§ 17b-245b — Federally qualified health centers. Reimbursement methodology in the Medicaid program.

Connecticut § 17b-245b

• Jurisdiction: Connecticut
• Title 17b: Social Services
• Ch. 319v: Medical Assistance

Text

(a) The Commissioner of Social Services shall, consistent with federal law, reimburse federally qualified health centers on an all-inclusive encounter rate per client encounter based on the prospective payment system required by 42 USC 1396a(bb). Any patient encounter with more than one health professional for the same type of service and multiple interactions with the same health professional that occur on the same day shall constitute a single encounter for purposes of reimbursement, except when the patient, after the first encounter, suffers illness or injury requiring additional diagnosis and treatment. A federally qualified health center shall be reimbursed in accordance with the requirements prescribed in section 17b-262-1002 of the regulations of Connecticut state agencies. (b) A federally qualified health center may not provide nonemergency periodic dental services on different dates of service for the purpose of billing for separate encounters. Any nonemergency periodic dental service, including, but not limited to, (1) an examination, (2) prophylaxis, and (3) radiographs, including bitewings, complete series and periapical imaging, if warranted, shall be completed in one visit. A second visit to complete any service normally included during the course of a nonemergency periodic dental visit shall not be eligible for reimbursement unless (A) medically necessary, and (B) such medical necessity is clearly documented in the patient's dental record.

Legislative History

(June 30 Sp. Sess. P.A. 03-3, S. 85; P.A. 07-101, S. 1; P.A. 22-118, S. 239.) History: June 30 Sp. Sess. P.A. 03-3 effective August 20, 2003; P.A. 07-101 allowed commissioner, to extent permitted by federal law, to reimburse a federally qualified health center for multiple medical, behavioral health or dental services provided under Medicaid program to an individual during the course of a calendar day and changed date re commissioner's report on cost-based reimbursement methodology from March 1, 2004, to January 1, 2008, effective July 1, 2007; P.A. 22-118 designated existing provisions as Subsec. (a) and therein, deleted cost-based reimbursement and authorization for reimbursement of multiple health visits in a calendar day, added reimbursement based on all-inclusive encounter rate, required multiple visits on a calendar day for same type of service or with same provider be treated as single visit for reimbursement except when patient suffers subsequent injury or illness requiring diagnosis or treatment, required reimbursement in accordance with regulations, deleted required reporting by Jan. 1, 2008, and added Subsec. (b) re nonemergency periodic dental visits, effective July 1, 2022.