Connecticut Administrative Code › Title 17 - Public Assistance and Welfare Services › 134d - Medical Assistance › Title XIX Rates for Community Health Centers › Section 17-134d-83 - Policy and procedures governing oxygen therapy on behalf of Title XIX medicaid recipients

Current through July 10, 2024
(a)
Scope
Section 17-134d-83 through Section
				  17-134d-85
				  of the regulations of Connecticut State Agencies governs the billing and
				  payment for Oxygen Therapy provided to persons determined eligible for such
				  goods and services under the provisions of Connecticut's Medical Assistance
				  Program in accordance with Chapter 302 of the General Statutes of
				  Connecticut.
(b)
Definitions
For the purpose of Regulation Section 17-134d-83 through
				  Section
				  17-134d-85,
				  the following definitions apply:
"Ambulatory" means an individual who is independently mobile
				  or wheelchair mobile and is able to participate in the active daily living
				  available to them in their living environment.
"Chronic Disease Hospital" means a long-term hospital having
				  facilities, medical staff and all necessary personnel for the diagnosis, care
				  and treatment of a wide range of chronic diseases as licensed by the Department
				  of Health Services.
"Department" means State of Connecticut Department of Income
				  Maintenance.
"Home" means the recipient's place of residence which
				  includes a boarding home or Home for the Aged. Home does not include a hospital
				  or long-term care facility.
"Hospital" means an establishment for the lodging, care and
				  treatment of persons suffering from disease or other abnormal physical or
				  mental conditions licensed by the Department of Health Services and includes
				  inpatient psychiatric services in general hospitals.
"Long-Term Care Facilities" (LTC) are institutions licensed
				  and certified under State law which have a provider agreement with the
				  Department of Income Maintenance to provide a variety of medical, personal
				  care, rehabilitative, and social services for recipients of Medical Assistance
				  who are afflicted with acute, chronic or convalescent diseases or injuries or
				  who because of their mental or physical condition require health-related care
				  and services above the level of room and board which can be provided only
				  through an institutional setting. These facilities include nursing facilities
				  licensed as chronic and convalescent nursing homes, rest homes with nursing
				  supervision and intermediate care facilities for the mentally retarded
				  (ICFs/MR).
"Medical Equipment, Devices and Supplies" (MEDS) means
				  Durable Medical Equipment, Medical Surgical Supplies, Orthotic and Prosthetic
				  Devices and Oxygen Therapy.
"Oxygen Concentrator" means an electrically operated device
				  that draws room air, separates the oxygen from the other gases in the air, and
				  delivers the oxygen at high concentrations to the patient.
"Oxygen Therapy" means oxygen, equipment, supplies and
				  services related to the delivery of oxygen.
"Oxygen Therapy Supplies" means all supplies needed for an
				  oxygen system to function; such as cannula or mask, tubing, regulator with flow
				  gauge and container.
"Portable Oxygen System" means oxygen in a portable unit
				  which weighs less than 12 lbs. allowing the user greater ambulatory
				  capability.
"Prescription" - The Certification of Medical Necessity form
				  (Medicare Form HCFA-484) shall be the prescription form used for all oxygen
				  therapy orders. This fully completed form signed by the prescribing physician
				  will be the only acceptable initial certification form for oxygen
				  services.
"Prior Authorization" (P.A.) means approval for a service
				  from the Department of Income Maintenance
before
the provider
				  actually provides the service. In order to receive approval from the Department
				  a provider must comply with all prior authorization requirements found in
				  Section
				  17-134d-84(b)
				  and (c). P.A. does not guarantee payment unless all other eligibility
				  requirements are met. Payment may not be made, however, if P.A. is required and
				  not obtained.
"Provider" means the vendor/supplier of oxygen therapy who is
				  enrolled with the Department as a MEDS supplier or supplier of oxygen
				  therapy.
"Pro Re Nata" (P.R.N.) means as the situation demands.
"Psychiatric Hospital" means a facility that is engaged in
				  providing, by or under the supervision of a physician, psychiatric services for
				  the diagnosis and treatment of mentally ill persons and which has been
				  accredited by the Joint Commission on Accreditation of Hospitals.
"Usual and Customary Charge to the General Public" means a
				  charge which will be made for the particular service by the provider to the
				  patient group accounting for the largest number of non-Medicaid services. In
				  determining such charge, all charges made to third party payors and special
				  discounts offered to an individual such as a senior citizen will be
				  excluded.
(c)
Provider Participation
In order to participate in the Medicaid program and receive
				  payment directly from the Department all MEDS providers must:
(1) meet and maintain all applicable
				licensing and certification requirements of Federal and State statutes and
				regulations; and
(2) meet and
				maintain all Departmental enrollment requirements; and
(3) have a valid provider agreement on file
				which is signed by the provider and the Department upon application for
				enrollment into the Medicaid program and periodically thereafter as required by
				the Department and which is in effect for the period as stated in the
				agreement. The provider agreement specifies conditions and terms (Federal and
				State statutes, regulations and standards) which govern the program and to
				which the provider is mandated to adhere in order to participate in the
				program.