Connecticut Administrative Code
Title 17a - Social and Human Services and Resources
453a - General Assistance Behavioral Health Program
Section 17a-453a-5 - Limitations, exclusions and non-payment of behavioral health services
Universal Citation: CT Reg of State Agencies 17a-453a-5
Current through March 14, 2024
(a) Limitations: The following limitations shall apply:
(1) DMHAS payment for
outpatient therapy shall be limited to one (1) session per contracted provider,
per day, for each eligible recipient for each of the following therapies,
unless additional behavioral health services are authorized in advance by the
designated agent:
(A) Individual
therapy;
(B) Group therapy;
or
(C) Family therapy;
(2) Unless authorized in advance
by the designated agent, medication management delivered by the same
practitioner, on the same day, for the same eligible recipient and for the
principal purpose of medication monitoring or management shall not be paid
separately from individual or group therapy;
(3) Group therapy sessions shall be limited
to a maximum of twelve (12) individuals per group session, excluding the
supervising clinician(s); education groups shall be limited to a maximum of
twenty-four (24) individuals per group session, excluding the supervising
professional(s);
(4) DMHAS payment
for the following shall be limited to one (1) each for each eligible recipient
during a twelve (12) month period, if authorized in advance by the designated
agent:
(A) Neuropsychological testing;
or
(B) Psychological
testing;
(5) Contracted
providers of chemical maintenance treatment shall deliver behavioral health
services at their licensed facility location, unless otherwise authorized in
advance by DMHAS;
(6) DMHAS payment
for laboratory services shall be limited to one (1) unit per allowable
laboratory service per eligible recipient per day, unless authorized by the
designated agent;
(7) DMHAS payment
for initial intake evaluations conducted by contracted providers shall only be
considered when:
(A) The individual is
eligible for medical services pursuant to section
17b-192 of the
Connecticut General Statutes at the time of the initial intake evaluation or is
found to be eligible retroactively for such benefits on the date on which the
initial intake evaluation occurred;
(B) The eligible recipient does not begin
treatment in a level of care, other than outpatient-mental health or
outpatient-substance use, with the same contracted provider not later than ten
(10) calendar days after the date of his or her initial intake
evaluation;
(C) The contracted
provider registers the procedure not later than fifteen (15) calendar days
after the date of the initial intake evaluation;
(D) The contracted provider has not received
payment for an initial intake evaluation for the same eligible recipient within
the previous six (6) months; and
(E) The contracted provider has neither
sought nor received payment for emergency room behavioral health services on
the same day as the date of the initial intake evaluation.
(b) Excluded services: The following shall be excluded under the GABHP:
(1) Any behavioral health services delivered
to an eligible recipient with a primary diagnosis which is outside the range of
DSM-IV diagnostic codes of 291.1 to 292.9, inclusive; 295 to 307.88, inclusive
or 307.90 to 315.9, inclusive;
(2)
Behavioral health services that DMHAS determines to be experimental in
nature;
(3) Behavioral health
services that the designated agent determines are not medically
necessary;
(4) Behavioral health
services which the designated agent determines to be similar or identical that
are delivered to the same eligible recipient;
(5) Behavioral health services, consultation
or information delivered over the telephone;
(6) Activities that DMHAS determines are
primarily for vocational or educational guidance that relate solely to a
specific employment opportunity, job skill, work setting or development of an
academic skill;
(7) Therapies,
treatments or procedures that relate to transsexual or gender-change medical or
surgical procedures; and
(8)
Activities, treatment or items delivered to an eligible recipient for which the
contracted provider does not usually charge others.
(c) DMHAS shall not pay a contracted provider of inpatient or residential services for the following:
(1) The day of discharge or transfer, unless
the eligible recipient is discharged or transferred on the same day as he or
she is admitted;
(2) A leave of
absence or pass from an inpatient or residential facility that occurs without
staff permission or against staff advice;
(3) A leave of absence or pass from an
inpatient or residential facility with staff permission, if the absence is
longer than 24 hours, unless authorized in advance by the designated agent;
and
(4) Emergency room behavioral
health services delivered on the same day as an acute psychiatric hospital
admission or a medically managed inpatient detoxification admission to the same
facility.
(d) DMHAS shall not pay a contracted provider for the following:
(1) Electroconvulsive therapy, unless
delivered by a licensed psychiatrist and pre-authorized by the designated
agent;
(2) Hypnosis, unless
delivered by a licensed psychiatrist or psychologist and pre-authorized by the
designated agent;
(3) Psychological
or intelligence testing, unless delivered by a licensed psychologist and
pre-authorized by the designated agent;
(4) Neuropsychological testing, unless
delivered by a licensed psychologist and preauthorized by the designated
agent;
(5) Behavioral health
services delivered by a staff member who is not a licensed behavioral health
professional or who is not a Connecticut certified alcohol and drug counselor,
unless the following conditions are met:
(A)
The individual is employed by or under contract with a licensed facility whose
medical director or clinical supervisor has determined that the staff member is
qualified to deliver behavioral health services to eligible
recipients;
(B) For acute
psychiatric hospitalization, intensive outpatient-mental health, observation
bed-mental health, outpatient-mental health and partial hospitalization-mental
health only, the individual is actively pursuing behavioral health licensure
and is under the direct supervision of licensed behavioral health professional
with at least two (2) years of experience in the delivery of behavioral health
treatment services; and
(C) The
supervising clinician has signed the eligible recipient's recovery
plan;
(6) Behavioral
health services delivered by staff of a licensed facility at a location other
than that which is specified on the facility's license;
(7) Any laboratory service delivered by a
laboratory that is not in compliance with the federal Clinical Laboratory
Improvement Amendments of 1988 (CLIA), 42 CFR 493; and
(8) Individual laboratory tests, where it is
determined by DMHAS that a panel or profile test should be conducted
instead.
Disclaimer: These regulations may not be the most recent version. Connecticut may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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