Conn. Agencies Regs. § 17b-262-764

Current through December 27, 2024

Section 17b-262-764 - Limitations

Coverage of PNMI rehabilitative services shall be subject to the following limitations:

(1) PNMI rehabilitative services shall be pre-authorized by the department or its agent based on a written service recommendation.

(2) PNMI rehabilitative services shall be based on the individual residential rehabilitation plan developed pursuant to section 17b-262-760(5) of the Regulations of Connecticut State Agencies and the requirements of sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies, and shall be performed by, or under the supervision of, a licensed clinician employed by, or under contract to, the performing provider.

(3) The department shall not pay for programs, services or components of services that are of an unproven, experimental, cosmetic or research nature.

(4) The department shall not pay for programs, services or components of services that do not relate to the client's diagnosis, symptoms, functional limitations or medical history.

(5) The department shall not pay for programs, services or components of services that are not included in the fee established by the department.

(6) The department shall not pay for programs, services or components of services that are intended solely to prepare individuals for paid or unpaid employment or for vocational equipment and uniforms.

(7) The department shall not pay for programs, services or components of services designed to provide socialization or recreational activities for clients.

(8) The department shall not pay for time spent by the provider transporting clients.

(9) The department shall not pay for services that are solely, educational or vocational.

(10) The department shall not pay for costs associated with room and board for clients.

(11) The department shall not pay for PNMI rehabilitative services that are provided out-of-state unless the services are pre-authorized and are not available within Connecticut.

(12) The department shall not pay any organization or individual for services covered under sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies, if such organization or individual is directly under contract to a provider for services covered under sections 17b-262-758 to 17b-262-769, inclusive, of the Regulations of Connecticut State Agencies.

Conn. Agencies Regs. § 17b-262-764

Adopted effective December 1, 2005