Sec.17a-301-5. Community services

(a) Community services shall be included as part of the individualized plan of care developed by the CAM agency. The plan must specify the frequency and provider of such services. Services contained in the plan must be based upon documented needs found in the assessment or reassessment of the individual's needs and shall be provided only when needed in order to avoid inappropriate institutionalization.

(b) The Program shall not:

(1) Reimburse for personnel or services delivered by a person or agency required by the State of Connecticut to be licensed, certified or otherwise approved unless that person or agency can show satisfactory evidence of such licensing, certification or approval. In the event that a CAM agency purchases services from a provider not required to be licensed and which

is not otherwise subject to quality assurance regulation, the CAM agency shall take such reasonable measures as are necessary prior to purchase to ensure the quality of services delivered; or

(2) Pay any claim to a provider of community services which cannot produce adequate records to document such claim for payment; or

(3) Pay for any cancelled services; or

(4) Pay for a service when the client does not receive the service, notwithstanding any prior notice of cancellation requirement of the provider; or

(5) Reimburse for services not included in the individualized plan of care.

(c) Provider payments shall be made at the lowest of:

(1) The Provider's usual and customary charge to the public;

(2) The fee or rate established by any State agency having the authority to establish such fee or rate;

(3) The amount billed by the provider; or

(4) The fee or rate negotiated by the CAM agency.

(d) The commissioner may make money payments directly to persons entitled to receive payments for services under the department's jurisdiction if these persons had been receiving such payments prior to transfer from the department of human resources. The payments shall be made from available department on aging funds and at intervals determined by the commissioner.

(1) If the department makes direct money payments, there shall be no payment for any service not expressly authorized by the commissioner or her designee. There shall be no payment for any service incurred by, or paid by, the recipient prior to the date of payment authorization.

(2) If the department makes direct money payments, the payment shall be for the gross amount of the service payment as authorized by the commissioner, with no deductions for social security (FICA), federal unemployment tax (FUTA) or state unemployment compensation tax (UC) payments.

(Effective June 2, 1992)