Conn. Agencies Regs. § 17b-262-759

Current through December 27, 2024

Section 17b-262-759 - Definitions

As used in sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies:

(1) "Adult" means a person who is 18 years of age or older;

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

(3) "DMHAS" means the Department of Mental Health and Addiction Services;

(4) "DPH" means the Department of Public Health;

(5) "Group home" means a privately operated, community-based residential facility that serves sixteen or fewer adult clients, is licensed by the Department of Public Health as either a private freestanding mental health residential living center or a private freestanding community residence pursuant to sections 19a-495-551 or 19a-495-560 of the Regulations of Connecticut State Agencies, is certified by the Department of Mental Health and Addiction Services as a provider of mental health rehabilitation services pursuant to section 17a-485d of the Connecticut General Statutes, and meets the requirements of section 17b-262-760 of the Regulations of Connecticut State Agencies for participation in the Medicaid program as a provider of PNMI rehabilitative services;

(6) "Licensed clinician" means:

(A) a doctor of medicine or osteopathy licensed under chapter 370 of the Connecticut General Statutes;

(B) a psychologist who is licensed under chapter 383 of the Connecticut General Statutes;

(C) a marriage and family therapist who is licensed under chapter 383a of the Connecticut General Statutes;

(D) a clinical social worker who is licensed under chapter 383b of the Connecticut General Statutes;

(E) an advanced practice registered nurse who is licensed under chapter 378 of the Connecticut General Statutes;

(F) a registered nurse who is licensed under chapter 378 of the Connecticut General Statutes and who has a minimum of one year of experience in the mental health field; or

(G) a professional counselor who is licensed under chapter 383c of the Connecticut General Statutes;

(7) "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;

(8) "Medically appropriate" means medical care that is provided in a timely manner and meets professionally recognized standards of acceptable medical care and is delivered in the appropriate medical setting;

(9) "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 medical condition or mental illness; or to prevent a condition from occurring;

(10) "Monthly rate" means the amount the department pays for each PNMI client for PNMI program services for each month of service in which there is a qualifying billable unit of service provided;

(11) "Provider" means an entity that participates in the Medicaid program as a qualified group home provider of PNMI adult rehabilitative services as evidenced by an executed provider agreement with DSS;

(12) "PNMI client" or "client" means a Medicaid-eligible adult who resides in a participating group home and who receives covered PNMI rehabilitative services in accordance with sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies;

(13) "Prior authorization" means approval for the provision of service from the department before the provider actually provides the service;

(14) "Private Non-Medical Institution" or "PNMI" means an entity that is a qualified group home provider of adult rehabilitative services under sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies and is not a health insuring organization, hospital, nursing home, or a community health care center;

(15) "Provider agreement" means the signed, written contractual agreement between the department and the provider of PNMI rehabilitative services;

(16) "Qualifying billable unit of service" means forty hours of rehabilitative services during a calendar month or the prorated equivalent based on the number of days the client is in residence at the group home during that month. For purposes of calculation, the forty hours, or the prorated equivalent, may be made up of fifteen minute sub-units, using a rounding convention to be determined by the department;

(17) "Rehabilitative services" means those services identified in section 17b-262-763 of the Regulations of Connecticut State Agencies when provided by a qualified provider on behalf of a PNMI client;

(18) "Residential rehabilitation plan" means a written plan developed by the performing provider in accordance with section 17b-262-760(5) of the Regulations of Connecticut State Agencies; and

(19) "Under the supervision" means that a licensed clinician provides periodic supervision of the work performed by unlicensed clinical staff and accepts primary responsibility for the rehabilitative services performed by the unlicensed staff.

Conn. Agencies Regs. § 17b-262-759

Adopted effective December 1, 2005