Connecticut Administrative Code

Regulations of Connecticut State AgenciesSec. 17b-262-214. DefinitionsFor purposes of section 17b-262-213 through 17b-262-224 the following definitions shall apply: (1) \"Allied Health Professional\" means an individual who is licensed or certified by the Department of Public Hea…

Regulations of Connecticut State AgenciesSec. 17b-262-215. Provider participationIn order to participate in the Connecticut Medical Assistance Program and provide SBCH Services eligible for Medicaid reimbursement from the Department, the provider shall meet the following requirem…

Regulations of Connecticut State AgenciesSec. 17b-262-216. EligibilityMedicaid funding is available for SBCH Services under section 17b-262-218 below on behalf of all children who are Medicaid recipients. (Effective January 31, 1996; Amended May 10, 2000) AUTHORITY: Conn. Gen. St…

Regulations of Connecticut State AgenciesSec. 17b-262-217. Need for servicesMedicaid shall reimburse for SBCH Services provided the following requirements are met: (a) The diagnostic and evaluation services recommended by the PPT and a licensed practitioner of the healing arts in…

Regulations of Connecticut State AgenciesSec. 17b-262-218. Services coveredThe Department shall pay for the following services:(a) AudiologyAudiology services include, but are not limited to: (1) identification of children with hearing loss; (2) determination of the range, nature…

Regulations of Connecticut State AgenciesSec. 17b-262-219. Limitations(a) No payments shall be made by Medicaid: (1) directly to health professionals or organizations under contract to a LEA for medically appropriate and necessary services covered under section 17b-262-218 above;…

Regulations of Connecticut State AgenciesSec. 17b-262-220. Documentation and record retention requirements(a) A permanent service record documenting each SBCH Service provided to each medicaid eligible child shall be maintained by the LEA at which the child is enrolled at the tim…

Regulations of Connecticut State AgenciesSec. 17b-262-221. Billing requirements(a) All SBCH Services performed on behalf of Medicaid-eligible children shall be recorded on the required claim forms for the SBCH provider and submitted to the Department in accordance with the billin…

Regulations of Connecticut State AgenciesSec. 17b-262-222. Establishment of rates(a) The Department shall establish payment rates for three (3) types of service specific to type of placement for SBCH Services: (1) a per month per child unit rate for SBCH treatment services, speci…

Regulations of Connecticut State AgenciesSec. 17b-262-223. Audit/compliance reviewAll supporting accounting and business records, statistical data, the child's permanent service record and all other records relating to the provision of SBCH Services paid for by the Department sha…

Regulations of Connecticut State AgenciesSec. 17b-262-224—17b-262-298. Reserved AUTHORITY: Conn. Gen. Stat. § 17b-262

Regulations of Connecticut State AgenciesSec. 17b-262-299. ScopeSections 17b-262-299 to 17b-262-311, inclusive, of the Regulations of Connecticut State Agencies set forth the requirements for payment of services provided by Intermediate Care Facilities for the Mentally Retarded t…

Regulations of Connecticut State AgenciesSec. 17b-262-3. Provider participationIn order to receive payment from the department for home health services, all Home Health Care Agencies shall be licensed by the Department of Public Health and shall meet the requirements for particip…

Regulations of Connecticut State AgenciesSec. 17b-262-300. DefinitionsAs used in sections 17b-262-299 to 17b-262-311, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Active treatment\" means the treatment as described in 42…

Regulations of Connecticut State AgenciesSec. 17b-262-301. Provider participationIn order to 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 an…

Regulations of Connecticut State AgenciesSec. 17b-262-302. EligibilityPayment to Intermediate Care Facilities for the Mentally Retarded is available on behalf of all clients who are determined to be in need of ICF/MR care by the Department of Mental Retardation and the Department…

Regulations of Connecticut State AgenciesSec. 17b-262-303. Services covered and limitations(a) Services Covered(1) The 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-…

Regulations of Connecticut State AgenciesSec. 17b-262-304. Need for services and authorization process(a) The decision to admit and the subsequent admission to a facility must be made by the Department of Mental Retardation or the admitting ICF/MR in conjunction with the client's…

Regulations of Connecticut State AgenciesSec. 17b-262-305. Client's bill of rights(a) An ICF/MR shall protect and promote the rights of each client as described in 42 CFR 483.420, as amended from time to time. (b) Requirements for the administration of the patient's personal allo…

Regulations of Connecticut State AgenciesSec. 17b-262-306. Bed reserve for hospitalization(a) DSS shall pay to reserve a bed in an ICF/MR for a client during a temporary absence in a hospital for up to fifteen (15) days in accordance with subsection (e) of this section. (b) The I…

Regulations of Connecticut State AgenciesSec. 17b-262-307. Bed reserve for home leave(a) DSS shall pay to reserve a bed in an ICF/MR for a client during a temporary absence for home leave for up to thirty-six (36) days per calendar year. The ICF/MR shall not make the reserved bed…

Regulations of Connecticut State AgenciesSec. 17b-262-308. Applied income(a) DSS is responsible for calculating the applied income. DSS shall notify the ICF/MR of the amount of any applied income that the facility is responsible for collecting. Applied income shall be deducted fr…

Regulations of Connecticut State AgenciesSec. 17b-262-309. Billing and payment procedures(a) The ICF/MR 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 ICFs/MR. (b)…

Regulations of Connecticut State AgenciesSec. 17b-262-310. RatesThe per diem rates for an ICF/MR shall be determined annually, pursuant to section 17b-340 of the Connecticut general statutes and sections 17-311-1 to 17-311-120, inclusive, of the Regulations of Connecticut State A…

Regulations of Connecticut State AgenciesSec. 17b-262-311. Documentation(a) The ICF/MR shall maintain all documentation required for rate setting purposes for a minimum of 10 years pursuant to section 17-311-56 of the Regulations of Connecticut State Agencies, including all docum…

Regulations of Connecticut State AgenciesSec. 17b-262-312—17b-262-336. Reserved AUTHORITY: Conn. Gen. Stat. § 17b-262

Regulations of Connecticut State AgenciesSec. 17b-262-337. ScopeSections 17b-262-337 to 17b-262-349, 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 or …

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 AUTHORITY: Conn. Gen. Stat. § 17b-262

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) AUTHORITY: Conn. Gen. Stat. § 1…

Regulations of Connecticut State AgenciesSec. 17b-262-440—17b-262-449. (Repealed) Repealed January 31, 2008. AUTHORITY: Conn. Gen. Stat. § 17b-262

Regulations of Connecticut State AgenciesSec. 17b-262-450—17b-262-451. Reserved AUTHORITY: Conn. Gen. Stat. § 17b-262

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…