Connecticut Administrative Code

Regulations of Connecticut State AgenciesSec. 17b-262-522. ScopeSections 17b-262-522 through 17b-262-532, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services general requirements to which providers of Medical Assistance Program …

Regulations of Connecticut State AgenciesSec. 17b-262-523. DefinitionsFor the purposes of sections 17b-262-522 through 17b-262-532, inclusive, of the Regulations of Connecticut State Agencies the following definitions apply: (1) \"Acute\" means symptoms that are severe and have a…

Regulations of Connecticut State AgenciesSec. 17b-262-524. Provider participation(a) To enroll in the Medical Assistance Program and receive payment from the department for the provision of goods or services to Medical Assistance Program clients, providers shall: (1) Meet and mai…

Regulations of Connecticut State AgenciesSec. 17b-262-525. Termination or suspension of provider agreement(a) Providers shall be subject to all of the conditions contained in section 17b-99 of the Connecticut General Statutes and sections 17-83k-1 through 17-83k-7 of the Regulati…

Regulations of Connecticut State AgenciesSec. 17b-262-526. General provider requirementsTo maintain enrollment in the Connecticut Medical Assistance Program, a provider shall abide by all federal and state statutes regulations and operational procedures promulgated by the departm…

Regulations of Connecticut State AgenciesSec. 17b-262-527. Need for goods or servicesThe department shall review the medical appropriateness and medical necessity of medical goods and services provided to Medical Assistance Program clients both before and after making payment for…

Regulations of Connecticut State AgenciesSec. 17b-262-528. Prior authorization(a) Prior authorization, to determine medical appropriateness and medical necessity, shall be required as a condition of payment for certain Medical Assistance Program goods or services as set forth in …

Regulations of Connecticut State AgenciesSec. 17b-262-529. Billing procedures(a) Claims from providers shall be submitted on the department's designated form or electronically transmitted to the department's fiscal agent within twelve months of the date the service was provided o…

Regulations of Connecticut State AgenciesSec. 17b-262-530. Payment rates(a) All schedules of payment for coverable Medical Assistance Program goods and services shall be established by the commissioner and paid by the department in accordance with all applicable federal and state…

Regulations of Connecticut State AgenciesSec. 17b-262-531. Payment limitationsPayment, by the department, to all providers shall be limited to medically appropriate and medically necessary goods or services furnished to Medical Assistance Program clients. The following payment li…

Regulations of Connecticut State AgenciesSec. 17b-262-532. Payment for out-of-state goods or services(a) Pursuant to 42 CFR 431.52, payment for Medical Assistance Program goods or services furnished to clients while they are out-of-state shall be made by the department to the sam…

Regulations of Connecticut State AgenciesSec. 17b-262-533. Sums paid in excess of the authorized schedules of payment or for other reasons of ineligibility for paymentAny payment, or part thereof, for Medical Assistance Program goods or services which represents an excess over th…

Regulations of Connecticut State AgenciesSec. 17b-262-534. Reserved AUTHORITY: Conn. Gen. Stat. § 17b-262 AUTHORITY: Conn. Gen. Stat. § 17b-262

Regulations of Connecticut State AgenciesSec. 17b-262-535. ScopeSections 17b-262-535 through 17b-262-545 inclusive set forth the Department of Social Services requirements for payment of chiropractic services, performed by licensed practitioners of chiropractic in private or grou…

Regulations of Connecticut State AgenciesSec. 17b-262-536. DefinitionsFor the purposes of sections 17b-262-535 through 17b-262-545 the following definitions shall apply: (1) \"Acute\" means having rapid onset, severe symptoms, and a short course.(2) \"Chiropractic\" means the ser…

Regulations of Connecticut State AgenciesSec. 17b-262-537. 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-262-538. EligibilityPayment for chiropractic 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 effect…

Regulations of Connecticut State AgenciesSec. 17b-262-539. Services covered and limitations(a) Except for the limitations and exclusions listed below, the department shall pay for the following: (1) the manual manipulation of the spine, but not for any procedures or services of a…

Regulations of Connecticut State AgenciesSec. 17b-262-540. Services not coveredThe department shall not pay for the following chiropractic services which are not covered under the Medical Assistance Program:(1) chiropractic practice does not include the prescription or administra…

Regulations of Connecticut State AgenciesSec. 17b-262-541. Need for serviceThe department shall pay for medically necessary and medically appropriate treatment only when: (a) provided by a licensed practitioner of chiropractic and the services are within the scope of practice of …

Regulations of Connecticut State AgenciesSec. 17b-262-542. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for: (1) manipulation of the spine in excess of five per client per provider per month; and(2) HealthTrack S…

Regulations of Connecticut State AgenciesSec. 17b-262-543. Billing procedures(a) The amount billed to the department shall represent the practitioner of chiropractic's usual and customary charge for the services delivered. (b) Claims from practitioners of chiropractic shall be su…

Regulations of Connecticut State AgenciesSec. 17b-262-544. 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-262-545. Documentation(a) Practitioners of chiropractic 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…

Regulations of Connecticut State AgenciesSec. 17b-262-546. Reserved AUTHORITY: Conn. Gen. Stat. § 17b-262 AUTHORITY: Conn. Gen. Stat. § 17b-262

Regulations of Connecticut State AgenciesSec. 17b-262-547. ScopeSections 17b-262-547 through 17b-262-557 inclusive set forth the Department of Social Services requirements for payment of natureopathic services provided by licensed natureopaths for clients who are determined eligi…

Regulations of Connecticut State AgenciesSec. 17b-262-548. DefinitionsFor the purposes of sections 17b-262-547 through 17b-262-557 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-262-549. Provider participationIn order to participate in the Medical Assistance Program and receive payment from the department, providers shall: (a) meet and maintain all applicable licensing, accreditation, and certification re…

Regulations of Connecticut State AgenciesSec. 17b-262-550. EligibilityPayment for natureopathic 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 effec…

Regulations of Connecticut State AgenciesSec. 17b-262-551. Services covered and limitationsExcept for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed natureopath which conform to accepted methods of diagnosis and t…

Regulations of Connecticut State AgenciesSec. 17b-262-552. Services not coveredThe department shall not pay for the following natureopathic services:(a) the administration of internal medication or substances simulating medicine, or the form of medicine; (b) the administration of…

Regulations of Connecticut State AgenciesSec. 17b-262-553. Need for serviceThe department shall pay for medically necessary and medically appropriate treatment only when: (a) provided by a licensed natureopath and the services are within the scope of the natureopath's scope of pr…

Regulations of Connecticut State AgenciesSec. 17b-262-554. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, shall be required for: (1) professional office or home visits in excess of five per client per provider per month, and (…

Regulations of Connecticut State AgenciesSec. 17b-262-555. Billing procedures(a) Claims for natureopathic services shall be submitted on hard copy invoice or electronically transmitted to the department's fiscal agent, in a form and manner as specified by the department, and shal…

Regulations of Connecticut State AgenciesSec. 17b-262-556. 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-262-557. Documentation(a) Natureopathic care providers 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 …

Regulations of Connecticut State AgenciesSec. 17b-262-558. Reserved AUTHORITY: Conn. Gen. Stat. § 17b-262 AUTHORITY: Conn. Gen. Stat. § 17b-262

Regulations of Connecticut State AgenciesSec. 17b-262-559. ScopeSections 17b-262-559 through 17b-262-571, inclusive, set forth the Department of Social Services requirements for payment of accepted methods of treatment provided by an ophthalmologist, optometrist, or optician for …

Regulations of Connecticut State AgenciesSec. 17b-262-560. DefinitionsFor the purposes of sections 17b-262-559 through 17b-262-571 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-262-561. 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-262-562. EligibilityPayment for vision care 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 effecti…

Regulations of Connecticut State AgenciesSec. 17b-262-563. Services covered and limitations(a) Except for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed ophthalmologist, optometrist, or optician which conform to a…

Regulations of Connecticut State AgenciesSec. 17b-262-564. Services not coveredThe department shall not pay for the following:(a) information or services provided to a client by a provider over the telephone;(b) cancelled office visits and appointments not kept;(c) a spare pair o…

Regulations of Connecticut State AgenciesSec. 17b-262-565. Need for serviceThe department shall pay for medically necessary and medically appropriate vision care services for Medical Assistance Program eligible clients, in relation to the diagnosis for which care is required, pro…

Regulations of Connecticut State AgenciesSec. 17b-262-566. Early periodic screening, diagnostic and treatment services(a) Prior authorization for EPSDT services not on the Vision Care fee schedule or which are on such fee schedule but for which there are limitations in the amount…

Regulations of Connecticut State AgenciesSec. 17b-262-567. Billing procedures(a) Claims from providers shall be submitted on the department's designated form or electronically submitted to the department's fiscal agent and shall include all information required by the department …

Regulations of Connecticut State AgenciesSec. 17b-262-568. Payment(a) Payment rates shall be the same for in-state and out-of-state providers.(b) Payment for professional services shall be made at the lowest of: (1) the provider's usual and customary charge;(2) the lowest Medicar…