-262-961. Services covered and limitations(a) The department shall pay the provider a single all-inclusive fee for a normal, uncomplicated labor and delivery, which covers all services provided by the birth center, including, but n…

Regulations of Connecticut State AgenciesSec. 17b-262-962. Payment and payment limitations(a) The department shall reimburse the provider when the provider has met all the requirements of sections 17b-262-956 to 17b-262-965, inclusive, of the Regulations of Connecticut State Agen…

Regulations of Connecticut State AgenciesSec. 17b-262-963. Prior authorization(a) The department shall require prior authorization for: (1) Any service identified on the department's fee schedule as requiring prior authorization;(2) EPSDT special services; and(3) any service that…

Regulations of Connecticut State AgenciesSec. 17b-262-964. Billing procedureProviders shall submit claims on a hard copy invoice or by electronic transmission to the department in a form and manner specified by the department, together with all information required by the departm…

Regulations of Connecticut State AgenciesSec. 17b-262-965. Documentation(a) Providers shall maintain a specific record for all services provided to each client, including, but not limited to: name, address, birth date, Medicaid identification number, pertinent diagnostic informat…

Regulations of Connecticut State AgenciesSec. 17b-262-966. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-994. ScopeSections 17b-262-994 to 17b-262-1004, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services’ requirements for payment to federally qualified health centers for servic…

Regulations of Connecticut State AgenciesSec. 17b-262-995. DefinitionsAs used in section 17b-262-994 to section 17b-262-1004, inclusive, of the Regulations of Connecticut State Agencies: (1) “Advanced practice registered nurse” or “APRN” means a person licensed under section 20-9…

Regulations of Connecticut State AgenciesSec. 17b-262-996. Provider participationIn order to participate in the Connecticut Medicaid program and provide FQHC services eligible for reimbursement from the department, each FQHC shall: (1) Comply with all applicable state licensing r…

Regulations of Connecticut State AgenciesSec. 17b-262-997. Services covered(a) Covered core services for FQHCs include the following: (1) Medical services furnished by a physician, PA, APRN or nurse midwife. The services shall be within the scope of practice of his or her profess…

Regulations of Connecticut State AgenciesSec. 17b-262-998. Services not coveredThe following services are not covered:(1) Services that are not covered in the Medicaid state plan;(2) Services that are not medically necessary;(3) Canceled services or appointments that are not kept…

Regulations of Connecticut State AgenciesSec. 17b-262-999. Billable services(a) Billable services for FQHCs shall include core and noncore services identified in section 17b-262-997 of the Regulations of Connecticut State Agencies. (b) Covered core and noncore services shall be b…