Sec. 17b-242. (Formerly Sec. 17-313). Payments to home health care agencies and homemaker-home health aide agencies. Appeals. Hearings. Regulations.
Sec. 17b-242. (Formerly Sec. 17-313). Payments to home health care agencies
and homemaker-home health aide agencies. Appeals. Hearings. Regulations. (a)
The Department of Social Services shall determine the rates to be paid to home health
care agencies and homemaker-home health aide agencies by the state or any town in
the state for persons aided or cared for by the state or any such town. For the period
from February 1, 1991, to January 31, 1992, inclusive, payment for each service to the
state shall be based upon the rate for such service as determined by the Office of Health
Care Access, except that for those providers whose Medicaid rates for the year ending
January 31, 1991, exceed the median rate, no increase shall be allowed. For those providers whose rates for the year ending January 31, 1991, are below the median rate, increases
shall not exceed the lower of the prior rate increased by the most recent annual increase
in the consumer price index for urban consumers or the median rate. In no case shall
any such rate exceed the eightieth percentile of rates in effect January 31, 1991, nor
shall any rate exceed the charge to the general public for similar services. Rates effective
February 1, 1992, shall be based upon rates as determined by the Office of Health Care
Access, except that increases shall not exceed the prior year's rate increased by the
most recent annual increase in the consumer price index for urban consumers and rates
effective February 1, 1992, shall remain in effect through June 30, 1993. Rates effective
July 1, 1993, shall be based upon rates as determined by the Office of Health Care
Access except if the Medicaid rates for any service for the period ending June 30, 1993,
exceed the median rate for such service, the increase effective July 1, 1993, shall not
exceed one per cent. If the Medicaid rate for any service for the period ending June 30,
1993, is below the median rate, the increase effective July 1, 1993, shall not exceed the
lower of the prior rate increased by one and one-half times the most recent annual increase in the consumer price index for urban consumers or the median rate plus one per
cent. The Commissioner of Social Services shall establish a fee schedule for home health
services to be effective on and after July 1, 1994. The commissioner may annually
increase any fee in the fee schedule based on an increase in the cost of services. The
commissioner shall increase the fee schedule for home health services provided under
the Connecticut home-care program for the elderly established under section 17b-342,
effective July 1, 2000, by two per cent over the fee schedule for home health services
for the previous year. The commissioner may increase any fee payable to a home health
care agency or homemaker-home health aide agency upon the application of such an
agency evidencing extraordinary costs related to (1) serving persons with AIDS; (2)
high-risk maternal and child health care; (3) escort services; or (4) extended hour services. In no case shall any rate or fee exceed the charge to the general public for similar
services. A home health care agency or homemaker-home health aide agency which,
due to any material change in circumstances, is aggrieved by a rate determined pursuant
to this subsection may, within ten days of receipt of written notice of such rate from the
Commissioner of Social Services, request in writing a hearing on all items of aggrievement. The commissioner shall, upon the receipt of all documentation necessary
to evaluate the request, determine whether there has been such a change in circumstances
and shall conduct a hearing if appropriate. The Commissioner of Social Services shall
adopt regulations, in accordance with chapter 54, to implement the provisions of this
subsection. The commissioner may implement policies and procedures to carry out the
provisions of this subsection while in the process of adopting regulations, provided
notice of intent to adopt the regulations is published in the Connecticut Law Journal
within twenty days of implementing the policies and procedures. Such policies and
procedures shall be valid for not longer than nine months.
(b) The Department of Social Services shall monitor the rates charged by home
health care agencies and homemaker-home health aide agencies. Such agencies shall
file annual cost reports and service charge information with the department.
(c) The home health services fee schedule shall include a fee for the administration
of medication, which shall apply when the purpose of a nurse's visit is limited to the
administration of medication. Administration of medication may include, but is not
limited to, blood pressure checks, glucometer readings, pulse rate checks and similar
indicators of health status. The fee for medication administration shall include administration of medications while the nurse is present, the pre-pouring of additional doses
that the client will self-administer at a later time and the teaching of self-administration.
The department shall not pay for medication administration in addition to any other
nursing service at the same visit. The department may establish prior authorization
requirements for this service. Before implementing such change, the Commissioner of
Social Services shall consult with the chairpersons of the joint standing committees of
the General Assembly having cognizance of matters relating to public health and human
services.
(d) The home health services fee schedule established pursuant to subsection (c) of
this section shall include rates for psychiatric nurse visits.
(e) The Department of Social Services, when processing or auditing claims for reimbursement submitted by home health care agencies and homemaker-home health aide
agencies shall, in accordance with the provisions of chapter 15, accept electronic records
and records bearing the electronic signature of a licensed physician or licensed practitioner of a healthcare profession that has been submitted to the home health care agency
or homemaker home-health aide agency.
(f) If the electronic record or signature that has been transmitted to a home health
care agency or homemaker-home health aide agency is illegible or the department is
unable to determine the validity of such electronic record or signature, the department
shall review additional evidence of the accuracy or validity of the record or signature,
including, but not limited to, (1) the original of the record or signature, or (2) a written
statement, made under penalty of false statement, from (A) the licensed physician or
licensed practitioner of a health care profession who signed such record, or (B) if such
licensed physician or licensed practitioner of a health care profession is unavailable,
the medical director of the agency verifying the accuracy or validity of such record or
signature, and the department shall make a determination whether the electronic record
or signature is valid.
(g) The Department of Social Services, when auditing claims submitted by home
health care agencies and homemaker-home health aide agencies, shall consider any
signature from a licensed physician or licensed practitioner of a health care profession
that may be required on a plan of care for home health services, to have been provided
in timely fashion if (1) the document bearing such signature was signed prior to the time
when such agency seeks reimbursement from the department for services provided, and
(2) verbal or telephone orders from the licensed physician or licensed practitioner of a
health care profession were received prior to the commencement of services covered
by the plan of care and such orders were subsequently documented. Nothing in this
subsection shall be construed as limiting the powers of the Commissioner of Public
Health to enforce the provisions of sections 19-13-D73 and 19-13-D74 of the regulations
of Connecticut state agencies and 42 CFR 484.18(c).
(h) For purposes of this section, "licensed practitioner of a healthcare profession"
has the same meaning as "licensed practitioner" in section 21a-244a.
(1957, P.A. 539; P.A. 73-117, S. 24, 31; P.A. 78-264, S. 2, 4; P.A. 91-406, S. 5, 29; June Sp. Sess. P.A. 91-8, S. 20,
63; May Sp. Sess. P.A. 92-16, S. 26, 89; P.A. 93-262, S. 1, 20, 87; 93-418, S. 24, 41; 93-435, S. 59, 95; May Sp. Sess.
P.A. 94-5, S. 22, 30; P.A. 95-257, S. 39, 58; 95-351, S. 14, 30; P.A. 96-268, S. 5, 34; P.A. 99-130; June Sp. Sess. P.A. 00-2, S. 16, 53; P.A. 02-101, S. 13; P.A. 03-2, S. 8; June 30 Sp. Sess. P.A. 03-6, S. 197; P.A. 05-118, S. 1; 05-272, S. 44.)
History: P.A. 73-117 replaced hospital cost commission with committee established under Sec. 17-311; P.A. 78-264
replaced public health nursing agencies with home health care and homemaker-home health aide agencies and replaced
previous rate provisions with statement that rate to be determined by commission on hospitals and health care; P.A. 91-406 corrected an internal reference; June Sp. Sess. P.A. 91-8 amended the section by replacing "state" with the specific
departments, by specifying the rates paid by the state to home health care agencies and homemaker-home health aide
agencies and by adding provisions re the appeal of a rate determination; May Sp. Sess. P.A. 92-16 provided that rates in
effect on February 1, 1992, shall remain in effect through June 30, 1993; P.A. 93-262 removed the references to departments
of income maintenance, human resources and aging and provided that the department of social services shall determine
rates to be charged home health care agencies and homemaker-home health aide agencies, made technical changes and
added provisions requiring commissioner to adopt regulations, effective July 1, 1993; P.A. 93-418 added provisions regarding rates effective July 1, 1993, which are determined by the commission on hospitals and health care and authorizing
income maintenance commissioner to establish fee schedule on and after July 1, 1994, effective July 1, 1993; P.A. 93-435
authorized the Revisors to substitute social services commissioner for income maintenance commissioner in P.A. 93-418,
effective June 28, 1993; May Sp. Sess. P.A. 94-5 allowed the fee schedule to be phased in over a two-year period and
allowed the commissioner to increase any fee payable to a home health care agency or homemaker-home health aide
agency if there are extraordinary costs, effective July 1, 1994; Sec. 17-313 transferred to Sec. 17b-242 in 1995; P.A. 95-257 replaced Commission on Hospitals and Health Care with Office of Health Care Access, effective July 1, 1995; P.A.
95-351 added Subdiv. (4) allowing the commissioner to increase any fee payable for extraordinary costs relating to extended
hour services, effective July 1, 1995 (Revisor's note: In the first sentence the phrase "rates to be charged by home health
care agencies and the rates to be paid" was changed editorially by the Revisors to read "rates to be charged by home health
care agencies and homemaker-home health aide agencies and the rates to be paid" to correct a clerical error in the preparation
of the 1995 General Statutes); P.A. 96-268 added reference to homemaker-home health aide agencies, effective July 1,
1996; P.A. 99-130 designated existing language as Subsec. (a), eliminating the responsibility of the department to determine
rates to be charged by home health care agencies and homemaker-home health aide agencies and added Subsec. (b) requiring
the department to monitor the rates charged by such agencies, requiring such agencies to file annual cost reports and service
charge information with the department, and made technical changes; June Sp. Sess. P.A. 00-2 amended Subsec. (a) by
deleting provision re phasing in the fee schedule over a two-year period and inserting provision requiring the commissioner
to increase by 2% the fee schedule for home health care services provided under the Connecticut home-care program for
the elderly, effective July 1, 2000; P.A. 02-101 amended Subsec. (a) to make a technical change, effective July 1, 2002;
P.A. 03-2 added Subsec. (c) re establishment of home health services fee schedule applicable when purpose of nurse's
visit is limited to administration of medication, effective February 28, 2003; June 30 Sp. Sess. P.A. 03-6 added Subsec.
(d) re rates for psychiatric nurse visits, effective August 20, 2003; P.A. 05-118 added Subsec. (e) allowing for submission
of electronic records and records bearing electronic signatures by agencies to department with respect to the processing
and auditing of claims for reimbursement and Subsec. (f) re the timely signature of a health care professional on a plan of
care for home health services submitted to department; P.A. 05-272 amended Subsec. (e) by requiring department to accept
electronic records and signatures of licensed physicians or licensed health care practitioners that have been submitted to
an agency, rather than signatures of "an individual duly authorized by any such agency to submit records to the department",
added new Subsec. (f) re process for reviewing and validating illegible electronic records or signatures transmitted to home
health care agencies or homemaker-home health aide agencies, redesignated existing Subsec. (f) as Subsec. (g), designating
provisions therein re document bearing signature as Subdiv. (1) and replacing "provided to such agency" with "signed",
added Subsec. (g)(2) re timeliness of signatures from licensed physicians or licensed practitioners of a health care profession
in cases involving verbal or telephone orders and re Department of Public Health's powers to enforce specified state and
federal regulations concerning patients' care plans and medication administration are not limited by Subsec. (g), and added
Subsec. (h) defining "licensed practitioner of a healthcare profession".