reglab/statecodes huggingface dataset:
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-274c. - Voluntary mail order option for maintenance prescription drugs and drugs covered under the Medicare Part D program.

(a) The Commissioner of Social Services may establish a voluntary mail order option for any maintenance prescription drug covered under the Medicaid program.
(b) Notwithstanding any provision of the general statutes or regulations adopted pursuant thereto, the Commissioner of Social Services may provide a voluntary mail order option, regardless of a mail order pharmacy's location, for any prescription drug covered under the Medicare Part D program established pursuant to Public Law 108-173, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.
(May 9 Sp. Sess. P.A. 02-1, S. 120; P.A. 04-76, S. 19; Nov. 2 Sp. Sess. P.A. 05-2, S. 5; P.A. 11-44, S. 127; P.A. 13-234, S. 96; P.A. 19-118, S. 9.)
History: May 9 Sp. Sess. P.A. 02-1 effective July 1, 2002; P.A. 04-76 deleted reference to “general assistance”; Nov. 2 Sp. Sess. P.A. 05-2 designated existing provisions as Subsec. (a) and added Subsec. (b) authorizing commissioner to provide a voluntary mail order option for any prescription drug covered under the Medicare Part D program, effective December 1, 2005; P.A. 11-44 amended Subsec. (a) by deleting reference to state-administered general assistance, effective July 1, 2011; P.A. 13-234 amended Subsec. (a) to delete reference to ConnPACE, effective January 1, 2014; P.A. 19-118 amended Subsec. (a) by deleting reference to Connecticut AIDS drug assistance program, effective July 1, 2019.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-274e. - Prescription drugs. Utilization of cost-efficient dosages.

A pharmacist, when filling a prescription under the Medicaid program, shall fill such prescription utilizing the most cost-efficient dosage, consistent with the prescription of a prescribing practitioner as defined in section 20-571, unless such pharmacist receives permission to do otherwise pursuant to the prior authorization requirements set forth in sections 17b-274 and 17b-491a.
(June 30 Sp. Sess. P.A. 03-3, S. 82; P.A. 11-44, S. 129; P.A. 13-234, S. 98; P.A. 19-118, S. 10.)
History: June 30 Sp. Sess. P.A. 03-3 effective August 20, 2003; P.A. 11-44 deleted reference to state-administered general assistance and made a technical change, effective July 1, 2011; P.A. 13-234 deleted reference to ConnPACE, effective January 1, 2014; P.A. 19-118 deleted reference to Connecticut AIDS drug assistance program, effective July 1, 2019.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-274f. - Step therapy program for Medicaid prescription drugs.

(a) The Commissioner of Social Services may establish a step therapy program for prescription drugs in the Medicaid program. The commissioner may condition payment for such drugs on a requirement that the drug prescribed be from the preferred drug list established pursuant to section 17b-274d prior to any other drug being prescribed, provided any step therapy program shall: (1) Require that the patient try and fail on only one prescribed drug on the preferred drug list before another drug can be prescribed and eligible for payment; (2) not apply to any mental health–related drugs; and (3) require that the prescribing practitioner, when medications for the treatment of any medical condition are restricted due to the step therapy program, has access to a clear and convenient process to expeditiously request an override of such restriction from the Department of Social Services. The department shall expeditiously grant an override of such restriction whenever the prescribing practitioner demonstrates that: (A) The preferred treatment required under step therapy has been ineffective in the treatment of the patient's medical condition in the past; (B) the drug regimen required under the step therapy program is expected to be ineffective based on the known relevant physical or mental characteristics of the patient and the known characteristics of the drug regimen; (C) the preferred treatment required under the step therapy program will cause or will likely cause an adverse reaction or other physical harm to the patient; or (D) it is in the best interest of the patient to provide the recommended drug regimen based on medical necessity.
(b) The duration of any step therapy program requirement shall not be longer than a period of thirty days, after which time the prescribing practitioner may deem such treatment as clinically ineffective for the patient. When the prescribing practitioner deems the treatment to be clinically ineffective, the drug prescribed and recommended by the practitioner shall be dispensed and covered under the Medicaid program.
(P.A. 13-234, S. 126.)
History: P.A. 13-234 effective July 1, 2013.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-274g. - Preferred drug list purchases. Prohibition on Medicaid cost sharing. Reporting, notice requirements for other Medicaid cost-sharing requirements.

(a) The Commissioner of Social Services shall not impose a cost-sharing requirement for the purchase of prescription drugs on the preferred drug list pursuant to section 17b-274d on a parent or needy caretaker relative otherwise eligible for Medicaid pursuant to section 17b-261. If the commissioner determines a cost-sharing requirement for nonpreferred drugs or other Medicaid services provided to such parent or needy caretaker relative is necessary, the commissioner shall, thirty days before imposing such requirement, notify (1) the joint standing committee of the General Assembly having cognizance of matters relating to human services, and (2) such parent or needy caretaker relative. The commissioner shall notify such parent or needy caretaker relative that he or she shall not be denied Medicaid service for inability to meet such cost-sharing requirement.
(b) The commissioner shall not impose cost sharing for nonpreferred prescription drugs if a physician certifies that the nonpreferred drug is medically necessary.
(c) If the commissioner imposes a cost-sharing requirement on a parent or needy caretaker relative otherwise eligible for Medicaid pursuant to section 17b-261, the commissioner shall submit a quarterly report, in accordance with the provisions of section 11-4a, to the joint standing committee of the General Assembly having cognizance of matters relating to human services on: (1) Any decrease in the number of visits to Medicaid providers by such parent or needy caretaker relative compared to the same time period before the cost-sharing requirement was imposed, and (2) any difference in the average number of visits to Medicaid providers made by such parent or needy caretaker relative compared to other Medicaid recipients of comparable health not subject to a cost-sharing requirement.
(June Sp. Sess. P.A. 17-2, S. 201.)
History: June Sp. Sess. P.A. 17-2 effective October 31, 2017.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-274h. - Auto refills of prescription drugs covered under Medicaid. Limitations. Legislative review process.

(a) The Commissioner of Social Services, in accordance with subsections (b) to (d), inclusive, of this section, may prohibit a pharmacy provider from automatically refilling certain prescription drugs for a medical assistance recipient, regardless of whether a recipient requests or consents to participation in an automatic prescription drug refill program. For any prescription subject to this prohibition, the Department of Social Services shall not make payment for a refill without an explicit verbal or written request for such payment from the recipient or the recipient's legal representative.
(b) The commissioner shall submit recommendations on the types, classes or usage of prescription drugs to be subject to the automatic refill prohibition described in subsection (a) of this section, and for prescription drugs to be exempted from such prohibition, to the joint standing committee of the General Assembly having cognizance of matters relating to human services.
(c) Not later than thirty days after the date of their receipt of such recommendations, the joint standing committee shall hold a public hearing on the recommendations, and notify the Commissioner of Social Services of the date and time of the public hearing. If the joint standing committee does not schedule the public hearing, the recommendations shall be deemed approved. At the conclusion of the public hearing held in accordance with the provisions of this section, the joint standing committee shall advise the commissioner of its approval, denial or modifications, if any, of the commissioner's recommendations. If the joint standing committee denies the commissioner's recommendations, the commissioner shall not implement such recommendations but may submit new recommendations to the committee for action in accordance with this subsection.
(d) The commissioner shall submit the recommendations, as approved or modified in accordance with subsection (c) of this section, to the Pharmaceutical and Therapeutics Committee established pursuant to section 17b-274d.
(P.A. 18-77, S. 1.)
History: P.A. 18-77 effective June 1, 2018.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-275. (Formerly Sec. 17-134r). - Physician and pharmacy lock-in procedure.

The Commissioner of Social Services shall implement, not later than October 1, 1984, a physician and pharmacy lock-in procedure to restrict the use of the health care delivery system by medical assistance recipients who are determined by the commissioner to have utilized medical services or items at a frequency or amount that is not medically necessary. The commissioner shall establish criteria and a case review system in order to make such determination. The commissioner shall require such recipients for a reasonable period of time to obtain medical services or items only from designated providers provided (1) the department gives the recipient notice and an opportunity for a hearing, in accordance with procedures established by the department, before such restrictions are imposed and (2) the department assures that the recipient has reasonable access, taking into account geographic location and reasonable travel time, to medical services of adequate quality.
(P.A. 84-352, S. 1, 4; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134r transferred to Sec. 17b-275 in 1995.
Cited. 233 C. 557.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-276a. - Amendment to Medicaid state plan to reduce expenditures for Medicaid nonemergency medical transportation. Limitations.

Notwithstanding any provision of the general statutes, on or before June 30, 2003, the Commissioner of Social Services, in consultation with the Secretary of the Office of Policy and Management, may submit an amendment to the Medicaid state plan or implement changes necessary to reduce expenditures for Medicaid nonemergency medical transportation, provided in implementing such efficiencies or reduction of services no category of eligible need shall be eliminated other than the reimbursement for personal vehicle use.
(May 9 Sp. Sess. P.A. 02-7, S. 60.)
History: May 9 Sp. Sess. P.A. 02-7 effective August 15, 2002.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-276b. - Nonemergency medical transportation services. Prior authorization.

All brokers of nonemergency medical transportation services that are provided under contract with the Department of Social Services shall provide a decision on a request for prior authorization for hospital discharge nonemergency ambulance trips not later than three business days after the date a hospital or ambulance company submits the request for prior authorization to the broker. If the broker fails to communicate a decision on the request for prior authorization in accordance with this section, the request shall be deemed approved.
(P.A. 09-210, S. 9.)
History: P.A. 09-210 effective July 1, 2009.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-276c. - Payment for medically necessary mode of transportation service.

The Commissioner of Social Services shall only authorize payment for the mode of transportation service that is medically necessary for a recipient of assistance under a medical assistance program administered by the Department of Social Services.
(Dec. Sp. Sess. P.A. 12-1, S. 25; P.A. 13-234, S. 111.)
History: Dec. Sp. Sess. P.A. 12-1 effective December 21, 2012; P.A. 13-234 deleted Subsec. (a) designator and provisions re nonemergency transportation of Medicaid recipients in stretcher vans and deleted former Subsec. (b) re regulations to establish oversight of stretcher vans, effective July 1, 2013.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-277a. - Program to inform applicants to the Healthy Start program of services provided by the Connecticut Home Visiting System.

The Commissioners of Public Health, Social Services and Mental Health and Addiction Services shall jointly establish a program to inform applicants to the Healthy Start program about the availability of, and eligibility for, services provided by the Connecticut Home Visiting System, established pursuant to section 17b-751b.
(P.A. 06-164, S. 2; P.A. 21-172, S. 14.)
History: P.A. 06-164 effective July 1, 2006; P.A. 21-172 replaced “Nurturing Families Network” with “Connecticut Home Visiting System”, effective July 1, 2021.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-277b. - Healthy Start program. Plan. Review.

Section 17b-277b is repealed, effective July 1, 2016.
(P.A. 13-234, S. 122; 13-247, S. 92; May Sp. Sess. P.A. 16-3, S. 209.)
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-277c. - Medicaid coverage for donor breast milk. Requirements. Regulations.

(a) The Commissioner of Social Services, to the extent permissible under federal law, shall provide Medicaid coverage for medically necessary pasteurized donor breast milk provided: (1) A physician, physician's assistant or advanced practice registered nurse licensed pursuant to chapter 370 or 378 signs an order stating that such milk is medically necessary for an infant Medicaid beneficiary in accordance with section 17b-259b; and (2) (A) the infant is medically or physically unable to receive maternal breast milk or participate in breastfeeding, or (B) the infant's mother is medically or physically unable to produce maternal breast milk in sufficient quantities.
(b) The commissioner shall adopt or amend regulations to implement the provisions of this section, including, but not limited to, establishing infant birth weight and health conditions that may make the provision of pasteurized donor breast milk medically necessary and time limits for Medicaid coverage of pasteurized donor breast milk. The commissioner may adopt a policy or procedure to implement the provisions of this section while in the process of adopting regulations, provided such policy or procedure is posted on the Internet web site of the Department of Social Services and on the eRegulations System prior to adoption of the policy.
(c) The commissioner, if necessary, shall seek federal approval for a Medicaid waiver or state plan amendment to implement the provisions of this section in accordance with the provisions of section 17b-8.
(P.A. 19-48, S. 1.)
History: P.A. 19-48 effective July 1, 2019.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278. (Formerly Sec. 17-134z). - Home leave absences for certain medical assistance recipients.

The Commissioner of Social Services shall amend the state's Medicaid plan to increase to thirty-six days per year the number of home leave absences allowed for a resident of an intermediate care facility for individuals with intellectual disabilities who is receiving medical assistance.
(P.A. 91-21; P.A. 93-262, S. 1, 87; P.A. 13-139, S. 7.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134z transferred to Sec. 17b-278 in 1995; P.A. 13-139 substituted “individuals with intellectual disabilities” for “the mentally retarded”.
Cited. 233 C. 557.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278a. - Coverage for treatment for smoking cessation.

The Commissioner of Social Services shall amend the Medicaid state plan to provide coverage for treatment for smoking cessation. Notwithstanding the provisions of section 17b-280a, such treatment may include coverage for prescription drugs, including over-the-counter drugs and counseling.
(P.A. 99-250, S. 1; P.A. 02-4, S. 19; P.A. 08-184, S. 61; P.A. 11-44, S. 106.)
History: P.A. 02-4 mandated provision of coverage for treatment ordered by licensed healthcare professional in accordance with plan approved by General Assembly committees, deleting provisions re treatment ordered by licensed physician to extent permitted by federal law and re coverage limited to maximum of $400 per person per year, effective July 1, 2002; P.A. 08-184 added provision re all prescriptive options for smoking cessation being available to patients whose initial treatment is not successful, effective July 1, 2008; P.A. 11-44 deleted provisions re treatment ordered by a health care professional and commissioner's plan to provide smoking cessation services, and added provision re coverage for treatment including prescription drugs, over-the-counter drugs and counseling, effective January 1, 2012.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278c. - Amendment to state Medicaid plan to provide mammogram examinations to certain women.

The Commissioner of Social Services, to the extent permitted by federal law, shall amend the Medicaid state plan to provide coverage for mammographic examinations for any woman eligible for Medicaid that is at least equal to the following minimum requirements: (1) A baseline mammogram for any such woman who is thirty-five to thirty-nine years of age, inclusive; and (2) a mammogram every year for any such woman who is forty years of age or older.
(P.A. 01-171, S. 24, 25.)
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278d. - Amendment to state Medicaid plan and state children's health insurance plan to provide neuropsychological testing for children diagnosed with cancer.

The Commissioner of Social Services, to the extent permitted by federal law, shall take such action as may be necessary to amend the Medicaid state plan and the state children's health insurance plan to provide coverage without prior authorization for each child diagnosed with cancer on or after January 1, 2000, who is covered under the HUSKY Health program, for neuropsychological testing ordered by a licensed physician, licensed physician assistant or licensed advanced practice registered nurse, to assess the extent of any cognitive or developmental delays in such child due to chemotherapy or radiation treatment.
(P.A. 06-131, S. 1; P.A. 15-69, S. 24; P.A. 19-98, S. 18; P.A. 21-196, S. 22.)
History: P.A. 06-131 effective June 6, 2006; P.A. 15-69 changed “HUSKY Plan, Part A or Part B” to “HUSKY Health program”, effective June 19, 2015; P.A. 19-98 added “or licensed advanced practice registered nurse”; P.A. 21-196 added reference to licensed physician assistants.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278e. - Amendment to state Medicaid plan to exclude payment for hospital-acquired conditions.

The Commissioner of Social Services shall amend the Medicaid state plan to indicate that approved inpatient hospital rates are not applicable to hospital-acquired conditions that are identified as nonpayable by Medicare pursuant to Section 5001(c) of the Deficit Reduction Act of 2005 so that hospitals are not paid for such hospital-acquired conditions.
(P.A. 09-2, S. 8.)
History: P.A. 09-2 effective April 1, 2009.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278f. - Amendment to state Medicaid plan to provide treatment for tuberculosis.

The Commissioner of Social Services shall amend the Medicaid state plan to provide coverage for the treatment of tuberculosis for any eligible person to the extent permitted under federal law.
(P.A. 10-3, S. 25.)
History: P.A. 10-3 effective April 14, 2010.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278g. - Medical assistance for eyeglasses and contact lenses. Regulations.

(a) To the extent permitted by federal law, no payment shall be provided by the Department of Social Services under the Medicaid program for more than one pair of eyeglasses every two years, except payment may be provided under the Medicaid program for an additional pair of eyeglasses during the two-year period when a Medicaid recipient's health care provider determines that such eyeglasses are necessary because of a change in the recipient's medical condition. Said department shall administer the payment for eyeglasses and contact lenses as cost effectively as possible.
(b) The Commissioner of Social Services, pursuant to section 17b-10, may implement policies and procedures to administer the provisions of subsection (a) of this section while in the process of adopting such policies and procedures in regulation form, provided the commissioner prints notice of intent to adopt regulations in the Connecticut Law Journal not later than twenty days after the date of implementation of such policies and procedures. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.
(P.A. 10-3, S. 28; 10-179, S. 49; June Sp. Sess. P.A. 10-2, S. 6; P.A. 11-44, S. 94; 11-48, S. 1.)
History: P.A. 10-3 effective May 1, 2010; P.A. 10-179 replaced provision re medical assistance program with provision re Medicaid program and substituted provision requiring department to use its best efforts to reduce costs with provision requiring department to administer payment for eyeglasses and contact lenses as cost effectively as possible, effective May 7, 2010; June Sp. Sess. P.A. 10-2 designated existing provisions as Subsec. (a) and added Subsec. (b) re implementing policies and procedures while adopting regulations, effective June 22, 2010; P.A. 11-44 replaced provision requiring payment for 1 pair of eyeglasses per year to payment for 1 pair every 2 years, effective July 1, 2011; P.A. 11-48 amended Subsec. (a) by adding exception to allow payment for an additional pair of eyeglasses during the 2-year period, effective July 1, 2011.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278h. - Medical assistance for chiropractic services. Regulations.

Section 17b-278h is repealed, effective July 1, 2015.
(June 12 Sp. Sess. P.A. 12-1, S. 17; June Sp. Sess. P.A. 15-5, S. 520.)
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278i. - Medical assistance for customized wheelchairs. Repairs. Refurbished equipment, parts and components. Regulations.

(a) Customized wheelchairs shall be covered under the Medicaid program only when a standard wheelchair does not meet an individual's needs as determined by the Department of Social Services. Wheelchair repairs and parts replacements may be subject to review and approval by the department. Refurbished wheelchairs, parts and components shall be utilized whenever practicable. The Department of Social Services may designate categories of durable medical equipment in addition to customized wheelchairs for which reused equipment, parts and components shall be utilized whenever practicable.
(b) The commissioner, pursuant to section 17b-10, may implement policies and procedures necessary to administer the provisions of this section while in the process of adopting such policies and procedures as regulations, provided the commissioner prints notice of intent to adopt regulations in the Connecticut Law Journal not later than twenty days after the date of implementation. Policies and procedures implemented pursuant to this section shall be valid until the time final regulations are adopted.
(Dec. Sp. Sess. P.A. 12-1, S. 8; P.A. 13-234, S. 85.)
History: Dec. Sp. Sess. P.A. 12-1 effective December 21, 2012; P.A. 13-234 amended Subsec. (a) to delete provision prohibiting assessment of the need for a customized wheelchair unless requested by department, to add provision allowing department to designate categories of durable medical equipment for which reused equipment, parts and components shall be utilized, and to make a technical change, effective June 19, 2013.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-278k. - Electronic transmission of prescriptions for durable medical equipment.

Not later than July 1, 2014, the Commissioner of Social Services shall accept electronic transmission of prescriptions for reimbursements under the medical assistance program for durable medical equipment including, but not limited to, wheelchairs, walkers and canes. Any electronic prescription under this section shall be electronically signed by a licensed health care provider with prescriptive authority.
(P.A. 14-217, S. 193.)
History: P.A. 14-217 effective June 13, 2014.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-279. (Formerly Sec. 17-134aa). - Medicaid prescription drug utilization review. Erectile dysfunction drugs. Prior authorization requirement and coverage limitation. Report.

The Commissioner of Social Services shall verify the propriety and reasonableness of payments to providers for drugs provided to Medicaid recipients through field audit examinations and other reasonable means to the extent possible within available appropriations. To the extent permitted by federal law, the commissioner shall require prior authorization for coverage of drugs for the treatment of erectile dysfunction. To the extent permitted by federal law, the commissioner may limit or exclude coverage for drugs for the treatment of erectile dysfunction for persons who have been convicted of a sexual offense who are required to register with the Commissioner of Emergency Services and Public Protection pursuant to chapter 969. The commissioner shall document financial and utilization statistics as to drugs provided to Medicaid recipients by therapeutic category and shall outline problems encountered in the administration of prescription drug utilization in the Medicaid program, suggested solutions and any recommendations for improvement.
(P.A. 89-296, S. 1, 9; P.A. 91-190, S. 1, 9; P.A. 93-262, S. 1, 87; May 9 Sp. Sess. P.A. 02-7, S. 88; P.A. 03-268, S. 8; P.A. 05-280, S. 15; P.A. 11-51, S. 134.)
History: P.A. 91-190 amended Subsec. (a) to eliminate advisory panel to review prescription drug utilization in the Medicaid program and repealed Subsec. (b) requiring commissioner to study feasibility of implementing a limited formulary of high volume drugs for medical assistance recipients and a rebate to the state from a pharmaceutical manufacturer or direct distributor of a percentage of total sales to the state, and to report results to general assembly committees by February 15, 1990; P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134aa transferred to Sec. 17b-279 in 1995; May 9 Sp. Sess. P.A. 02-7 deleted “, including the generic incentive dispensing fee”, effective September 1, 2002; P.A. 03-268 deleted requirement that commissioner submit annual report to human services and appropriations committees; P.A. 05-280 required commissioner to implement prior authorization for coverage of drugs for the treatment of erectile dysfunction under the Medicaid program and permitted commissioner to limit or exclude coverage for such drugs for persons who have been convicted of a sexual offense who are required to register with the Commissioner of Public Safety pursuant to chapter 969, effective July 1, 2005; pursuant to P.A. 11-51, “Commissioner of Public Safety” was changed editorially by the Revisors to “Commissioner of Emergency Services and Public Protection”, effective July 1, 2011.
Cited. 233 C. 557.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-280a. - Payment for over-the-counter medications under medical assistance program. Exceptions.

No payment shall be made under a medical assistance program administered by the Department of Social Services for over-the-counter medications, except for (1) insulin and insulin syringes, (2) nutritional supplements for individuals who are required to be tube fed or who cannot safely ingest nutrition in any other form, and as may be required by federal law, (3) smoking cessation medications as provided in section 17b-278a, (4) over-the-counter medications and products determined by the Commissioner of Social Services to be appropriate for coverage based on their clinical efficacy, safety and cost effectiveness, and (5) over-the-counter medications that are required to be covered pursuant to 42 CFR 440.347, including medications for individuals with specified diagnoses that have a rating of “A” or “B” in the current recommendations of the United States Preventive Services Task Force, provided the Department of Social Services may also pay for such over-the-counter medications under a medical assistance program or portion thereof that is not subject to 42 CFR 440.347.
(P.A. 10-3, S. 12; 10-179, S. 48; June Sp. Sess. P.A. 10-1, S. 50; P.A. 11-44, S. 107; P.A. 14-157, S. 1; 14-217, S. 74; P.A. 15-165, S. 1; P.A. 19-118, S. 36.)
History: P.A. 10-3 effective May 1, 2010; P.A. 10-179 changed May 1, 2010, to June 1, 2010, and added exception for medical assistance program established pursuant to Sec. 17b-256, effective May 7, 2010; June Sp. Sess. P.A. 10-1 deleted reference to on and after June 1, 2010, and added exception for nutritional supplements for certain individuals, effective June 22, 2010; P.A. 11-44 inserted Subdiv. (1) and (2) designators, added Subdiv. (3) re smoking cessation drugs, added provisions re notice to pharmacists and General Assembly, and made technical changes, effective July 1, 2011; P.A. 14-157 added provision re over-the-counter drugs covered pursuant to 42 CFR 440.347 as exception to prohibition on payments for over-the-counter drugs, added provision allowing department to pay for such drugs under medical assistance program not subject to 42 CFR 440.347, and made technical changes, effective June 11, 2014; P.A. 14-217 made identical changes as P.A. 14-157, effective June 13, 2014; P.A. 15-165 added new Subdiv. (5) re coverage for medications and products determined by commissioner to be appropriate, redesignated existing Subdiv. (5) as Subdiv. (6), deleted provision re notice requirement for billing by pharmacists, and changed “drugs” to “medications”, effective July 1, 2015; P.A. 19-118 deleted former Subdiv. (1) re medical assistance program and redesignated existing Subdivs. (2) to (6) as new Subdivs. (1) to (5), effective July 1, 2019.
See Sec. 17b-10a re implementation of policies and procedures while in the process of adopting as regulation.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-280b. - Proposed revisions to reimbursement methodology for covered outpatient drugs under the Medicaid program. Legislative review.

(a) On and after October 31, 2017, the Commissioner of Social Services shall submit any proposed revision to the reimbursement methodology and dispensing fees for covered outpatient drugs under the Medicaid program, including, but not limited to, a proposed revision requested by or on behalf of the General Assembly, to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies prior to the implementation of any such proposed revision.
(b) Not later than thirty days prior to submission to the joint standing committees of the General Assembly under subsection (a) of this section of a proposed revision to the reimbursement methodology and dispensing fees for covered outpatient drugs under the Medicaid program, the Commissioner of Social Services shall publish a notice that the commissioner intends to seek such proposed revision in the Connecticut Law Journal and on the Department of Social Services' Internet web site, along with a summary of the provisions of the proposed revision and the manner in which individuals may submit comments. The commissioner shall allow thirty days for written comments on the proposed revision prior to submission of the proposed revision to the General Assembly under subsection (a) of this section and shall include all written comments with the proposed revision in the submission to the General Assembly.
(June Sp. Sess. P.A. 17-2, S. 571.)
History: June Sp. Sess. P.A. 17-2 effective October 31, 2017.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-280c. - Methadone maintenance. Minimum rates.

(a) For purposes of this section: (1) “Methadone maintenance” means a chemical maintenance program under which an addiction to one drug, including, but not limited to, heroin, is treated with the drug methadone in a weekly program that includes on and off-site methadone administration, drug testing and counseling; and (2) “chemical maintenance provider” means a provider certified and licensed by the federal Substance Abuse and Mental Health Services Administration and the state Department of Public Health who meets all federal and state requirements, including, but not limited to, requirements specific to the provision of chemical maintenance services.
(b) The Commissioner of Social Services shall amend the Medicaid state plan to provide a minimum weekly reimbursement rate of eighty-eight dollars and fifty-two cents to a chemical maintenance provider for methadone maintenance treatment of a Medicaid beneficiary, provided no such provider receiving a higher rate shall have such rate reduced to the minimum as a result of the implementation of a new minimum reimbursement rate.
(c) The Commissioner of Social Services, pursuant to section 17b-10, may implement policies and procedures to administer the provisions of this section while in the process of adopting such policies and procedures in regulation form, provided the commissioner posts notice of the intent to adopt the regulations on the department's Internet web site and the eRegulations System not later than twenty days after the date of implementation. Such policies and procedures shall be valid until the time final regulations are adopted.
(P.A. 19-117, S. 311; June Sp. Sess. P.A. 21-2, S. 332.)
History: P.A. 19-117 effective July 1, 2019; June Sp. Sess. P.A. 21-2 deleted Subsec. (c) re payment performance standards, redesignated existing Subsec. (d) as new Subsec. (c) and made a technical change, effective July 1, 2021.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-281. (Formerly Sec. 17-134cc). - Payment of oxygen products and services under medical assistance program.

Notwithstanding any provision of the regulations of Connecticut state agencies, effective July 1, 1989, the state shall pay for oxygen products and services for Medicaid recipients when such recipients meet the medical criteria for coverage under the Medicare program, except that payment for oxygen products and services via oxygen concentrators in rest homes with nursing supervision and in chronic and convalescent homes shall be included in the per diem reimbursement rate established by the Commissioner of Social Services. Reimbursement for alternative oxygen products and services in such facilities may be made if substantiated by medical necessity.
(P.A. 89-296, S. 3, 9; P.A. 93-262, S. 1, 87.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134cc transferred to Sec. 17b-281 in 1995.
Cited. 233 C. 557.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-281a. - Procedure for preauthorization of purchase or rental of durable medical equipment.

(a) The Commissioner of Social Services shall extend the procedure in effect on October 1, 1998, for the preauthorization of the purchase or rental of new durable medical equipment and modification or repair of existing equipment to include services provided to Medicaid recipients who are also recipients of Medicare. The commissioner may enter into any necessary agreements with the Centers for Medicare and Medicaid Services to ensure the coordination of authorization and payment for durable medical equipment for such recipients.
(b) Access to such procedure shall not be denied to a recipient on the basis that a Medicare coverage determination has not been made prior to the submission of a request for preauthorization to the commissioner. The commissioner shall not make payment for an item to a supplier of durable medical equipment on behalf of a Medicare recipient until the commissioner has received documentation establishing that a claim has been filed with, and a coverage and reimbursement decision has been rendered under, the Medicare program.
(P.A. 98-239, S. 6; P.A. 03-19, S. 41.)
History: P.A. 03-19 replaced “Health Care Financing Administration” with “Centers for Medicare and Medicaid Services” in Subsec. (a), effective May 12, 2003.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-281b. - Used durable medical equipment. Payments to vendors or suppliers.

The Commissioner of Social Services may authorize payment for used durable medical equipment to a vendor or supplier of durable medical equipment enrolled as a medical equipment, devices and supplies provider under the Medicaid program.
(June Sp. Sess. P.A. 01-2, S. 8, 69; June Sp. Sess. P.A. 01-9, S. 129, 131; May 9 Sp. Sess. P.A. 02-7, S. 48.)
History: June Sp. Sess. P.A. 01-2 effective July 2, 2001; June Sp. Sess. P.A. 01-9 revised effective date of June Sp. Sess. P.A. 01-2 but without affecting this section; May 9 Sp. Sess. P.A. 02-7 amended section to permit commissioner to authorize payment to a vendor or supplier of used durable medical equipment provided under the Medicaid program and eliminated requirement that commissioner seek federal waiver to provide coverage for such equipment, effective August 15, 2002.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-281c. - Authority of commissioner to modify medical equipment fee schedules.

The Commissioner of Social Services may modify the state medical assistance durable medical equipment, medical surgical supply, oxygen, orthotic and prosthetic devices and hearing aid fee schedules, applicable regulations, policies and procedures or purchase of service contracts to achieve any expenditure reductions adopted under public act 03-1 of the June 30 special session*. In the event that such modifications require revisions to any existing state regulations, the commissioner may make such modifications while in the process of adopting the modifications in regulation form provided the commissioner publishes notice of any modifications of regulations in the Connecticut Law Journal within twenty days of implementation of such modifications. Such modifications may include, but shall not be limited to: (1) A change in the reimbursement to customized manually priced devices to a formula based on a percentage of list or acquisition of costs; (2) a percentage reduction in payments to all other durable medical equipment, medical surgical supply, oxygen, orthotic and prosthetic devices and hearing aid providers; (3) the application of any rental costs for durable medical equipment when the department subsequently purchases the same equipment for a recipient; and (4) the selection of a vendor or vendors to be the providers of durable medical equipment, medical surgical supply, oxygen, orthotic and prosthetic devices and hearing aid services pursuant to a competitive bidding process. In no event shall any modifications to the state medical assistance fee schedules, regulations, policies and procedures or purchase of service contracts implemented by the commissioner pursuant to this section be estimated to achieve expenditure reductions in an amount less than adopted in public act 03-1 of the June 30 special session*.
(June 30 Sp. Sess. P.A. 03-3, S. 53.)
*Note: Public act 03-1 of the June 30 special session is entitled “An Act Concerning Expenditures and Revenue for the Biennium Ending June 30, 2005”. (See Reference Table captioned “Public Acts of June 30, 2003” in Volume 16 which lists the sections amended, created or repealed by the act.)
History: June 30 Sp. Sess. P.A. 03-3 effective August 20, 2003.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-282. (Formerly Sec. 17-134dd). - Medical assistance for certain children and elderly and disabled persons.

On and after January 1, 1991, the Commissioner of Social Services may provide, in accordance with federal law and regulations and within available appropriations, medical assistance under the Medicaid program to (1) children over five and under nine years of age whose families have an income below one hundred per cent of the federal poverty level and (2) elderly and disabled persons who would be eligible to receive supplemental security income benefits except for income and who have incomes below one hundred per cent of the federal poverty level.
(P.A. 90-134, S. 3, 28; P.A. 93-262, S. 1, 87; June 18 Sp. Sess. P.A. 97-2, S. 73, 165.)
History: P.A. 93-262 authorized substitution of commissioner and department of social services for commissioner and department of income maintenance, effective July 1, 1993; Sec. 17-134dd transferred to Sec. 17b-282 in 1995; June 18 Sp. Sess. P.A. 97-2 made technical changes, effective July 1, 1997.
Cited. 233 C. 557.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-282a. - Coverage for in-patient dental services in certain instances involving children and developmentally disabled persons.

The Commissioner of Social Services, to the extent permitted by federal law, shall amend the Medicaid state plan to provide coverage for general anesthesia, nursing and related hospital services provided in conjunction with dental services, provided such anesthesia, nursing and related hospital services are provided in conjunction with in-patient dental services if the following conditions are met:
(1) The anesthesia, nursing and related hospital services are deemed medically necessary by the treating dentist or oral surgeon and the patient's primary care physician in accordance with the department's requirements for prior authorization of services, if required; and
(2) The patient is either (A) a child under the age of four who is determined by a licensed dentist, in conjunction with a licensed physician who specializes in primary care, to have a dental condition of significant dental complexity that it requires certain dental procedures to be performed in a hospital, or (B) a person who has a developmental disability, as determined by a licensed physician who specializes in primary care, that places the person at serious risk. The expense of such anesthesia, nursing and related hospital services shall be deemed a medical expense under such health insurance policy and shall not be subject to any limits on dental benefits under such policy.
(P.A. 99-284, S. 42, 60.)
History: P.A. 99-284 effective January 1, 2000.
2023 Connecticut General Statutes › Title 17b - Social Services › Chapter 319v - Medical Assistance › Section 17b-282b. - Implementation of state-wide dental plan. Waiver.

Not later than July 1, 2004, and prior to the implementation of a state-wide dental plan that provides for the administration of the dental services portion of the department's medical assistance, the Commissioner of Social Services shall amend the federal waiver approved pursuant to Section 1915(b) of the Social Security Act. Such waiver amendment shall be submitted to the joint standing committees of the General Assembly having cognizance of matters relating to human services and appropriations and the budgets of state agencies in accordance with the provisions of section 17b-8.
(P.A. 03-155, S. 2; P.A. 04-16, S. 9; Sept. Sp. Sess. P.A. 09-5, S. 49.)
History: P.A. 03-155 effective July 1, 2003; P.A. 04-16 made technical changes in Subsec. (b); Sept. Sp. Sess. P.A. 09-5 deleted former Subsec. (b) re prior authorization requirements and made a conforming change, effective October 5, 2009.