Section 17b-262-642 - DefinitionsFor the purposes of sections 17b-262-641 through 17b-262-650, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply:
(1)"Client" means a person eligible for goods or services under the department's Medicaid Program.(2)"Commissioner" means the Commissioner of Social Services appointed pursuant to section 17b-1(a) of the Connecticut General Statutes.(3)"Department" means the Department of Social Services or its agent.(4)"HealthTrack Services" means the services described in section 1905(r) of the Social Security Act.(5)"HealthTrack Special Services" means medically necessary and medically appropriate health care, diagnostic services, treatment, or other measures necessary to correct or ameliorate disabilities and physical and mental illnesses and conditions discovered as a result of a periodic comprehensive health screening or interperiodic encounter. Such services are provided in accordance with section 1905(r)(5) of the Social Security Act, and are: (A) services not covered under the State Plan or contained in a fee schedule published by the department; or(B) services covered under the State Plan and contained in a fee schedule published by the department which exceed the limit on the amount of services established by the department that are contained in regulation.(6)"Interperiodic Encounter" means any medically necessary visit to a Connecticut Medicaid provider, other than for the purpose of performing a periodic comprehensive health screening. Such encounters include, but are not limited to, physician's office visits, clinic visits, and other primary care visits.(7)"Laboratory" means a licensed clinical laboratory as defined in section 19a-30 of the Connecticut General Statutes and which is independent of a physician's, nurse-midwife's, or nurse practitioner's office, or an inpatient or outpatient hospital department or clinic.(8)"Licensed Practitioner of the Healing Arts" means a professional person providing health care pursuant to a license issued by the Department of Public Health (DPH).(9)"Medical Appropriateness or Medically Appropriate" means health care that is provided in a timely manner and meets professionally recognized standards of acceptable medical care; is delivered in the appropriate medical setting; and is the least costly of multiple, equally-effective, alternative treatments or diagnostic modalities.(10)"Medicaid" means the program operated by the department pursuant to section 17b-260 of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act.(11)"Medical Necessity or Medically Necessary" means health care provided to correct or diminish the adverse effects of a medical condition or mental illness; to assist an individual in attaining or maintaining an optimal level of health; to diagnose a condition; or prevent a medical condition from occurring.(12)"Panel or Profile Tests" means certain multiple tests performed on a single specimen or material derived from the human body which are related to a condition, disorder, or family of disorders, which when combined mathematically or otherwise, comprise a finished identifiable laboratory study or studies.(13)"Prior Authorization" means approval for the provision of a service or the delivery of goods from the department before the provider actually provides the service or delivers the goods.(14)"Provider" means a laboratory which provides testing and analysis services and which is independent of a physician's, nurse-midwife's, or nurse practitioner's office, or an inpatient or outpatient hospital department.(15)"Provider Agreement" means the signed, written, contractual agreement between the department and the provider of services or goods.(16)"State Plan" means the document which contains the services covered by the Connecticut Medicaid Program in compliance with 42 CFR 430(B).Conn. Agencies Regs. § 17b-262-642
Adopted effective May 10, 2000