Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 134d - Medical Assistance › Long Term Care Facility Preadmission Screening and Community Based Services Program › Section 17-134d-56 - Reimbursement of clinic outpatient services and clinic off-site medical services furnished by free-standing clinics

Current through July 10, 2024
(a)
Definitions
(1) "Free-Standing
				Clinic" means a facility providing medical or medically related clinic
				outpatient services or clinic off-site services by or under the direction of a
				physician or dentist and the facility is not part of, or related to, a
				hospital. Such facilities provide mental health, rehabilitation, dental and
				medical services and are subject to Sections 171 through 171.4 of the
				Department's Manual.
(2) In
				addition to the provisions set forth in the Department's Manual, Section 171B,
				"Clinic Outpatient Services" means services performed at the clinic, a
				satellite site, school, or community center.
(3) "Clinic Off-Site Services" means
				diagnostic, preventive, therapeutic, rehabilitative, or palliative items or
				services furnished by or under the direction of a physician or dentist employed
				by or under contract to a free-standing clinic to a Medicaid eligible recipient
				at a location which is not a part of the clinic. Such locations are the
				recipient's home, acute care hospital, skilled nursing facility, intermediate
				care facility, or intermediate care facility for the mentally retarded.
				Off-site services, as may be restricted by location in accordance with Section
				(b) of this regulation, include: Mental Health Services, Occupational Therapy
				Services, Physical Therapy Services, Speech Therapy Services, Audiological
				Services, Physician's Services, Respiratory Therapy Services, Primary Care
				Services, and Dental Services. Such services are subject to the provisions of
				the Department's Manual Sections 171 through 171.4 except as modified by this
				regulation.
(4) "By or under the
				direction of a physician or dentist" means a free-standing clinic's services
				may be provided by the clinic's allied health professionals (as defined in
				Sections 171.1.B through 171.4.B of the Department's Manual) whether or not a
				physician is physically present in the clinic at the time that services are
				provided. The physician:
(A) must assume
				professional responsibility for the services provided;
(B) assure that the services are medically
				appropriate, i.e., the services are intended to meet a medical or
				medically-related need, as opposed to needs which are social, recreational or
				educational;
(C) need not be on the
				premises, but must be readily available, meaning within fifteen (15)
				minutes.
(5)
				"Outpatient" means a patient of an organized medical facility, or distinct part
				of that facility who is expected by the facility to receive and who does
				receive professional services for less than a 24-hour period regardless of the
				hour of admission, whether or not a bed is used, or whether or not the patient
				remains in the facility past midnight.
(6) "Plan of Care" means a written
				individualized plan. Such plan shall contain the diagnosis, type, amount,
				frequency, and duration of services to be provided and the specific goals and
				objectives developed and based on an evaluation and diagnosis for the maximum
				reduction of physical or mental disability and restoration of a recipient to
				his best possible functional level.
(7) "Satellite Site" means a location
				separate from the primary clinic facility at which clinic outpatient services
				are furnished on an ongoing basis meaning with stated hours per day and days
				per week.
(8) "Home" means the
				recipient's place of residence which includes a boarding home or home for the
				aged. Home does not include a hospital, skilled nursing facility, intermediate
				care facility, or intermediate care facility for the mentally
				retarded.
(9) "Department's Manual"
				means the Department of Income Maintenance Medical Services Policy Manual.
				References to manual sections in this regulation shall mean those sections as
				they may be amended from time to time.
(10) "Medical or Medically-Related Service"
				means services which are required in the diagnosis, treatment, care, or
				prevention of some physical or emotional problem.
(11) "Eligible Person" means a person
				eligible for the Medical Assistance Program in accordance with Section 17-134b
				of the General Statutes of Connecticut and regulations promulgated pursuant to
				Section 17-134d of the General Statutes of Connecticut