Connecticut Administrative Code

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…

Regulations of Connecticut State AgenciesSec. 17b-262-5. PolicyNo home health care agency 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 home health care agenc…

Regulations of Connecticut State AgenciesSec. 17b-262-500. DefinitionsFor the purposes of sections 17b-262-499 through 17b-262-510 the following definitions shall apply: (1) \"Active Treatment\" means the definition contained in 42 Code of Federal Regulations (CFR), Part 441, sec…

Regulations of Connecticut State AgenciesSec. 17b-262-501. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, providers shall meet the following requirements: (a) General:(1) meet and maintain all applicable licensi…

Regulations of Connecticut State AgenciesSec. 17b-262-502. EligibilityPayment for inpatient psychiatric hospital services shall be available on behalf of Medical Assistance Program clients under age twenty-one and age sixty-five or over under the conditions and limitations which …

Regulations of Connecticut State AgenciesSec. 17b-262-503. Services coveredThe department shall pay for the following:(a) medically necessary and medically appropriate inpatient psychiatric services for clients under age twenty-one or age sixty-five or over when the need for serv…

Regulations of Connecticut State AgenciesSec. 17b-262-504. Services not coveredThe department shall not pay for the following inpatient psychiatric hospital services which are not covered under the Medical Assistance Program: (a) procedures or services of an unproven, educational…

Regulations of Connecticut State AgenciesSec. 17b-262-505. Certification of need review requirements for inpatient psychiatric services for a client under age twenty-one in a psychiatric hospital(a) In order to receive payment for inpatient psychiatric hospital services for indiv…

Regulations of Connecticut State AgenciesSec. 17b-262-506. Individual plan of care requirements for inpatient psychiatric services for a client under age twenty-one in a psychiatric hospital(a) Inpatient psychiatric services for clients under age twenty-one shall constitute activ…

Regulations of Connecticut State AgenciesSec. 17b-262-507. Individual plan of care for a client age sixty-five or over in a psychiatric hospital(a) A written, individual plan of care shall be developed to ensure that institutional care maintains the client at, or restores them to…

Regulations of Connecticut State AgenciesSec. 17b-262-508. Utilization review program for inpatient psychiatric services for clients under age twenty-one or age sixty-five or over(a) The department's Utilization Review Program conducts utilization review activities for services d…

Regulations of Connecticut State AgenciesSec. 17b-262-509. Billing proceduresClaims from inpatient psychiatric 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 re…

Regulations of Connecticut State AgenciesSec. 17b-262-510. Documentation and record retention(a) A provider shall meet the special medical record requirements for a psychiatric hospital and shall maintain records to support claims made for payment. All documentation shall be made…

Regulations of Connecticut State AgenciesSec. 17b-262-511. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-512. ScopeSections 17b-262-512 through 17b-262-520 inclusive set forth the Department of Social Services requirements for the payment of radiology services performed by an independent radiology or ultrasound center provided in…

Regulations of Connecticut State AgenciesSec. 17b-262-513. DefinitionsFor the purposes of sections 17b-262-512 through 17b-262-520 the following definitions shall apply: (1) \"Acute\" means having rapid onset, severe symptoms, and a short course.(2) \"Client\" means a person elig…

Regulations of Connecticut State AgenciesSec. 17b-262-514. 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-262-515. EligibilityPayment for radiology or ultrasound center 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 service…

Regulations of Connecticut State AgenciesSec. 17b-262-516. Services coveredThe department shall pay for:(a) medically appropriate and medically necessary radiology or ultrasound center services as published in the department's fee schedule when ordered by a licensed physician or …

Regulations of Connecticut State AgenciesSec. 17b-262-517. Need for service and authorization process(a) Need for ServiceThe department shall pay for independent radiology and ultrasound center services which are ordered by a duly licensed physician or other licensed practitioner…