Section 17b-262-707 - Need for service and authorization process(a) The department shall pay for an admission that is medically necessary and medically appropriate as evidenced by the following: (1) certification by a licensed practitioner that a client admitted to a nursing facility meets the criteria outlined in section 19-13-D8t(d)(1) of the Regulations of Connecticut State Agencies. This certification of the need for care shall be made prior to the department's authorization of payment. The licensed practitioner shall use and sign all forms specified by the department;(2) the department's evaluation and written authorization of the client's need for nursing facility services as ordered by the licensed practitioner;(3) a health screen for clients eligible for the Connecticut Home Care Program for Elders as described in section 17b-342-4(a) of the Regulations of Connecticut State Agencies;(4) a preadmission MI/MR screen signed by the department; or an exemption form, in accordance with 42 CFR 483.106(b), as amended from time to time, for any hospital discharge, readmission or transfer for which a preadmission MI/MR screen was not completed; and(5) a preadmission screening level II evaluation for any individual suspected of having mental illness or mental retardation as identified by the preadmission MI/MR screen.(b) The department shall pay a provider only when the department has authorized payment for the client's admission to that nursing facility.(c) A nursing facility may admit a client on an emergency basis only if: (1) the Office of Protection and Advocacy, established in accordance with section 46a-10 of the Connecticut General Statutes, in conjunction with DMHAS or DMR authorizes the emergency admission of a client with mental illness or mental retardation to a nursing facility for up to seven (7) days in accordance with 42 CFR 483.130(d)(5), as amended from time to time; or(2) the commissioner of public health authorizes an emergency transfer as prescribed in section 19a-534 of the Connecticut General Statutes.(d) if a client is admitted on an emergency basis, the nursing facility is not required to meet: (1) the waiting list requirements of section 19a-533 of the Connecticut General Statutes and sections 17-311-200 to 17-311-209, inclusive, of the Regulations of Connecticut State Agencies, as long as emergency admissions are uniformly and consistently made without regard to source of payment; and(2) the requirements of subsections (a)(3) to (a)(5) of this section.(e) A client who requires admission after hours is not considered an emergency admission.Conn. Agencies Regs. § 17b-262-707
Adopted effective March 1, 2002