reglab/statecodes huggingface dataset:
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(c) - Personal Data › Section 17a-451(c)-2 - General nature and purpose of personal data systems

Current through July 10, 2024
The Department of Mental Health maintains the following
				personal data systems:
(a)
Personnel Records
(1) Personnel
			 records are maintained at the Department facility which employs the individual
			 or which has the individual on its payroll for administrative purposes. A
			 directory listing sites where personnel records are kept is located at the
			 Department of Mental Health, Personnel Unit, 90 Washington Street, Hartford,
			 Connecticut, 06106.
(2) Personnel
			 records are maintained in both manual and automated forms.
(3) The purpose of the personnel records
			 system is to provide data necessary for personnel and payroll management
			 activities and/or to satisfy the requirements of state or federal
			 laws.
(4) The title and business
			 address of the Department official responsible for this system of records and
			 to whom requests for disclosure or amendment of the records in the system
			 should be directed may be obtained from the directory referred to in subsection
			 (1) above.
(5) Routine sources of
			 data in these records may include applicants for employment, employees,
			 previous employers, references, and other state agencies.
(6) Personal data in these records are
			 maintained under authority of Conn. Gen. Stat. Secs.
			 5-193
			 to
			 5-269, inclusive, and
			 54-142k (k), as may be amended from time to time.
(7) Categories of personal data maintained in
			 this system may include birth date, sex, race, educational history,
			 licensure/certification, employment history, financial information, medical or
			 emotional condition or history, family or other relationships, administrative
			 investigation material, disciplinary action, reputation or character
			 information and conviction records.
(8) Categories of other data maintained in
			 this system may include address, phone number and social security
			 number.
(9) These records are
			 maintained on applicants for employment and on current and former employees of
			 the Department.
(10) These records
			 are routinely used by employees of the Department who are assigned
			 responsibility for personnel, payroll and employment-related
			 activities.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(c) - Personal Data › Section 17a-451(c)-3 - Maintenance of personal data

Current through July 10, 2024
(a) Records for
			 each personal data system are maintained in accordance with schedules prepared
			 by the Connecticut State Library, Department of Public Records Administration
			 and retention schedules approved by the Public Records Administrator as
			 authorized by Conn. Gen. Stat. Sec.
			 11-8a,
			 as may be amended from time to time. Retention schedules are on file in the
			 Personnel Office at the Office of the Commissioner and at each Department
			 facility. They may be examined during the normal business hours, which are 8:30
			 a.m. to 4:30 p.m. at the Office of the Commissioner and 8:00 a.m. to 4:00 p.m.
			 at the facilities.
(b) Personal
			 data will not be maintained unless relevant and necessary to accomplish the
			 lawful purposes of the Department. Where the Department finds irrelevant or
			 unnecessary public records in its possession, the Department shall dispose of
			 the records in accordance with its records retention schedule and with the
			 approval of the Public Records Administrator pursuant to Conn. Gen. Stat. Sec.
			 11-8a,
			 as may be amended from time to time, or, if the records are not disposable
			 under the records retention schedule, request permission from the Public
			 Records Administrator to dispose of the records under Conn. Gen. Stat. Sec.
			 11-8a,
			 as may be amended from time to time.
(c) The Department shall collect and maintain
			 all records with accurateness and completeness.
(d) Insofar as it is consistent with the
			 needs and mission of the Department, it shall, wherever practical, collect
			 personal data directly from the person to whom a record pertains.
(e) When an individual is asked to supply
			 personal data to the Department, the Department shall disclose to that
			 individual, upon request:
(1) the name of the
			 Department and division within the Department requesting the personal
			 data;
(2) the legal authority under
			 which the Department is empowered to collect and maintain the personal
			 data;
(3) the individual's rights
			 pertaining to such records under the Personal Data Act and the Department
			 regulations;
(4) the known
			 consequences arising from supplying or refusing to supply the requested
			 personal data;
(5) the proposed use
			 to be made of the requested personal data.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(c) - Personal Data › Section 17a-451(c)-5 - Procedure for contesting the content of personal data

Current through July 10, 2024
(a) Any person who believes that the
			 Department is maintaining inaccurate, incomplete or irrelevant personal data
			 concerning her/him may file a written request with the Department for
			 correction of said personal data.
(b) Within 30 days of receipt of such
			 request, the Department shall give written notice to that person that it will
			 make the requested correction, or if the correction is not to be made as
			 submitted, the Department shall state the reason for its denial of such request
			 and notify the person of her/his right to add her/his own statement to her/his
			 personal data records.
(c)
			 Following such denial by the Department, the person requesting such correction
			 shall be permitted to add a statement to her/his personal data record setting
			 forth what that person believes to be an accurate, complete and relevant
			 version of the personal data in question. Such statements shall become a
			 permanent part of the Department's personal data system and shall be disclosed
			 to any individual, agency or organization to which the disputed personal data
			 is disclosed.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-2 - Applicability

Current through July 10, 2024
Only those covered service providers supported partially or in
				full with DMHAS funds are subject to sections
				17a-451(t)
				-1 to
				17a-451(t)
				-19 inclusive of the Regulations of Connecticut State Agencies. The
				Commissioner may determine that a mental health or substance use disorder
				service offered by a covered service provider shall be exempt from sections
				17a-451 (t)-1 to 17a-451 (t)-19 inclusive of the Regulations of Connecticut
				State Agencies, if the Commissioner makes a written finding that:
(1) DMHAS funding to the covered service
			 provider for such mental health or substance use disorder service does not
			 exceed 20% of its budget; and
(2)
			 The covered service provider has an adequate procedure for the redress of
			 grievances relating to such mental health or substance use disorder
			 service.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-3 - Posting

Current through July 10, 2024
All covered service providers shall prominently post a summary
				version of this regulation, in a form provided by the Commissioner, together
				with the name and telephone number of the relevant client rights officer, and a
				list of available advocacy programs, in every unit, mental health or substance
				use disorder service location, and client lounge operated by the covered
				service provider.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-4 - Notice

Current through July 10, 2024
If a covered service provider denies, involuntarily reduces or
				terminates a mental health or substance use disorder service, then the covered
				service provider shall provide the client with a written notice of the action
				taken and the reason for such action. The notice shall also inform the client
				of the following procedures available to the client if the client is
				dissatisfied with the action:
(1)
			 Filing a grievance as specified in section
			 17a-451(t)
			 -5 of the Regulations of Connecticut State Agencies;
(2) Filing an accelerated grievance as
			 specified in section
			 17a-451(t)
			 -7 of the Regulations of Connecticut State Agencies; and
(3) Filing a request for continuation of
			 mental health or substance use disorder services as specified in section
			 17a-451(t)
			 -8 of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-5 - Filing of grievances

Current through July 10, 2024
(a) A written
			 grievance may be filed by a client or by a person authorized by law to act on
			 behalf of the client with the client rights officer. Except as provided under
			 section
			 17a-451(t)
			 -7 of the Regulations of Connecticut State Agencies, a grievance shall be filed
			 not later than forty-five calendar days after the receipt of notice of the
			 action complained of, unless good cause is shown for a late filing, as
			 determined by the client rights officer. A grievance may be withdrawn at any
			 time. Withdrawal of a grievance shall not affect any covered service provider
			 corrective action begun under section
			 17a-451(t)
			 -6 of the Regulations of Connecticut State Agencies.
(b) Each covered service provider shall
			 designate a person to serve as a client rights officer. A covered service
			 provider may designate another covered service provider's client rights officer
			 to serve as its client rights officer. A covered service provider may also
			 designate another person to act as a client rights officer, if the originally
			 designated client rights officer is not available. A person employed by the
			 covered service provider as a patient advocate shall not serve as a client
			 rights officer.
(c) A grievance
			 shall be filed in writing with the client rights officer. Upon request, staff
			 members of a covered service provider shall assist clients in preparing written
			 grievances and submitting them to the client rights officer. A copy of all
			 records concerning a grievance shall be kept by the client rights
			 officer.
(d) The client rights
			 officer shall provide written notice to all clients filing a grievance of
			 available advocacy programs and the client's right to select an advocate of his
			 or her choice to assist in pursuing the grievance, subject to the provisions of
			 subsection (e) of this section. If a client selects an advocate to assist in
			 pursuing the grievance, the client shall provide the client rights officer with
			 written notice of the client's selection and the client shall sign a consent to
			 disclose information and records protected by state and federal law to the
			 advocate.
(e) A covered service
			 provider may disapprove an advocate selected by the client who is receiving
			 mental health or substance use disorder services from the same covered service
			 provider on the ground that it is clinically detrimental.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-7 - Accelerated grievances

Current through July 10, 2024
(a) An accelerated
			 grievance may be filed by a client or a person authorized by law to act on the
			 client's behalf regarding, (1) the involuntary reduction or termination of
			 opioid substitution therapy, or (2) the termination of substance use disorder
			 services consisting of inpatient treatment scheduled for a period of not more
			 than thirty calendar days. Such grievance shall comply with the requirements of
			 section
			 17a-451(t)
			 -5 of the Regulations of Connecticut State Agencies except that it shall be
			 filed not later than five business days after the receipt of notice of the
			 action complained of as specified in section
			 17a-451(t)
			 -4 of the Regulations of Connecticut State Agencies.
(b) An accelerated grievance shall be
			 processed as specified in section
			 17a-451(t)
			 -6 of the Regulations of Connecticut State Agencies except that the inquiry,
			 disposition, and if necessary the decision of the head of a covered service
			 provider or covered service provider's designee shall be completed not later
			 than five business days after the receipt of the grievance, unless the head of
			 the covered service provider or such designee authorizes, and the client or
			 person authorized by law to act on the client's behalf consents in writing, to
			 additional time for completion, in increments of not more than five business
			 days.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-8 - Requests for continuation of mental health or substance use disorder services

Current through July 10, 2024
(a) If a covered
			 service provider or the covered service provider's designee terminated mental
			 health or substance use disorder services without an offer of modified mental
			 health or substance use disorder services, then a request for continuation of
			 mental health or substance use disorder services may be filed by a client or a
			 person authorized by law to act on the client's behalf. The request for
			 continuation of mental health or substance use disorder services shall be filed
			 in writing with the Commissioner or the Commissioner's designee not later than
			 five business days after the receipt of notice of the termination of mental
			 health or substance use disorder services.
(b) The Commissioner or the Commissioner's
			 designee shall issue a decision regarding the request for continuation of
			 mental health or substance use disorder services, not later than five business
			 days after receiving the written request. The Commissioner or the
			 Commissioner's designee may order the continuation, modification, or
			 termination of the mental health or substance use disorder service. The
			 Commissioner or the Commissioner's designee shall consider the clinical needs
			 of the client and the potential for any risk of harm to the client, or others
			 or to property. The Commissioner or the Commissioner's designee may modify any
			 order entered as specified in this section at any time based on these same
			 considerations.
(c) Any order
			 entered as specified in this section shall automatically expire upon the
			 occurrence of any one of the following events:
(1) Implementation of an informal resolution,
			 or
(2) Withdrawal of the grievance,
			 or
(3) Fifteen business days elapse
			 after the client's receipt of the written decision of the head of the covered
			 service provider and further review is not requested, or
(4) Thirty calendar days elapse after the
			 date of the mailing of the final determination and a fair hearing is not
			 requested, or
(5) A request for a
			 hearing is disposed of as specified in section
			 17a-451(t)
			 -13 of the Regulations of Connecticut State Agencies, or
(6) A final decision is issued by the
			 Commissioner.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-9 - Further review

Current through July 10, 2024
(a) A client may
			 request the Commissioner or the Commissioner's designee to conduct a further
			 review of a decision of a covered service provider not later than fifteen
			 business days after the client's receipt of the covered service provider's
			 decision, unless the time is extended by the Commissioner or the Commissioner's
			 designee for good cause shown. If a decision of a covered service provider is
			 not more than seven business days overdue, the client may treat it as a denial
			 and request further review. Additionally, if the covered service provider fails
			 to implement an informal resolution that was agreed to by the client, and where
			 such failure is not due to the client's action or inaction, the client may
			 request further review. A request for further review shall be in writing, and
			 shall state what decision of the covered service provider is being reviewed and
			 the grounds upon which the request is based.
(b) Upon receipt of the request for further
			 review, the Commissioner's designee shall conduct such additional investigation
			 as the Commissioner's designee determines is necessary, receive additional
			 information from the parties, and may convene a conference of all parties to be
			 held not later than twenty-one calendar days after the receipt of the request
			 for further review. If the grievance cannot be informally resolved the
			 Commissioner's designee shall issue a written decision not later than fifteen
			 calendar days after the date of the conference, or not later than twenty-one
			 calendar days after receipt of the request for further review, if no conference
			 is held. The written decision of the Commissioner's designee shall serve as
			 DMHAS' final determination.
(c) If
			 the final determination results in the denial, involuntary reduction or
			 termination of mental health or substance use disorder services, it shall
			 include a statement informing the client that the client may request a hearing
			 as specified in section
			 17a-451(t)
			 -10 to 17a-451 (t)-19, inclusive, of the Regulations of Connecticut State
			 Agencies.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-10 - Eligibility for a hearing

Current through July 10, 2024
Any client who has received an unfavorable final determination
				from DMHAS and (a) requested and was denied a mental health or substance use
				disorder service from a covered service provider, or (b) received mental health
				or substance use disorder services that were involuntarily reduced or
				terminated, may request a hearing as specified in sections
				17a-451(t)
				-10 to 17a-451 (t)-19, inclusive, of the Regulations of Connecticut State
				Agencies.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-11 - Request for a hearing

Current through July 10, 2024
A request for a hearing shall be mailed to the Commissioner not
				later than thirty calendar days after the date of mailing of the final
				determination. A request for a hearing shall identify the mental health or
				substance use disorder service that has been denied, involuntarily reduced or
				terminated, and shall specify the date of the final determination on the
				matter.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-12 - Scheduling and notice of hearing

Current through July 10, 2024
Upon receipt of a request for a hearing, the Commissioner shall
				designate a hearing officer. The hearing officer shall schedule a hearing to be
				held not later than forty-five calendar days after the date of the request,
				provided that if a request for an expedited hearing is made by a party, the
				hearing officer shall attempt to expedite the hearing if the hearing officer
				determines that a delay would be significantly damaging to that party. The
				hearing officer shall acknowledge a client's request for a hearing in writing
				and provide the client and the client's advocate, if applicable, written notice
				of the hearing. The notice of the hearing shall comply with the requirements of
				section
				4-177
				of the Connecticut General Statutes. If the matter involves a covered service
				provider, the covered service provider shall be notified by the hearing officer
				that it may participate in the hearing. The hearing officer, upon notice to the
				covered service provider, DMHAS, the client, and the client's advocate, if any
				is known, may reschedule the hearing.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-13 - Resolution of request for hearing

Current through July 10, 2024
(a) A request for a
			 hearing shall be resolved pursuant to section
			 4-177
			 of the Connecticut General Statutes in one or more of the following ways:
(1) The client's withdrawal of the request
			 for hearing. The withdrawal shall be voluntary, in writing to the Commissioner
			 and made at any time prior to the hearing. The withdrawal shall be acknowledged
			 in writing by the hearing officer and shall be the final action on the
			 complaint.
(2) Dismissal of the
			 request by the hearing officer. This action may be taken, if:
(A) The client fails to appear at the
			 designated time and place; or
(B)
			 The issue is resolved prior to or during the hearing by voluntary agreement of
			 both parties.
(3) Final
			 decision by the Commissioner after receiving a proposed decision from the
			 hearing officer following a hearing.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-14 - Conduct of proceedings

Current through July 10, 2024
The hearing shall be conducted as a contested case under the
				provisions of Chapter 54 of the Uniform Administrative Procedure Act, sections
				4-166 to
				4-189,
				inclusive, of the Connecticut General Statutes. The client has the burden of
				proving by a preponderance of evidence that the final determination from DMHAS
				does not comply with state and federal law or is clearly
				erroneous.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-15 - Witnesses and testimony

Current through July 10, 2024
All witnesses shall be under oath. The client may act as a
				witness on the client's own behalf, and may bring additional witnesses. DMHAS
				and any affected covered service provider may present any appropriate
				witness.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 451(t) - Fair Hearing Policy › Section 17a-451(t)-19 - Final decision

Current through July 10, 2024
Upon conclusion of the hearing, the hearing officer shall
				prepare a proposed written decision and shall mail it to the parties by
				certified mail, return receipt requested, as well as providing it to the
				Commissioner. The proposed decision shall contain a statement of the reasons
				for the proposed decision and a finding of facts and conclusions of law on each
				issue of fact or law necessary to the proposed decision. Any party may, not
				later than fifteen calendar days after the mailing of the proposed decision,
				provide the Commissioner with written argument in support of, or in opposition
				to, said proposed decision, and may request the opportunity for oral argument.
				The Commissioner shall render a final decision which may, in whole or in part,
				accept, modify or reject the proposed decision.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-1 - Scope

Current through July 10, 2024
These regulations are issued pursuant to subsection (b) of
				section 17a-453a of the Connecticut General Statutes and govern the operation
				of the behavioral health managed care program for eligible recipients of
				medical services under the state-administered general assistance
				program.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-3 - Eligibility

Current through July 10, 2024
(a) In order to be eligible for covered
			 behavioral health services under the GABHP, the individual shall:
(1) Be determined eligible by DSS for medical
			 services pursuant to section
			 17b-192 of the
			 Connecticut General Statutes;
(2)
			 Be determined by DMHAS staff or the designated agent to need covered behavioral
			 health services available through the GABHP established pursuant to section
			 17a-453a of the Connecticut General Statutes. Such determination shall be based
			 upon an evaluation of medical necessity that includes, but is not limited to,
			 evaluation of:
(A) The individual's mental
			 status;
(B) Problems identified by
			 the individual; and
(C) The
			 individual's history of behavioral health services; and
(3) Meet the criteria for a diagnosis of one
			 or more psychiatric disabilities, substance use disorders or both as specified
			 in the following range of DSM-IV diagnostic codes:
(A) 291.1 to 292.9, inclusive; or
(B) 295.0 to 315.9, inclusive, except for
			 diagnosis 307.89, Pain Disorder Associated with a Medical Condition.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-5 - Limitations, exclusions and non-payment of behavioral health services

Current through July 10, 2024
(a)
Limitations:
The following
			 limitations shall apply:
(1) DMHAS payment for
			 outpatient therapy shall be limited to one (1) session per contracted provider,
			 per day, for each eligible recipient for each of the following therapies,
			 unless additional behavioral health services are authorized in advance by the
			 designated agent:
(A) Individual
			 therapy;
(B) Group therapy;
			 or
(C) Family therapy;
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-6 - Prior authorization review

Current through July 10, 2024
(a) The prior
			 authorization review shall determine whether covered behavioral health services
			 are medically necessary and determine the appropriate level of care. Contracted
			 providers shall obtain prior authorization from the designated agent by
			 contacting the designated agent by telephone before admitting a potentially
			 eligible or eligible recipient to a covered behavioral health service, except
			 that contracted providers shall obtain authorization for covered outpatient
			 services as specified in section
			 17a-453a-8
			 of the Regulations of Connecticut State Agencies.
(b) The contracted provider shall provide the
			 designated agent with the following information for the purpose of prior
			 authorization review of covered behavioral health services requested for a
			 potentially eligible or eligible recipient:
(1) Identifying information;
(2) DSM-IV provisional or admitting diagnosis
			 or diagnoses;
(3) Level of care
			 requested;
(4) Clinical
			 presentation of the potentially eligible or eligible recipient and
			 justification for the requested covered behavioral health service, including
			 such factors as mental status, natural supports and strengths;
(5) Recovery plan objectives;
(6) Current symptoms of a psychiatric
			 disability, a substance use disorder or both;
(7) Clinical risk assessment and relapse
			 potential;
(8) Medication(s)
			 used;
(9) Substance(s)
			 used;
(10) Whether the potentially
			 eligible or eligible recipient is voluntarily agreeing to treatment;
(11) Legal status of the potentially eligible
			 or eligible recipient, if known;
(12) Potentially eligible or eligible
			 recipient's preference for a covered behavioral health service and contracted
			 provider;
(13) Treatment
			 location;
(14) Provisional
			 discharge or aftercare plan or both;
(15) Projected date of discharge;
(16) Name of the potentially eligible or
			 eligible recipient's primary care physician, if any; and
(17) All other information that the
			 designated agent may require.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-7 - Continued stay authorization review

Current through July 10, 2024
(a) The continued
			 stay authorization review shall determine whether previously authorized covered
			 behavioral health services continue to be medically necessary. If a contracted
			 provider determines that additional care may be needed beyond that which has
			 been authorized for a potentially eligible or eligible recipient, the
			 contracted provider shall contact the designated agent by telephone not less
			 than four (4) hours prior to the expiration of the existing authorization for
			 acute care services and not more than forty-eight (48) hours prior to the
			 expiration of the existing authorization for other covered behavioral health
			 services in order to obtain a continued stay authorization.
(b) The contracted provider shall furnish all
			 information that may be requested by the designated agent for the purpose of
			 determining continued stay authorization of covered behavioral health services
			 requested for a potentially eligible or eligible recipient, including, but not
			 limited to, the following:
(1) Identifying
			 information;
(2) DSM-IV current
			 diagnosis or diagnoses;
(3) Level
			 of care requested;
(4) Clinical
			 presentation of the potentially eligible or eligible recipient and
			 justification for the requested covered behavioral health service, including
			 such factors as mental status, natural supports and strengths;
(5) Recovery plan objectives;
(6) Current symptoms of mental illness or
			 substance use disorders or both;
(7) Clinical risk assessment and relapse
			 potential;
(8) Medication(s)
			 used;
(9) Substance(s)
			 used;
(10) Whether the potentially
			 eligible or eligible recipient is voluntarily agreeing to treatment;
(11) Legal status of the potentially eligible
			 or eligible recipient, if known;
(12) Potentially eligible or eligible
			 recipient's preference for a covered behavioral health service and contracted
			 provider;
(13) Treatment
			 location;
(14) Provisional
			 discharge or aftercare plan or both;
(15) Projected date of discharge;
(16) Name of the potentially eligible or
			 eligible recipient's primary care physician, if any; and
(17) All other information that the
			 designated agent may require.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-8 - Alternative authorization review

Current through July 10, 2024
(a) Web-based
			 registration or outpatient treatment review (OTR) submission shall be the
			 alternative methods to prior authorization review and continued stay review.
			 The web-based registration and OTR submission shall be in the format as
			 determined by DMHAS or its designated agent.
(b) The alternative authorization review
			 shall be designed to determine whether the following covered behavioral health
			 services are medically necessary:
(1)
			 Outpatient-substance use;
(2)
			 Outpatient-mental health; and
(3)
			 Chemical maintenance treatment.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-9 - Recovery and discharge planning

Current through July 10, 2024
Except for those providing laboratory services, all contracted
				providers shall meet the following requirements:
(a) The contracted provider shall develop a
			 recovery plan with each eligible recipient:
(1) The recovery plan shall be developed with
			 participation from the eligible recipient or, if the eligible recipient does
			 not participate in its development, shall contain a written explanation as to
			 why the eligible recipient did not participate; and
(2) The recovery plan shall reflect:
(A) The eligible recipient's preferences,
			 interests, strengths and areas of health;
(B) Specific outcomes that the eligible
			 recipient desires related to the eligible recipient's preferences, interests,
			 strengths and areas of health;
(C)
			 Activities, supports and covered behavioral health services that may assist
			 with the achievement of the eligible recipient's desired outcomes;
(D) Regularly scheduled review and, if
			 necessary, revision of the recovery plan; and
(E) Review by, and signatures of the eligible
			 recipient, counselor or clinician responsible for the development of the
			 recovery plan with the eligible recipient, and his or her supervisor if the
			 counselor or clinician is not licensed or certified.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-10 - Quality management

Current through July 10, 2024
(a)
Compliance with confidentiality requirements:
The contracted
			 provider shall comply with all state and federal requirements pertaining to the
			 communication, storage, dissemination, and retention of confidential
			 information regarding potentially eligible or eligible recipients with a
			 psychiatric disability, a substance use disorder or both, including the Health
			 Insurance Portability and Accountability Act (HIPAA); 45 CFR 164, 42 CFR 2; and
			 17a-688(c) and Chapter 899 of the Connecticut General Statutes; and other such
			 laws and regulations as may apply. In addition, the contracted provider shall
			 assume responsibility for obtaining any release of information that may be
			 necessary to meet contractual data transmittal and behavioral health service
			 coordination requirements specified in sections
			 17a-453a-1 to
			 17a-453a-19,
			 inclusive, of the Regulations of Connecticut State Agencies.
(b)
Critical incident reporting:
Except for providers of laboratory services, a contracted provider shall report
			 every critical incident to the DMHAS Office of the Commissioner in the form and
			 manner specified by the department.
(c)
Other reporting
			 requirements:
The contracted provider shall submit to DMHAS or its
			 designated agent timely and accurate information in the format specified by
			 DMHAS or its designated agent. This information includes, but is not limited
			 to, the following:
(1) Demographic data
			 regarding the eligible recipients served;
(2) Descriptions of the covered behavioral
			 health services delivered;
(3)
			 Descriptions of the contracted provider's staff sufficient for DMHAS to assess
			 the agency's cultural competency;
(4) Treatment outcomes;
(5) Results of risk assessment screenings;
			 and
(6) A critical incident review
			 summary, including recommendations, in the format and manner specified by the
			 department.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-11 - Provider application

Current through July 10, 2024
(a) In order to be
			 considered for participation in the GABHP, a provider shall request in writing
			 an application packet from the designated agent. The application packet shall
			 be completed by the provider and shall include all information required by
			 DMHAS.
(b) DMHAS shall require, at
			 a minimum, the following information from a provider:
(1) Name, address, telephone number and
			 contact person;
(2) Age groups and
			 genders treated;
(3) Staff
			 licenses, competencies and language(s) spoken;
(4) Problems and disorders treated;
(5) Level(s) of care offered and capacity for
			 each;
(6) Treatment specialties;
			 and
(7) A copy of the
			 state-required facility license(s).
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-12 - Provider credentials

Current through July 10, 2024
(a) The provider
			 credentialing process is described as follows:
(1) The purpose of the credentialing process
			 is for DMHAS to determine if a provider applying to participate in the GABHP
			 has the requisite qualifications.
(2) The credentialing process shall include
			 the assessment and validation of qualifications of providers to determine
			 whether the provider is qualified to offer specific levels of care and meets
			 the credentialing requirements specified for those levels of care in this
			 section. If DMHAS determines that a provider has not met the required
			 qualifications as specified in this section, DMHAS shall not contract with the
			 provider under the GABHP.
(3) The
			 designated agent shall collect and review documentation that includes, but is
			 not limited to:
(A) Status of facility or
			 professional licensure, certification or accreditation;
(B) Experience in providing behavioral health
			 services to individuals;
(C)
			 Evidence of adequate malpractice insurance coverage; and
(D) Descriptions detailing programmatic and
			 staffing information for each behavioral health service and level of care
			 proposed for credentialing.
(4) The designated agent shall review the
			 credentials of each provider for each behavioral health service or level of
			 care that the provider proposes to deliver and shall make a recommendation to
			 DMHAS. DMHAS shall decide whether the provider meets the credentialing
			 qualifications necessary to offer the proposed behavioral health service(s) or
			 level(s) of care.
(5) The provider
			 shall be required to submit to the designated agent additional information or
			 clarification, if any discrepancies or questions are identified.
(6) The provider shall be required to meet
			 all credentialing criteria as specified in this section. If any of the
			 credentialing criteria are not met, the provider shall be denied participation
			 in the GABHP.
(7) Any provider that
			 has been sanctioned by DSS for violations while participating in the Medicaid
			 program shall not be credentialed for the GABHP.
(8) DMHAS shall notify the provider in
			 writing of the outcome of the credentialing process. If DMHAS determines that
			 the provider meets the requisite credentialing qualifications as specified in
			 this section, then DMHAS may initiate the contracting process as specified in
			 section
			 17a-453a-13 of
			 the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-13 - Provider contract

Current through July 10, 2024
(a) DMHAS, in its
			 sole discretion, may extend an offer to contract with a provider who has been
			 credentialed for covered behavioral health services under the GABHP.
(1) A provider who has been credentialed for
			 a covered behavioral health service may not participate in the GABHP unless the
			 provider has executed a contract with DMHAS to deliver a covered behavioral
			 health service to eligible recipients. The contract shall specify the terms and
			 conditions that shall govern the GABHP and to which the contracted provider
			 must adhere in order to participate in the GABHP.
(2) DMHAS shall not pay for covered
			 behavioral health services that are delivered to eligible recipients in the
			 absence of a fully executed contract with DMHAS, unless covered behavioral
			 health services were delivered by an out-of-network provider as specified in
			 section
			 17a-453a-19
			 of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-14 - Administration of contracted providers' claims for payment

Current through July 10, 2024
(a) Contracted providers shall only be paid
			 for covered behavioral health services that:
(1) Are delivered to eligible recipients;
			 and
(2) The contracted provider
			 received all applicable prior authorization, continued stay authorization and
			 alternative authorization as specified in sections17a-453a-6
			 through
			 17a-453a-8
			 of the Regulations of State Agencies, concerning the delivery of covered
			 behavioral health services to eligible recipients.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-15 - Provider claim for payment grievance process

Current through July 10, 2024
(a) If a
			 contracted provider's claim for payment is denied by the designated agent, the
			 contracted provider may file a claim for payment grievance with the designated
			 agent. Contracted providers may initiate a first-level claim for payment
			 grievance to the designated agent not later than thirty (30) calendar days
			 after the date of the denial decision. The first-level claim for payment
			 grievance shall not include any right to an administrative hearing from either
			 DMHAS or its designated agent.
(b)
			 DMHAS or its designated agent shall notify the contracted provider in writing
			 of its first- level claim for payment grievance decision not later than thirty
			 (30) calendar days following the date of receipt of all information as
			 determined necessary by DMHAS to render a decision.
(c) Contracted provider may initiate a
			 second-level claim for payment grievance. The second-level claim for payment
			 grievance shall be submitted in writing directly to DMHAS not later than seven
			 (7) calendar days following the date of the first-level claim for payment
			 grievance denial decision. The second-level claim for payment grievance shall
			 be submitted in writing and accompanied by all information as determined
			 necessary by DMHAS to render a decision on the second-level claim for payment
			 grievance.
(d) DMHAS shall neither
			 accept, nor review, a second-level claim for payment grievance that does not
			 conform with the submission requirements as specified in this section, unless
			 the designated agent has failed to respond to the contracted provider within
			 the time frame as specified in this section.
(e) Any second-level claim for payment
			 grievance decision issued by DMHAS shall be final and shall conclude the
			 grievance process. The second-level claim for payment grievance shall not
			 include any right to an administrative hearing from either DMHAS or its
			 designated agent.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-16 - Audit

Current through July 10, 2024
(a) DMHAS or its designated agent may conduct
			 audits of a contracted provider's clinical, programmatic, fiscal or other
			 records to verify the accuracy of the contracted provider's claims for payment
			 and the contracted provider's compliance with state and federal law and the
			 contracted provider contract. Audits shall be conducted when care has been
			 authorized, claims have been paid or when DMHAS deems it necessary to carry out
			 its responsibilities under state or federal law.
(b) Audits may include, but are not limited
			 to, review of the following:
(1) The
			 contracted provider's claim(s) for payment;
(2) The covered behavioral health services
			 delivered by the contracted provider to an eligible recipient;
(3) The contracted provider's credentialing
			 or re-credentialing information;
(4) The contracted provider's information
			 supplied to DMHAS regarding a request for reconsideration of contract
			 termination;
(5) The contracted
			 provider's compliance with state and federal law and the provider contract;
			 and
(6) Whether the contracted
			 provider has engaged in any fiscal irregularities.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-17 - Administrative hearing to appeal audit recovery or progressive sanctions

Current through July 10, 2024
(a) Contracted providers have a right to an
			 administrative hearing as follows:
(1) The
			 contracted provider is subject to recovery of payments following an audit
			 conducted by DMHAS or its designated agent as specified in section
			 17a-453a-16 of the
			 Regulations of Connecticut State Agencies;
(2) The contracted provider is subject to
			 progressive sanctions following an audit conducted by DMHAS or its designated
			 agent as specified in section
			 17a-453a-16 of the
			 Regulations of Connecticut State Agencies; and
(3) The commissioner has determined that the
			 contracted provider's participation in the GABHP should be terminated for any
			 of the reasons as specified in section
			 17a-453a-13(e)
			 of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-18 - Appeals and fair hearings

Current through July 10, 2024
There are two (2) types of appeals that an individual may file
				with DMHAS or its designated agent:
(a)
First-level appeal.
(1) A first-level appeal may be filed by the
			 individual or his or her authorized representative. The first-level appeal
			 shall be filed with the designated agent not later than seven (7) calendar days
			 after the decision by the designated agent to deny, reduce or terminate covered
			 behavioral health services, unless good cause is shown for late filing as
			 determined by the designated agent. A first-level appeal is not a "contested
			 case" pursuant to section
			 4-166(2)
			 of the Connecticut General Statutes.
(2) A first-level appeal shall be filed in
			 writing with all supporting records. All records relating to a first-level
			 appeal shall be kept confidential, unless disclosure is otherwise required by
			 law or authorized in writing by the individual.
(3) DMHAS or its designated agent shall send
			 written notice of the first-level appeal decision by the designated agent to
			 the individual or his or her authorized representative and to the contracted
			 provider not later than seven (7) calendar days after the designated agent has
			 determined it has received all information necessary to render a
			 decision.
(4) If the designated
			 agent fails to issue a decision within seven (7) calendar days, the individual
			 or his or her authorized representative may treat it as a denial and request
			 further review under the second-level appeal.
Connecticut Administrative Code › Title 17a - Social and Human Services and Resources › 453a - General Assistance Behavioral Health Program › Section 17a-453a-19 - Out-of-network providers

Current through July 10, 2024
(a) An
			 out-of-network provider is a provider who does not have an executed contract
			 with DMHAS to participate in GABHP. An out-of-network provider only may deliver
			 covered behavioral health services to eligible recipients, as specified in this
			 section.
(b)
Covered
			 behavioral health services:
Out-of-network providers are eligible for
			 payment under GABHP for acute care services only.
(c)
Service limitations, exclusions,
			 and non-reimbursable services:
(1)
			 Out-of-network providers shall be subject to all service limitations,
			 exclusions and non-reimbursable services that apply to contracted providers as
			 specified in section
			 17a-453a-5
			 of the Regulations of Connecticut State Agencies.
(2) DMHAS shall not pay an out-of-network
			 provider for any covered behavioral health services except for a maximum of
			 four (4) acute care services delivered to an eligible recipient in a calendar
			 year.