Connecticut Administrative Code

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…

Regulations of Connecticut State AgenciesSec. 17b-262-828. Documentation and audit requirements(a) Providers shall maintain a specific record for all services rendered for each client eligible for Medicaid payment including, but not limited to: (1) Client’s name, address, birth d…

Regulations of Connecticut State AgenciesSec. 17b-262-829. ScopeSections 17b-262-829 to 17b-262-848, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the payment of hospice services on behalf of clients who a…

Regulations of Connecticut State AgenciesSec. 17b-262-830. DefinitionsAs used in section 17b-262-829 to section 17b-262-848, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Advanced practice registered nurse\" or \"APRN\" means an advanced practice registered n…

Regulations of Connecticut State AgenciesSec. 17b-262-831. Provider participationTo enroll in Medicaid 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, shall be c…

Regulations of Connecticut State AgenciesSec. 17b-262-832. EligibilityPayment for hospice services is provided to persons who meet all of the following conditions: (1) the individual is eligible for Medicaid; and(2) the individual is certified by a physician as being terminally i…

Regulations of Connecticut State AgenciesSec. 17b-262-833. Refusal to serveNo hospice 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 hospice has a legitimate, n…

Regulations of Connecticut State AgenciesSec. 17b-262-834. Certification of terminal illness(a) The provider shall obtain an initial certification of the client's terminal illness jointly from the medical director of the hospice or a physician member of the hospice interdisciplin…

Regulations of Connecticut State AgenciesSec. 17b-262-835. Plan of care(a) The interdisciplinary team in conjunction with the attending physician shall establish an initial written plan of care for each client within 48 hours of the client's election of hospice. Services may not …

Regulations of Connecticut State AgenciesSec. 17b-262-836. Election of hospice(a) A client who meets the eligibility requirement of 42 CFR 418.20 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her legal …

Regulations of Connecticut State AgenciesSec. 17b-262-837. Discharge from hospice(a) The provider may discharge a client if: (1) the client moves out of the provider's service area or transfers to another hospice;(2) the client is no longer terminally ill;(3) the client revokes t…

Regulations of Connecticut State AgenciesSec. 17b-262-838. Services covered(a) The following documents shall be in place prior to the provision of hospice services: (1) certification of terminal illness for the applicable election period. The certification may be in writing, elec…

Regulations of Connecticut State AgenciesSec. 17b-262-839. Coordination of hospice and waiver services(a) For clients who receive waiver services prior to electing the hospice benefit under Medicaid, waiver services shall continue to be available. (b) It is the responsibility of …

Regulations of Connecticut State AgenciesSec. 17b-262-840. VolunteersThe provider shall maintain a volunteer program consistent with 42 CFR 418.78.(Adopted effective July 7, 2009)

Regulations of Connecticut State AgenciesSec. 17b-262-841. Service limitations(a) The department shall pay only for services listed in its fee schedule.(b) the department shall not pay separately for any services that are related to the treatment of the terminal condition for whi…

Regulations of Connecticut State AgenciesSec. 17b-262-842. Services not covered(a) When a client elects the hospice benefit, the client waives his or her right to receive the following services under Medicaid: (1) treatment intended to cure the terminal illness;(2) treatment rela…

Regulations of Connecticut State AgenciesSec. 17b-262-843. Prior authorization(a) Prior authorization, on forms and in the manner specified by the department shall be required for: (1) general inpatient days beyond the fifth day; and(2) any service which the department indicates …

Regulations of Connecticut State AgenciesSec. 17b-262-844. Billing procedures(a) Claims from providers shall be submitted on the department's designated form or electronically transmitted to the department, in a form and manner as specified by the department and shall include all…

Regulations of Connecticut State AgenciesSec. 17b-262-845. Payment(a) The Commissioner shall establish fees that are consistent with section 1902(a)(13)(B) of the Social Security Act. (b) the Commissioner may increase any fee payable to a hospice upon the application of such an a…

Regulations of Connecticut State AgenciesSec. 17b-262-846. Payment limitations(a) It is expected that the provider shall provide bereavement counseling to the client's family after the client's death; however the department shall not pay the provider for such bereavement counseli…

Regulations of Connecticut State AgenciesSec. 17b-262-847. Review process(a) a client or client representative may request a review with the hospice whenever a requested good or service is denied. (b) Review Process:(1) The hospice shall have a timely and organized review process…

Regulations of Connecticut State AgenciesSec. 17b-262-848. 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. In the event of a dispute …

Regulations of Connecticut State AgenciesSec. 17b-262-849. ScopeSections 17b-262-849 to 17b-262-861, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for Medicaid coverage of rehabilitation services for individu…

Regulations of Connecticut State AgenciesSec. 17b-262-850. DefinitionsAs used in sections 17b-262-849 to 17b-262-861, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Admission\" means an individual's initial participation in a rehabilitation services program; (…

Regulations of Connecticut State AgenciesSec. 17b-262-851. Provider participationIn order to participate in the Medicaid program and provide rehabilitation services that are eligible for Medicaid reimbursement from the department, the provider shall: (1) Enroll with the departmen…

Regulations of Connecticut State AgenciesSec. 17b-262-852. EligibilityMedicaid coverage for the cost of rehabilitation services is available for individuals with behavioral health conditions when the service is medically necessary and is provided by a provider to an individual wi…

Regulations of Connecticut State AgenciesSec. 17b-262-853. Need for servicesPayment for rehabilitation services shall be made by the department only if all of the following conditions are met: (1) Medicaid payment for rehabilitation services may be made only to the extent that a …

Regulations of Connecticut State AgenciesSec. 17b-262-854. Covered services(a) Rehabilitation services shall be recommended by a physician or other licensed clinician operating within his or her scope of practice. (b) Rehabilitation services are services designed to assist indivi…

Regulations of Connecticut State AgenciesSec. 17b-262-855. Coverage limitations(a) Coverage of services shall be subject to the following limitations: (1) Services that do not meet medical necessity requirements or any applicable authorization or certification requirements are no…

Regulations of Connecticut State AgenciesSec. 17b-262-856. Non-billable activitiesThe following activities are not billable:(1) Telephone contact with the department for the purpose of requesting or reviewing authorization; (2) documentation of progress notes or billing documenta…

Regulations of Connecticut State AgenciesSec. 17b-262-857. Authorization(1) Services are subject to prior authorization or registration requirements to the extent required by this section. Where a service is subject to authorization or registration requirements, Medicaid payment …

Regulations of Connecticut State AgenciesSec. 17b-262-858. Documentation and record retention requirements(a) Providers shall comply with the following documentation and record retention requirements: (1) An initial rehabilitation plan and all updated versions, including the curr…

Regulations of Connecticut State AgenciesSec. 17b-262-859. Billing requirements(a) Claims for office-based off-site rehabilitation services shall be billed with routine outpatient procedure codes and an off-site modifier or appropriate place of service code as designated by the d…

Regulations of Connecticut State AgenciesSec. 17b-262-860. Payment(a) In order to receive payment from the department, the provider shall be enrolled in the Connecticut Medical Assistance Program and comply with the requirements of sections 17b-262-522 through 17b-262-533, inclus…

Regulations of Connecticut State AgenciesSec. 17b-262-861. Audit and compliance reviewsAll supporting accounting and business records, statistical data and all other records relating to the provision of rehabilitation services paid for by the department shall be subject to audit …

Regulations of Connecticut State AgenciesSec. 17b-262-862. Scope (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-863. Definitions (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-864. Limitations on Coverage of Certain Non-emergency Dental Services (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-865. Services Not Covered (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-866. Prior Authorization Requirements (Repealed) Repealed July 9, 2025.(Effective April 3, 2013; Repealed July 9, 2025)

Regulations of Connecticut State AgenciesSec. 17b-262-9. SanctionsIf the department determines, in accordance with sections 17b-262-1 through 17b-262-9, that these regulations have been violated, the department shall provide the home health care agency a written notice of violati…

Regulations of Connecticut State AgenciesSec. 17b-262-912. ScopeSections 17b-262-912 to 17b-262-925, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of services performed by licensed behavioral heal…

Regulations of Connecticut State AgenciesSec. 17b-262-913. DefinitionsAs used in sections 17b-262-912 to 17b-262-925, inclusive, of the Regulations of Connecticut State Agencies: (1) \"Advanced practice registered nurse\" or \"APRN\" means an individual licensed pursuant to secti…

Regulations of Connecticut State AgenciesSec. 17b-262-914. Provider participationIn order to enroll in Medicaid and receive payment from the department, a provider shall: (1) Comply with all applicable licensing, accreditation and certification requirements;(2) comply with all de…

Regulations of Connecticut State AgenciesSec. 17b-262-915. EligibilityThe department shall pay for medically necessary behavioral health clinician services provided to clients eligible for such services, subject to the conditions and limitations that apply to these services. (Eff…

Regulations of Connecticut State AgenciesSec. 17b-262-916. Services coveredThe department shall pay only for behavioral health clinician services that are:(1) Within the licensed behavioral health clinician's scope of practice as defined by chapters 376b, 383a, 383b or 383c of th…

Regulations of Connecticut State AgenciesSec. 17b-262-917. Service limitationsThe department shall pay for covered services only in accordance with the treatment plan and with the following additional limits: (1) Only one diagnostic interview in any twelve-month period per licens…

Regulations of Connecticut State AgenciesSec. 17b-262-918. Services not coveredThe department shall not pay for the following behavioral health clinician services:(1) Information or services furnished by the licensed behavioral health clinician to the client electronically or ove…

Regulations of Connecticut State AgenciesSec. 17b-262-919. Need for service and treatment planThe department shall pay for medically necessary behavioral health clinician services. The provider shall establish a treatment plan for each client based on the initial diagnostic evalu…

Regulations of Connecticut State AgenciesSec. 17b-262-920. Prior authorization and registration(a) Where a service requires prior authorization or registration under this section, the department shall not pay for such service unless the provider complies with this section and all…