Section 17b-262-822 - Service limitations(a) General (1) Payment for individual, group, family or multiple-family psychotherapy is limited to one visit of each type per day, per provider, per client.(2) Family and group psychotherapy sessions shall be not less than 45 minutes in length, except in an intermediate care program where family and group psychotherapy sessions shall be not less than 30 minutes.(3) More than one psychiatric diagnostic interview examination shall only be provided in a single episode of care under the following circumstances:(A) When it is necessary to have a psychologist perform an interview to initiate or determine the need for psychological testing; or(B) When a client's presentation requires that a physician or a psychiatric advanced practice registered nurse evaluate the need for medication for a client who is in the care of a non-medical practitioner.(4) Group psychotherapy sessions, are limited in size to a maximum of twelve participants per group session regardless of the payment source of each participant, except as provided in subdivision (8) of subsection (d) of this section.(5) Group psychotherapy sessions shall be facilitated by an individual qualified as provided in the applicable licensure category in sections 17a-262-819(c) to (e), inclusive, of the Regulations of Connecticut State Agencies.(6) Multiple-family group psychotherapy sessions are limited in size to a maximum of 24 participants regardless of the payment source of each participant. Such sessions may be conducted with or without the client present.(7) Family therapy shall be reimbursable for one identified client per encounter, without regard to the number of family members in attendance or the presence of behavioral health conditions among other family members in attendance.(b) Chemical maintenance treatment (1) Services shall be billed as chemical maintenance treatment when the goal is to stabilize a client on methadone or other federally approved medication for as long as is needed to avoid return to previous patterns of substance abuse. The induction phase of treatment, the maintenance phase and any tapering of treatment dosage downward, even to abstinence, shall be billed as chemical maintenance treatment.(2) Payment shall be available only for services provided at the clinic. Payment shall not be made for weeks when no face-to-face services are provided.(3) A weekly rate payment for chemical maintenance treatment shall be paid when opiate agonist medication and medication management services are provided to a client. Intake evaluation, initial physical examination; on-site drug abuse testing and monitoring; and individual, group and family counseling are services that are also included in the weekly rate, if medically necessary.(4) Intermediate care programs may be billed separately if medically necessary.(c) Ambulatory chemical detoxification (1) Services shall be billed as ambulatory chemical detoxification when the goal is to systematically reduce to abstinence a client's dependence on a substance. The goal of abstinence shall be documented in the client's initial plan of care.(2) Ambulatory chemical detoxification treatment services shall be limited to one clinic visit per day, per client regardless of the number of times the client is seen in the clinic during any given day.(3) Ambulatory chemical detoxification treatment services shall be limited to a maximum of 90 days from the date the client is admitted into the program.(4) Payment for ambulatory chemical detoxification includes, but is not limited to: An intake evaluation; a physical examination; all medication; medication management; laboratory and monitoring; and individual, group and family counseling, with the exception of intermediate care programs that specifically address a substance abuse disorder and are provided by the clinic.(5) Chemical maintenance and ambulatory chemical detoxification shall not be billed for the same time period.(d) Intermediate care programs shall meet the following requirements: (1) Care planning shall be individualized and coordinated to meet the client's needs.(2) Clinic programs shall provide time-limited, active psychiatric or substance abuse treatment that offers therapeutically intensive, coordinated and structured clinical services within a stable therapeutic milieu.(3) Clinic programs shall be designed to serve clients with serious functional impairments resulting from a behavioral health condition, and further serve to avert hospitalization or increase a client's level of independent functioning.(4) Clinic programs shall provide an adult escort to support the transportation of clients under 16 years of age, transported by a Medicaid non-emergency medical transportation provider, unless the parent or guardian of the client between the ages of 12 to 15 years does not feel an escort is necessary for the client and has provided written consent for transportation of the client to the program without an escort.(5) Clients may attend day treatment, IOP or PHP for a maximum of five days per week.(6) A treatment day at a day treatment program or PHP shall include a minimum of four hours of scheduled programming, of which three and one half hours shall be documented behavioral health clinic services.(7) A treatment day at an IOP shall include a minimum of three hours of scheduled programming, of which two and one half hours shall be documented behavioral health clinic services.(8) Psychotherapy and psycho-educational group size in intermediate care programs shall be limited to 12 participants except that psycho-educational group size for substance abuse related conditions shall be limited to 24 participants and may comprise no more than one and one-half hours of an intermediate care program.(9) The department shall pay for partial hospitalization services only when provided in a CMHC.Conn. Agencies Regs. § 17b-262-822
Effective October 9, 2013