Conn. Agencies Regs. § 17b-262-768

Current through December 27, 2024

Section 17b-262-768 - Payment

Payment by the department for PNMI rehabilitative services shall be made in accordance with the following provisions.

(a) The department shall make payments on the basis of monthly rates for PNMI programs.

(b) A statewide capitated monthly rate will be established annually and applied uniformly to all facility providers and to all Medicaid eligible recipients provided with a qualified billable unit of service.

(c) The statewide capitated rate shall be based upon annual audited cost reports filed by licensed and certified service providers to include cost allocations based upon semi-annual time studies of facility staff hours related to rehabilitative services.

(d) The Department shall establish interim PNMI rates for the first and second year of service coverage based upon estimated costs. The interim rates will be replaced based upon cost report filings for the period and related payment adjustments will be made accordingly.

(e) Prospective rates for subsequent periods will be based upon allowable costs for the cost period ending twelve months prior to the start of the rate period. These rates will be updated, within available appropriations, by the projected increase or decrease in the consumer price index for urban consumers for the twenty-four months between the mid-point of the cost period and the mid-point of the rate year.

(1) Allowable costs for purposes of establishing the statewide capitated rate are the reasonable and necessary costs attributable to the provision of rehabilitative services covered under this regulation but shall exclude any other costs such as transportation, recreation or vocational services that are not part of rehabilitative services. Allowable costs will be determined based on a survey of all group homes covered under this regulation.

(f) The calculation of the PNMI rates shall not include any services that have been reimbursed by Medicaid under other service categories.

(g) The PNMI rates shall exclude payment for non-Medicaid covered services, such as room and board.

(h) Payments shall not be made if the recipient has been absent from the program for the entire calendar month.

(i) The provider shall seek payment from any other resources that are available for payment of rendered services prior to billing the Department.

(j) Claims for payment shall be supported by documentation of required services.

Conn. Agencies Regs. § 17b-262-768

Adopted effective December 1, 2005