Conn. Agencies Regs. § 17b-262-608

Current through December 27, 2024

Section 17b-262-608 - Definitions

For the purposes of sections 17b-262-607 through 17b-262-618 the following definitions shall apply:

(1) "Acute" means having rapid onset, severe symptoms, and a short course.

(2) "Allied Health Professional (AHP)" means a professional or paraprofessional individual who is qualified by special training, education, skills, and experience in providing health care and treatment and shall include, but shall not be limited to: licensed practical nurses, certified nurse assistants, and other qualified therapists.

(3) "By or Under the Supervision" means the nurse practitioner shall assume professional responsibility for the service performed by the allied health professional, overseeing or participating in the work of the allied health professional including, but not limited to:

(A) availability of the nurse practitioner to the allied health professional in person and within five minutes;

(B) availability of the nurse practitioner on a regularly scheduled basis to review the practice, charts, and records of the allied health professional and to support the allied health professional in the performance of services; and

(C) a predetermined plan for emergency situations, including the designation of an alternate nurse practitioner in the absence of the regular nurse practitioner.

(4) "Child" means a person who is under twenty-one years of age.

(5) "Client" means a person eligible for goods or services under the department's Medical Assistance Program.

(6) "Commissioner" means the Commissioner of Social Services appointed pursuant to subsection (a) of section 17b-1 of the Connecticut General Statutes.

(7) "Concurrent Review" means the review of the medical necessity and appropriateness of admission upon or within a short period following an admission and the periodic review of services provided during the course of treatment.

(8) "Consultation" means those services rendered by a nurse practitioner whose opinion or advice is requested by the client's nurse practitioner or agency in the evaluation or treatment of the client's illness.

(9) "CPT or Physician's Current Procedural Terminology" means a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by licensed practitioners as published by the American Medical Association, as amended from time to time.

(10) "Criteria" means the predetermined measurement variables on which judgment or comparison of necessity, appropriateness, or quality of health services shall be made.

(11) "Department" means the Department of Social Services or its agent.

(12) "Emergency" means a medical condition, including labor and delivery, manifesting itself by acute symptoms of sufficient severity, including severe pain, such that the absence of immediate medical attention could reasonably be expected to result in placing the client's health in serious jeopardy, serious impairment to bodily functions, or serious dysfunction of any bodily organ or part.

(13) "Family Planning Services" means any medically approved diagnostic procedure, treatment, counseling, drug, supply, or device which is prescribed or furnished by a provider to individuals of childbearing age for the purpose of enabling such individuals to freely determine the number and spacing of their children.

(14) "Fees" means the rates for services, treatments, and drugs administered by nurse practitioners which shall be established by the commissioner and contained in the department's fee schedules.

(15) "HealthTrack Services" means the services described in subsection (r) of section 1905 of the Social Security Act.

(16) "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 subdivision (5) of subsection (r) of section 1905 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.

(17) "Home" means the client's place of residence which includes a boarding home or home for the aged. Home does not include a hospital or long-term care facility; long-term care facility includes a nursing facility, chronic disease hospital, and intermediate care facility for the mentally retarded (ICF/MR).

(18) "Hospital" means a facility licensed by the Department of Public Health as a general short-term hospital or a hospital for mental illness as defined in section 17a-495 of the Connecticut General Statutes, or a chronic disease hospital as defined in subdivision (2) of subsection (b) of section 19-13-D1 of the Regulations of Connecticut State Agencies, which is part of the Public Health Code.

(19) "Inpatient" means a client who has been admitted to a general hospital for the purpose of receiving medically necessary and appropriate medical, dental, and other health related services and is present at midnight for the census count.

(20) "Institution" means the definition contained in Title 42 of the CFR, Part 435, section 435.1009.

(21) "Interperiodic Encounter" means any medically necessary visit to a Connect-icut Medical Assistance 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.

(22) "Legend Device" means the definition contained in section 20-571 of the Connecticut General Statutes.

(23) "Legend Drug" means the definition contained in section 20-571 of the Connecticut General Statutes.

(24) "Licensed Practitioner" means any Connecticut medical professional granted prescriptive powers within the scope of his or her professional practice as defined and limited by federal or state law.

(25) "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).

(26) "Long-Term Care Facility" means a medical institution which provides, at a minimum, skilled nursing services or nursing supervision and assistance with personal care on a daily basis. Long-term care facilities include:

(A) nursing facilities,

(B) chronic disease hospitals--inpatient, and

(C) intermediate care facilities for the mentally retarded (ICFs/MR).

(27) "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.

(28) "Medical Assistance Program" means the medical assistance provided pursuant to Chapter 319v of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act. The program is also referred to as Medicaid.

(29) "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 to prevent a medical condition from occurring.

(30) "Medical Record" means the definition contained in section 19a-14-40 of the Regulations of Connecticut State Agencies, which is also the Public Health Code.

(31) "Nurse Practitioner" means an advanced practice registered nurse (APRN) who holds a current license as such issued by the Department of Public Health (DPH) under Chapter 378 of the Connecticut General Statutes, and who performs within the scope of practice for APRNs established pursuant to the Connecticut General Statutes and all relevant regulations.

(32) "Panel or Profile Tests" means certain multiple tests performed on a single specimen of blood or urine. They are distinguished from the single or multiple tests performed on an individual, immediate, or "stat" reporting basis.

(33) "Physician" means an individual licensed under Chapter 370 or 371 of the Connecticut General Statutes as a doctor of medicine or osteopathy.

(34) "Plan of Care" means the definitions contained in Title 42 of the CFR, Part 441, sections 441.102, 441.103, 441.155, and 441.156.

(35) "Prescription" means an order issued by a licensed practitioner that is documented in writing and signed by the practitioner issuing the order. The prescription needs to be renewed six months from the date of issuance. In long-term care facilities the signed order of a licensed practitioner shall be accepted in lieu of a written or oral prescription. The written prescription shall include:

(A) the date of the prescription;

(B) the name and address of the client;

(C) the client's date of birth;

(D) the diagnosis;

(E) the item prescribed;

(F) the quantity prescribed and strength, when applicable;

(G) the timeframe for the product's use;

(H) the number of refills, if any:

(I) the name and address of the prescribing practitioner and his or her Drug Enforcement Act number when appropriate;

(J) the dated signature of the licensed practitioner prescribing; and

(K) directions for the use of the medication and any cautionary statements required.

(36) "Prior Authorization" means approval for the provision of a service or delivery of goods from the department before the provider actually provides the service or delivers the goods.

(37) "Provider" means a nurse practitioner who is enrolled in the Medical Assistance Program.

(38) "Provider Agreement" means the signed, written, contractual agreement between the department and the provider of services or goods.

(39) "Quality of Care" means the evaluation of medical care to determine if it meets the professionally recognized standards of acceptable medical care for the condition and the client under treatment.

(40) "Retrospective Review" means the review conducted after services are provided to a client, to determine the medical necessity, appropriateness, and quality of the services provided.

(41) "Routine Medical Visits" means visits intended to check a client's general medical condition rather than visits which are medically necessary to treat a specific medical problem. For clients under twenty-one years of age, this can mean a Health-Track interperiodic encounter or a periodic comprehensive health screening.

(42) "State Plan" means the document which contains the services covered by the Connecticut Medical Assistance Program in compliance with Part 430, Subpart B, of Title 42 of the Code of Federal Regulations (CFR).

(43) "Utilization Review" means the evaluation of the necessity, appropriateness, and quality of the use of medical services, procedures, and facilities. Utilization review evaluates the medical necessity and medical appropriateness of admissions, the services performed or to be performed, the length of stay, and the discharge practices. It is conducted on a concurrent, prospective, or retrospective basis.

Conn. Agencies Regs. § 17b-262-608

Effective August 10, 1998