Connecticut General Statutes
Chapter 319v - Medical Assistance
Section 17b-261g. - Reimbursement under Medicaid program for certain therapy services provided to children by home health care agencies.

To the extent permitted by federal law, the Commissioner of Social Services shall provide reimbursement under the Medicaid program to children for physical therapy, occupational therapy and speech therapy services provided by a home health care agency, as defined in section 19a-490, in the child's home or a substantially equivalent environment. For purposes of such reimbursement, a substantially equivalent environment may include, but not be limited to, facilities that provide child care services, as defined in subsection (a) of section 19a-77, and after school programs, as defined in section 10-16x.

(P.A. 06-188, S. 50; June Sp. Sess. P.A. 07-5, S. 25; P.A. 15-227, S. 25.)
History: P.A. 06-188 effective July 1, 2006; June Sp. Sess. P.A. 07-5 inserted “To the extent permitted by federal law”, substituted “Medicaid” for “HUSKY Plan, Part A”, and substituted “physical therapy, occupational therapy and speech therapy services” for “services”, effective October 6, 2007; pursuant to P.A. 15-227, “child day care services” was changed editorially by the Revisors to “child care services”, effective July 1, 2015.

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Structure Connecticut General Statutes

Connecticut General Statutes

Title 17b - Social Services

Chapter 319v - Medical Assistance

Section 17b-220. (Formerly Sec. 17-292g). - Reimbursement of medical providers.

Section 17b-221. (Formerly Sec. 17-292h). - Regulations. Reimbursement of hospitals.

Section 17b-221a. - Revenue from Riverview Hospital to be used to pay Medicaid claims.

Section 17b-221b. - Federal matching funds for special-education-related services. Portion to be used for Medicaid claims.

Section 17b-222. (Formerly Sec. 17-294). - “Humane institution” defined. Daily report.

Section 17b-223. (Formerly Sec. 17-295). - Support in humane institutions.

Section 17b-224. (Formerly Sec. 17-295b). - Liability of patient for per capita cost of care.

Section 17b-225. (Formerly Sec. 17-295c). - Availability of patient information to certain agencies.

Section 17b-226. (Formerly Sec. 17-295d). - Consideration of the costs mandated by collective bargaining agreements.

Section 17b-226a. - Provider billing rates for goods and services.

Section 17b-227. (Formerly Sec. 17-297). - Payment for services in state humane institutions.

Section 17b-228. (Formerly Sec. 17-298). - Court action by state to recover unpaid portion of charges.

Section 17b-229. (Formerly Sec. 17-299). - Liability for prior charges.

Section 17b-230. (Formerly Sec. 17-300). - Claim of state on death of institution patient.

Section 17b-231. (Formerly Sec. 17-301). - Refund for support of persons in state institutions.

Section 17b-232. (Formerly Sec. 17-306). - Payment for board and care in boarding home, group home, chronic and convalescent hospital or other residential facility.

Section 17b-233. (Formerly Sec. 17-307). - Care of handicapped and other children at Newington Children's Hospital. Children with drug-related conditions not to be admitted.

Section 17b-234 and 17b-235. (Formerly Secs. 17-308 and 17-308a). - State payment toward support of patients at Newington Children's Hospital. Payment of retroactive claims.

Section 17b-236. (Formerly Sec. 17-309). - Admission of physically disabled children to The Children's Center.

Section 17b-237. (Formerly Sec. 17-310). - State aid toward support of children at center.

Section 17b-238. (Formerly Sec. 17-311). - State payments to hospitals.

Section 17b-239. (Formerly Sec. 17-312). - Payments to hospitals, emergency department physicians. Value-based methodologies. Readmission penalties. Compliance with federal law. Regulations.

Section 17b-239a. - Payments to short-term general hospitals located in certain distressed municipalities and targeted investment communities with enterprise zones.

Section 17b-239b. - Chronic disease hospitals. Prior authorization procedures. Regulations.

Section 17b-239c. - Interim disproportionate share payments to short-term general hospitals.

Section 17b-239d. - Payments for outpatient hospital services.

Section 17b-239e. - Hospital rate plan. Supplemental pools and payments. Quality measures.

Section 17b-240. (Formerly Sec. 17-312a). - State payments to hospitals. Rates established by the Office of Health Care Access division of the Department of Public Health.

Section 17b-241. (Formerly Sec. 17-312b). - Payments to mental health and substance abuse residential facilities and freestanding detoxification centers.

Section 17b-241a. - Payments to the Department of Mental Health and Addiction Services for targeted case management services. Submission of expenditures for intensive care management.

Section 17b-241b. - Rate for private psychiatric residential treatment facilities.

Section 17b-242. (Formerly Sec. 17-313). - Payments to home health care agencies and home health aide agencies. Appeals. Hearings. Authorized practitioners. Regulations.

Section 17b-242a. - Prior authorization for Medicaid home health services, physical therapy, occupational therapy and speech therapy. Regulations.

Section 17b-242b. - Pilot program for ventilator-dependent Medicaid recipients receiving medical care at home.

Section 17b-243. (Formerly Sec. 17-313a). - Payments to rehabilitation centers.

Section 17b-244. (Formerly Sec. 17-313b). - Payments to private facilities providing functional or vocational services for severely handicapped persons and payments for residential care. Establishment of rate. Regulations.

Section 17b-244a. - Rates for payment to residential facilities for individuals with intellectual disabilities.

Section 17b-245. (Formerly Sec. 17-313c). - Payments to day care and vocational training programs sponsored by certain associations.

Section 17b-245a. - Payments to federally qualified health centers.

Section 17b-245b. - Federally qualified health centers. Reimbursement methodology in the Medicaid program.

Section 17b-245c. - Demonstration project to provide telemedicine to Medicaid recipients at federally qualified community health centers.

Section 17b-245d. - Information to be provided by federally qualified health centers. Adjustment of encounter rates.

Section 17b-245e. - Telehealth services provided under the Medicaid program. Report.

Section 17b-245f. - Diabetes. Program to recommend federally-qualified health centers and other covered entities. Working group. Medicaid waiver. Report to General Assembly. Regulations.

Section 17b-245g. - Telehealth services under the Connecticut medical assistance program. Audio-only telehealth services. Coverage criteria. Reimbursement.

Section 17b-246. (Formerly Sec. 17-313d). - Rates to include reimbursement for reasonable costs mandated by collective bargaining agreements.

Section 17b-247. (Formerly Sec. 17-314l). - Contracts for stock and standard durable medical equipment. Payment of laboratory services.

Section 17b-248. (Formerly Sec. 17-316). - Liability of home or institution having life care contract.

Section 17b-249. (Formerly Sec. 17-317). - Support of mentally ill persons accused of crime.

Section 17b-250. (Formerly Sec. 17-318). - Payment of hospital expense of inmate transferred from correctional institution.

Section 17b-252. (Formerly Sec. 17-12q). - Connecticut Partnership for Long-Term Care.

Section 17b-253. (Formerly Sec. 17-12r). - Connecticut Partnership for Long-Term Care: Amendments to Medicaid regulations and state plan. Regulations.

Section 17b-254. (Formerly Sec. 17-12s). - Connecticut Partnership for Long-Term Care: Foundation funds and federal approval. Report.

Section 17b-255. (Formerly Sec. 17-12gg). - Insurance assistance for people with AIDS. Managed care insurance program for persons with AIDS.

Section 17b-256. (Formerly Sec. 17-314m). - Prescription drug and insurance assistance program for persons with acquired immunodeficiency syndrome or human immunodeficiency virus. Annual report. Enrollment in Medicare Part D.

Section 17b-256d. - State medical assistance program. Use of federally-qualified community health centers.

Section 17b-256e. - Reports re potential participants in affordable pharmaceutical drug program.

Section 17b-256f. - Eligibility for Medicare savings programs. Regulations.

Section 17b-257a. - Qualified alien eligibility for Medicaid. Medical assistance for certain qualified alien children and pregnant women.

Section 17b-257b. - Alien eligibility for state medical assistance. Regulations.

Section 17b-257c. - Payments to long-term care facilities for care of illegal immigrants admitted to acute care or psychiatric hospitals. Eligibility. Regulations.

Section 17b-257d. - Notice of terminating alien's state medical assistance.

Section 17b-257e. - Postpartum care for women without legal immigration status. Income eligibility.

Section 17b-258. (Formerly Sec. 17-12jj). - Health insurance assistance for unemployed persons.

Section 17b-259. (Formerly Sec. 17-274). - Medically necessary services.

Section 17b-259a. - Imposition of cost sharing requirements on recipients of medical assistance. Exception.

Section 17b-259b. - “Medically necessary” and “medical necessity” defined. Notice of denial of services. Regulations.

Section 17b-260. (Formerly Sec. 17-134a). - Acceptance of federal grants for medical assistance.

Section 17b-260a. - Medicaid-financed home and community-based programs for individuals with acquired brain injury. Advisory committee.

Section 17b-260b. - Home and community-based service waivers serving persons with acquired brain injury and persons with intellectual disability. Amendments.

Section 17b-260c. - Medicaid waiver to provide coverage for family planning services.

Section 17b-260d. - Home and community-based services waiver serving persons with acquired immune deficiency syndrome or human immunodeficiency virus.

Section 17b-260e. - Federal funding reductions. Requirements for state to offset Medicaid reductions for family planning services.

Section 17b-261. (Formerly Sec. 17-134b). - Medicaid. Eligibility. Assets. Waiver from federal law.

Section 17b-261a. - Transfer or assignment of assets resulting in the imposition of a penalty period. Return or partial return of asset. Regulations.

Section 17b-261b. - Program eligibility determined by department. Spousal support.

Section 17b-261c. - Medical assistance. Changes in circumstances.

Section 17b-261d. - Disease management initiative. Implementation. Annual report.

Section 17b-261e. - Mobile field hospital: HUSKY Health program coverage.

Section 17b-261f. - Mobile field hospital account.

Section 17b-261g. - Reimbursement under Medicaid program for certain therapy services provided to children by home health care agencies.

Section 17b-261h. - Enrollment of HUSKY A recipients in available employer-sponsored private health insurance. Waiver from federal law. Regulations.

Section 17b-261i. - Administrative services for Medicaid recipients. Regulations.

Section 17b-261j. - Easy Breathing model in HUSKY Health program.

Section 17b-261k. - Protected amount for the community spouse of an institutionalized Medicaid applicant. Regulations.

Section 17b-261l. - Treatment of reverse annuity mortgage loan proceeds under Medicaid. Regulations.

Section 17b-261m. - Administrative services organization. Contract for services. Establishment of rates.

Section 17b-261n. - Coverage for low-income adults under Medicaid program. Amendment to state Medicaid plan to establish alternative benefit package. Waiver application re eligibility and coverage. Regulations.

Section 17b-261o. - Imposition of penalty period when undue hardship exists. Exception.

Section 17b-261p. - Notice re determination of penalty period. Filing claim of undue hardship. Nursing home involvement.

Section 17b-261q. - Action by nursing home facility to collect debt for unpaid care provided during penalty period.

Section 17b-261r. - Determination of applied income. Notice. Action by nursing home facility to recover applied income.

Section 17b-261s. - Copy of complaint, judgment or decree to be mailed in action by nursing home facility.

Section 17b-261t. - Contents of Medicaid benefits cards.

Section 17b-261u. - Alternate coverage after loss of Medicaid eligibility for parent or needy caretaker relative. Review. Quarterly reports.

Section 17b-261v. - Parent or needy caretaker relative. Review of Medicaid coverage options.

Section 17b-261w. - Prior authorization, utilization review criteria for medical assistance. Waivers. Suspensions. Notice requirements.

Section 17b-261x. - Minimum protected resource allowance for community spouse of institutionalized Medicaid recipient.

Section 17b-261y. - Department to compile annual data on denial of Medicaid eligibility in any matter in which Probate Court issued order or decree re assets or income affecting Medicaid eligibility.

Section 17b-262. (Formerly Sec. 17-134d). - Regulations. Admissions to nursing home facilities.

Section 17b-263. (Formerly Sec. 17-274b). - Utilization of outpatient mental health services. Contracts for services. Fee schedule and payment for services.

Section 17b-263a. - Amendment to state Medicaid plan to include assertive community treatment teams and community support services.

Section 17b-263b. - Pilot program for individuals ages nineteen to twenty-one with a mental disorder and chronic health condition. Eligibility.

Section 17b-263c. - Medical homes. Regulations.

Section 17b-264. (Formerly Sec. 17-134e). - Extension of other public assistance provisions.

Section 17b-265. (Formerly Sec. 17-134f). - Department subrogated to right of recovery of applicant or recipient. Utilization of personal health insurance. Insurance coverage of medical assistance recipients. Limitations.

Section 17b-265a. - Physicians providing services to dually eligible Medicaid and Medicare clients. Rates.

Section 17b-265b. - Reimbursement rates for pathologists.

Section 17b-265c. - Medicaid and Medicare dually eligible pilot program.

Section 17b-265d. - Definition of full benefit dually eligible Medicare Part D beneficiary. Prescription drug coverage under Medicare Part D. Copayment coverage. Enrollment in benchmark plan. Commissioner's enrollment authority.

Section 17b-265e. - Medicare Part D Supplemental Needs Fund. Payment by department for nonformulary prescription drugs. Rebates required for pharmaceutical manufacturers. Contracts for supplemental rebates.

Section 17b-265f. - Payment by the department for pharmacy claims. Limitations. Investigation of pharmacy.

Section 17b-265g. - Health insurer. Duties owed to the state and Commissioner of Social Services.

Section 17b-266. (Formerly Sec. 17-134g). - Purchase of insurance. Contracts for comprehensive health care on a prepayment or per capita basis. Certification of providers by commissioner. Payment of capitation claims. Deposit of funds for expenditure...

Section 17b-266a. - Contract with pharmacy benefits management organization.

Section 17b-267. (Formerly Sec. 17-134h). - Use of fiscal intermediaries in connection with medical assistance.

Section 17b-268. (Formerly Sec. 17-134i). - Withdrawal of member of group providing services.

Section 17b-269. (Formerly Sec. 17-134j). - Bonding of officers and employees.

Section 17b-270. (Formerly Sec. 17-134k). - Liability of agency and its officers.

Section 17b-271. (Formerly Sec. 17-134l). - Termination of agreement.

Section 17b-272. (Formerly Sec. 17-134m). - Personal fund allowance.

Section 17b-273. (Formerly Sec. 17-134o). - Payment rate for ambulance rides eligible under medical assistance program. Payment methodology for ambulance services.

Section 17b-274. (Formerly Sec. 17-134q). - Periodic investigations of pharmacies by Division of Criminal Justice. Brand medically necessary. Procedure for prior approval to dispense brand name drug. Disclosure.

Section 17b-274a. - Maximum allowable costs for generic prescription drugs. Implementation of maximum allowable cost list.

Section 17b-274b. - Pharmaceutical purchasing initiative. Annual report.

Section 17b-274c. - Voluntary mail order option for maintenance prescription drugs and drugs covered under the Medicare Part D program.

Section 17b-274d. - Pharmaceutical and Therapeutics Committee. Membership. Duties. Preferred drug lists. Automatic refill recommendations. Supplemental rebates. Administrative hearings.

Section 17b-274e. - Prescription drugs. Utilization of cost-efficient dosages.

Section 17b-274f. - Step therapy program for Medicaid prescription drugs.

Section 17b-274g. - Preferred drug list purchases. Prohibition on Medicaid cost sharing. Reporting, notice requirements for other Medicaid cost-sharing requirements.

Section 17b-274h. - Auto refills of prescription drugs covered under Medicaid. Limitations. Legislative review process.

Section 17b-275. (Formerly Sec. 17-134r). - Physician and pharmacy lock-in procedure.

Section 17b-276. (Formerly Sec. 17-134s). - Competitive bidding process for nonemergency transportation services. Disclosure of payment source. Fee schedules.

Section 17b-276a. - Amendment to Medicaid state plan to reduce expenditures for Medicaid nonemergency medical transportation. Limitations.

Section 17b-276b. - Nonemergency medical transportation services. Prior authorization.

Section 17b-276c. - Payment for medically necessary mode of transportation service.

Section 17b-277. (Formerly Sec. 17-134u). - Medicaid for pregnant women. Presumptive Medicaid eligibility for pregnant women and newborn children. Postpartum care.

Section 17b-277a. - Program to inform applicants to the Healthy Start program of services provided by the Connecticut Home Visiting System.

Section 17b-277b. - Healthy Start program. Plan. Review.

Section 17b-277c. - Medicaid coverage for donor breast milk. Requirements. Regulations.

Section 17b-278. (Formerly Sec. 17-134z). - Home leave absences for certain medical assistance recipients.

Section 17b-278a. - Coverage for treatment for smoking cessation.

Section 17b-278b. - Medical assistance for breast and cervical cancer.

Section 17b-278c. - Amendment to state Medicaid plan to provide mammogram examinations to certain women.

Section 17b-278d. - Amendment to state Medicaid plan and state children's health insurance plan to provide neuropsychological testing for children diagnosed with cancer.

Section 17b-278e. - Amendment to state Medicaid plan to exclude payment for hospital-acquired conditions.

Section 17b-278f. - Amendment to state Medicaid plan to provide treatment for tuberculosis.

Section 17b-278g. - Medical assistance for eyeglasses and contact lenses. Regulations.

Section 17b-278h. - Medical assistance for chiropractic services. Regulations.

Section 17b-278i. - Medical assistance for customized wheelchairs. Repairs. Refurbished equipment, parts and components. Regulations.

Section 17b-278j. - Complex rehabilitation technology. Definitions. Report.

Section 17b-278k. - Electronic transmission of prescriptions for durable medical equipment.

Section 17b-279. (Formerly Sec. 17-134aa). - Medicaid prescription drug utilization review. Erectile dysfunction drugs. Prior authorization requirement and coverage limitation. Report.

Section 17b-280. (Formerly Sec. 17-134bb). - Reimbursement rate for covered outpatient drugs under the Medicaid program.

Section 17b-280a. - Payment for over-the-counter medications under medical assistance program. Exceptions.

Section 17b-280b. - Proposed revisions to reimbursement methodology for covered outpatient drugs under the Medicaid program. Legislative review.

Section 17b-280c. - Methadone maintenance. Minimum rates.

Section 17b-281. (Formerly Sec. 17-134cc). - Payment of oxygen products and services under medical assistance program.

Section 17b-281a. - Procedure for preauthorization of purchase or rental of durable medical equipment.

Section 17b-281b. - Used durable medical equipment. Payments to vendors or suppliers.

Section 17b-281c. - Authority of commissioner to modify medical equipment fee schedules.

Section 17b-282. (Formerly Sec. 17-134dd). - Medical assistance for certain children and elderly and disabled persons.

Section 17b-282a. - Coverage for in-patient dental services in certain instances involving children and developmentally disabled persons.

Section 17b-282b. - Implementation of state-wide dental plan. Waiver.

Section 17b-282c. - Nonemergency dental services. Regulations.

Section 17b-282d. - Commissioner to modify nonemergency dental services. Regulations.

Section 17b-282e. - Orthodontic services for Medicaid recipients under twenty-one years of age.

Section 17b-282f. - Mobile dental clinics. Medicaid coverage areas. Regulations.

Section 17b-283. (Formerly Sec. 17-134ee). - Medicaid home and community-based services waiver program for children and young adults with disabilities.

Section 17b-283a. - Active duty armed forces member application for Medicaid home or community-based program on behalf of eligible spouse or child.

Section 17b-284. (Formerly Sec. 17-134ff). - Medical assistance for certain employed persons.

Section 17b-285. (Formerly Sec. 17-134gg). - Assignment of spousal support of an institutionalized person or person in need of institutional care.

Section 17b-286. - Medicaid management information system. Reports.

Section 17b-287. (Formerly Sec. 17-292a). - Assistance for person who needs hospitalization and is not a resident of any town.

Section 17b-288. - Organ transplant account. Regulations.

Section 17b-289. - Short title: HUSKY and HUSKY Plus Act. HUSKY Plan, Part A and HUSKY Plan, Part B participants.

Section 17b-290. - Definitions.

Section 17b-291. - Children's health insurance plan.

Section 17b-292. - HUSKY B. Eligibility. Expedited eligibility under HUSKY B. Presumptive eligibility under Medicaid. State-funded coverage for certain children not otherwise covered. Postpartum care.

Section 17b-292a. - Information for redetermination of eligibility under HUSKY Plan.

Section 17b-292b. - Prenatal care under HUSKY B. Unborn child option. Income eligibility.

Section 17b-293. - Minimum benefit coverage under HUSKY Plan, Part B.

Section 17b-294. - HUSKY Plus programs.

Section 17b-294a. - HUSKY Plus program. Administration. Eligibility. Regulations.

Section 17b-295. - Cost-sharing requirements under HUSKY B.

Section 17b-296. - Provision for clinicians in managed care plans. Provision by managed care organizations of services under HUSKY Plan.

Section 17b-297. - Outreach programs for HUSKY Plan, Part A and Part B.

Section 17b-297a. - Funds to promote enrollment of children eligible for other income-based assistance programs in HUSKY B.

Section 17b-297b. - Procedures for sharing information in applications for school lunch program for purpose of determining eligibility under HUSKY Health program.

Section 17b-298. - Regulations re quality of care under HUSKY Plan. Outcome criteria. Sanctions. Reports re HUSKY Plans to General Assembly.

Section 17b-299. - Applications. Approval.

Section 17b-300. - Notification of member's change of circumstance.

Section 17b-301. - Recovery of payment for false statement, misrepresentation or concealment.

Section 17b-301a to 17b-301p. - Prohibited acts re medical assistance: Definitions. Prohibited acts re medical assistance; penalties. Attorney General's investigation of prohibited acts; civil action. Civil action by individual; consent for withdrawa...

Section 17b-302. - Public involvement in design and implementation of HUSKY Plan, Part B. Submission of plan for public involvement to General Assembly.

Section 17b-303. - Income disregard. Application for federal waiver.

Section 17b-304. - Regulations.

Section 17b-306. - Plan for a system of preventive health services for children in the HUSKY Health program.

Section 17b-306a. - Child health quality improvement program. Purpose and scope. Annual reports.

Section 17b-307. - Primary care case management pilot program.

Section 17b-307a. - Medicaid reimbursement system incentivizing collaboration between primary care providers and behavioral and mental health care providers for HUSKY Health program members.

Section 17b-311. - Charter Oak Health Plan.

Section 17b-312. - Medicaid waiver to seek federal funds to support the Covered Connecticut program.

Section 17b-313. - Innovation waiver for health care expansion.

Section 17b-314 to 17b-319. - Reserved for future use.