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

Regulations of Connecticut State AgenciesSec. 17b-262-338. Definitions.For the purposes of sections 17b-262-337 to 17b-262-349, inclusive, of the Regulations of Connecticut State Agencies, the following definitions apply:(1) “Accountable provider” means the maternity billing prov…

Regulations of Connecticut State AgenciesSec. 17b-262-339. Provider participation(a) In order to enroll in Medicaid and for billing providers to receive payment from the department, performing providers and billing providers shall comply with sections 17b-262-522 to 17b-262-533, …

Regulations of Connecticut State AgenciesSec. 17b-262-340. EligibilityPayment to a billing provider for physicians’ services billed by the billing provider shall be available on behalf of clients who have a need for such services, provided such services are medically necessary, s…

Regulations of Connecticut State AgenciesSec. 17b-262-341. Goods and services covered and limitationsThe department shall pay billing providers for the following physicians’ services:(1) Those procedures that are medically necessary to treat the client’s condition;(2) physicians’…

Regulations of Connecticut State AgenciesSec. 17b-262-341a. Physician Assistants(a) The department shall pay the billing provider for physicians’ services provided by a physician assistant who: (1) Provides services under the personal supervision of a physician;(2) acts within th…

Regulations of Connecticut State AgenciesSec. 17b-262-342. Goods and services not coveredThe department shall not pay for the following goods or services or goods or services related to the following: (1) Immunizations, biological products and other products available to provider…

Regulations of Connecticut State AgenciesSec. 17b-262-343. Need for servicePayment is available to billing providers for an initial office visit and continuing services that are medically necessary, provided that: (a) The services are within the provider’s scope of practice; and(…

Regulations of Connecticut State AgenciesSec. 17b-262-344. Prior authorization(a) Prior authorization, on forms and in the manner specified by the department, is required in order for payment to be available for the following physicians’ services. Prior authorization is also requ…

Regulations of Connecticut State AgenciesSec. 17b-262-345. Billing procedures(a) Billing providers 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 b…

Regulations of Connecticut State AgenciesSec. 17b-262-346. Payment(a) Fees shall be the same for in-state, border and out-of-state providers.(b) Payment shall be made at the lowest of: (1) The billing provider’s usual and customary charge;(2) the lowest Medicare rate;(3) the amou…

Regulations of Connecticut State AgenciesSec. 17b-262-347. Payment rateThe department shall establish and may periodically update the fees for covered physicians’ services in the department’s fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (Adopted eff…

Regulations of Connecticut State AgenciesSec. 17b-262-348. Payment limitations(a) The department shall pay only for physicians’ services performed by or under the personal supervision of a physician.(b) The department shall pay the fee for an initial visit by a provider in an off…

Regulations of Connecticut State AgenciesSec. 17b-262-349. Documentation and audit requirements(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, pertine…

Regulations of Connecticut State AgenciesSec. 17b-262-350—17b-262-439. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-4. EligibilityPayment for home health services is available to all persons eligible for Medicaid subject to the conditions and limitations which apply to these services. (Effective June 4, 1996)

Regulations of Connecticut State AgenciesSec. 17b-262-440—17b-262-449. (Repealed) Repealed January 31, 2008.

Regulations of Connecticut State AgenciesSec. 17b-262-450—17b-262-451. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-452. ScopeSections 17b-262-452 through 17b-262-463 inclusive set forth the Department of Social Services requirements for payment of: (a) medical and clinical services provided by licensed psychiatrists in private or group pra…

Regulations of Connecticut State AgenciesSec. 17b-262-453. DefinitionsFor the purposes of sections 17b-262-452 through 17b-262-463 the following definitions shall apply: (1) \"Acute\" means having rapid onset, severe symptoms, and a short course.(2) \"Acute Care\" means medical c…

Regulations of Connecticut State AgenciesSec. 17b-262-454. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, providers shall: (a) meet and maintain all applicable licensing, accreditation, and certification require…

Regulations of Connecticut State AgenciesSec. 17b-262-455. EligibilityPayment for psychiatrists' services shall be available on behalf of all persons eligible for the Medical Assistance Program subject to the conditions and limitations which apply to these services. (Adopted effe…

Regulations of Connecticut State AgenciesSec. 17b-262-456. Services covered and limitationsExcept for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed psychiatrist which conform to accepted methods of diagnosis and …

Regulations of Connecticut State AgenciesSec. 17b-262-457. Need for serviceThe department shall pay for medically necessary and medically appropriate psychiatric services for Medical Assistance Program eligible clients which are provided by a licensed physician who specializes in…

Regulations of Connecticut State AgenciesSec. 17b-262-458. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for all clients, including clients originally referred by another state agency for: (1) treatment services i…

Regulations of Connecticut State AgenciesSec. 17b-262-459. Billing procedures(a) Claims from psychiatrists 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 depar…

Regulations of Connecticut State AgenciesSec. 17b-262-460. 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-262-461. Payment rateThe commissioner establishes the fees contained in the psychiatrists' and allied health professionals' fee schedules pursuant to section 4-67c of the Connecticut General Statutes. (Adopted effective May 11, 19…

Regulations of Connecticut State AgenciesSec. 17b-262-462. Payment limitations(a) Psychiatrists' services shall be performed at the psychiatrist's private or group practice location, hospital, long-term care facility, clinic, or the client's home. (b) The psychiatrist who employs…

Regulations of Connecticut State AgenciesSec. 17b-262-463. Documentation(a) Psychiatrists shall maintain a specific record for all services received for each client eligible for Medical Assistance Program payment including, but not limited to: name, address, birth date, Medical A…

Regulations of Connecticut State AgenciesSec. 17b-262-464—17b-262-466. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-467. ScopePsychologists' services provide professional therapeutic intervention relating to mental, emotional, and social problems involving individuals or groups, taking into consideration the sum of actions, traits, attitude…

Regulations of Connecticut State AgenciesSec. 17b-262-468. DefinitionsFor the purposes of sections 17b-262-467 through 17b-262-478 the following definitions shall apply: (1) \"Client\" means a person eligible for goods or services under the department's Medical Assistance Program…

Regulations of Connecticut State AgenciesSec. 17b-262-469. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, providers shall: (a) meet and maintain all applicable licensing, accreditation, and certification require…

Regulations of Connecticut State AgenciesSec. 17b-262-470. EligibilityPayment for psychologists' services shall be available on behalf of all persons eligible for the Medical Assistance Program subject to the conditions and limitations which apply to these services. (Effective Ju…

Regulations of Connecticut State AgenciesSec. 17b-262-471. Services covered and limitationsExcept for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed psychologist which conform to accepted methods of diagnosis and …

Regulations of Connecticut State AgenciesSec. 17b-262-472. Services not coveredThe department shall not pay for the following psychological services:(a) information or services furnished by the psychologist to the client over the telephone;(b) all evaluations, diagnostic intervie…

Regulations of Connecticut State AgenciesSec. 17b-262-473. Need for service and authorization process(a) Need for ServiceThe department shall pay for psychological services which are provided by a licensed psychologist and are medically necessary and medically appropriate for the…

Regulations of Connecticut State AgenciesSec. 17b-262-474. Billing procedures(a) Claims from psychologists 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 depar…

Regulations of Connecticut State AgenciesSec. 17b-262-475. Payment(a) Psychologists who are fully or partially salaried by a general hospital, public or private institution, group practice, or clinic shall not receive payment from the department unless the psychologist maintains …

Regulations of Connecticut State AgenciesSec. 17b-262-476. Payment rateThe commissioner establishes the fees contained in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (Effective June 8, 1998)

Regulations of Connecticut State AgenciesSec. 17b-262-477. Payment limitations(a) The psychologist's interview of the client's family during the course of treatment in the psychologist's office shall be paid at the rate for individual therapy regardless of the number of persons i…

Regulations of Connecticut State AgenciesSec. 17b-262-478. Documentation(a) Psychologists shall maintain a specific record for all services received for each client eligible for Medical Assistance Program payment including, but not limited to: name, address, birth date, Medical A…

Regulations of Connecticut State AgenciesSec. 17b-262-479—17b-262-492. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-493. ScopeSections 17b-262-493 to 17b-262-498 inclusive, set forth the copayment requirements for clients who are eligible to receive prescription drugs, over-the-counter drugs, or refills covered under the Medicaid, General A…

Regulations of Connecticut State AgenciesSec. 17b-262-494. DefinitionsFor the purposes of sections 17b-262-493 to 17b-262-498 inclusive, the following definitions shall apply: (1) \"Client\" means a person eligible for services under the department's Medical Assistance Program. (…

Regulations of Connecticut State AgenciesSec. 17b-262-495. Services requiring a copaymentExcept for the exclusions specified in section 17b-262-496 below, a copayment shall be imposed on each prescription, over-the-counter drug, or refill which is furnished to a client and covere…

Regulations of Connecticut State AgenciesSec. 17b-262-496. Copayment exclusionsThe following list contains those clients and services not subject to a copayment:(a) The categories of clients and services described in subsection (b) of section 1916 of the Social Security Act and P…

Regulations of Connecticut State AgenciesSec. 17b-262-497. Copayment responsibilities(a) Each pharmacy provider shall collect the copayment amount from the client at the time of the service unless the pharmacy provider, in dispensing a prescription, over-the-counter drug, or refi…

Regulations of Connecticut State AgenciesSec. 17b-262-498. Copayment rateThe copayment amount shall be $1.00 for each prescription drug, over-the-counter drug or refill. (Adopted effective November 13, 1997)

Regulations of Connecticut State AgenciesSec. 17b-262-499. ScopeSections 17b-262-499 through 17b-262-510 inclusive set forth the Department of Social Services requirements for payment for Connecticut's Medical Assistance Program, when clients under age twenty-one and age sixty-fi…