Conn. Agencies Regs. § 17b-262-456

Current through December 27, 2024

Section 17b-262-456 - Services covered and limitations

Except for the limitations and exclusions listed below, the department shall pay for the professional services of a licensed psychiatrist which conform to accepted methods of diagnosis and treatment, but shall not pay for anything of an unproven, educational, social, research, experimental, or cosmetic nature; for services in excess of those deemed medically necessary and medically appropriate by the department to treat the client's condition; or for services not directly related to the client's diagnosis, symptoms, or medical history.

(a) The department shall pay for:

(1) psychiatric evaluation;

(2) psychotherapy, including: individual, group, family, hypnosis, and electroshock;

(3) psychiatric consultation;

(4) drugs, as limited in subsection (b) of section 17b-262-456;

(5) all admitting and inpatient services performed by the admitting psychiatrist in an acute care hospital after the psychiatrist has received prior authorization for the admission pursuant to the department's utilization review program as delineated in section 17-134d-80 of the Regulations of Connecticut State Agencies; and

(6) HealthTrack Services and HealthTrack Special Services.

(b) Limitations on covered services shall be as follows:

(1) a psychiatric evaluation shall be limited to one evaluation in any twelve month period per client per provider;

(2) only one unit of therapy of the same type shall be paid for on the same day:

(3) group psychiatric sessions shall be limited in size to a maximum of eight persons per group session regardless of the payment source of each participant;

(4) services covered shall be limited to those listed in the department's applicable fee schedule; and

(5) hypnosis and electroshock therapy shall be personally provided by a psychiatrist.

(c)Services Not Covered

The department shall not pay for the following psychiatric services:

(1) Information or services furnished by the provider to the client over the telephone;

(2) Concurrent services for the same client involving the same services or procedure;

(3) Office visits to obtain a prescription, the need for which has already been ascertained; and

(4) Cancelled office visits or appointments not kept.

Conn. Agencies Regs. § 17b-262-456

Adopted effective May 11, 1998; Amended April 2, 2015