Conn. Agencies Regs. § 17b-262-760

Current through December 27, 2024

Section 17b-262-760 - Provider participation

In order to participate in the Medicaid program and provide PNMI rehabilitative services that are eligible for Medicaid reimbursement from the department, the provider shall:

(1) Enroll with the department and have on file a valid provider agreement;

(2) Be certified by DMHAS as a group home provider of rehabilitation services;

(3) Comply with all Medicaid record keeping, documentation and other requirements, including, but not limited to, those delineated in the department's administrative manuals, provider agreements and memoranda of understanding;

(4) Follow all laws, rules, regulations, policies and amendments that govern the Medicaid program as they relate to reimbursement for PNMI rehabilitative services;

(5) Develop an individual residential rehabilitation plan for each PNMI client in accordance with section 19a-495-551(k)(3) of the Regulations of Connecticut State Agencies not later than thirty days after the PNMI client's admission to the program. Such plan shall contain specific behavioral health goals and objectives that are based on each client's mental health diagnosis and diagnostic and functional evaluation and are targeted toward the maximum reduction of a client's behavioral health symptoms, restoration of functioning, and recovery, and shall identify the type, amount, frequency and duration of services to be provided;

(6) Ensure that a licensed clinician employed by, or under contract with, the performing provider reviews and signs the individual residential rehabilitation plan. The first review and signature shall occur not more than thirty days after admission;

(7) Keep current service and progress notes in a permanent case record for each PNMI client in accordance with section 19a-495-551(k)(3)(H) of the Regulations of Connecticut State Agencies;

(8) Cooperate with the department in the rate setting process including, but not limited to, time studies, licensing or any quality assurance reviews or periodic audits to ensure compliance with PNMI program requirements;

(9) Provide an initial orientation, training and periodic supervision to direct service staff related to the provision of rehabilitative services;

(10) Ensure that all group home staff are certified in first aid and cardiopulmonary resuscitation;

(11) Conduct ongoing assessment and service planning;

(12) Promote independent management of medication including the supervision and monitoring of self-administration as appropriate;

(13) Be 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;

(14) Ensure that the facility director holds a bachelor's degree in a human service discipline and a minimum of three years of experience in a mental health services related position;

(15) Ensure that the facility director (or other manager) is accessible after-hours, by telephone or pager, to staff on duty; and

(16) Ensure that direct service staff hold either a bachelor's degree in a behavioral health related specialty or have two years experience in the provision of mental health services.

Conn. Agencies Regs. § 17b-262-760

Adopted effective December 1, 2005