Connecticut Administrative Code

Regulations of Connecticut State AgenciesSec. 17b-262-782. EligibilityPayment for chronic disease hospital services is available on behalf of all clients subject to the conditions and limitations that apply to these services. (Adopted effective October 6, 2009) AUTHORITY: Conn. G…

Regulations of Connecticut State AgenciesSec. 17b-262-783. Need for serviceIn order for a client to be approved for admission to a chronic disease hospital, the client shall meet the criteria for admission as either a chronic disease client or a rehabilitation client. All care sh…

Regulations of Connecticut State AgenciesSec. 17b-262-784. Services coveredThe department shall pay an all-inclusive per diem rate to the provider for each resident for whom payment has been authorized pursuant to section 17b-262-783 of the Regulations of Connecticut State Agenci…

Regulations of Connecticut State AgenciesSec. 17b-262-785. Service limitationsPayment shall be made for the date of admission but not for the date of discharge. Exceptions to this are: (a) payment shall be made for the date of death when the resident dies in the chronic disease h…

Regulations of Connecticut State AgenciesSec. 17b-262-786. Services not covered(a) The department shall not pay a chronic disease hospital that is characterized as an institution for mental diseases except for services to clients aged 65 and older or under age 22 in accordance wi…

Regulations of Connecticut State AgenciesSec. 17b-262-787. Authorization process(a) The department shall pay a provider only when the department has authorized payment for the client's admission to that chronic disease hospital. (b) The provider shall comply with the authorizatio…

Regulations of Connecticut State AgenciesSec. 17b-262-788. Applied income(a) A client who receives chronic disease hospital services is responsible for paying applied income to the chronic disease hospital. (b) The department shall calculate the applied income. The department sha…

Regulations of Connecticut State AgenciesSec. 17b-262-789. Billing and payment procedures(a) Claims from providers 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 t…

Regulations of Connecticut State AgenciesSec. 17b-262-790. Rates(a) The per diem rate for a chronic disease hospital is determined annually pursuant to section 17b-239 of the Connecticut General Statutes for freestanding chronic disease hospitals or section 17b-340 of the Connect…

Regulations of Connecticut State AgenciesSec. 17b-262-791. Documentation(a) The chronic disease hospital shall maintain all documentation required for rate setting purposes in accordance with section 17-311-56 of the Regulations of Connecticut State Agencies. This documentation i…

Regulations of Connecticut State AgenciesSec. 17b-262-792. ScopeSections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment to providers of hearing aids and supplies that are…

Regulations of Connecticut State AgenciesSec. 17b-262-793. DefinitionsAs used in sections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Actual acquisition cost\" means the price paid to a manufacturer by a hearing aid provider for …

Regulations of Connecticut State AgenciesSec. 17b-262-794. Provider participationTo enroll in the Medicaid program and receive payment from the department, providers shall comply with sections 17b-262-792 to 17b-262-803, inclusive, of the Regulations of Connecticut State Agencies…

Regulations of Connecticut State AgenciesSec. 17b-262-795. Need for service(a) The department shall pay for the purchase or repair of a medically necessary hearing aid or supply, subject to the conditions and limitations described in sections 17b-262-792 to 17b-262-803, inclusive…

Regulations of Connecticut State AgenciesSec. 17b-262-796. EligibilityPayment to a provider for hearing aids and related supplies is available for clients who have a need for such products and services which meets the department's definition of a hearing aid when the items are me…

Regulations of Connecticut State AgenciesSec. 17b-262-797. Services covered and limitations(a) The department shall maintain a fee schedule for hearing aids and supplies, subject to the conditions and limitations set forth in sections 17b-262-792 to 17b-262-803, inclusive, of the…

Regulations of Connecticut State AgenciesSec. 17b-262-798. Goods and services not coveredThe department shall not pay providers for:(a) Any hearing aid that is of an unproven, experimental or research nature or for services in excess of those deemed medically necessary by the dep…

Regulations of Connecticut State AgenciesSec. 17b-262-799. Payment and payment limitations(a) Fees shall be the same for in-state, border-state and out-of-state providers.(b) Payment shall be made at the lowest of: (1) The provider's usual and customary charge;(2) the lowest Medi…

Regulations of Connecticut State AgenciesSec. 17b-262-8. Legitimate non-discriminatory reason(a) In any case in which a home health care agency is required to provide written justification based upon legitimate non-discriminatory reasons in accordance with this section, the home …

Regulations of Connecticut State AgenciesSec. 17b-262-800. Prior authorization(a) The department shall require PA for: (1) Any hearing aid that is identified on the department's fee schedule as requiring PA;(2) EPSDT special services; and(3) any service or device that is not on t…

Regulations of Connecticut State AgenciesSec. 17b-262-801. Billing procedure(a) Claims from providers shall be submitted on a hard copy invoice or electronically transmitted to the department in a form and in a manner specified by the department and shall include all information …

Regulations of Connecticut State AgenciesSec. 17b-262-802. Documentation(a) Providers shall maintain all fiscal and medical records related to services and goods rendered or delivered to clients. (b) All required documentation, including evidence of a medical evaluation for a hea…

Regulations of Connecticut State AgenciesSec. 17b-262-803. 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-262-804. ScopeSections 17b-262-804 to 17b-262-816, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment for Psychiatric Residential Treatment Facilities …

Regulations of Connecticut State AgenciesSec. 17b-262-805. DefinitionsAs used in section 17b-262-804 to section 17b-262-816, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Active treatment\" means \"active treatment\" as defined in 42 CFR, Part 441, section 44…

Regulations of Connecticut State AgenciesSec. 17b-262-806. Provider participationIn order to enroll in Medicaid and receive payment from the department, a provider shall meet the following requirements: (a) General:(1) meet and maintain all applicable licensing, accreditation and…

Regulations of Connecticut State AgenciesSec. 17b-262-807. EligibilityPayment for PRTF services shall be available, subject to the conditions and limitations set forth in sections 17b-262-804 to17b-262-816, inclusive, of the Regulations of Connecticut State Agencies, for services…

Regulations of Connecticut State AgenciesSec. 17b-262-808. Services covered(a) The department shall pay a per diem rate, which is an inclusive payment for all services that are required to be provided by the facility as a condition for participation as a PRTF, including, but not …

Regulations of Connecticut State AgenciesSec. 17b-262-809. Services not coveredThe department shall not pay for the following PRTF services that are not covered under Medicaid: (a) procedures or services of an unproven, educational, social, research, experimental or cosmetic natu…

Regulations of Connecticut State AgenciesSec. 17b-262-810. Certification of need requirements(a) In order to receive payment for PRTF services for an individual, admissions shall have a certification of need as required in 42 CFR 441 Subpart D, as amended from time to time. (b) T…

Regulations of Connecticut State AgenciesSec. 17b-262-811. Individual plan of care requirements(a) PRTF services for clients shall involve active treatment, as documented in the professionally developed and supervised individual plan of care. (b) A physician shall: (1) assume pro…

Regulations of Connecticut State AgenciesSec. 17b-262-812. Utilization review program(a) The department conducts utilization review activities for services delivered by the PRTF for clients where Medicaid has been determined to be the appropriate payer. (b) To determine whether a…

Regulations of Connecticut State AgenciesSec. 17b-262-813. Billing proceduresClaims from 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 required by the departme…

Regulations of Connecticut State AgenciesSec. 17b-262-814. Documentation and record retention(a) A provider shall meet the medical record requirements for a PRTF and shall maintain records to support claims made for payment. All documentation shall be made available upon request …

Regulations of Connecticut State AgenciesSec. 17b-262-815. PaymentThe Department shall reimburse PRTFs at a negotiated per diem rate.(Adopted effective September 4, 2009) AUTHORITY: Conn. Gen. Stat. § 17b-262 AUTHORITY: Conn. Gen. Stat. § 17b-262

Regulations of Connecticut State AgenciesSec. 17b-262-816. Audit and compliance reviewAll supporting accounting and business records, statistical data and all other records relating to the provision of PRTF services paid for by the department shall be subject to audit or complian…

Regulations of Connecticut State AgenciesSec. 17b-262-817. ScopeSections 17b-262-817 to 17b-262-828, 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 beh…

Regulations of Connecticut State AgenciesSec. 17b-262-818. DefinitionsFor the purposes of sections 17b-262-817 to 17b-262-828, inclusive, of the Regulations of Connecticut State Agencies, the following definitions shall apply: (1) “Allied Health Professional” or “AHP” means: (A) …

Regulations of Connecticut State AgenciesSec. 17b-262-819. Provider participation(a) Providers shall meet and maintain all department enrollment requirements, as described in sections 17b-262-522 to 17b-262-533, inclusive, of the Regulations of Connecticut State Agencies, to rece…

Regulations of Connecticut State AgenciesSec. 17b-262-820. EligibilityPayment for behavioral health clinic services shall be available to all clients eligible for Medicaid subject to the conditions and limitations that apply to provision of the services. (Effective October 9, 201…

Regulations of Connecticut State AgenciesSec. 17b-262-821. Services covered(a) The department shall pay providers for those procedures listed in the department’s behavioral health clinic fee schedule, provided such services are: (1) Within the clinic’s scope of practice as descri…

Regulations of Connecticut State AgenciesSec. 17b-262-822. Service limitations(a) General (1) Payment for individual, group, family or multiple-family psychotherapy is limited to one visit of each type per day, per provider, per client. (2) Family and group psychotherapy sessions…

Regulations of Connecticut State AgenciesSec. 17b-262-823. Services not coveredThe department shall not pay for the following:(1) Information or services provided to a client over the telephone;(2) Cancelled services and appointments not kept;(3) Any services, treatment or items …

Regulations of Connecticut State AgenciesSec. 17b-262-824. Need for service(a) Each client’s care shall be under the direction of a physician directly employed by or under contract with the clinic. The physician shall authorize the care provided and periodically review the need f…

Regulations of Connecticut State AgenciesSec. 17b-262-825. Authorization(a) Behavioral health clinic services for clients with psychiatric and substance abuse disorders shall be subject to authorization requirements to the extent required by this section. Where a service is subje…

Regulations of Connecticut State AgenciesSec. 17b-262-826. Billing requirements(a) Claims shall be submitted by the providers 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-262-827. Payment(a) The commissioner shall establish fees in accordance with section 4-67c of the Connecticut General Statutes. Fees shall be the same for in-state, border and out-of-state providers. (b) If the client is present f…