Connecticut Administrative Code

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…

Regulations of Connecticut State AgenciesSec. 17b-262-569. Payment rateThe commissioner establishes the fees contained in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (Adopted effective March 6, 1998; Amended June 11, 2003)

Regulations of Connecticut State AgenciesSec. 17b-262-570. Payment limitations(a) Contact lenses shall be covered, when such lenses provide better management of a visual or ocular condition than can be achieved with spectacle lenses, including, but not limited to the diagnosis of…

Regulations of Connecticut State AgenciesSec. 17b-262-571. Documentation(a) Vision care providers shall maintain a specific record for all services and supplies received for each client eligible for Medical Assistance Program payment including, but not limited to: name, address, …

Regulations of Connecticut State AgenciesSec. 17b-262-572. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-573. ScopeSections 17b-262-573 through 17b-262-585 inclusive set forth the Department of Social Services requirements for payment of nurse-midwifery services performed by licensed nurse-midwifes for clients who are determined …

Regulations of Connecticut State AgenciesSec. 17b-262-574. Definitions.For the purposes of sections 17b-262-573 to 17b-262-585, 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-262-575. Provider participationIn order to enroll in the Medical Assistance Program and receive payment from the department, a nurse-midwife shall: (a) meet all applicable licensing, accreditation, and certification requirements;(…

Regulations of Connecticut State AgenciesSec. 17b-262-576. EligibilityPayment for nurse-midwifery services shall be available on behalf of all women and newborns, only throughout the maternity cycle, eligible for the Medical Assistance program subject to the conditions and limita…

Regulations of Connecticut State AgenciesSec. 17b-262-577. Services covered and limitationsExcept for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed and certified nurse-midwife which conform to accepted methods of…

Regulations of Connecticut State AgenciesSec. 17b-262-578. Services not coveredThe department shall not pay for the following:(a) nurse-midwifery services to newborns occurring beyond the maternity cycle;(b) any examinations, laboratory tests, biological products, immunizations, …

Regulations of Connecticut State AgenciesSec. 17b-262-579. Need for serviceThe department shall pay for medically necessary and appropriate nurse-midwifery services for Medical Assistance Program eligible clients: (a) requiring care during an essentially normal maternity cycle or…

Regulations of Connecticut State AgenciesSec. 17b-262-580. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for: (1) more than one visit per day per client; and(2) HealthTrack Special Services. (A) HealthTrack Specia…

Regulations of Connecticut State AgenciesSec. 17b-262-581. Billing procedures(a) Claims from nurse-midwifes 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 depa…

Regulations of Connecticut State AgenciesSec. 17b-262-582. PaymentPayment shall be made at the lowest of:(a) the provider's usual and customary charge to the general public;(b) the lowest Medicare rate;(c) the amount in the applicable fee schedule as published by the department;(…

Regulations of Connecticut State AgenciesSec. 17b-262-583. Payment rate(a) The commissioner establishes the fees contained in the department's fee schedule pursuant to section 4-67c of the Connecticut General Statutes. (b) Payment rates shall be the same for in-state and out-of-s…

Regulations of Connecticut State AgenciesSec. 17b-262-584. Payment limitations(a) The department shall pay for an initial visit by a nurse-midwife only once per client. Initial visits refer to the nurse-midwife's first contact with the client and reflect higher fees for the addit…

Regulations of Connecticut State AgenciesSec. 17b-262-585. Documentation(a) Nurse-midwifes shall maintain a specific medical record for all services rendered to each client eligible for Medical Assistance Program payment including, but not limited to: name, address, birth date, M…

Regulations of Connecticut State AgenciesSec. 17b-262-586. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-587. Purpose and scopeSections 17b-262-587 through 17b-262-596b, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of personal care assistance ser…

Regulations of Connecticut State AgenciesSec. 17b-262-588. DefinitionsFor the purposes of sections 17b-262-587 through 17b-262-596b, inclusive, of the Regulations of Connecticut State Agencies, the following definitions shall apply: (1) \"Activities of Daily Living\" means hands-…

Regulations of Connecticut State AgenciesSec. 17b-262-589. Eligibility and determination of need(a) In order to be eligible to receive coverage for the cost of personal care assistance services under the Department's Personal Care Assistance Waiver Program, an individual shall ei…

Regulations of Connecticut State AgenciesSec. 17b-262-590. Application process(a) The application process consists of: (1) a financial eligibility determination by the Department in accordance with the eligibility standards for participation in the Department's Title XIX medical …

Regulations of Connecticut State AgenciesSec. 17b-262-591. Waiting list(a) As a result of the limitation of the number of slots and/or funding, the Department shall establish and maintain a statewide waiting list for the Personal Care Assistance Waiver program when the Department…

Regulations of Connecticut State AgenciesSec. 17b-262-592. Limitations(a) The Department does not offer Personal Care Assistance Waiver services to more than the number of consumers specified in the federally approved Personal Care Assistance Waiver or to more than the number of …

Regulations of Connecticut State AgenciesSec. 17b-262-593. Services covered(a) Services covered are: (1) personal care assistance services provided in accordance with a personal care services plan which enable the consumer to carry out activities of daily living and instrumental …

Regulations of Connecticut State AgenciesSec. 17b-262-594. Determining the cost effectiveness of the service planIn order to determine the cost effectiveness of the consumer's service plan, the Department shall do all of the following: (1) Obtain the monthly average nursing facil…

Regulations of Connecticut State AgenciesSec. 17b-262-595. Payment(a) Payment for personal care assistance services for adults is made at the lowest of: (1) the maximum rate determined by the department for personal care assistance services;(2) a rate below the maximum based on a…

Regulations of Connecticut State AgenciesSec. 17b-262-596. Personal care assistant qualifications(a) The consumer is responsible for ensuring that his or her personal care assistants meet all of the following qualifications: (1) be at least 16 years of age except that, if the con…

Regulations of Connecticut State AgenciesSec. 17b-262-596a. Fair hearingsApplicants for and recipients of services under the Personal Care Assistance program may request and receive a fair hearing, in accordance with the rules of the Department's Medicaid program when the Departm…

Regulations of Connecticut State AgenciesSec. 17b-262-596b. (Repealed) Repealed March 9, 2006.

Regulations of Connecticut State AgenciesSec. 17b-262-597. ScopeSections 17b-262-597 through 17b-262-605 inclusive set forth the Department of Social Services (DSS) requirements for payment of early intervention services provided by the Department of Mental Retardation (DMR), or …

Regulations of Connecticut State AgenciesSec. 17b-262-598. DefinitionsFor the purposes of section 17b-262-597 through 17b-262-605 the following definitions shall apply: (1) \"Allied Health Professional or AHP\" means an individual who is licensed or certified or who is qualified …

Regulations of Connecticut State AgenciesSec. 17b-262-599. Provider participation(a) Billing ProviderIn order to enroll in the Medical Assistance Program and receive payment from the department for early intervention services rendered, the billing provider shall: (1) meet and mai…

Regulations of Connecticut State AgenciesSec. 17b-262-6. Designation of service area(a) All home health care agencies shall designate their service area by identifying the zip codes of the areas which they serve on a form to be provided by the department. All changes in that serv…

Regulations of Connecticut State AgenciesSec. 17b-262-600. Eligibility(a) Payment for early intervention services shall be available for all children eligible for the Medical Assistance Program subject to the conditions and limitations which apply to early intervention services a…

Regulations of Connecticut State AgenciesSec. 17b-262-601. Services covered and limitations(a) The department shall pay for the following: (1) evaluations and assessments;(2) early intervention services, which are medically appropriate and medically necessary as follows: (A) assi…

Regulations of Connecticut State AgenciesSec. 17b-262-602. Billing proceduresAll claims submitted to the department for payment of evaluation and early intervention services including assessments and assistive technology devices, shall be substantiated by documentation in the Bir…

Regulations of Connecticut State AgenciesSec. 17b-262-603. Payment(a) The department shall establish payment rates effective July 1, 1996.(b) The rate period shall be the state fiscal year.(c) Interim rates shall be issued for each rate period and such rates shall be replaced by …

Regulations of Connecticut State AgenciesSec. 17b-262-604. Documentation requirementsEarly intervention services shall be paid by the department only when the lead agency ensures compliance of the following documentation requirements on file with the performing provider, as appro…

Regulations of Connecticut State AgenciesSec. 17b-262-605. Audit and record retention(a) All supporting accounting and business records, statistical data, early intervention records, and other records relating to the provision of evaluation, assessment, service coordination, and …

Regulations of Connecticut State AgenciesSec. 17b-262-606. Reserved

Regulations of Connecticut State AgenciesSec. 17b-262-607. ScopeSections 17b-262-607 through 17b-262-618 inclusive set forth the Department of Social Services requirements for payment of nurse practitioner services provided by licensed advanced practice registered nurses for clie…

Regulations of Connecticut State AgenciesSec. 17b-262-608. Definitions.For the purposes of sections 17b-262-607 to 17b-262-618, 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-262-609. 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-262-610. EligibilityPayment for nurse practitioner 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. (Effectiv…

Regulations of Connecticut State AgenciesSec. 17b-262-611. Services covered and limitations(a) Except for the limitations and exclusions listed below, the department shall pay for: (1) medically necessary and medically appropriate professional services of a nurse practitioner whi…

Regulations of Connecticut State AgenciesSec. 17b-262-612. Services not coveredThe department shall not pay for the following:(a) Any procedures or services of an unproven, educational, social, research, experimental or cosmetic nature; for any diagnostic, therapeutic or treatmen…

Regulations of Connecticut State AgenciesSec. 17b-262-613. Need for serviceThe department shall pay for an initial office visit and continuing services which the department deems are medically necessary and medically appropriate, in relation to the diagnosis for which care is req…

Regulations of Connecticut State AgenciesSec. 17b-262-614. Prior authorization(a) Prior authorization, on forms and in a manner as specified by the department, is required for the following services: (1) more than one visit on the same day for the same client by the same provider…