Conn. Agencies Regs. § 17b-262-818

Current through December 27, 2024

Section 17b-262-818 - Definitions

For the purposes of sections 17b-262-817 to 17b-262-828, inclusive, of the Regulations of Connecticut State Agencies, the following definitions shall apply:

(1) "Allied Health Professional" or "AHP" means:

(A) A licensed or certified practitioner performing within the practitioner's scope of practice in any of the professional and occupational license or certification categories pertaining to behavioral health covered in title 20 of the Connecticut General Statutes; or

(B) a license-eligible individual as defined in subdivision (23) of this section;

(2) "Ambulatory chemical detoxification services" has the same meaning as provided in section 19a-495-570 of the Regulations of Connecticut State Agencies;

(3) "Authorization" means approval of payment for services by the department before payment is made. "Authorization" includes, prior authorization, registration and retroactive authorization;

(4) "Behavioral health clinic" or "clinic" means a facility that provides services to outpatients, is not part of a hospital and is licensed as one of the following:

(A) A day treatment facility;

(B) a psychiatric outpatient clinic for adults;

(C) an ambulatory chemical detoxification facility;

(D) a chemical maintenance treatment service;

(E) a day or evening treatment service;

(F) an outpatient treatment facility for substance abuse; or

(G) an outpatient psychiatric clinic for children;

(5) "Behavioral health clinic service" means preventive, diagnostic, therapeutic, rehabilitative or palliative items or services within the behavioral health clinic's scope of practice provided by:

(A) A physician within the scope of practice as defined in chapter 370 of the Connecticut General Statutes;

(B) an AHP acting within the practitioner's scope of practice, as defined in title 20 of the Connecticut General Statutes;

(C) an unlicensed or non-certified individual, working under the direct supervision of a licensed AHP, who is otherwise qualified to perform services under the applicable licensure category in sections 17b-262-819(c) to 17b-262-819(e), inclusive, of the Regulations of Connecticut State Agencies;

(6) "Chemical maintenance treatment" has the same meaning as provided in section 19a-495-570 of the Regulations of Connecticut State Agencies;

(7) "Client" means a person eligible for goods or services under Medicaid;

(8) "Commissioner" means the Commissioner of Social Services or his or her designee;

(9) "Community Mental Health Center" or "CMHC" has the same meaning as provided in section 1861(ff)(3)(B) of the Social Security Act;

(10) "Day treatment facility" has the same meaning as provided in section 19a-495-550 of the Regulations of Connecticut State Agencies;

(11) "Day or evening treatment service" has the same meaning as provided in section 19a-495-570 of the Regulations of Connecticut State Agencies;

(12) "Day treatment program" means a day treatment facility, or day or evening treatment service that provides services between four and twelve hours per day;

(13) "Department" means the Department of Social Services or its agent;

(14) "Drug abuse testing" means the taking of physical samples or specimens and the qualitative screening of these samples or specimens for substances of abuse;

(15) "Early and Periodic Screening, Diagnostic and Treatment Special Services" or "EPSDT Special Services" means services provided in accordance with section 1905(r)(5) of the Social Security Act, as amended from time to time;

(16) "Episode of care" means a period of care that ends when the client has been discharged by the provider or there has been an extended cessation in treatment defined as 120 days from the last time the client was treated at the clinic;

(17) "Escort" means a person 21 years of age or older who accompanies a client under the age of 16 during transport in a motor vehicle from one location to another for the purpose of the client's protection and safety. "Escort" does not include the driver of a public transportation vehicle;

(18) "Fee" means the department's payment for services established by the commissioner and contained in the department's fee schedules;

(19) "Formulation" means a clinical assessment of information obtained that is used to provide the framework for developing the appropriate treatment approach for a specific client;

(20) "Group psychotherapy" means a type of behavioral health care in which clients meet in groups facilitated for the purpose of discussing their psychiatric or substance use disorders, the impact of these disorders and the barriers that may be overcome in order to progress in their recovery;

(21) "Intensive Outpatient Program" or "IOP" means an integrated program provided at a psychiatric outpatient clinic for adults, an outpatient treatment service for substance abuse or an outpatient psychiatric clinic for children;

(22) "Intermediate care program" means a day or evening treatment service, IOP or Partial Hospitalization Program;

(23) "License-eligible" means an individual (A) whose education, training, skills and experience satisfy the criteria, including accumulation of all supervised service hours, for one of the behavioral health licensure categories of title 20 of the Connecticut General Statutes, and (B) who has applied for but not yet passed the licensure exam;

(24) "Medicaid" means the program operated by the Department of Social Services pursuant to section 17b-260 of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act;

(25) "Medical necessity" or "medically necessary" has the same meaning as provided in section 17b-259b of the Connecticut General Statutes;

(26) "Off-site services" means services that are provided at a location other than the clinic or a satellite of the clinic;

(27) "Outpatient Psychiatric Clinic for Children" or "OPCC" has the same meaning as provided in section 17a-20-11 of the Regulations of Connecticut State Agencies;

(28)"Outpatient treatment service for substance abuse" has the same meaning as provided in section 19a-495-570 of the Regulations of Connecticut State Agencies;

(29) "Partial Hospitalization Program" or "PHP" has the same meaning as provided in sections 1861(ff)(1) to 1861(ff)(3), inclusive, of the Social Security Act;

(30) "Physician" means an individual licensed or board-certified pursuant to chapter 370 of the Connecticut General Statutes and who has experience in the diagnosis and treatment of behavioral health or substance related conditions;

(31) "Plan of care" means a written individualized plan that contains the client's diagnosis; the type, amount, frequency and duration of services to be provided; and the specific goals and objectives developed subsequent to an evaluation and diagnosis in order to attain or maintain a client's achievable level of independent functioning;

(32) "Prior authorization" means approval of payment for a service from the department before the provider actually provides the service;

(33) "Provider" means a behavioral health clinic enrolled in Medicaid;

(34) "Psychiatric outpatient clinic for adults" has the same meaning as provided in section 19a-495-550 of the Regulations of Connecticut State Agencies;

(35) "Psycho-educational group" means a type of behavioral health care that utilizes a pre-determined and time limited curriculum that focuses on educating clients with a common diagnosis about their disorders, specific ways of coping and progressing in their recovery;

(36) "Registration" means the process of notifying the department of the initiation of a behavioral health clinic service that includes information regarding the evaluation findings and plan of care. Registration may serve in lieu of authorization if a service is designated by the department as requiring registration only;

(37) "Satellite site" has the same meaning as provided in section 17a-20-11 of the Regulations of Connecticut State Agencies;

(38) "Under the direct supervision" means that a physician or licensed AHP provides weekly supervision of the work performed by unlicensed clinical staff or non-certified staff or individuals in training, and a minimum of monthly supervision for the work performed by certified staff; and accepts primary responsibility for the behavioral health services performed by the unlicensed, certified or non-certified staff or individuals in training; and

(39) "Usual and customary charge" means the fee that the provider accepts for the service or procedure in the majority of non-Medicaid cases. If the provider varies the fees so that no one amount is accepted in the majority of cases, "usual and customary" shall be defined as the median accepted fee. "Usual and customary charge" does not include token fees and other exceptional charges.

Conn. Agencies Regs. § 17b-262-818

Effective October 9, 2013