Section 17b-262-342 - Goods and services not coveredThe department shall not pay for the following goods or services or goods or services related to the following:
(1) Immunizations, biological products and other products available to providers free of charge;(2) Examinations and laboratory tests for preventable diseases that are furnished free of charge;(3) Information or services provided to a client by a provider electronically or over the telephone;(5) An office visit for the sole purpose of the client obtaining a prescription where the provider previously determined the need for the prescription;(6) Cancelled services and appointments not kept;(7) Services provided in a general hospital if the department determines the admission does not, or retrospectively did not, comply with the department's utilization review requirements in section 17-134d-80 of the Regulations of Connecticut State Agencies;(8) Infertility treatment;(9) Sterilizations performed on mentally incompetent individuals or institutionalized individuals;(10) More than one visit per day to the same provider by a client;(11) Services to treat obesity other than those described in section 17b-262-341(9) of the Regulations of Connecticut State Agencies; and(12) Any procedures or services of an unproven, educational, social, research, experimental or cosmetic nature; any diagnostic, therapeutic or treatment services in excess of those deemed medically necessary by the department to treat the client's condition or services not directly related to the client's diagnosis, symptoms or medical history.Conn. Agencies Regs. § 17b-262-342
Adopted effective January 31, 2008; Amended March 11, 2013; Amended April 2, 2015