Conn. Gen. Stat. § 17b-242

Current with legislation from the 2024 Regular and Special Sessions.

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

(a) The Department of Social Services shall determine the rates to be paid to home health care agencies and home health aide agencies by the state or any town in the state for persons aided or cared for by the state or any such town. The Commissioner of Social Services shall establish a fee schedule for home health services to be effective on and after July 1, 1994. The commissioner may annually modify such fee schedule if such modification is needed to ensure that the conversion to an administrative services organization is cost neutral to home health care agencies and home health aide agencies in the aggregate and ensures patient access. Utilization may be a factor in determining cost neutrality. The commissioner shall increase the fee schedule for home health services provided under the Connecticut home-care program for the elderly established under section 17b-342, effective July 1, 2000, by two per cent over the fee schedule for home health services for the previous year. On and after January 1, 2024, the commissioner shall increase the fee schedule for complex care nursing services provided to individuals over the age of eighteen such that the rate of reimbursement is equal to the rate for such services provided to individuals age eighteen and under. There shall be no differential in fees paid for such services based on the age of the patient. The commissioner may increase any fee payable to a home health care agency or home health aide agency upon the application of such an agency evidencing extraordinary costs related to (1) serving persons with AIDS; (2) high-risk maternal and child health care; (3) escort services; or (4) extended hour services. In no case shall any rate or fee exceed the charge to the general public for similar services. A home health care agency or home health aide agency which, due to any material change in circumstances, is aggrieved by a rate determined pursuant to this subsection may, within ten days of receipt of written notice of such rate from the Commissioner of Social Services, request in writing a hearing on all items of aggrievement. The commissioner shall, upon the receipt of all documentation necessary to evaluate the request, determine whether there has been such a change in circumstances and shall conduct a hearing if appropriate. The Commissioner of Social Services shall adopt regulations, in accordance with chapter 54, to implement the provisions of this subsection. The commissioner may implement policies and procedures to carry out the provisions of this subsection while in the process of adopting regulations, provided notice of intent to adopt the regulations is posted on the eRegulations System not later than twenty days after the date of implementing the policies and procedures. Such policies and procedures shall be valid for not longer than nine months. For purposes of this subsection, "complex care nursing services" means intensive, specialized nursing services provided to a patient with complex care needs who requires skilled nursing care at home.

(b) The Department of Social Services shall monitor the rates charged by home health care agencies and home health aide agencies. Such agencies shall file annual cost reports and service charge information with the department.

(c) The home health services fee schedule shall include a fee for the administration of medication, which shall apply when the purpose of a nurse's visit is limited to the administration of medication. Administration of medication may include, but is not limited to, blood pressure checks, glucometer readings, pulse rate checks and similar indicators of health status. The fee for medication administration shall include administration of medications while the nurse is present, the pre-pouring of additional doses that the client will self-administer at a later time and the teaching of self-administration. The department shall not pay for medication administration in addition to any other nursing service at the same visit. The department may establish prior authorization requirements for this service. Before implementing such change, the Commissioner of Social Services shall consult with the chairpersons of the joint standing committees of the General Assembly having cognizance of matters relating to public health and human services. The commissioner shall monitor Medicaid home health care savings achieved through the implementation of nurse delegation of medication administration pursuant to section 19a-492e. If, by January 1, 2016, the commissioner determines that the rate of savings is not adequate to meet the annualized savings assumed in the budget for the biennium ending June 30, 2017, the department may reduce rates for medication administration as necessary to achieve the savings assumed in the budget. Prior to any rate reduction, the department shall report to the joint standing committees of the General Assembly having cognizance of matters relating to appropriations and the budgets of state agencies and human services provider specific cost and utilization trend data for those patients receiving medication administration. Should the department determine it necessary to reduce medication administration rates under this section, it shall examine the possibility of establishing a separate Medicaid supplemental rate or a pay-for-performance program for those providers, as determined by the commissioner, who have established successful nurse delegation programs.

(d) The home health services fee schedule established pursuant to subsection (c) of this section shall include rates for psychiatric nurse visits.

(e) The Department of Social Services, when processing or auditing claims for reimbursement submitted by home health care agencies and home health aide agencies shall, in accordance with the provisions of chapter 15, accept electronic records and records bearing the electronic signature of a licensed physician or licensed practitioner of a healthcare profession that has been submitted to the home health care agency or home health aide agency.

(f) If the electronic record or signature that has been transmitted to a home health care agency or home health aide agency is illegible or the department is unable to determine the validity of such electronic record or signature, the department shall review additional evidence of the accuracy or validity of the record or signature, including, but not limited to, (1) the original of the record or signature, or (2) a written statement, made under penalty of false statement, from (A) the licensed physician or licensed practitioner of a health care profession who signed such record, or (B) if such licensed physician or licensed practitioner of a health care profession is unavailable, the medical director of the agency verifying the accuracy or validity of such record or signature, and the department shall make a determination whether the electronic record or signature is valid.

(g) The Department of Social Services, when auditing claims submitted by home health care agencies and home health aide agencies, shall consider any signature from a licensed physician or licensed practitioner of a health care profession that may be required on a plan of care for home health services, to have been provided in timely fashion if (1) the document bearing such signature was signed prior to the time when such agency seeks reimbursement from the department for services provided, and (2) verbal or telephone orders from the licensed physician or licensed practitioner of a health care profession were received prior to the commencement of services covered by the plan of care and such orders were subsequently documented. Nothing in this subsection shall be construed as limiting the powers of the Commissioner of Public Health to enforce the provisions of sections 19-13 -D73 and 19-13-D74 of the regulations of Connecticut state agencies and 42 CFR 484.18(c).

(h) Any order for home health care services covered by the Department of Social Services may be issued by any licensed practitioner authorized to issue such an order pursuant to section 19a-496a. Any Department of Social Services regulation, policy or procedure that applies to a physician who orders such home health care services, including related provisions such as review and approval of care plans for home health care services, shall apply to any licensed practitioner authorized to order such home health care services pursuant to section 19a-496a.

(i) For purposes of this section, "licensed practitioner of a healthcare profession" has the same meaning as "licensed practitioner" in section 21a-244a.

Conn. Gen. Stat. § 17b-242

(1957, P.A. 539; P.A. 73-117, S. 24, 31; P.A. 78-264, S. 2, 4; P.A. 91-406 , S. 5 , 29 ; June Sp. Sess. P.A. 91-8 , S. 20 , 63 ; May Sp. Sess. P.A. 92-16 , S. 26 , 89 ; P.A. 93-262 , S. 1 , 20 , 87 ; 93-418 , S. 24 , 41 ; 93-435 , S. 59 , 95 ; May Sp. Sess. P.A. 94-5 , S. 22 , 30 ; P.A. 95-257 , S. 39 , 58 ; 95-351 , S. 14 , 30 ; P.A. 96-268 , S. 5 , 34 ; P.A. 99-130 ; June Sp. Sess. P.A. 00-2, S. 16, 53; P.A. 02-101 , S. 13 ; P.A. 03-2 , S. 8 ; June 30 Sp. Sess. P.A. 03-6, S. 197; P.A. 05-118 , S. 1 ; 05-272 , S. 44 ; P.A. 11-44 , S. 114 ; 11-61 , S. 123 ; Dec. Sp. Sess. P.A. 12-1 , S. 6 ; P.A. 13-234 , S. 78 ; June Sp. Sess. P.A. 15-5 , S. 387 .)

Amended by P.A. 23-0204,S. 282 of the Connecticut Acts of the 2023 Regular Session, eff. 1/1/2024.

Amended by P.A. 21-0133, S. 1 of the Connecticut Acts of the 2021 Regular Session, eff. 7/7/2021.

Amended by P.A. 19-0097, S. 1 of the Connecticut Acts of the 2019 Regular Session, eff. 7/1/2019.

Amended by P.A. 15-0005, S. 387 of the Connecticut Acts of the 2015 Special Session, eff. 7/1/2015.