reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-167 - Requests for increases in self-pay charges

Current through July 10, 2024
(a) In the event
				of any unforeseen or material change in circumstances, a facility may submit an
				application for an increase in the self-pay charges established by the
				commissioner pursuant to the procedure set forth in section
				17-311-160
				through
				17-311-163,
				supra, by making application for permission to impose charges to self-pay
				patients in excess of the authorized self-pay charges. Such application must
				clearly set forth that the application is made pursuant to subsection 1 (c) of
				Public Act 79-182.
(b) In reviewing
				and evaluating a facility's request for permission to impose self-pay charges
				in excess of those authorized by the commissioner pursuant to section
				17-311-160,
				et seq. supra, whenever applicable the commissioner shall consider, but not be
				limited to, the following:
(1) The cost impact
				of compliance with any statute, regulation, ordinance, or tax, lawfully
				promulgated or imposed by any federal, state of local governmental authority
				having jurisdiction over the operations of the facility, including but not
				limited to increases in local real estate taxes and changes in the public
				health code mandated by the Connecticut department of health
				services;
(2) Changes in the level
				of care provided by the facility;
(3) The cost of substantial additions,
				renovations, and improvements to real property not included in the cost year
				base data used to establish the facility's self-pay charges;
(4) Unforeseen changes in the general economy
				significantly affecting the system under which the state rates were determined
				as the basis for establishing the self-pay charges;
(5) In the case of a facility where self-pay
				charges were determined pursuant to section
				17-311-161(e)
				above, evidence from the department of health services establishing that the
				conditions which led to the imposition of the provisions of section
				17-311-161(e)
				have been remedied.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-168 - Requirements for filing annual reports

Current through July 10, 2024
(a) All facilities
				having 10 or more beds must file the annual report utilized by the commissioner
				of income maintenance in determining rates pursuant to section 17-314 of the
				general statutes. This annual report must be filled out completely and filed
				with the commissioner no later than the 31st day of December of each
				year.
(b) Any facility which fails
				to file the annual report will not be granted an increase in its previously
				approved self-pay charges.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-169 - Self-pay charges for newly constructed or acquired facilities

Current through July 10, 2024
(a) Self-pay charges for newly constructed or
				acquired facilities shall be established in accordance with section
				17-311-161
				on the basis of the State rates for such facilities determined in accordance
				with section
				17-311-55 of the
				regulations governing state agencies. Any facility which does not serve state
				patients must nevertheless provide the Commissioner with the necessary data to
				determine state rates, so that the state rates can be used as the basis for
				determining self-pay charges.
(b)
				At such time as the state rates for a facility are changed, the self-pay
				charges shall also be redetermined in accordance with section
				17-311-161.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-200 - Definitions

Current through July 10, 2024
For purposes of the enforcement of Section
				  19a-533
				  of the General Statutes of Connecticut, and as implemented by Sections
				  17-311-200 through
				  17-311-209
				  of the Regulations of Connecticut State Agencies, the following definitions
				  shall apply:
(a) "nursing home" means
				any chronic disease hospital, chronic and convalescent facility or any rest
				home with nursing supervision, as defined by section
				19a-521,
				which has a provider agreement with the Department of Income Maintenance to
				provide services to recipients of medical assistance pursuant to Part IV of
				chapter 302 of the Connecticut General Statutes and to accept reimbursement for
				the cost of such services pursuant to said program, or which receives payment
				from the state for rendering care to indigent persons.
(b) "indigent person" means any person who is
				eligible for or who is receiving medical assistance benefits from the state or
				general assistance benefits from a town;
(c) "applicant for admission" means any
				person who either himself or through any representative, including but not
				limited to his guardian, conservator, family member, physician, social worker
				or discharge planner, indicates a desire to the nursing home to be admitted
				into such nursing home.
Such indication of desire for admission to the nursing home
				  may be communicated to the facility by a person or his representative in
				  person, by mail or by telephone. Nursing homes may not restrict applicant for
				  admission status to those persons who have personally visited the facility,
				  completed and signed application forms, submitted medical, social or financial
				  information, or in any other way not expressly permitted by this
				  section.
(d) "dated list of
				applications" shall constitute an inquiry list, i.e. a chronological dated list
				indicating in order the name of each person who indicated a desire to the
				nursing home to be admitted into such nursing home as indicated in subsection
				(c) above.
(e) "waiting list" shall
				constitute a chronological list of persons who have substantially completed and
				returned to the nursing home the written application for admission. The names
				of such persons shall appear on the waiting list in the order in which such
				persons return their substantially completed applications to the
				facility.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-201 - Prohibition of discrimination against indigent applicants

Current through July 10, 2024
A nursing home which receives payment from the state for
				  rendering care to indigent persons shall be prohibited from discriminating
				  against indigent persons who apply for admission to such facility on the basis
				  of source of payment.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-202 - Admission in order of application of all applicants

Current through July 10, 2024
A nursing home which receives payment from the state for
				  rendering care to indigent persons shall admit all applicants for admission to
				  such facility (i.e. indigents, Self-Pay, Medicare, V.A., etc.) in the order in
				  which such applicants appear on the waiting list, unless a statute or
				  regulation otherwise provides.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-203 - Provision of receipts

Current through July 10, 2024
Each nursing home shall provide a receipt to all applicants
				  for admission as defined
supra.
Nursing homes shall ask all
				  applicants whether they desire to receive a receipt and be placed on the dated
				  list of applicants at such time as the applicant indicates a desire to be
				  admitted into such nursing home. Receipts shall be provided to applicants
				  stating the date and time of the aforesaid initial contact of the nursing home
				  by the applicant or his representative. Each receipt shall be consecutively
				  numbered and shall state the name and address of the applicant for admission
				  and the date and time of such application. Receipts shall be provided
				  immediately to a person or his representative who personally appeared at the
				  facility or mailed within two business days to a person or his representative
				  who applied to the facility by mail or by telephone. Facilities may require
				  that requests for receipts and the issuance thereof be effected during normal
				  business hours, provided that such requirement is applied to all applicants for
				  admission in a non-discriminatory manner.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-204 - Maintenance of dated list of applications

Current through July 10, 2024
When a person indicates a desire to be admitted into a
				  nursing home, his name shall be placed immediately on the facility's dated list
				  of applications. Such dated list of applications shall be in a bound volume and
				  shall be in the chronological order in which persons contacted the facility and
				  indicated a desire to be admitted with the date and time of initial contact
				  indicated by the person's name.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-205 - Mailing of written application to persons on dated list of applications

Current through July 10, 2024
(a) Within two (2) business days after such
				initial contact, the facility shall mail its written application form to such
				person or his representative. At the beginning of the front page of such
				written application the following wording shall appear in capital letters in
				bold face type and/or underlined:
YOU HAVE CONTACTED THIS NURSING HOME AND INDICATED A
				  DESIRE TO BE ADMITTED AS A PATIENT TO THIS FACILITY. BECAUSE OF THIS, YOU HAVE
				  ALREADY BEEN ISSUED A RECEIPT INDICATING THE DATE AND TIME OF YOUR INITIAL
				  REQUEST AND YOUR NAME HAS BEEN PLACED ON OUR DATED LIST OF APPLICATIONS OR
				  INQUIRY LIST.
PLEASE FIND ENCLOSED THIS FACILITY'S WRITTEN
				  APPLICATION FORM. AS SOON AS YOU SUBSTANTIALLY COMPLETE AND RETURN THE FORM TO
				  THE FACILITY, YOUR NAME WILL BE PLACED ON OUR WAITING LIST FOR ADMISSION TO THE
				  FACILITY. YOUR NAME WILL ONLY BE PLACED ON OUR WAITING LIST AFTER YOU
				  SUBSTANTIALLY COMPLETE AND RETURN THIS WRITTEN APPLICATION FORM TO
				  US.
(b) In
				determining whether a returned written application is "substantially complete,"
				a nursing home may not reject as incomplete a written application when said
				facility has accepted as "substantially complete" other written applications
				which are equal to or lesser than the rejected written application in their
				completeness.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-206 - Maintenance of a waiting list

Current through July 10, 2024
(a) Each nursing
				home shall maintain a "waiting list for admission" which shall constitute a
				single, bound volume of the names of persons who have substantially completed
				and returned to the facility the written application form. Looseleaf binders,
				or any other volume which is subject to additions, deletions or other changes,
				shall not constitute compliance with this requirement. Once an applicant's name
				is placed on the waiting list for admission, said name may not be removed until
				such person has been admitted to the nursing home, such person expires, or such
				person or his representative gives the nursing home written notice of the
				withdrawal of the application, or pursuant to subsection (b) of this section.
An offer to admit an applicant on a specific day which is
				  refused by the applicant shall not justify the deletion of the applicant's name
				  from the waiting list. Whenever a nursing home passes over the name of an
				  applicant on its waiting list and admits another, a dated notation must be made
				  on the waiting list indicating why such applicant was not admitted and
				  supporting documentation of the reason must be maintained and readily
				  available.
Nursing homes shall inform an applicant for admission of
				  his/her place on the waiting list whenever the applicant requests such
				  information during normal business hours.
(b) If a nursing home desires to remove an
				applicant's name from its waiting list who is unresponsive to facility
				telephone calls and letters, the nursing home may no sooner than 120 days after
				initial placement of the person's name on its waiting list inquire by letter to
				such applicant as to whether or not he desires continuation of his name on the
				waiting list. If such applicant does not respond to such letter and at least an
				additional 120 days pass, the facility may send a second such letter. If such
				applicant still does not respond and at least an additional 30 days pass, the
				facility may remove such applicant's name from its waiting list.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-207 - Daily logs

Current through July 10, 2024
Each nursing home shall maintain a "daily log" in a single
				  bound volume for each calendar year which must be completed on a daily basis by
				  indicating, for each day, the number of applications for admission, the number
				  of indigent persons applying for admission, the number of vacancies, the number
				  of persons admitted to the facility and the number of indigent persons admitted
				  to the facility, and the number of individuals readmitted to the nursing home
				  after a period of hospitalization. Daily logs for the last three calendar years
				  shall be maintained in a single location in the nursing home. Looseleaf
				  binders, or any other volume which is subject to additions, deletions or other
				  changes, shall not constitute compliance with this
				  requirement.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 311 - Cost Related Reimbursement System for Long-Term Care Facilities\t › II - Arbitration Proceedings › Section 17-311-208 - Enforcement of statute regardless of intervening change in ownership

Current through July 10, 2024
Since, as per Conn. Gen. Stat. §
									19a-533(d)
				  statutory rate sanctions apply to the rate year resulting from the cost report
				  for the twelve month fiscal year during which violations of the statute took
				  place, Conn. Gen. Stat. §
									19a-533
				  rate sanctions are part of the rate history of a nursing home into which a
				  buyer steps. Therefore, such rate sanctions shall be implemented regardless of
				  any intervening change in ownership.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-101 - Principles to be used in computing rates

Current through July 10, 2024
The principles of hospital cost reimbursement to be used in
				computing rates pursuant to Section 17-312(a), (b) and (c) shall be those set
				forth in Title XVIII of the Social Security Act as amended by Public Law 97-248
				i.e., "Medicare" principles as they existed for retrospective reasonable cost
				reimbursement.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-102 - General reimbursement policy

Current through July 10, 2024
The Department of Income Maintenance (hereinafter the
				Department) will reimburse inpatient acute care services in accordance with
				rules set forth herein.
Definitions.
(a) "Admissions" means the same volume of
			 treatment defined as discharges.
(b) "Discharge" means any patient who was
			 discharged at a date subsequent to the date admitted to the hospital for
			 treatment as an inpatient, except that it shall also mean such patient admitted
			 and discharged on the same day where such patient:
(1) died, or
(2) left against medical advice.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-103 - Medicaid interim per diem rate

Current through July 10, 2024
(a)
Interim
			 Rate Computation
The Department will reimburse inpatient acute care services
				based on an interim per diem rate subject to cost settlement per Section
				17-312-104(b)
				of these regulations.
(b)
			 The interim rate is calculated for each hospital as follows:
The target amount per discharge from the most recently filed
				cost report will be increased by the estimated TEFRA update factors from the
				cost report period to the interim rate period. The product will be the rate
				period estimated target amount per discharge.
The Department will divide the estimated target amount per
				discharge by the average length of stay as calculated from the most recently
				filed cost report to determine an interim per diem rate of payment. To this
				quotient will be added the estimated per diem costs of those items excludable
				from the TEFRA calculation as defined in Section
				17-312-105(d)
				of these regulations. The sum of this calculation is the Medicaid interim per
				diem rate.
(c)
Information and Notification
Information Requirements
All hospitals must provide adequate cost data annually based on
				financial and statistical records for the year ending September 30. The
				hospital must submit a cost report each year on forms prescribed by the
				Department. The Department requires that these reports be completed and filed
				within 60 days after issuance. The cost data must be based on an approved
				method of cost finding and on the accrual basis of accounting. If the filing is
				not done on a timely basis, the Department may withhold payment to the
				provider.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-104 - Determination of TEFRA reimbursement level

Current through July 10, 2024
(a)
TEFRA
			 Payment Methodology
The Department will determine Medicaid allowable inpatient
				costs pursuant to TEFRA principles of reimbursement. The components of Medicaid
				allowable inpatient cost will be determined in the following manner:
(1) Computation of Target Rates
(A) Base Costs for Computing Target Rates
Target rates will be based on the provider's fiscal year ending
				during the calendar year 1982. The Department will use the appropriate cost and
				statistical data from the provider's TEFRA base year. The Department will
				calculate the total Medicaid allowable inpatient cost by applying Medicare
				Principles of Reimbursement in effect at that time. The Medicaid allowable
				inpatient cost is divided by the number of Medicaid discharges to produce the
				TEFRA base year operating cost per discharge. Hospital based physicians,
				capital, direct medical education, malpractice and kidney acquisition costs, as
				determined by using Medicare principles of reimbursement, will be excluded from
				this calculation. The methodology for computing the TEFRA Base Year Operating
				Cost per Discharge (BPOR) is defined as:
Click here
				to view image
where:
OC=
Total Title XIX Inpatient Operating Cost for the TEFRA
						  base year net of excludable cost (Form HCFA-2552, Worksheet D-1, Part II, line
						  56).
D=
Medicaid discharges for the hospital's TEFRA base
						  year.
(B)
			 Annual Adjustment Factor
To compute the TEFRA allowed amount, the Department will
				continue to use the update factor used by Medicare to revise the yearly rates
				for nonparticipating PPS hospitals and units. The update factor is published
				annually in the Federal Register.
(C) Computation of Hospital Target Rates
The hospital specific final target rate will be calculated by
				multiplying the TEFRA Base Year Operating Cost per Discharge by the accumulated
				update factor from the TEFRA base year to the cost report.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-105 - Other related information

Current through July 10, 2024
(a)
Rebasing
After the implementation year, the Commissioner may in his sole
				discretion, select a new base period using actual cost data from more recent
				years for prospectively determining the target rate in the event that he
				determines that to do so is appropriate, equitable and does not prejudice the
				interests of the State.
(b)
Allowable and Nonallowable Costs
Allowable costs, nonallowable costs, and reasonableness of
				costs will be based on Medicare principles of reimbursement as defined in
				Section
				17-312-102.
(c)
Reporting Year
For the purpose of determining payment rates, the reporting
				year is the hospital's fiscal year.
(d)
Excludable costs
The Department will reimburse hospitals for hospital based
				physicians, capital, direct medical education, malpractice, and kidney
				acquisition costs attributable to Medicaid based on Medicare principles of
				reimbursement.
(e)
Change of Ownership Resulting From a Sale or Lease
When a sale or lease occurs, the provider's target rate basis
				will remain the same as before the transaction.
(f)
Retention of Records
Each hospital will maintain financial and statistical records
				of the period covered by such cost reports for a period of not less than ten
				years following the date of submittal of the cost report to the Department.
				These records must be accurate and in sufficient detail to substantiate the
				cost data reported. The provider will make such records or copies thereof
				available upon demand to the Department, or its representatives.
(g)
Audits
(1) Desk Audit
Each cost report will be subjected to a review to ensure
				completeness, appropriateness and accuracy.
(2) Field Audit
Field audits will be performed on a timetable determined by the
				Department. The purpose of the field audit of the facility's financial and
				statistical records is to verify that the data submitted on the cost report is
				accurate, complete and reasonable. The field audits are conducted in conformity
				with Medicare regulations and are of sufficient scope to determine that only
				proper items of cost applicable to the services furnished were included in the
				provider's calculation of its costs and to determine whether the expense
				attributable to such proper items of cost were accurately determined to be
				reasonable. Any item not supported by adequate documentation or which is found
				to be unallowable will be disallowed by field audit. Proper adjustments to
				future payments will be made to recover amounts determined by field audit to be
				overpayments.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-106 - Free-standing chronic disease hospitals with over 50% medicaid patient days

Current through July 10, 2024
(a)
Commission Rate Order.
A
			 chronic disease hospital having more than an average of 50% of its inpatient
			 days paid for by the Department may seek to obtain an adjustment of
			 reimbursement from the Department. In order to be considered it shall submit,
			 within thirty (30) days of the issuance of a final uncontested order by the
			 Commission on Hospitals and Health Care (Commission) a copy of such rate order
			 together with a schedule of the hospital's rates and charges as filed with the
			 Commission in compliance with such rate order.
(b)
All-Inclusive Rate.
The
			 Commissioner may establish, based upon consideration of the Commission rate
			 order and upon documents submitted to the Department by the hospital, and the
			 cost elements set forth in Section 17-312(c) of the General Statutes, and any
			 other information the Commissioner deems appropriate, an annualized interim
			 all-inclusive per diem rate including routine services and ancillary services,
			 to be paid by the Department to the hospital effective with the date authorized
			 by the Commission.
(c)
Year-end Settlement.
Each chronic disease hospital reimbursed in
			 accordance with this section shall submit to the Department, within sixty (60)
			 days following the end of the hospital's fiscal year, a verified complete
			 statement of actual utilization of hospital routine and ancillary services by
			 patients paid for by the Department. Services may be paid for based upon
			 consideration of the rates approved by the Commission for said services and the
			 cost elements set forth in Section 17-312(c) of the General Statutes. Any
			 amount owed to the Department or owing to the provider will be calculated by
			 comparing actual routine and ancillary services utilized during the period to
			 the interim all-inclusive per diem rate. Within sixty (60) days of receipt of
			 the data submitted by the hospital, the Commissioner shall determine, based
			 upon the data and upon such reviews of it as he shall deem necessary, the
			 amount owed either by the Department to the hospital or by the hospital to the
			 Department and shall forward to the hospital a statement reflecting that
			 determination. That amount shall be paid within sixty (60) days of the
			 hospital's receipt of the statement of balance owed.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-107 - Disproportionate share adjustment

Current through July 10, 2024
For purposes of this regulation, the following definitions
				apply:
(a)
Definitions
(1) "Medicaid inpatient utilization"-For a
			 hospital, the total number of its Medicaid inpatient days including newborn in
			 a cost reporting period, divided by the total number of the hospital's
			 inpatient days including newborn in that same period.
(2) "Low-income utilization rate"-For a
			 hospital, the sum (expressed as a percentage) of the fraction, calculated as
			 follows:
(A) Total Medicaid inpatient revenues
			 paid to the hospital, plus the amount of the cash subsidies received directly
			 from State and local governments in a cost reporting period, divided by the
			 total amount of revenues of the hospital for inpatient services (including the
			 amount of such cash subsidies) in the same cost reporting period;
			 and,
(B) The total amount of the
			 hospital's charges for inpatient hospital services attributable to charity care
			 (care provided to individuals who have no source of payment, third-party or
			 personal resources) in a cost reporting period, divided by the total amount of
			 the hospital's charges for inpatient services in the hospital in the same
			 period. The total inpatient charges attributed to charity care shall not
			 include contractual allowances and discounts (other than for indigent patients
			 not eligible for Medical assistance under an approved Medicaid State plan) that
			 is, reductions in charges given to other third-party payers, such as HMOs,
			 Medicare or Blue Cross.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-201 - Non-required acute hospital care

Current through July 10, 2024
For hospital patients who no longer require acute hospital
				care, the Department will only pay for those patients who qualify for Medicaid
				certified Skilled Nursing Facility or Intermediate Care Facility services at
				the rate established pursuant to Section
				17-312-101
				and specified below in Section
				17-312-202
				and
				17-312-203.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-202 - Interim rate of payment to hospitals

Current through July 10, 2024
As an interim rate of payment to hospitals, prior to cost
				settlement, the Department will pay:
(1) for the first seven days of hospital care
			 for patients who no longer require acute care, a rate which is equal to fifty
			 percent (50%) of the hospital's interim non-intensive care per diem rate;
(2) for the eighth through
			 fourteenth day of such care a rate which is equal to seventy-five percent (75%)
			 of the hospital's interim non-intensive care per diem rate; and
(3) for days of such care after the
			 fourteenth day a rate equal to one hundred percent (100%) of the hospital's
			 interim non-intensive care per diem rate.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 312 - Title XIX Payments to Hospitals, Including Principles of Hospital Cost Reimbursement and Rates of Payment for Administratively Necessary Days › Section 17-312-203 - Rate of payment to hospitals for cost settlement purposes

Current through July 10, 2024
As a rate of payment to hospitals for cost settlement purposes,
				the Department will pay:
(1) for the
			 first seven days of hospital care for patients who no longer require acute
			 care, a rate which is equal to fifty percent (50%) of the hospitals
			 non-intensive care per diem rate;
(2) for the eighth through fourteenth day of
			 such care, a rate which is equal to seventy-five percent (75%) of the
			 hospital's non-intensive care unit per diem rate; and
(3) for days of such care after the
			 fourteenth day, a rate equal to one hundred percent (100%) of the hospital's
			 non-intensive care unit per diem rate.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-2 - Filing of operational plan

Current through July 10, 2024
Each private organization operating community living
				arrangements (CLA) shall annually file an operational plan with the primary
				regional office of the Department of Mental Retardation.
(1) The operational plan shall be filed no
			 later than the first business day following April 1 of each year for use in
			 negotiating and establishing rates for the subsequent contract year July 1
			 through June 30.
(2) A residential
			 client needs assessment, which includes needs of each client residing in a
			 community living arrangement, serves as the basis for the cost elements in the
			 operational plan.
(3) Forms and
			 specific expense and revenue categories shall be provided by the Department of
			 Mental Retardation in order to assure that all data supplied by the filing
			 organizations is consistent in form and content to facilitate comparison
			 statewide.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-3 - Filing of audited consolidated operational report (ACOR)

Current through July 10, 2024
Each private organization operating community living
				arrangements or community living arrangements and day services shall annually
				file an audited consolidated operational report with the primary regional
				office of the Department of Mental Retardation.
(1) The ACOR shall be filed no later than the
			 first business day following October 15 for the contract year July 1 through
			 June 30.
(2) The ACOR shall provide
			 actual audited costs, revenues, and client data for the preceding contract year
			 July 1 through June 30.
(3) Forms
			 and specific expense and revenue categories shall be provided by the Department
			 of Mental Retardation in order to assure that all data supplied by the filing
			 organizations is consistent in format and content to facilitate comparison
			 statewide.
(4) The ACOR shall be
			 completed in accordance with generally accepted accounting principles and
			 audited in accordance with generally accepted auditing standards. Audited
			 financial statements, notes to same and the auditor's opinion letter shall
			 accompany the ACOR filing.
(5)
			 Whenever costs are incurred between related parties, allowable cost shall be
			 defined as and limited to the cost to the related party. Findings of
			 relatedness may be made in the absence of majority stock ownership of the
			 related parties in respective organizations. The related party principle
			 applies to any transaction between a provider and a related party, including
			 but not limited to one time or multiple transactions involving services or
			 supplies and one time sales or lease of the facility itself. Related party
			 transactions must be identified as such in the ACOR and the unallowable portion
			 excluded in the appropriate section of the ACOR.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-4 - Consequences for failure to file on or before dates specified in these regulations

Current through July 10, 2024
(1) For each day
			 that the ACOR is not filed, following the dates specified in these regulations,
			 a penalty of one half of one percent (.50%) of the current monthly payment
			 attributable to administrative and general expenses shall be assessed from the
			 total monthly payment for expenses for the first thirty days; three-quarters of
			 one percent (.75%) for the second thirty days and one percent (1.0%) beyond
			 sixty days. This penalty shall result in a reduction in payment for the month
			 following the calculation of the penalty.
(2) The Commissioner of Mental Retardation
			 may waive imposition of the penalty if he deems that extraordinary
			 circumstances prevented the timely filing of the ACOR. The waiver shall be
			 granted according to terms and for a period of time established by the
			 Commissioner of Mental Retardation. An organization must request a waiver, in
			 writing, prior to the filing dates specified in these regulations.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-7 - Per diem room and board reimbursement rates for community training homes payable by the department of social services

Current through July 10, 2024
The per diem room and board reimbursement rate for community
				training homes which is paid by the Department of Social Services shall be the
				rate computed pursuant to Section
				17-311-54
				of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313-9 - Establishment of comprehensive payment levels and computation of residential service rates paid by the department of mental retardation for community training homes

Current through July 10, 2024
(a)
Definitions
As used in this section:
(1) "Client assessment documents" means
			 documents which represent a composite assessment of individual client needs to
			 assist in establishing the appropriate level of supervision. The forms and
			 assessment are provided by the Department of Mental Retardation.
(2) "Department" means the Department of
			 Mental Retardation.
(3) "Personal
			 need allowance" means income which is available to a resident which may not be
			 used for payment of room, board or service.
(4) "Ongoing comprehensive support" means
			 twenty-four hour supervision with periodic special interventions required due
			 to complex medical or behavioral needs of the resident(s).
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-10 - Interim room and board and client-based service rate determination process for newly licensed community living arrangements

Current through July 10, 2024
Newly licensed community living arrangements shall file an
				operational plan with the appropriate Department of Mental Retardation regional
				director.
(1) The Department of Mental
			 Retardation shall negotiate the cost elements which will serve as the basis for
			 an interim client-based service rate and the Department of Income Maintenance
			 shall establish an interim room and board rate.
(2) The interim rates established pursuant to
			 this section will serve as the basis for the one-time, start-up funding
			 provided by the Department of Mental Retardation pursuant to Sec. 19-483b-3 of
			 the Regulations of State Agencies.
(3) Newly licensed community living
			 arrangements shall be reimbursed at 100 percent of the negotiated rate for the
			 first 60 days after the first client is in residence. There shall be a
			 proportional adjustment, reflected in the line item cost settlement, for each
			 day after 60 days for which the community living arrangement is not fully
			 occupied, unless the organization provides adequate justification for the
			 reduced occupancy.
This proportional adjustment will be calculated in accordance
				with Section
				17-313b-8(1)
				(iii) of these regulations, except that the first 60 days shall not be included
				in the calculation.
(4)
			 Interim rates shall remain in effect until a room and board rate is established
			 pursuant to Section
			 17-313b-5
			 or Section
			 17-313b-6
			 of these regulations based upon a 12 month ACOR ending June 30th and a
			 client-based service rate is established pursuant to Section
			 17-313b-8
			 of these regulations based upon a 12 month ACOR ending June 30th.
These interim per diem rates may be revised by the commissioner
				at any time based on additional information which may become available to
				him.
(5) Interim room and
			 board rates shall be replaced by revised rates computed on the basis of actual
			 per diem costs which are allowable as defined in Section
			 17-313b-5
			 or Section
			 17-313b-6
			 of these regulations for the period in which the interim rates were in effect.
			 Proper retroactive adjustments, in favor of the community living arrangement or
			 the state shall be made to all amounts paid on the basis of interim
			 rates.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-11 - Amortization of start-up costs not paid by the Department of Mental Retardation through start-up funding

Current through July 10, 2024
Costs that are normally identified under generally accepted
				accounting principles as organizational expenses and/or costs which are to be
				capitalized shall be excluded from costs proposed to the Department of Mental
				Retardation for start-up funding under Section 19-483a G.S. and applicable
				regulations. Any such excluded costs shall be amortized over a reasonable
				period of not less than thirty-six (36) months beginning with the month during
				which the first client is in residence and shall be reimbursed in the service
				portion of the rate.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-12 - Interim contract year adjustment of client-based service rate

Current through July 10, 2024
Organizations are not to exceed cost elements included in their
				negotiated rate without prior written authorization from the appropriate
				Department of Mental Retardation regional director.
An organization may only request negotiation on an adjusted
				client-based service rate when a new client enters the community living
				arrangement whose needs, as documented in a residential client needs
				assessment, will cause a significant variation in the existing client-based
				service rate or in an emergency situation.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-13 - Phase-in of client-based service rate system

Current through July 10, 2024
Three separate rate setting systems shall exist to establish
				service rates for the contract year July 1, 1987 through June 30, 1988. For
				succeeding contract years, all existing community living arrangements shall
				have client-based service rates established in accordance with Sec.
				17-313b-8
				of these regulations. After June 30, 1988, all newly licensed community living
				arrangements will have an initial rate established in accordance with Sec.
				17-313b-10
				of these regulations.
(1) All
			 organizations shall file an unaudited consolidated operational report on or
			 before the date established by emergency regulation for the period July 1, 1985
			 through June 30, 1986. For any organization which failed to comply with the
			 provisions of Section
			 17-313b-2
			 of the emergency regulations, effective July 9, 1987, the commissioner may
			 authorize rates comparable to the lowest rate paid to a community living
			 arrangement for the same level of care.
(2) Pilot organizations, selected on a
			 voluntary basis from a region designated by the Commissioner of Mental
			 Retardation, shall file operational plans on or before dates agreed upon by
			 such organizations and the Department of Mental Retardation, for the contract
			 year July 1, 1987 through June 30, 1988.
(i)
			 Room and board reimbursement rates shall be established for the community
			 living arrangements operated by the pilot organizations, in accordance with
			 Sec.
			 17-313b-5
			 or Sec.
			 17-313b-6
			 of these regulations, whichever is applicable for the contract year July 1,
			 1987 through June 30, 1988.
(ii)
			 Client-based service rates shall be negotiated and established for the
			 community living arrangements operated by the pilot organizations in accordance
			 with Sec.
			 17-313b-8
			 of these regulations, for the contract year July 1, 1987 through June 30, 1988,
			 and shall supercede any previously established rates for the pilot
			 organizations.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-14 - Record maintenance and retention

Current through July 10, 2024
Each organization shall maintain all supporting accounting and
				business records and records relating to the provision of service which shall
				be available for review at a place and time determined by the Department of
				Mental Retardation or the Department of Income Maintenance for a minimum period
				of ten (10) years without regard for changes in ownership. The Commissioner may
				disallow those costs for which appropriate documentation has not been
				maintained. All organizations shall be required to maintain their books of
				account on the accrual method of accounting, and accurate time records shall be
				maintained for all persons paid salaries or wages.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-15 - Audits

Current through July 10, 2024
The Departments of Income Maintenance and Mental Retardation
				shall have the right to audit all supporting accounting and business records
				and all records relating to the provision of services to clients funded by the
				respective departments in community living arrangements.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-16 - Other reporting requirements

Current through July 10, 2024
Each organization which has filed an initial operational plan
				negotiated client-based service rate(s) and has had room and board rate(s)
				established under that plan shall file subsequent mid-year operational report
				summaries on forms provided by the Department of Mental Retardation. Mid-year
				reports shall be used for ongoing assessment of management, financial and
				programmatic performance.
Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 313b - Establishment of Rates for Community Living Arrangements Licensed by the Department of Mental Retardation › Section 17-313b-17 - Temporary service supplement

Current through July 10, 2024
An organization may apply to the Commissioner of Mental
				Retardation for a temporary service supplement to the established client-based
				service rate for any community living arrangement. A temporary service
				supplement shall be available only for payment for time-bounded,
				client-specific, outcome-oriented resources to be used during periods of
				unanticipated client stress and transition. The need for a temporary service
				supplement must be documented and approved by the interdisciplinary team for
				the specific client. The Commissioner of Mental Retardation shall certify the
				need for and amount of the supplement to the commissioner who shall authorize
				payment of the supplement from funds appropriated to the Department of Mental
				Retardation. In no event shall a temporary service supplement be paid for
				longer than eighteen (18) months.