Section 17b-262-734 - Payment(a)Payment(1) The commissioner shall establish the fees for home health care services in the department's fee schedule pursuant to section 17b-242 of the Connecticut General Statutes.(2) The department shall pay for home health aide services based on each unit of service the aide spends providing the services as described in the fee schedule.(3) The department shall pay therapists as described in the fee schedule.(4) The department shall pay for nursing services based on each visit or unit of service the nurse spends providing the services as described in the fee schedule.(b)Payment Limitations(1) The department shall reimburse a provider when all of the requirements of sections 17b-262-726 to 17b-262-735, inclusive, of the Regulations of Connecticut State Agencies have been met.(2) When two or more clients in the same household are receiving nursing care services, except extended nursing services, the department shall pay the full unit fee for the primary client and a reduced fee for each subsequent client. The procedure code and modifier used for billing shall reflect the purpose of the visit for each subsequent client.(3) The following limitations shall apply when extended nursing services are required to care for multiple clients in the same household:(A) If one nurse is required, the department shall pay the full unit fee for the primary client and a reduced unit fee for the unit of time during which the nurse is providing care to one subsequent client. No payment shall be made for additional subsequent clients. The billing instructions for home health agencies shall include a detailed description of the billing process. The care plans shall support the ability of one nurse to provide services safely to multiple clients.(B) If more than one nurse is required, the department shall pay the fee as described in section 17b-262-734(b)(3)(A) of the Regulations of Connecticut State Agencies for each nurse. The care plans shall support the need for multiple nurses.(4) When home health aides are caring for multiple clients in the same household, the department shall pay each aide the full unit fee. The department shall pay for the home health aide to care for one client for any one 15-minute unit of time.(5) The fee for home health care services shall include transportation.(6) The fee for home health aide services shall include supervision of the home health aide by a registered nurse.(7) The department shall pay the same fee for out-of-state providers as for instate providers.Conn. Agencies Regs. § 17b-262-734
Adopted effective March 7, 2007