Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment of Nursing Facilities › Section 17b-262-702 - Definitions

Current through July 10, 2024
For the purposes of sections 17b-262-701 to 17b-262-711, inclusive, the following definitions shall apply:
(1) "Applied income" means the amount of income that each client receiving nursing facility services is expected to pay each month toward the cost of his or her care, calculated according to the department's Uniform Policy Manual, section 5045.20;
(2) "Client" means a person eligible for goods or services under the department's Medicaid program;
(3) "Chronic disease hospital" means "chronic disease hospital" as defined in section 19-13-D1 of the Regulations of Connecticut State Agencies;
(4) "Commissioner" means the Commissioner of Social Services, or the commissioner's designee;
(5) "Department" means the Department of Social Services or its agent;
(6) "DMHAS" means the Department of Mental Health and Addiction Services or its agent;
(7) "DMR" means the Department of Mental Retardation or its agent;
(8) "Home leave" means an absence from the nursing facility for any reason other than admission to a hospital. It is taken at the discretion of the resident;
(9) "Hospital" means "hospital" as defined in section 19a-537 of the Connecticut General Statutes;
(10) "Institution for Mental Diseases" or "IMD" means "institution for mental diseases" as defined in 42 CFR 435.1009, as amended from time to time;
(11) "Licensed practitioner" means any person licensed by the state of Connecticut, any other state, District of Columbia, or the Commonwealth of Puerto Rico and authorized to prescribe treatments within the scope of his or her practice as defined and limited by federal and state law;
(12) "Medical appropriateness" or "medically appropriate" means health care that is provided in a timely manner and meets professionally recognized standards of acceptable medical care; is delivered in the appropriate medical setting; and, is the least costly of multiple, equally-effective, alternate treatments or diagnostic modalities;
(13) "Medicaid" means the program operated by the Department of Social Services pursuant to section 17b-260 of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act;
(14) "Medical necessity" or "medically necessary" means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or to prevent a medical condition from occurring;
(15) "Nursing facility" or "NF" means "nursing facility" as defined in 42 USC 1396r(a), as amended from time to time;
(16) "Preadmission screening and resident review" or "PASRR" means the program defined in 42 USC 1396r(e)(7) and 42 CFR Part 483, Subpart C, as amended from time to time;
(17) "Preadmission MI/MR screen" means the level I screen required under the PASRR program and described in 42 CFR 483.106 and 42 CFR 483.128, as amended from time to time. It shall be completed on the forms and in the manner prescribed by the department;
(18) "Preadmission screening level II evaluation" means the level II screen as described in 42 CFR 483.112 and 42 CFR 483.128, as amended from time to time. It shall be completed on the forms and in the manner prescribed by the department;
(19) "Provider" means a nursing facility that is enrolled in the Medicaid program;
(20) "Provider agreement" means the signed, written, contractual agreement between the department and the provider;
(21) "Reserve bed day" means a day when a nursing facility client is temporarily absent from the nursing facility and for which payment is made by the department in accordance with section 19a-537 of the Connecticut General Statutes;
(22) "Resident" means a person living in a nursing facility; and
(23) "Usual and customary charge" means the amount that the provider charges for the service or procedure in the majority of non-Medicaid cases. If the provider varies the charges so that no one amount is charged in the majority of cases, usual and customary shall be defined as the median charge. Token charges for charity patients and other exceptional charges are to be excluded.