reglab/statecodes huggingface dataset:
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-262-914 - Provider participation

Current through July 10, 2024
In order to enroll in Medicaid and receive payment from the department, a provider shall:
(1) Comply with all applicable licensing, accreditation and certification requirements;
(2) comply with all departmental enrollment requirements, including sections 17b-262-522 to 17b-262-532, inclusive, of the Regulations of Connecticut State Agencies;
(3) comply with sections 17b-262-912 to 17b-262-925, inclusive, of the Regulations of Connecticut State Agencies; and
(4) have a valid provider agreement on file with the department.
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-262-915 - Eligibility

Current through July 10, 2024
The department shall pay for medically necessary behavioral health clinician services provided to clients eligible for such services, subject to the conditions and limitations that apply to these services.
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-262-916 - Services covered

Current through July 10, 2024
The department shall pay only for behavioral health clinician services that are:
(1) Within the licensed behavioral health clinician's scope of practice as defined by chapters 376b, 383a, 383b or 383c of the Connecticut General Statutes, as applicable to the behavioral health clinician; and
(2) medically necessary to treat the client's condition.
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-262-917 - Service limitations

Current through July 10, 2024
The department shall pay for covered services only in accordance with the treatment plan and with the following additional limits:
(1) Only one diagnostic interview in any twelve-month period per licensed behavioral health clinician per client;
(2) only one unit of individual counseling or individual psychotherapy per client, per day;
(3) only one unit of family counseling or family psychotherapy per client, per day;
(4) only one unit of group counseling or group psychotherapy per client, per day;
(5) group psychotherapy sessions shall include a maximum of twelve participants per group session, to the extent clinically appropriate, regardless of each participant's payment source, and the provider shall document the number of participants in each session in the client's chart;
(6) family, group and multiple-family group psychotherapy sessions shall be at least forty-five minutes in length, and the provider shall document the length of time of each session in the client's chart;
(7) family and multiple-family group psychotherapy shall be reimbursable for one identified family member client per session, without regard to the number of family members in attendance or the presence of behavioral health conditions among other family members in attendance; and
(8) multiple-family group psychotherapy shall include a maximum of twenty-four participants per group regardless of each participant's payment source, shall include members of at least two unrelated families and the provider shall document the number of participants in each session in the client's chart.
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-262-918 - Services not covered

Current through July 10, 2024
The department shall not pay for the following behavioral health clinician services:
(1) Information or services furnished by the licensed behavioral health clinician to the client electronically or over the telephone, except for case management services provided to clients age eighteen and under;
(2) case management services provided to clients age nineteen and older;
(3) evaluations, diagnostic interviews and therapy services performed in hospital inpatient or outpatient settings;
(4) concurrent services involving the same treatment modalities for the same client by different health professionals;
(5) cancelled office visits or appointments not kept;
(6) services, treatment or items for which the provider does not usually charge;
(7) behavioral health clinician services in excess of those medically necessary to treat the client's condition;
(8) services not directly related to the client's diagnosis, symptoms or medical history;
(9) services provided by anyone other than the provider; and
(10) services that are primarily for vocational or educational guidance.
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-262-919 - Need for service and treatment plan

Current through July 10, 2024
The department shall pay for medically necessary behavioral health clinician services. The provider shall establish a treatment plan for each client based on the initial diagnostic evaluation before commencing treatment and shall regularly update the treatment plan in accordance with the client's progress as necessary and at least every six months. Notwithstanding section 17b-962-917 of the Regulations of Connecticut State Agencies, the department shall pay for an initial diagnostic evaluation in order to enable the licensed behavioral health clinician to develop the treatment plan. The treatment plan shall specify the treatment modalities and frequency of care necessary to meet the client's needs, identify measurable outcomes to be achieved and identify any medical providers with whom the licensed behavioral health clinician is coordinating care.
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-262-920 - Prior authorization and registration

Current through July 10, 2024
(a) Where a service requires prior authorization or registration under this section, the department shall not pay for such service unless the provider complies with this section and all of the department's requirements for prior authorization or registration, as applicable.
(b) The department shall designate services that require prior authorization or registration in the department's fee schedule or on the department's website or by other means accessible to providers, with advance notice given to providers before changing the prior authorization or registration requirements. Registration may serve in lieu of prior authorization only if the department designates a service as requiring registration but not prior authorization. Prior authorization is also required for:
(1) Any service that is not in the department's fee schedule; and
(2) EPSDT Special Services.
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-262-921 - Billing procedures

Current through July 10, 2024
(a) Providers shall submit claims on the department's designated form or by electronic transmission as established by the department and shall include all information required by the department to process the claim for payment.
(b) The amount billed to the department shall represent the licensed behavioral health clinician's usual and customary charge for the services provided.
(c) When a licensed behavioral health clinician is requested to attend a staff conference for a client, the name of the referring practitioner, clinic or agency shall be entered in the appropriate section of the claim form.
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-262-922 - Payment

Current through July 10, 2024
(a) Licensed behavioral health clinicians who are fully or partially compensated by a Medicaid participating general hospital, public or private institution, freestanding clinic or federally qualified health center shall not receive payment from the department for services rendered at such entities unless the licensed behavioral health clinician maintains an office for private practice at a separate location from the entity referenced above where the licensed behavioral health clinician is employed. The licensed behavioral health clinician shall bill the department only for a service provided to a client whose overall treatment is provided through the provider's private practice, although each individual service may be provided either at the practice, the client's home or in the community.
(b) Payment for services directly performed by a licensed behavioral health clinician in private practice 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 department's applicable fee schedule.
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-262-924 - Payment limitations

Current through July 10, 2024
(a) The fees for a diagnostic interview examination, as stipulated in the department's applicable fee schedule, represent one unit of service. The provider shall bill for only one unit of service for a diagnostic interview examination regardless of the number of days it takes to complete.
(b) If a session includes a combination of individual and family psychotherapy, the provider shall bill for the modality that comprises the greater part of the session. The provider shall not bill for both individual and family psychotherapy for the same date of service unless each modality individually meets the minimum time requirement for the modality specified in the department's fee schedule or in section 17b-262-917 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 Services Provided by Licensed Behavioral Health Clinicians in Independent Practice › Section 17b-262-925 - Documentation

Current through July 10, 2024
(a) Providers shall maintain (1) a specific record for all services provided to each client including, but not limited to: name, address, birth date, Medicaid identification number, pertinent diagnostic information, a current treatment plan signed by the licensed behavioral health clinician and (2) documentation of services provided, including, types of service or modalities, date of service, location of the service and the start and stop time of the service.
(b) For treatment services, the provider shall document the treatment intervention and progress with respect to the client's goals as identified in the treatment plan.
(c) Providers shall maintain all required documentation in its original form for a minimum of five years or longer if required by applicable statutes and regulations, subject to review by the department. In the event of a dispute concerning a service provided, the provider shall maintain documentation until the end of the dispute, five years or the time required by applicable statues and regulations, whichever is greater.
(d) The department may disallow and recover any amounts paid to the provider for which required documentation is not maintained and provided to the department upon request.
(e) The department may audit any relevant records and documentation and take any other appropriate quality assurance measures it deems necessary to assure compliance with these and other regulatory and statutory requirements.
(f) Providers shall make all entries in ink or electronically and shall incorporate all documentation into a client's permanent medical record in a complete, prompt and accurate manner.
(g) Providers shall make all documentation available to the department upon request in accordance with 42 CFR 431.107.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Birth Centers › Section 17b-262-956 - Scope

Current through July 10, 2024
Sections 17b-262-956 to 17b-262-965, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services requirements for payment to birth centers that are medically necessary and are provided to clients who are determined to be eligible to receive such goods and services under Medicaid 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 to Birth Centers › Section 17b-262-958 - Provider participation

Current through July 10, 2024
(a) To enroll in Medicaid and receive payment from the department, a provider shall comply with sections 17b-262-956 to 17b-262-965, inclusive, of the Regulations of Connecticut State Agencies and sections 17b-262-522 to 17b-262-532, inclusive, of the Regulations of Connecticut State Agencies.
(b) A birth center shall:
(1) Be accredited by the Commission for the Accreditation of Birth Centers;
(2) be licensed by the Department of Public Health as a maternity hospital in accordance with section 19-13-D14 of the Regulations of Connecticut State Agencies or be licensed by the Department of Public Health as a birth center in accordance with regulations adopted by the Department of Public Health that specifically regulate birth centers; and
(3) comply with (A) section 19a-505 of the Connecticut General Statutes and (B) section 19-13-D14 of the Regulations of Connecticut State Agencies or such other regulations adopted by the Department of Public Health that specifically regulate birth centers.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Birth Centers › Section 17b-262-960 - Eligibility

Current through July 10, 2024
Payment to a provider for birth center services is available for clients who have a need for such products and services when the items are medically necessary, subject to the conditions and limitations set forth in sections 17b-262-956 to 17b-262-965, 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 to Birth Centers › Section 17b-262-961 - Services covered and limitations

Current through July 10, 2024
(a) The department shall pay the provider a single all-inclusive fee for a normal, uncomplicated labor and delivery, which covers all services provided by the birth center, including, but not limited to:
(1) Care for, labor, delivery and recovery of the maternal patient;
(2) nursery care and other services provided to the infant patient; and
(3) other ambulatory services within the provider's scope of services established by the Department of Public Health that are offered by the provider and that are otherwise covered by Medicaid.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Birth Centers › Section 17b-262-962 - Payment and payment limitations

Current through July 10, 2024
(a) The department shall reimburse the provider when the provider has met all the requirements of sections 17b-262-956 to 17b-262-965, inclusive, of the Regulations of Connecticut State Agencies.
(b) The department's payment to the provider includes all birth center charges, including, but not limited to: charges for labor, delivery, anesthesia, laboratory, radiology, pharmacy, nursing and other clinical staff care. The department shall not pay any other charges to the provider.
(c) The department shall not pay the provider for a delivery at home or in any setting other than the birth center, except for services described in subsection (d) of this section.
(d) If the client is transferred to a hospital prior to the actual delivery, the department shall reimburse the provider for services provided in the birth center prior to such transfer at the lower of billed charges or the reduced fee specified for such services on the department's fee schedule.
(e) If the delivery occurs at the birth center, the department shall pay the provider at the lower of the fee on the department's fee schedule or the provider's usual and customary rate.
(f) Payment to the provider excludes all services provided by a licensed practitioner. Each licensed practitioner shall bill the department for services in accordance with the regulations applicable to the licensed practitioner's provider type.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Birth Centers › Section 17b-262-963 - Prior authorization

Current through July 10, 2024
(a) The department shall require prior authorization for:
(1) Any service identified on the department's fee schedule as requiring prior authorization;
(2) EPSDT special services; and
(3) any service that is not identified on the department's fee schedule.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Birth Centers › Section 17b-262-965 - Documentation

Current through July 10, 2024
(a) Providers shall maintain a specific record for all services provided to each client, including, but not limited to: name, address, birth date, Medicaid identification number, pertinent diagnostic information, treatment notes signed by the licensed practitioner, documentation of services provided and the dates the services were provided.
(b) Providers shall maintain all required documentation in its original form for at least five years or longer in accordance with applicable federal and state statutes and regulations, subject to review by authorized department personnel. If there is 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.
(c) The department may disallow and recover any amounts paid to the provider for which required documentation is not maintained or not provided to the department upon request.
(d) The department may audit all relevant records and documentation and take any other appropriate quality assurance measures it deems necessary to assure compliance with regulatory and statutory requirements.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-994 - Scope

Current through July 10, 2024
Sections 17b-262-994 to 17b-262-1004, inclusive, of the Regulations of Connecticut State Agencies set forth the Department of Social Services' requirements for payment to federally qualified health centers for services provided to clients who are eligible to receive such services under Medicaid pursuant to section 17b-261 of the Connecticut General Statutes. Federally qualified health centers shall be reimbursed in accordance with the Medicaid prospective payment system under 42 USC 1396a(bb).
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-995 - Definitions

Current through July 10, 2024
As used in section 17b-262-994 to section 17b-262-1004, inclusive, of the Regulations of Connecticut State Agencies:
(1) "Advanced practice registered nurse" or "APRN" means a person licensed under section 20-94a of the Connecticut General Statutes;
(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 in Chapters 376b, 378, 379a, 383a, 383c, and 384b of the Connecticut General Statutes and shall include alcohol and drug counselors, certified dietitians, certified nutritionists, dental hygienists, marital and family therapists, professional counselors, and registered nurses;
(B) A licensed master social worker working under the professional supervision of a physician, APRN, psychologist, licensed marital and family therapist, LCSW or a licensed professional counselor in accordance with section 20-195m of the Connecticut General Statutes; and
(C) A license-eligible individual as defined in subdivision (30) of this section;
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-996 - Provider participation

Current through July 10, 2024
In order to participate in the Connecticut Medicaid program and provide FQHC services eligible for reimbursement from the department, each FQHC shall:
(1) Comply with all applicable state licensing requirements;
(2) Comply with all departmental enrollment requirements, including sections 17b-262-522 to 17b-262-532, inclusive, of the Regulations of Connecticut State Agencies;
(3) Ensure that all health professionals and allied health professionals employed by or under contract arrangements with the FQHC to provide services meet all applicable federal and state licensing and certification requirements;
(4) Submit a copy of the FQHC's scope of project and any amendments to the scope of project in accordance with subsection (c) of section 17b-245d of the Connecticut General Statutes; and
(5) Submit a copy of the HRSA Notification of Grant Award Authorization of Public Health Service Funds.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-997 - Services covered

Current through July 10, 2024
(a) Covered core services for FQHCs include the following:
(1) Medical services furnished by a physician, PA, APRN or nurse midwife. The services shall be within the scope of practice of his or her profession under state law. There shall be a written agreement between the FQHC and the physician, PA, APRN or nurse midwife, stating that he or she will be paid by the FQHC for such services; and
(2) Services and supplies furnished as incident to professional services furnished by a physician, physician assistant, or advanced practice registered nurse.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-998 - Services not covered

Current through July 10, 2024
The following services are not covered:
(1) Services that are not covered in the Medicaid state plan;
(2) Services that are not medically necessary;
(3) Canceled services or appointments that are not kept;
(4) Inpatient services, except as provided in section 17b-262-999(d) (1);
(5) Simple foot hygiene;
(6) Any service requiring authorization or registration for which the provider did not obtain such authorization or registration;
(7) Any procedures or services that are solely educational, social, research, recreational, experimental or generally not accepted by medical practice; or
(8) Visits for the sole purpose of obtaining or refilling a prescription, the need for which was previously determined.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-999 - Billable services

Current through July 10, 2024
(a) Billable services for FQHCs shall include core and noncore services identified in section 17b-262-997 of the Regulations of Connecticut State Agencies.
(b) Covered core and noncore services shall be billed on an encounter basis in accordance with section 17b-262-1002 and are subject to the following limitations:
(1) Billable encounters shall include encounters that:
(A) Take place at a service site approved by HRSA as part of a FQHC; or
(B) Take place in a patient's home for the purpose of providing services to FQHC patients; and
(C) Are documented in the patient health records.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-1000 - Prior authorization requirements

Current through July 10, 2024
(a) In order to receive payment from the department, each FQHC shall comply with all prior authorization requirements. The department in its sole discretion determines what information is necessary to approve a prior authorization request. Prior authorization does not guarantee payment unless all other requirements for payment are met.
(b) The department shall designate services that require prior authorization or registration on the department's fee schedule, on the department's website or by other means accessible to providers with advance written notice to providers before establishing or amending such requirements. Registration may serve in lieu of prior authorization only if the department designates a service as requiring registration but not prior authorization. Prior authorization is also required for the following:
(1) Dental procedures or services that require prior authorization as set forth on the dental fee schedule;
(2) Chiropractic services in excess of 5 encounters per month;
(3) EPSDT Special Services; and
(4) Any procedure or service that is not listed on the department's medical clinic, behavioral health clinic or dental fee schedule as applicable.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-1001 - Change in scope of services

Current through July 10, 2024
(a) Each FQHC shall notify the department of any increase or decrease in the scope of services provided by the FQHC in accordance with section 17b-245d of the Connecticut General Statutes. If the FQHC seeks an adjustment to its encounter rate based on the change in scope of services, the FQHC shall submit a written request to the department in accordance with subsection (c) of this section.
(b) Examples of changes in scope of services by a FQHC for which the department may adjust the encounter rate include, but are not limited to, the following:
(1) A change in the volume or amount of services as a result of a significant expansion or reduction of an existing clinic, or the addition or discontinuance of a satellite or new site;
(2) A change in operational costs that is attributable to capital expenditures, including new service facilities or regulatory compliance, provided that the additional costs result in a change in the volume, amount, or intensity of services. The cost of a new or expanded building alone would not necessarily qualify;
(3) The addition or deletion of any Medicaid covered service eligible under the FQHC reimbursement program;
(4) A change in the operational costs attributable to changes in technology or medical practices at the FQHC;
(5) A change of costs due to recurring taxes, malpractice insurance premiums, or workers' compensation premiums that were not recognized and included in the PPS baseline calculation;
(6) A change in federal or state regulatory requirements that would impact FQHC costs; or
(7) A HRSA-approved change in the scope of project, provided that the change is consistent with federal and state Medicaid regulations.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-1002 - Billing requirements

Current through July 10, 2024
(a) Each FQHC shall bill for FQHC services per encounter. Claims are limited to one all-inclusive encounter per day to include all services received by a client on the same day unless the client suffers an illness or injury subsequent to the first encounter that requires additional diagnosis or treatment or if the client has different types of visits on the same day such as medical and dental or medical and behavioral health. Medicaid pays for one medical, one dental, and one behavioral health encounter per day.
(b) Each FQHC shall submit medical and behavioral health claims on the CMS-1500 utilizing both the encounter code and all applicable HCPCS code(s) on the FQHC fee schedule that identify the services provided.
(c) Each FQHC shall submit dental health claims on the original designated American Dental Association Dental Claim form.
(d) Each FQHC shall submit claims electronically or on the department's designated form and shall include all information required by the department to process the claim for payment.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-1003 - Reimbursement

Current through July 10, 2024
(a) The department shall reimburse a FQHC an all-inclusive encounter rate per client encounter in accordance with a PPS as required by 42 USC 1396a(bb).
(b) The department shall establish the baseline encounter rate for each FQHC in existence during fiscal years 1999 and 2000 as follows:
(1) Total encounters and costs shall be obtained from the annual reports submitted by the FQHC for fiscal years 1999 and 2000;
(2) Each year's total costs shall be divided by the total encounters. The FQHC shall include the costs of all Medicaid covered services provided by the FQHC;
(3) A two-year average of the calculated cost per encounter rates for fiscal years 1999 and 2000 will be used for each facility. The department shall determine the two-year average for each FQHC by calculating the average cost per encounter rate separately for each year, then adding the averages together and dividing by two.
Connecticut Administrative Code › Title 17b - Social Services › 262 - Requirements for Payment of Home Health Agencies › Requirements for Payment to Federally Qualified Health Centers › Section 17b-262-1004 - Documentation and audit requirements

Current through July 10, 2024
(a) Each FQHC shall maintain a specific record for all services provided to each client including, but not limited to: name, address, birth date, Medicaid Identification Number, pertinent diagnostic information, treatment notes signed by the provider, documentation of services provided and the dates on which the services were provided.
(b) For services performed by an LMSW, an unlicensed individual, a non-certified individual or an individual in training, progress notes shall be co-signed by the supervisor at least weekly for each client in care and shall contain the name, credentials and the date of such signature. For services provided by a certified individual, evidence of clinical supervision for each client in care shall be documented in the client's chart and shall contain the name, credentials and the date of such signature. The supervisor's signature means that the supervisor attests to having reviewed the documentation.
(c) Each FQHC shall maintain all required documentation in its original form for at least five years or longer in accordance with statute or regulation, subject to review by authorized departmental personnel. In the event of a dispute concerning a service provided, the provider shall maintain the documentation until the dispute is resolved.
(d) The department may disallow and recover any amounts paid to the provider for which the required documentation is not maintained and not provided to the department upon request.
(e) The department may audit all relevant records and documentation and may take any other appropriate quality assurance measures it deems necessary to assure compliance with all regulatory and statutory requirements.
(f) Notwithstanding the provisions of subsections (a) through (d) of this section, FQHCs may maintain an electronic medical record system such that medical records for all patients treated within the FQHC shall be available to, and shared by, all health professionals.
Connecticut Administrative Code › Title 17b - Social Services › 342 - Connecticut Home Care Program for Elders, Standards for Access Agencies and Assisted Living Service Agencies Program Requirements › Section 17b-342-3 - Service limitations, payment limitations, cost limits, waiting list and fee setting

Current through July 10, 2024
(a)
Service Limitations
(1) All home care services provided to individuals under the Connecticut Home Care Program shall be authorized in accordance with procedures established by the department prior to the delivery of the service;
(2) Reimbursement is not available from the department for personnel or agencies providing a home care service when such person or agency is required to be licensed, certified or otherwise regulated and does not fulfill the relevant regulatory requirements including the requirements under sections 17b-342-1 to 17b-342-5 of the Regulations of Connecticut State Agencies;
(3) When two or more providers of community based or home health services offer essentially the same service, the least costly service provider shall be used, provided that the quality of the service is similar;
(4) Providers of services, including subcontractors of the access agency and assisted living service agencies, shall maintain records to support claims made for payment, which shall be subject to audit by the department or its designee for at least seven years;
(5) Reimbursement is not available from the department for services canceled in advance either by phone or in writing;
(6) Reimbursement is not available from the department when an individual does not utilize or refuses to utilize an arranged service;
(7) Reimbursement is not available from the department for any services provided prior to the assessment or the determination of program eligibility or not documented in an approved plan of care;
(8) Reimbursement is not available from the department including, but not limited to, when an individual dies, is hospitalized, enters a nursing facility, moves temporarily or permanently out of state, requests services to be terminated or is determined ineligible;
(9) Reimbursement is not available from the department if the access agency or assisted living service agency is determined not to have followed the requirements and process established by the department for uncollectible mandatory client contribution towards their care;
(10) Reimbursement is not available for home and community based services determined not to have been performed;
(11) Reimbursement is not available for services arranged by program clients or representatives, access agencies, assisted living service agencies or service providers without prior approval by the department or department designee;
(12) Reimbursement is not available for duplication of services or payment; and
(13) Reimbursement is not available from more than one department or state agency program.
Connecticut Administrative Code › Title 17b - Social Services › 342 - Connecticut Home Care Program for Elders, Standards for Access Agencies and Assisted Living Service Agencies Program Requirements › Section 17b-342-4 - Nursing facility and hospital requirements

Current through July 10, 2024
(a)
Nursing Facility Admission Requirements
Nursing Facilities shall comply with the following Connecticut Home Care Program requirements:
(1) Information and Forms Distributions
When a nursing facility identifies an elderly applicant for admission to the facility, the nursing facility shall inform the person about the program by providing a copy of the Home Care Request Form and program information.
(A) Medicaid Recipients and Applicants
Prior to admission to a nursing facility, recipients and individuals who have applied for Medicaid who are aged 65 years or older shall:
(i) Complete and submit to the department a Home Care Request form to confirm that they are Medicaid recipients or applicants;
(ii) be screened by the department through its health screen form to determine the need for nursing home care and the feasibility of home care pursuant to section 17b-342-1(b)(15) of the Regulations of Connecticut State Agencies; and
(iii) receive department authorization for admission and Medicaid payment for nursing facility care or home care. The effective date for Medicaid reimbursement on behalf of such person shall be no earlier than the date admission is authorized by the department.
Connecticut Administrative Code › Title 17b - Social Services › 342 - Connecticut Home Care Program for Elders, Standards for Access Agencies and Assisted Living Service Agencies Program Requirements › Section 17b-342-5 - Reporting

Current through July 10, 2024
All nursing facilities, hospitals, access agencies, assisted living service agencies, lead service providers and home care service providers shall comply with any reporting, quality assurance review and audit requirements established by the department for purposes of administering, monitoring and evaluating the Connecticut Home Care Program.
Connecticut Administrative Code › Title 17b - Social Services › 349e - Connecticut Statewide Respite Care Program › Section 17b-349e-1 - Scope

Current through July 10, 2024
(a) Sections 17b-349e-1 to 17b-349e-9, inclusive, of the Regulations of Connecticut State Agencies, describe administration, eligibility criteria, provider qualifications, service parameters and funding guidelines for the Connecticut Statewide Respite Care Program. Sections 17b-349e-1 to 17b-349e-9, inclusive, of the Regulations of Connecticut State Agencies apply to all activities and persons participating in the Connecticut Statewide Respite Care Program, including, but not limited to, applicants, eligible individuals, caregivers, sponsor agencies and providers.
(b) Pursuant to section 17b-349e of the Connecticut General Statutes, the Connecticut Statewide Respite Care Program is limited to the provision of and payment for respite care for individuals with Alzheimer's disease or related disorders as described in sections 17b-349e-1 to 17b-349e-9, inclusive, of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17b - Social Services › 349e - Connecticut Statewide Respite Care Program › Section 17b-349e-2 - Purposes

Current through July 10, 2024
The purpose of the Connecticut Statewide Respite Care Program is to provide, within available appropriations, the following:
(1) Respite care services for individuals with Alzheimer's disease residing in the community in order to relieve some of the stress experienced by caregivers caused by the responsibility of daily caregiving;
(2) Supportive services to relieve caregivers in order to prevent premature institutionalization of an individual with Alzheimer's disease; and
(3) New services, or expand available services, for eligible individuals with Alzheimer's disease residing in the community.
Connecticut Administrative Code › Title 17b - Social Services › 349e - Connecticut Statewide Respite Care Program › Section 17b-349e-4 - Organization and administration of program

Current through July 10, 2024
(a) The division shall oversee and regularly monitor the administration of the program as follows:
(1) The division shall ensure that the first five hundred thousand dollars ($500,000) of funds appropriated is distributed in equal shares among Connecticut's five regional Area Agencies on Aging as sponsor agencies administering the program. The division may allocate appropriations exceeding five hundred thousand dollars ($500,000) to sponsor agencies based upon the demonstrated level of need for services in a particular region, and may transfer funds between regions based upon the demonstrated level of need in a particular region. A percentage of each allocation to the sponsor agencies shall be designated to cover the cost of administering the program.
(2) The division shall regularly monitor the administration of the program to ensure, verify and determine the effectiveness and quality of the program.
Connecticut Administrative Code › Title 17b - Social Services › 349e - Connecticut Statewide Respite Care Program › Section 17b-349e-5 - Application process

Current through July 10, 2024
(a) The application process includes all activity related to a request for a determination of eligibility under the program. The process begins with the receipt of an application by a sponsor agency and continues in effect until there is an official disposition of the eligibility request from that sponsor agency.
(b) The sponsor agency servicing the city or town in which the applicant resides shall perform appropriate assessments and make a written determination of eligibility within thirty days after the receipt of an application.
(c) When the applicant is incompetent or incapable of filing an application on the applicant's own behalf, the sponsor agency shall recognize any representative as defined in section 17b-349e-3 of the Regulations of Connecticut State Agencies for the purpose of initiating such application.
(d) Each sponsor agency has the responsibility to explain to the applicant or the applicant's representative the purposes and eligibility requirements of the program and the applicant's rights and responsibilities. Each sponsor agency shall accept and process applications and maintain files that shall include applications and documents supporting each application.
(e) The applicant or the applicant's representative is responsible for completing the application forms truthfully, legibly and accurately. The applicant or the applicant's representative shall provide the sponsor agency with documentation required to support statements made on the application.
(f) Each applicant or eligible individual shall notify the sponsor agency whenever a change in his or her circumstances relating to income, assets or address occurs.
Connecticut Administrative Code › Title 17b - Social Services › 349e - Connecticut Statewide Respite Care Program › Section 17b-349e-6 - Eligibility

Current through July 10, 2024
(a) An eligible individual shall be any person diagnosed with Alzheimer's or related diseases. An eligible individual who has been given a generic diagnosis of dementia shall have had a sufficient medical evaluation to rule out unrelated conditions such as depression, traumatic brain injury, alcoholism or drug interactions. An eligible individual shall have a physician with whom the sponsor agency may contact regarding the eligible individual. The physician shall certify that the eligible individual has completed an appropriate medical examination showing a diagnosis of irreversible and deteriorating dementia of the Alzheimer's type.
(b) An eligible individual shall be a resident of the state of Connecticut, be residing in a home in the community and be at risk of long-term institutional placement if the eligible individual's regular caregiver cannot continue in that role.
(c) An eligible individual shall not have an annual income or liquid assets that exceed the amounts designated in section 17b-349e of the Connecticut General Statutes. On July 1, 2009, and annually thereafter, the department shall recalculate the income and asset limitations over that of the previous year to account for the annual cost of living adjustment in Social Security income, if any.
(d) An individual receiving services through the Connecticut Homecare Program for Elders shall not be eligible for services under the Connecticut Statewide Respite Care Program.
Connecticut Administrative Code › Title 17b - Social Services › 349e - Connecticut Statewide Respite Care Program › Section 17b-349e-7 - Sponsor agency requirements

Current through July 10, 2024
(a) Each sponsor agency shall contract annually with the department to administer the regional program. Each sponsor agency shall determine the maximum number of eligible individuals to be served in its respective region based on the financial allocation made by the department. The sponsor agency shall not admit or serve more eligible individuals than can be afforded within available appropriations.
(b) Each sponsor agency shall determine the eligibility of all applicants for services under the program, additional sources of payment for such services and assess and collect all co-payments through retrospective billing.
(c) Each sponsor agency shall develop, as necessary, a service plan for each eligible individual to be served under the program, pay providers as required, provide statistical and financial reports as required by the department, and comply with sections 17b-349e-1 to 17b-349e-9, inclusive, of the Regulations of Connecticut State Agencies.
Connecticut Administrative Code › Title 17b - Social Services › 349e - Connecticut Statewide Respite Care Program › Section 17b-349e-8 - Provider qualifications and requirements

Current through July 10, 2024
(a) Providers shall enter into contracts with sponsor agencies for the delivery of respite care services to individual clients under the program, and shall be accountable to each contracting sponsor agency as well as to individual clients or each individual's representative for the provision of those services.
(b) Providers shall have demonstrated prior experience and training in delivering services to individuals with Alzheimer's disease and agree to provide services at the rates set by the department.
(c) Providers who have received accreditation by the Joint Commission on the Accreditation of Healthcare Organizations, when available, shall receive preference in contracting for services.
(d) Providers shall meet the requirements of provider participation of the specified services as established for the Connecticut Home Care Program for Elders, pursuant to section 17b-342-2 of the Regulations of Connecticut State Agencies to the extent that such requirements do not conflict with sections 17b-349e-1 to 17b-349e-9, inclusive, of the Regulations of Connecticut State Agencies.
(e) A provider under the Connecticut Statewide Respite Care Program shall not be a spouse or conservator of the person receiving the services. A relative of the conservator of the eligible individual receiving the services may be a provider with prior approval of the department.