reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Payment of Behavioral Health Clinic Services › Section 17b-262-824 - Need for service

Current through July 10, 2024
(a) Each client's care shall be under the direction of a physician directly employed by or under contract with the clinic. The physician shall authorize the care provided and periodically review the need for continuing care.
(b) Psychiatric diagnostic evaluations shall be provided by an allied health professional who is permitted to conduct such evaluations under the applicable clinic licensure category.
(c) The psychiatric diagnostic evaluation shall be used in formulating the plan of care and shall be completed for each client. The evaluation shall contain the following components:
(1) The client's mental status;
(2) Psychosocial history or updated psychosocial history for clients who have previously been in the provider's care;
(3) Psychiatric or substance abuse history or updated psychiatric or substance abuse history for clients who have previously been in the provider's care;
(4) Current medications, if indicated, medication history, or updated medication history for clients who have previously been in the provider's care;
(5) Orders for and medical interpretation of laboratory or other medical diagnostic studies, if indicated;
(6) The initial diagnosis, functional status and formulation; and
(7) Treatment recommendations or further disposition of the client.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Payment of Behavioral Health Clinic Services › Section 17b-262-825 - Authorization

Current through July 10, 2024
(a) Behavioral health clinic services for clients with psychiatric and substance abuse disorders shall be subject to authorization requirements to the extent required by this section. Where a service is subject to authorization requirements, Medicaid payment for such service shall not be available unless the provider complies with such requirements.
(b) Services that require authorization shall be designated as such on the provider's fee schedule published at www.ctdssmap.com.
(c) The following requirements shall apply to all services that require authorization under subsection (b) of this subsection:
(1) The initial authorization period shall be based on the needs of the client;
(2) In order to receive payment from the department, a provider shall comply with all authorization requirements. The department or its agent, in its sole discretion, determines what information is necessary in order to approve an authorization request. Authorization does not, however, guarantee payment unless all other requirements for payment are met;
(3) A provider shall present medical or social information adequate for evaluating medical necessity when requesting authorization. The provider shall maintain documentation adequate to support requests for authorization including, but not limited to, medical or social information adequate for evaluating medical necessity;
(4) Requests for authorization for the continuation of services shall include the progress made to date with respect to established treatment goals, the future gains expected from additional treatment and medical or social information adequate for evaluating medical necessity;
(5) The provider shall maintain documentation adequate to support requests for continued authorization including, but not limited to: Progress made to date with respect to established treatment goals; the future gains expected from additional treatment; and medical or social information adequate for evaluating medical necessity; and
(6) The department may require a review of the discharge plan and actions taken to support the successful implementation of the discharge plan as a condition of authorization.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Payment of Behavioral Health Clinic Services › Section 17b-262-826 - Billing requirements

Current through July 10, 2024
(a) Claims shal
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be submitted by the providers on the department's designated form or electronically transmitted to the department's fiscal agent and shall include all information required by the department to process the claim for payment.
(b) The provider shall bill its usual and customary charge for the services delivered, except as set forth in section 17b-262-827(b) of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Payment of Behavioral Health Clinic Services › Section 17b-262-827 - Payment

Current through July 10, 2024
(a) The commissioner shall establish fees in accordance with section 4-67c of the Connecticut General Statutes. Fees shall be the same for in-state, border and out-of-state providers.
(b) If the client is present for up to half of the intermediate care program day and attends at least one individual, family or group session, the provider may bill half of the applicable Medicaid fee or rate. If the client is present for more than a half of the intermediate care program day but less than a full day and attends at least two individual, family or group sessions, the provider may bill the full day charge on file. If the client does not attend at least one individual, group or family session the provider is not entitled to any payment from the department.
(c) A single per diem fee shall be billed for intermediate care programs inclusive of all medication evaluation or management services, treatment and rehabilitative services, administrative services and coordination with or linkages to other health care services. A provider may bill separately for medically necessary individual or family psychotherapy services provided outside of the program hours of operation if such services are necessary for the purpose of client transition or continuity of care.
(d) If a session includes a combination of individual and family psychotherapy, the provider shall bill for the type of psychotherapy that comprises the greater part of the session. Individual and family psychotherapy shall not both be billed for the same date of service unless each type of session individually meets the minimum time requirement for the modality.
(e) Practitioners who are clinic-based either on a full-time or part-time basis are not entitled to individual payment from the department for services rendered to clients at the clinic. The clinic shall bill for the services, except as provided in section 17b-262-460(c) of the Regulations of Connecticut State Agencies.
(f) Payment for services provided to a client is contingent upon the client's eligibility on the date that services are rendered.
(g) The department shall pay the lower of:
(1) The amount in the applicable fee schedule;
(2) The amount on the provider's rate letter; or
(3) The amount billed by the provider.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Payment of Behavioral Health Clinic Services › Section 17b-262-828 - Documentation and audit requirements

Current through July 10, 2024
(a) Providers shall maintain a specific record for all services rendered for each client eligible for Medicaid payment including, but not limited to:
(1) Client's name, address, birth date and Medicaid identification number;
(2) Results of the initial evaluation and clinical tests, and a summary of current diagnosis, functional status, symptoms, prognosis and progress to date;
(3) The initial plan of care, signed by a physician not more than 30 days after the initial evaluation, that includes the types and frequencies of treatment ordered. The physician shall also sign the plan of care at the time of each periodic review and when the plan of care is updated to reflect any change in the types of service. When a physician signs off on the plan of care, the signature indicates that the plan of care is valid, conducted properly and based on the evaluation;
(4) Documentation of each service provided by the clinician, including types of service or modalities, date of service, location or site at which the service was rendered and the start and stop time of the service;
(5) The name and credentials of the individual performing the services on that date; and
(6) Medication prescription and monitoring.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-829 - Scope

Current through July 10, 2024
Sections 17b-262-829 to 17b-262-848, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for the payment of hospice services on behalf of clients who are determined eligible to receive services under the Connecticut Medicaid program pursuant to section 17b-262 of the Connecticut General Statutes.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-831 - Provider participation

Current through July 10, 2024
To enroll in Medicaid and receive payment from the department, providers shall comply with sections 17b-262-522 to 17b-262-533, inclusive, of the Regulations of Connecticut State Agencies, shall be certified as a provider of hospice services under the Medicare program as described in 42 CFR 418.50 through 418.100, inclusive, and shall be licensed as a hospice by the State Department of Public Health in accordance with section 19a-122b of the Connecticut General Statutes and section 19-13D72(b)(2) of Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-832 - Eligibility

Current through July 10, 2024
Payment for hospice services is provided to persons who meet all of the following conditions:
(1) the individual is eligible for Medicaid; and
(2) the individual is certified by a physician as being terminally ill.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-833 - Refusal to serve

Current through July 10, 2024
No hospice enrolled as a Medicaid provider shall select a service area or refuse to serve any person, based on the geographical location of the service to be provided unless the hospice has a legitimate, non-discriminatory reason for its choice of service area or its refusal to serve as provided in section 17b-262-5 to 17b-262-8, inclusive, of the Regulations of Connecticut State Agencies. Providers shall designate service areas, document any refusals to serve and be subject to the sanctions in section 17b-262-9 of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-834 - Certification of terminal illness

Current through July 10, 2024
(a) The provider shall obtain an initial certification of the client's terminal illness jointly from the medical director of the hospice or a physician member of the hospice interdisciplinary group and the client's attending physician, if an attending physician is identified, prior to the beginning of hospice services.
(b) The initial certification shall state that the client's life expectancy is six months or less and shall include clinical information to support this medical prognosis. The initial certification is valid for the first 90 days of hospice care.
(c) At the end of the first 90-day period, a second 90-day period may be certified by the medical director of the hospice or the physician member of the hospice interdisciplinary group. The certification shall include clinical information to support this medical prognosis;
(d) An unlimited number of 60-day periods may be certified following the first two 90-day periods by the medical director of the hospice or the physician member of the hospice interdisciplinary group. The certification shall include clinical information to support this medical prognosis
(e) An APRN may not certify or recertify a terminally ill diagnosis.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-835 - Plan of care

Current through July 10, 2024
(a) The interdisciplinary team in conjunction with the attending physician shall establish an initial written plan of care for each client within 48 hours of the client's election of hospice. Services may not be billed until the plan is established.
(b) The interdisciplinary team, in collaboration with the individual's attending physician, if any, must review, revise and document the individualized plan as frequently as the client's condition requires, but no less frequently than every 14 calendar days.
(c) The plan of care shall specify the care and services necessary to meet the client's and family's needs identified in the comprehensive assessment.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-836 - Election of hospice

Current through July 10, 2024
(a) A client who meets the eligibility requirement of 42 CFR 418.20 may file an election statement with a particular hospice. If the individual is physically or mentally incapacitated, his or her legal representative may file the election statement. The election statement must indicate;
(1) that the individual is electing a hospice benefit and identify which hospice he has chosen;
(2) the effective date of the election;
(3) that the individual understands that hospice services are palliative rather than curative and waives all rights to Medicaid payment for services to cure the terminal illness and related condition. Medicaid shall continue to pay for covered benefits that are not related to the terminal illness; and
(4) that the individual is eligible to receive hospice services only through the provider he has designated.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-837 - Discharge from hospice

Current through July 10, 2024
(a) The provider may discharge a client if:
(1) the client moves out of the provider's service area or transfers to another hospice;
(2) the client is no longer terminally ill;
(3) the client revokes the hospice benefit;
(4) the client dies; or
(5) the provider determines that there is just cause because the client or other person living with the client is disruptive, abusive or uncooperative to the extent that delivery of care to the client or the ability of the hospice to operate effectively is seriously impaired. A discharge for just cause shall meet the criteria and follow the process described in 42 CFR 418.26(a)(3).
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-838 - Services covered

Current through July 10, 2024
(a) The following documents shall be in place prior to the provision of hospice services:
(1) certification of terminal illness for the applicable election period. The certification may be in writing, electronically transmitted or verbal. A facsimile is acceptable provided the original is available on request. Verbal orders are acceptable provided a written order is received within 48 hours of the verbal order.
(2) a statement signed by the client or his or her legal representative electing the hospice benefit; and
(3) an initial plan of care within 48 hours following election of the hospice benefit.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-839 - Coordination of hospice and waiver services

Current through July 10, 2024
(a) For clients who receive waiver services prior to electing the hospice benefit under Medicaid, waiver services shall continue to be available.
(b) It is the responsibility of hospice to develop a plan of care that coordinates the hospice and waiver services. It is the responsibility of the hospice to initiate coordination with the waiver program case manager so that the client receives all of the care and services necessary. The waiver program's case manger is responsible for adjusting the waiver services so there is no duplication of services provider by the hospice or the waiver. These objectives should be accomplished according to the following principles:
(1) The best interest of the client is the key consideration. In circumstances when the hospice and waiver program case managers cannot agree on what is best for the client they shall ask the department for assistance in this determination.
(2) Each program shall provide services consistent with the goals of their respective programs. The goal of hospice care is to keep the client as comfortable as possible while maintaining his or her dignity and quality of life; the goal of the waiver program is to keep clients out of institutions.
(3) Services related to the terminal diagnosis are the responsibility of the hospice.
(4) Services provided prior to the date of terminal diagnosis are generally considered to be unrelated to the terminal diagnosis.
(5) Services unrelated to the terminal diagnosis may be billed in addition to the hospice reimbursement by the provider rendering the service.
(6) For the purpose of developing a plan of care, the presumption is that waiver services provided prior to the date of the terminal diagnosis should continue to be provided as waiver services. It is presumed that services initiated after the date of the terminal diagnosis are the responsibility of the hospice although this is subject to review and reconsideration by the hospice as approved by the department.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-841 - Service limitations

Current through July 10, 2024
(a) The department shall pay only for services listed in its fee schedule.
(b) the department shall not pay separately for any services that are related to the treatment of the terminal condition for which hospice services were elected.
(c) Hospice services are covered in a nursing facility only if the nursing facility has a written agreement with the provider such that the provider takes full responsibility for the professional management of the client's hospice care and the nursing facility agrees to provide room and board to the client. The agreement shall meet the requirements of 42 CFR 418.112.
(d) For a client eligible for both Medicare and Medicaid, the only service payable by Medicaid is the room and board charge for a client in a nursing facility. Room and board means the facility's per diem rate that includes the services described in section 17b-262-705 of the Regulations of Connecticut State Agencies.
(e) The department shall pay for only one level of care on any day.
(f) Respite care is not available for a client who resides in a nursing facility, hospital or ICF/MR.
(g) Bereavement counseling shall be available for the family for up to 13 months following the client's death but is not separately reimbursable.
(h) Home health agency services are not covered unless they are unrelated to the terminal illness and prior authorized by the department.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-842 - Services not covered

Current through July 10, 2024
(a) When a client elects the hospice benefit, the client waives his or her right to receive the following services under Medicaid:
(1) treatment intended to cure the terminal illness;
(2) treatment related to the terminal illness except for the treatment provided by the designated hospice;
(3) hospice services provided by a provider other than the one designated by the client on the hospice form submitted to the department. However, the provider may subcontract with another hospice for services as described is section. 17b-262-838(f); and
(4) any services that are duplicative of any service provided by the hospice provider with the exception of services of the client's attending physician.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-843 - Prior authorization

Current through July 10, 2024
(a) Prior authorization, on forms and in the manner specified by the department shall be required for:
(1) general inpatient days beyond the fifth day; and
(2) any service which the department indicates on its fee schedule requires prior authorization.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-844 - Billing procedures

Current through July 10, 2024
(a) Claims from providers shall be submitted on the department's designated form or electronically transmitted to the department, in a form and manner as specified by the department and shall include all information required by the department to process the claim for payment.
(b) The provider is responsible for:
(1) completing any admission and discharge forms consistent with the department's instructions; and
(2) exhausting other payment sources of which the provider is aware before billing the department.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-845 - Payment

Current through July 10, 2024
(a) The Commissioner shall establish fees that are consistent with section 1902(a)(13)(B) of the Social Security Act.
(b) the Commissioner may increase any fee payable to a hospice upon the application of such an agency evidencing extraordinary costs related to providing escort services. In no case shall any rate or fee exceed the charge to the general public for similar services.
(c) The department shall reimburse the provider at the per diem rate for the appropriate level of care.
(d) The department shall reimburse a provider when all of the requirements of sections 17b-262-829 to 17b-262-848, inclusive, of the Regulations of Connecticut State Agencies have been met.
(e) The fee for routine, inpatient or respite services represents the per diem reimbursement for the client and is payment for all services provided by the provider on that day. Only one level of care may be billed on any day.
(f) The fee for continuous hospice care is paid on an hourly basis. A minimum of eight hours must be medically necessary in a 24-hour period to qualify for continuous hospice care.
(g) The department shall pay the fee for the routine, inpatient or respite level of care for each day the client is within an election period, regardless of the volume or intensity of services provided on that day.
(h) The department shall pay the same fee for border providers as for in-state providers.
(i) When a client who has elected hospice resides in a nursing facility or ICF/MR, the department shall make a payment equal to the department's rate for the nursing facility or ICF/MR. This payment represents payment for room and board services and is payable to the provider. It is the responsibility of the provider to reimburse the nursing facility or ICF/MR for room and board expenses. Applied income shall be deducted from the room and board payment.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-847 - Review process

Current through July 10, 2024
(a) a client or client representative may request a review with the hospice whenever a requested good or service is denied.
(b)
Review Process:
(1) The hospice shall have a timely and organized review process. The review process shall be available whenever:
(A) the hospice denies a requested good or service; or
(B) the hospice fails to respond to a client's request for goods and services within five working days of such request.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Hospice › Section 17b-262-848 - Documentation

Current through July 10, 2024
(a) All required documentation shall be maintained for at least five years, or longer, by the provider in accordance with statute or regulation, subject to review by the department. In the event of a dispute concerning a service provided, documentation shall be maintained until the end of the dispute, five years or the length of time required by statute or regulation, whichever is longest.
(b) Failure to maintain and provide all required documentation to the department upon request shall result in the disallowance and recovery by the department of any future or past payments made to the provider for which the required documentation is not maintained and not provided to the department upon request.
(c) The following information shall be documented in writing or electronically, consistent with the requirements described in the Provider Enrollment Agreement and maintained on file with the provider for each Medicaid client:
(1) signed and dated physician orders;
(2) initial and subsequent plans of care signed and dated by the licensed practitioner or interdisciplinary team;
(3) Medicaid identification number;
(4) pertinent diagnostic information;
(5) documentation of each service provided and its duration;
(6) dates of services provided;
(7) all election forms signed by the client indicating that he has elected the hospice benefit and which hospice he has elected to provide services;
(8) the initial certification of terminal illness signed by the attending physician and the medical director of the hospice;
(9) subsequent certifications of terminal illness signed by the medical director of the hospice or the physician member of the interdisciplinary team;
(10) forms signed and dated by the client indicating any change in the designation of the hospice, if applicable; and
(11) revocation statements signed and dated by the client, if applicable.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-849 - Scope

Current through July 10, 2024
Sections 17b-262-849 to 17b-262-861, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for Medicaid coverage of rehabilitation services for individuals with behavioral health conditions who are determined eligible for Connecticut's Medicaid program pursuant to section 17b-261 of the Connecticut General Statutes.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-850 - Definitions

Current through July 10, 2024
As used in sections 17b-262-849 to 17b-262-861, inclusive, of the Regulations of Connecticut State Agencies:
(1) "Admission" means an individual's initial participation in a rehabilitation services program;
(2) "Allied health professional" or "AHP" means:
(A) a licensed or certified practitioner performing within his or her scope of practice in any of the professional and occupational license or certification categories pertaining to behavioral health covered in Title 20 of the Connecticut General Statutes; or
(B) a license or certification-eligible individual whose education, training, skills and experience satisfy the criteria for any of the professional and occupational licensure or certification categories pertaining to behavioral health covered in Title 20 of the Connecticut General Statutes;
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-852 - Eligibility

Current through July 10, 2024
Medicaid coverage for the cost of rehabilitation services is available for individuals with behavioral health conditions when the service is medically necessary and is provided by a provider to an individual with a behavioral health condition, subject to all of the qualifications, conditions and limitations contained in sections 17b-262-849 to 17b-262-861, inclusive, of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-853 - Need for services

Current through July 10, 2024
Payment for rehabilitation services shall be made by the department only if all of the following conditions are met:
(1) Medicaid payment for rehabilitation services may be made only to the extent that a covered rehabilitation service is provided by a qualified participating provider of such services and the service is medically necessary for the client. Where a service is subject to prior authorization requirements in accordance with section 17b-262-855 or 17b-262-857 of the Regulations of Connecticut State Agencies, eligibility for Medicaid payment is conditioned upon compliance with such requirements. Furthermore, all Medicaid payments, including payments for services that are prior authorized or for which registration is required, are subject to record keeping and post-payment review and audit requirements, and are subject to subsequent recoupment if it is subsequently determined that the service was not medically necessary or if record keeping or other requirements for payment are not satisfied;
(2) For no more than thirty days after an individual's admission, rehabilitation services shall be provided in accordance with an initial assessment of need that is signed by a licensed clinician operating within his or her scope of practice. This assessment shall, for no more than thirty days after an individual's admission, be utilized as the individual's rehabilitation plan;
(3) Not later than thirty days after an individual's admission, the rehabilitation services shall be provided in accordance with the rehabilitation plan developed in accordance with section 17a-20-42 of the Regulations of Connecticut State Agencies. The rehabilitation plan shall include a progress note that describes the services that the individual has received to date; the individual's overall response; the individual's specific progress toward the goals and objectives listed in the rehabilitation plan and justification of the need for continued treatment. The progress note shall include discussion of any variance between the services listed on the rehabilitation plan and the services actually delivered. The progress note shall also include discussion of suggested changes, if any, to the rehabilitation plan. The rehabilitation plan shall be reviewed and signed by the licensed clinician employed by or under contract with the provider at least every ninety days thereafter; and
(4) The individual is sufficiently stable to be able to function outside of a twenty-four hour medically managed setting and participate in community-based treatment services.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-856 - Non-billable activities

Current through July 10, 2024
The following activities are not billable:
(1) Telephone contact with the department for the purpose of requesting or reviewing authorization;
(2) documentation of progress notes or billing documentation;
(3) individual or group supervision, routine case reviews and rounds; ad hoc consultation with supervisors; and discussion or consultation among participants of the rehabilitation team, including those conducted for the purpose of treatment planning;
(4) travel to an appointment with an individual or family; travel to and from collateral appointments (e.g. school planning meeting, court appearance); or transportation of the individual to or from meetings or appointments, unless the provider is also engaged in an activity that otherwise qualifies as a service;
(5) time on-call that does not otherwise qualify as a rehabilitation service;
(6) time spent performing routine services, such as cleaning, cooking, shopping or child care designed to provide relief or respite for the family;
(7) time spent waiting for individuals at their homes when they have a scheduled appointment and the individual has not arrived;
(8) no shows, missed or cancelled appointments;
(9) services of less than eight minutes duration for rehabilitation procedures whose billing codes are defined in 15-minute increments; and
(10) time spent engaged in activities required by a credentialing or oversight entity such as gathering and submitting care plan or service data or other information.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-858 - Documentation and record retention requirements

Current through July 10, 2024
(a) Providers shall comply with the following documentation and record retention requirements:
(1) An initial rehabilitation plan and all updated versions, including the current plan, shall be maintained.
(2) All rehabilitation service providers are required to develop a rehabilitation plan that meets the requirements of section 17a-20-42 of the Regulations of Connecticut State Agencies, except as provided for under subsection 17b-262-851(7) of the Regulations of Connecticut State Agencies. The rehabilitation plan shall include a medication plan, if the rehabilitation service includes medication management. The medication plan shall include an order and instructions for administration for each medication prescribed by a provider staff member and a list of other medications that the individual is taking that may be prescribed by non-clinic practitioners.
(3) A case record that meets the requirements of section 17a-20-54 of the Regulations of Connecticut State Agencies, shall be maintained and shall include, at a minimum: identifying information; social and health history; the reason for admission to the rehabilitation program; copies of the initial and all subsequent orders for rehabilitation services; the rehabilitation plan; identification of the care and services provided; a current list of all medications; and the plan for discharge and disposition of the individual. This case record requirement applies to all providers of rehabilitation services for individuals, not just to DCF-licensed psychiatric clinics that are subject to section 17b-20-54 of the Regulations of Connecticut State Agencies.
(4) Encounter notes shall be maintained for each rehabilitative service provided. The notes shall include the service rendered; actual time the service was rendered; location of service; the goal and objective that is the focus of the intervention; a general description of the content of the intervention to provide evidence that it is a rehabilitative service, as described in section 17b-262-854 of the Regulations of Connecticut State Agencies; and the individual's response to the intervention. Encounter notes shall be signed and dated and shall indicate the credentials of the staff member who provided the service.
(5) For EDT programs the encounter notes shall document the duration of each distinct therapeutic session or activity and progress toward treatment goals.
(6) For the purpose of documenting the supervision of services provided by unlicensed direct care staff, licensed clinical staff shall document in the case record that they have reviewed the encounter notes corresponding to services provided by such unlicensed direct care staff at least once every 30 days. Documentation shall include the signature and credentials of the licensed clinical staff that reviewed the encounter notes.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-859 - Billing requirements

Current through July 10, 2024
(a) Claims for office-based off-site rehabilitation services shall be billed with routine outpatient procedure codes and an off-site modifier or appropriate place of service code as designated by the department.
(b) For home and community-based rehabilitation services that are delivered by more than one staff member, each staff member may bill for time spent engaged in rehabilitative services, whether the staff members are working together or independently. When more than one staff member is in the home at the same time co-facilitating a family therapy or crisis intervention, each staff member may bill for the time spent engaged in this activity. The staff members may co-sign a single note that documents the rehabilitation service that was conducted by the team. If the staff members worked with different family members, each staff member shall write an encounter note in accordance with section 17b-262-858(a)(4) of the Regulations of Connecticut State Agencies.
(c) A single per diem fee shall be billed for EDT inclusive of all medication evaluation or management services, treatment and rehabilitative services, administrative services and coordination with or linkages to other health care services. The provider may bill separately for medically necessary individual psychotherapy clinic services while the individual continues to receive extended day treatment services, if such services are rendered outside of the EDT program hours of operation, are provided by persons other than EDT program staff and are necessary for the individual's transition or continuity of care.
(d) For EDT if the individual is present for up to half of the program day and attends at least one therapy session, the provider may bill for half of their fee on file. If the individual is present for more than half of the program day but less than a full day and attends at least two therapy sessions, the provider may bill the full day charge on file. If the individual does not attend at least one therapy session the clinic is not entitled to any payment from the department.
(e) Claims for payment of rehabilitation services shall be on the department's uniform billing form or electronically transmitted to the department's fiscal agent and shall include all information required by the department to process the claim for payment. All claims submitted to the department for payment of services covered under section 17b-262-854 of the Regulations of Connecticut State Agencies shall be substantiated by documentation in the individual's permanent case record.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-860 - Payment

Current through July 10, 2024
(a) In order to receive payment from the department, the provider shall be enrolled in the Connecticut Medical Assistance Program and comply with the requirements of sections 17b-262-522 through 17b-262-533, inclusive, of the Regulations of Connecticut State Agencies.
(b) The department shall establish rates for rehabilitation services. By enrolling in the program and providing covered rehabilitation services to individuals, the provider agrees to accept the department's rate as payment in full for rehabilitation services provided to individuals.
(c) Office-based off-site rehabilitation services provided by a provider that is not a Federally Qualified Health Center shall be reimbursed at the same rate applicable to such services when provided at a primary or satellite site as provided for on the clinic's DCF license.
(d) Office-based off-site rehabilitation services provided by Federally Qualified Health Centers shall be reimbursed at the Federally Qualified Health Center's psychiatric encounter rate.
(e) Home and community-based rehabilitation services and EMPS provided by Federally Qualified Health Centers shall be reimbursed at the same rates paid to non-Federally Qualified Health Center providers.
(f) Rates for rehabilitation services include any associated travel costs.
(g) Payment shall be made at the lowest of:
(1) The provider's usual and customary charge;
(2) the lowest Medicare rate; or
(3) the amount in the provider's rate letter or the amount on the applicable fee schedule as published by the department.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Rehabilitation Services for Individuals Under Age 21 with Behavioral Health Disorders › Section 17b-262-861 - Audit and compliance reviews

Current through July 10, 2024
All supporting accounting and business records, statistical data and all other records relating to the provision of rehabilitation services paid for by the department shall be subject to audit or compliance review by authorized personnel. All documentation shall be made available, upon request, to authorized representatives of the department.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Limitations on Non-Emergency Dental Services Provided to Medicaid Clients Twenty-One Years of Age and Older › Section 17b-262-862 - Scope

Current through July 10, 2024
Sections 17b-262-862 to 17b-262-866, inclusive, of the Regulations of Connecticut State Agencies set forth limitations on the extent of non-emergency dental services provided to adults twenty-one years of age and older who receive services under the Connecticut Medicaid program. Such limitations include coverage limits, prior authorization requirements and services that are not covered under Medicaid. These regulations supplement but do not supplant Department Medical Services Policies for dental services, including but not limited to, provider participation, eligibility, coverage limitations, billing procedures and payment, to the extent that such policies have the force of law pursuant to section 17b-10 of the Connecticut General Statutes.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Limitations on Non-Emergency Dental Services Provided to Medicaid Clients Twenty-One Years of Age and Older › Section 17b-262-864 - Limitations on Coverage of Certain Non-emergency Dental Services

Current through July 10, 2024
The limitations on coverage of certain non-emergency dental services in subsection (a) of this section apply to healthy adults. The limitations on non-emergency dental services in subsection (b) of this section apply to all adults twenty-one years of age and older and are subject to the prior authorization requirements in section 17b-262-866 of the Regulations of Connecticut State Agencies.
(a) Coverage of non-emergency dental services provided to healthy adults shall be limited as follows:
(1) One comprehensive oral examination per client per lifetime. If a client changes dental providers, the new provider may request approval to conduct an additional comprehensive oral examination through the prior authorization process described in section 17b-262-866 of the Regulations of Connecticut State Agencies;
(2) One periodic oral examination per client per year;
(3) Four intraoral periapical x-rays per year;
(4) One set of bitewing x-rays per year; and
(5) One prophylaxis procedure per year.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Limitations on Non-Emergency Dental Services Provided to Medicaid Clients Twenty-One Years of Age and Older › Section 17b-262-865 - Services Not Covered

Current through July 10, 2024
Medicaid does not cover the following dental services for adults twenty-one years of age and older:
(1) Fixed bridges;
(2) cosmetic dentistry;
(3) orthodontia; and
(4) resin-based composite restorations to the molar teeth (teeth numbers 1, 2, 3, 14, 15, 16, 17, 18, 19, 30, 31 and 32).
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Limitations on Non-Emergency Dental Services Provided to Medicaid Clients Twenty-One Years of Age and Older › Section 17b-262-866 - Prior Authorization Requirements

Current through July 10, 2024
(a) Prior authorization, in a form and in a manner specified by the department, shall be required for certain dental services. In order for a prior authorization request for coverage to be considered by the department, the dental provider requesting authorization and payment shall complete and submit all necessary forms and information as specified by the department. Depending on the service requested, this information may include, but is not limited to, a treatment plan, narrative description of the client's medical condition and radiographs. Authorization does not guarantee payment unless all other requirements for payment are met.
(b) All prior authorization requirements shall be based upon provider specialty, evidence-based dentistry and according to procedures performed by each specialty. In particular, the department delineates restrictions for clients under 21 years of age and clients 21 years of age and older.
(c) The department considers a number of factors in determining whether coverage of a particular procedure or service shall be subject to prior authorization. These factors include, but are not limited to, the relative likelihood that the procedure may be subject to unnecessary or inappropriate utilization, the availability of alternative forms of treatment and the cost of the procedure or service.
(d) The department identifies those procedures that are subject to prior authorization requirements on its website at www.ctdssmap.com under "Fee Schedule."
(e) If the department denies a request for prior authorization, the recipient may request an administrative hearing with the department in accordance with section 17b-60 of the Connecticut General Statutes.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Services Provided by Licensed Behavioral Health Clinicians in Independent Practice › Section 17b-262-912 - Scope

Current through July 10, 2024
Sections 17b-262-912 to 17b-262-925, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment of services performed by licensed behavioral health clinicians in independent practice for HUSKY C and HUSKY D clients under age twenty-one and HUSKY A clients of any age who are determined eligible to receive services under Connecticut's Medicaid program pursuant to sections 17b-261, 17b-261n and 17b-277 of the Connecticut General Statutes.