Connecticut Administrative Code

Regulations of Connecticut State AgenciesSec. 17b-262-728. Services covered and limitations(a) Subject to the limitations and exclusions identified in sections 17b-262-724 to 17b-262-735, inclusive, of the Regulations of Connecticut State Agencies, the department shall pay for me…

Regulations of Connecticut State AgenciesSec. 17b-262-729. Services not coveredThe department shall not pay a home health care agency:(1) for services provided to a client who is receiving the same service concurrently from an individual therapist, clinic, hospital, practitioner,…

Regulations of Connecticut State AgenciesSec. 17b-262-730. Cost effectiveness test(a) The department shall apply a cost effectiveness test for all prior authorization requests for: (1) home health aide services in excess of fourteen hours per week; and (2) all extended nursing se…

Regulations of Connecticut State AgenciesSec. 17b-262-731. Need for service(a) The department shall pay for medically necessary and medically appropriate home health care services only under orders of a licensed practitioner as part of a care plan. (b) The department shall pay fo…

Regulations of Connecticut State AgenciesSec. 17b-262-732. Prior authorization(a) To receive payment from the department the provider shall comply with the prior authorization requirements described in section 17b-262-528 of the Regulations of Connecticut State Agencies and this …

Regulations of Connecticut State AgenciesSec. 17b-262-733. Billing procedures(a) Claims from home health care agencies shall be submitted on the department's designated form or electronically transmitted to the department or its agent, in a form and manner as specified by the dep…

Regulations of Connecticut State AgenciesSec. 17b-262-734. Payment(a) Payment(1) The commissioner shall establish the fees for home health care services in the department's fee schedule pursuant to section 17b-242 of the Connecticut General Statutes. (2) The department shall pay …

Regulations of Connecticut State AgenciesSec. 17b-262-735. Documentation(a) All required documentation shall be maintained for at least five years, or longer by the provider in accordance with statute or regulation, subject to review by the department. Documentation as set forth …

Regulations of Connecticut State AgenciesSec. 17b-262-736. ScopeSections 17b-262-736 to 17b-262-746, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment to providers of orthotic and prosthetic devices th…

Regulations of Connecticut State AgenciesSec. 17b-262-737. DefinitionsAs used in sections 17b-262-736 to 17b-262-746, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Chronic disease hospital\" means a \"chronic disease hosp…

Regulations of Connecticut State AgenciesSec. 17b-262-738. Provider participationTo enroll in the Medicaid program 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…

Regulations of Connecticut State AgenciesSec. 17b-262-739. EligibilityA provider may receive reimbursement from the department for the provision of an orthotic and prosthetic device to a client. No reimbursement shall be made unless a licensed practitioner has prescribed the orth…

Regulations of Connecticut State AgenciesSec. 17b-262-740. Services covered and limitations(a) Services Covered(1) The department shall pay for the purchase or repair of a medically necessary and medically appropriate orthotic or prosthetic device, except as limited by sections 1…

Regulations of Connecticut State AgenciesSec. 17b-262-741. Goods and services not coveredThe department shall not pay providers for:(1) any orthotic or prosthetic device that is of an unproven, experimental or research nature or for services in excess of those deemed medically ne…

Regulations of Connecticut State AgenciesSec. 17b-262-742. Prior authorization(a) The department shall require PA for any orthotic or prosthetic device identified on the department's published fee schedule as requiring PA. (b) To receive reimbursement from the department a provid…

Regulations of Connecticut State AgenciesSec. 17b-262-743. Billing procedure(a) Claims from providers shall be submitted on a hard copy invoice or electronically transmitted to the department or its agent in a form and in a manner specified by the department and shall include all…

Regulations of Connecticut State AgenciesSec. 17b-262-744. Payment limitations(a) The department shall reimburse a provider when all requirements of sections 17b-262-736 to 17b-262-746, inclusive, of the Regulations of Connecticut State Agencies have been met. (b) The department …

Regulations of Connecticut State AgenciesSec. 17b-262-745. Documentation(a) All required documentation shall be maintained for at least five (5) years in the provider's primary place of business and shall be subject to review by the department. In the event of a dispute concernin…

Regulations of Connecticut State AgenciesSec. 17b-262-746. Other(a) Where brand names or stock or model numbers are specified on the prescription or the PA, no substitution shall be permitted without the written approval of the department. (b) The provider shall instruct the clie…

Regulations of Connecticut State AgenciesSec. 17b-262-747. ScopeSections 17b-262-747 to 17b-262-757, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of rehabilitative services provided by private no…

Regulations of Connecticut State AgenciesSec. 17b-262-748. DefinitionsAs used in sections 17b-262-747 through 17b-262-757, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply: (1) \"Billing provider\" means the Connecticut Department …

Regulations of Connecticut State AgenciesSec. 17b-262-749. Provider and billing provider requirementsTo participate in the Medicaid program and provide PNMI rehabilitative services that are eligible for Medicaid reimbursement from the department, the following requirements shall …

Regulations of Connecticut State AgenciesSec. 17b-262-750. EligibilityPayment for PNMI rehabilitative services shall be subject to available appropriations and shall be available for services rendered to PNMI clients under the conditions and limitations that are set forth in sect…

Regulations of Connecticut State AgenciesSec. 17b-262-751. Need for servicesPayment for PNMI rehabilitative services shall be made by the department only if all of the following conditions are met: (1) The client shall be assessed by the billing provider or its agent to determine…

Regulations of Connecticut State AgenciesSec. 17b-262-752. Covered servicesPNMI rehabilitative services shall include the following services:(1) Assessment, treatment planning and support activities that assist the client in gaining access to authorized services. These services i…

Regulations of Connecticut State AgenciesSec. 17b-262-753. LimitationsCoverage of PNMI rehabilitative services shall be subject to the following limitations:(1) PNMI rehabilitative services shall be pre-authorized by DCF based on a written service recommendation. (2) The PNMI reh…

Regulations of Connecticut State AgenciesSec. 17b-262-754. Documentation and record retention requirementsPNMI rehabilitative services shall be reimbursed by the department when documentation of compliance with the following requirements is on file with the billing provider or th…

Regulations of Connecticut State AgenciesSec. 17b-262-755. Billing requirements(a) Claims for payment of PNMI rehabilitation services shall be submitted by the billing provider on the department's uniform billing form or electronically transmitted to the Department's fiscal agent…

Regulations of Connecticut State AgenciesSec. 17b-262-756. PaymentPayment by the department for PNMI rehabilitative services shall be made in accordance with the following provisions. (1) The department shall make payments on the basis of monthly rates for each of three types of …

Regulations of Connecticut State AgenciesSec. 17b-262-757. Audit and compliance reviewAll supporting accounting and business records, statistical data and all other records relating to the provision of PNMI rehabilitative services paid for by the department shall be subject to au…

Regulations of Connecticut State AgenciesSec. 17b-262-758. ScopeSections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of rehabilitative services provided by private no…

Regulations of Connecticut State AgenciesSec. 17b-262-759. DefinitionsAs used in sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Adult\" means a person who is 18 years of age or older;(2) \"Department\" or \"DSS\" means the …

Regulations of Connecticut State AgenciesSec. 17b-262-760. Provider participationIn order to participate in the Medicaid program and provide PNMI rehabilitative services that are eligible for Medicaid reimbursement from the department, the provider shall: (1) Enroll with the depa…

Regulations of Connecticut State AgenciesSec. 17b-262-761. EligibilityPayment for PNMI rehabilitative services shall be available for services rendered to PNMI clients under the conditions and limitations that are set forth in sections 17b-262-758 to 17b-262-769, inclusive, of th…

Regulations of Connecticut State AgenciesSec. 17b-262-762. Need for servicesPayment for PNMI rehabilitative services shall be made by the department only if all of the following conditions are met: (1) For up to thirty days of a PNMI client's initial stay in a PNMI program, the P…

Regulations of Connecticut State AgenciesSec. 17b-262-763. Covered servicesPNMI rehabilitative services are services designed to assist individuals with a serious and persistent mental illness to achieve their highest degree of independent functioning and recovery. These services…

Regulations of Connecticut State AgenciesSec. 17b-262-764. LimitationsCoverage of PNMI rehabilitative services shall be subject to the following limitations:(1) PNMI rehabilitative services shall be pre-authorized by the department or its agent based on a written service recommen…

Regulations of Connecticut State AgenciesSec. 17b-262-765. Prior authorization(a) Prior authorization of the need for PNMI adult rehabilitative services is required in order for Medicaid payment to be available for the services. Prior authorization shall be obtained on forms and …

Regulations of Connecticut State AgenciesSec. 17b-262-766. Documentation and record retention requirementsProviders shall comply with the following documentation and record retention requirements:(1) An initial residential rehabilitation plan and all updated versions, including t…

Regulations of Connecticut State AgenciesSec. 17b-262-767. Billing requirements(a) Claims for payment of PNMI rehabilitation services shall be on the department's uniform billing form or electronically transmitted to the department's fiscal agent and shall include all information…

Regulations of Connecticut State AgenciesSec. 17b-262-768. PaymentPayment by the department for PNMI rehabilitative services shall be made in accordance with the following provisions. (a) The department shall make payments on the basis of monthly rates for PNMI programs.(b) A sta…

Regulations of Connecticut State AgenciesSec. 17b-262-769. Audit and compliance reviewAll supporting accounting and business records, statistical data and all other records relating to the provision of PNMI rehabilitative services paid for by the department shall be subject to au…

Regulations of Connecticut State AgenciesSec. 17b-262-770. ScopeSections 17b-262-770 to 17b-262-773, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the establishment by Medicaid entities of policies and pro…

Regulations of Connecticut State AgenciesSec. 17b-262-771. DefinitionsAs used in sections 17b-262-770 to 17b-262-773, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Entity\" means a government agency, organization, unit, corporation, partnership, or other busi…

Regulations of Connecticut State AgenciesSec. 17b-262-772. Provider participationTo receive payment from the Department for the provision of goods or services to Medicaid clients, entities shall comply with sections 17b-262-770 to 17b-262-773, inclusive, of the Regulations of Con…

Regulations of Connecticut State AgenciesSec. 17b-262-773. Establishment and dissemination of written policies(a) An entity shall establish and disseminate written policies, which shall also be adopted by its contractors or agents. Written policies may be on paper or in electroni…

Regulations of Connecticut State AgenciesSec. 17b-262-774—17b-262-778. Reserved AUTHORITY: Conn. Gen. Stat. § 17b-262