Conn. Agencies Regs. § 17b-262-594

Current through December 27, 2024

Section 17b-262-594 - Determining the cost effectiveness of the service plan

In order to determine the cost effectiveness of the consumer's service plan, the Department shall do all of the following:

(1) Obtain the monthly average nursing facility cost; and

(2) Determine the monthly cost of the service plan; and

(3) Determine the monthly cost of other medical services that the consumer will require in order to live in the community. These other medical services include: home health care, nursing services, physical therapy, occupational therapy and/or speech therapy. These costs are based on the consumer's expected utilization of these services, multiplied by the Medicaid rates established by the Department for such services; and

(4) Determine the monthly cost of other state administered home and community based services. These other home and community based services costs include but are not limited to those services provided by the department's Community Based Services Program and all funds provided by programs administered by any other state agency which help to maintain the consumer in the community; and

(5) Add the cost of other medical services and other state administered home and community based services to the costs of the service plan to obtain the consumer's total cost of care; and

(6) Compare the consumer's total cost of care to the average nursing facility cost.

The Department may not approve a personal care assistance plan when the cost of all of the foregoing services exceeds the cost of care in a nursing facility.

If due to a temporary acute condition the consumer requires personal care assistance services that exceed the monthly average nursing facility cost for a period that is not expected to exceed four months, the Department, at its discretion, may approve a plan that provides such additional personal care assistance services provided that the annualized cost of personal care assistance services and other services does not exceed the annualized cost of nursing facility services.

Conn. Agencies Regs. § 17b-262-594

Adopted effective February 8, 1999; Amended March 9, 2006