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-262-913 - Definitions

Current through July 10, 2024
As used in sections 17b-262-912 to 17b-262-925, inclusive, of the Regulations of Connecticut State Agencies:
(1) "Advanced practice registered nurse" or "APRN" means an individual licensed pursuant to section 20-94a of the Connecticut General Statutes;
(2) "Behavioral health clinician services" means preventive, diagnostic, therapeutic, rehabilitative or palliative services provided by a licensed behavioral health clinician within the licensed behavioral health clinician's scope of practice under state law;
(3) "Client" means a person who is eligible for goods or services under Medicaid and is a HUSKY C or HUSKY D member under age twenty-one or a HUSKY A member of any age;
(4) "Commissioner" means the Commissioner of Social Services or the commissioner's agent;
(5) "Current treatment plan" means a treatment plan that has been reviewed and updated by the provider not more than six months before each treatment session;
(6) "Department" means the Department of Social Services or its agent;
(7) "Early and Periodic Screening, Diagnostic and Treatment Services" or "EPSDT Services" means the services described in 42 USC 1396d(r)(5);
(8) "Early and Periodic Screening, Diagnostic and Treatment Special Services" or "EPSDT Special Services" means services that are not covered under the Medicaid State Plan but are covered as EPSDT services for Medicaid-eligible children pursuant to 42 USC 1396d(r)(5) when the service is (A) medically necessary, (B) the need for the service is identified in an EPSDT screen, (C) the service is provided by a participating provider and (D) the service is a type of service that may be covered by a state Medicaid agency and qualifies for federal reimbursement under 42 USC 1396d;
(9) "Federally qualified health center" has the same meaning as provided in 42 USC 1396d (
l
);
(10) "Home" means a client's place of residence, including, but not limited to, a boarding house, community living arrangement, nursing facility or residential care home. "Home" does not include facilities such as hospitals, chronic disease hospitals, intermediate care facilities for the mentally retarded or other facilities that are paid an all-inclusive rate directly by Medicaid for the care of the client;
(11) "HUSKY A" means the Medicaid coverage groups for children, caretaker relatives and pregnant women authorized by Title XIX of the Social Security Act (Medicaid) and operated pursuant to sections 17b-261 and 17b-277 of the Connecticut General Statutes;
(12) "HUSKY C" means the Medicaid coverage groups for the aged, blind and disabled authorized by Title XIX of the Social Security Act (Medicaid) and operated pursuant to section 17b-261 of the Connecticut General Statutes;
(13) "HUSKY D" means the Medicaid coverage groups for low-income adults authorized by 42 USC 1396a(a)(10)(A)(i) (VIII) and operated pursuant to section 17b-261n of the Connecticut General Statues, formerly referred to as the State-Administered General Assistance program;
(14) "Licensed alcohol and drug counselor" means an individual licensed pursuant to section 20-74s of the Connecticut General Statutes;
(15) "Licensed behavioral health clinician" means a licensed alcohol and drug counselor, licensed marital and family therapist, licensed clinical social worker or licensed professional counselor;
(16) "Licensed clinical social worker" means a person licensed pursuant to section 20-195n of the Connecticut General Statutes;
(17) "Licensed marital and family therapist" means an individual licensed pursuant to section 20-195c of the Connecticut General Statutes;
(18) "Licensed professional counselor" means an individual licensed pursuant to sections 20-195cc and 20-195dd of the Connecticut General Statutes;
(19) "Licensed practitioner" means a physician, APRN or physician assistant;
(20) "Medicaid" means the program operated by the department pursuant to section 17b-260 of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act;
(21) "Medical necessity" or "medically necessary" has the same meaning as provided in section 17b-259b of the Connecticut General Statutes;
(22) "Physician" means an individual licensed pursuant to section 20-13 of the Connecticut General Statutes;
(23) "Physician assistant" means a person licensed pursuant to section 20-12b of the Connecticut General Statutes;
(24) "Prior authorization" means the department's approval for the provision of a service before a provider actually provides such service, except where section 17b-262-920 of the Regulations of Connecticut State Agencies specifically authorizes the department to grant prior authorization before paying for a service but after the provider has provided such service;
(25) "Provider" means a licensed behavioral health clinician enrolled in Medicaid pursuant to a valid provider agreement with the department;
(26) "Provider agreement" means the signed, written agreement between the department and the provider for enrollment in Medicaid;
(27) "Registration" means the process of notifying the department of the initiation of a behavioral health clinician service, including evaluation findings and plan of care information;
(28) "State Plan" means the current Medicaid coverage and eligibility plan established, submitted and maintained by the department and approved by the Centers for Medicare and Medicaid Services in accordance with 42 CFR 430, Subpart B;
(29) "Treatment plan" means a written individualized plan developed and updated in accordance with section 17b-262-919 of the Regulations of Connecticut State Agencies that contains the type, amount, frequency and duration of services to be provided, and measurable goals and objectives developed in collaboration with the client after evaluation, in order to improve the client's condition to the point that treatment by the licensed behavioral health clinician no longer becomes necessary, aside from occasional follow-up or maintenance visits; and
(30) "Utilization management" means the prospective, retrospective or concurrent assessment of the medical necessity of services given, or proposed to be given, to a client.