Section 17b-262-749 - Provider and billing provider requirementsTo participate in the Medicaid program and provide PNMI rehabilitative services that are eligible for Medicaid reimbursement from the department, the following requirements shall be met:
(1) The performing provider shall: (A) Enroll with the department and have on file a valid provider agreement.(B) Be licensed or approved by DCF or another state agency as (A) a residential treatment facility, group home, maternity home, or similar institution; or (B) a child placing agency that offers therapeutic foster care or a professional parent program.(C) Comply with all Medicaid record keeping, documentation and other requirements, including, but not limited to, those delineated in the department's administrative manuals, provider agreements and memoranda of understanding.(D) Follow all laws, rules, regulations, policies and amendments that govern the Medicaid program as they relate to reimbursement for PNMI rehabilitative services.(E) Develop an individual treatment plan for each PNMI client in accordance with section 17a-145-94 of the Regulations of Connecticut State Agencies not later than thirty days after the PNMI client's admission to the program. The individual treatment plan shall be developed in conjunction with DCF, the child and the child's family, whenever possible, and shall be signed and dated by a licensed clinical staff member employed by or under contract with the performing provider. Such plan shall contain specific behavioral health goals and objectives that are based on an evaluation and diagnosis for the maximum reduction of a client's behavioral health problems and shall identify the type, amount, frequency and duration of services to be provided.(F) Ensure that a licensed clinical staff member employed by or under contract with the performing provider reviews and signs the individual treatment plan within each six month calendar period following the date of a PNMI client's admission.(G) Keep current service and progress notes in a permanent case record for each PNMI client in accordance with sections 17a-145-94 and 17a-145-98 of the Regulations of Connecticut State Agencies. Such entries shall be made on at least a monthly basis.(H) Furnish information and documentation to the billing provider that is sufficient to allow the billing provider to prepare PNMI claims for rehabilitative services.(I) Cooperate with the department and the billing provider in the rate setting process; licensing; or any quality assurance reviews or periodic audits to ensure compliance with PNMI program requirements.(J) Assign billing responsibilities related to the claiming of federal financial participation for state PNMI Medicaid costs to the billing provider.(2) The billing provider shall: (A) Have a valid provider agreement and contract on file that is signed by the performing provider, the billing provider and the department that assigns responsibility for the claiming of federal financial participation to the department. The agreement shall be updated periodically in accordance with Medicaid requirements.(B) Ensure that the performing provider meets and maintains all applicable licensing, accreditation and certification requirements in accordance with federal and state laws.(C) Comply with all Medicaid record keeping, documentation, and other requirements, including, but not limited to, those delineated in department PNMI rehabilitative service administrative manuals, provider agreements and memoranda of understanding.(D) Follow all laws, rules, regulations, policies and amendments that govern the Medicaid program as they relate to PNMI rehabilitative services.(E) Carry out regular licensing and quality assurance reviews of performing providers.(F) Assist the department in establishing PNMI rates that are based upon Medicaid eligible activities that are not otherwise being claimed for federal financial participation.Conn. Agencies Regs. § 17b-262-749
Adopted effective March 11, 2003