Conn. Agencies Regs. § 17b-262-748

Current through December 27, 2024

Section 17b-262-748 - Definitions

As used in sections 17b-262-747 through 17b-262-757, inclusive, of the Regulations of Connecticut State Agencies the following definitions shall apply:

(1) "Billing provider" means the Connecticut Department of Children and Families.

(2) "Child" means a person who is under twenty-one (21) years of age.

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

(4) "DCF" means the Department of Children and Families.

(5) "Individual treatment plan" means a written plan developed by the performing provider in accordance with section 17b-262-749(a)(5) of the Regulations of Connecticut State Agencies.

(6) "Licensed clinical staff" means:

(A) a doctor of medicine or osteopathy licensed under chapter 370 of the Connecticut General Statutes;

(B) a psychologist who is licensed under chapter 383 of the Connecticut General Statutes;

(C) a marriage and family therapist who is licensed under chapter 383a of the Connecticut General Statutes;

(D) a clinical social worker who is licensed under chapter 383b of the Connecticut General Statutes;

(E) an alcohol and drug counselor who is licensed under chapter 376b of the Connecticut General Statutes;

(F) an advanced practice registered nurse who is licensed under chapter 378 of the Connecticut General Statues; or

(G) a registered nurse who is licensed under chapter 378 of the Connecticut General Statutes and who has a minimum of one year of experience in the mental health field.

(7) "Medicaid" means the program operated by the department pursuant to Section 17b-260 of the Connecticut General Statutes and authorized by Title XIX of the Social Security Act.

(8) "Medically necessary" or "medically appropriate" 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 medical condition or mental illness; or to prevent a condition from occurring.

(9) "Monthly rate" means the amount the department pays for each PNMI client for PNMI program services for each month of service.

(10) "Performing provider" means an entity that participates in the Medicaid program as a provider of PNMI children's rehabilitative services and that is a state licensed or approved (A) residential treatment facility; group home; maternity home; or similar institution; or (B) child placing agency that offers a therapeutic foster care or professional parent program.

(11) "PNMI client" or "client" means a client who is a child that (A) has been placed with a PNMI performing provider by a state agency and (B) determined by the department to be eligible for Medicaid.

(12) "Private Non-Medical Institution" or "PNMI" means an entity that is not a health insuring organization, hospital, nursing home, or a community health care center, but which (A) provides residential services for children and is licensed or approved by the state of Connecticut as (i) a residential treatment facility, group home, maternity home, or similar institution or (ii) a child placing agency that offers a therapeutic foster care or a professional parent program or (B) is an out-of-state facility determined by the Commissioner of the Department of Children and Families to meet comparable licensure standards or requirements.

(13) "Residential treatment facility" means a 24 hour mental health facility that is licensed or approved by the Department of Children and Families and that operates for the purpose of effecting positive change and normal growth and development for emotionally disturbed, behavior disordered and socially maladjusted children.

(14) "Group home" means a community based residential facility with a homelike environment that is licensed or approved by the Department of Children and Families; provides board and care, counseling, life-skill training and recreation; and arranges for or helps residents access educational, vocational and therapy services that are offered in the community.

(15) "Maternity home" means a maternity home that (A) is licensed by DCF as a group home; (B) is a 24 hour facility that provides board, care, treatment and the therapeutic environment required to promote positive change and growth in pregnant adolescents and young mothers; and (C) has neonatal and postnatal programs that are designed to assess client needs and develop skills in parenting, socialization and independent living.

(16) "Therapeutic foster care" means a program offered by a DCF approved or licensed child placing agency that recruits, trains and supports foster parents who provide family foster care to children with emotional and behavioral needs.

(17) "Professional parent program" means a program provided by a DCF approved or licensed child placing agency that (A) recruits, trains and supports foster parents who provide family foster care to children with multiple needs and (B) serves children who need a greater level of care than those children who are served in a therapeutic foster care agency program.

(18) "Provider agreement and contract" means the signed, written contractual agreement between the department and the performing provider and the billing provider of PNMI children's rehabilitative services.

(19) "Rehabilitative services" means those services described in 42 C.F.R. 440.130(d), as amended from time to time, and include those services identified in section 17b-262-752 of the Regulations of Connecticut State Agencies.

(20) "Title V Agency" means the Department of Public Health, which administers Title V of the Social Security Act, known as the Maternal and Child Health Services Block Grant.

(21) "PNMI program" means the component part of the state's Title V program, which is administered through agreement among the billing provider, the department and the Title V Agency.

Conn. Agencies Regs. § 17b-262-748

Adopted effective March 11, 2003