Kaiser Family Foundation
Benefits by State: Connecticut (October 2006) Notes
 
 
 


Acute Care Services

Is the Benefit Covered? Copayment Requirement Prior Approval Requirement Coverage Limitations Reimbursement Methodology Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
  Yes         Prospective cost based rate per episode of care using Medicare payment rates as ceiling   CN & MN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
  Yes     Specified services   1 psych evaluation/year, 1 psych therapy/day with maximum of 13 services in 90 days or 26 services in 6 months, medication reviews not separately reimbursable   Fee for service   CN & MN
Federally Qualified Health Center Services
  Yes         Prospective cost based rate/visit with ancillaries paid fee for service   CN & MN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
  Yes     Non-emergency admissions except maternity, emergency readmissions within 2 days of discharge     Cost based payment   CN & MN
Outpatient Hospital Services
  Yes       1 visit/day   Fee for service or percentage of charge   CN & MN
Rehabilitation Services: Mental Health and Substance Abuse
  Yes       10 days/occurrence in approved Alcohol Abuse Treatment Center for acute and evaluation phase of treatment   Prospective per diem or global rate   CN & MN
Rural Health Clinic Services
  No          
Practitioner Services
Certified Registered Nurse Anesthetist Services
  No          
Chiropractor Services
  No          
Dental Services
  Yes     Specified services   Periodontal and fixed bridges not covered, frequency of x-rays limited by type   Fee for service   CN & MN
Medical and Remedial Care - Other Practitioners
  See service-specific FN          
Medical/Surgical Services of a Dentist
  Yes         Fee for service   CN & MN
Nurse Midwife Services
  Yes         Fee for service   CN & MN
Nurse Practitioner Services
  Yes         Fee for service at 90% of physician fee   CN & MN
Optometrist Services
  Yes     Visual training   1 refractive exam/year   Fee for service with some services paid 90% of physician fee   CN & MN
Physician Services
  Yes     Specified surgical procedures   1 psych evaluation/year, 1 psych therapy/day   Fee for service   CN & MN
Podiatrist Services
  No          
Psychologist Services
  No          
Prescription Drugs
Prescription Drugs
  Yes     Vitamins, nutritional supplements, other specified drugs including amphetamines   30 day supply for acute conditions, 30 day supply or 240 dosage units for chronic conditions,   AWP-14% for brand Rx, AWP-40% for generic Rx, plus $3.15 dispensing fee   CN & MN
Physical Therapy and Other Services
Occupational Therapy Services
  No          
Physical Therapy Services
  No          
Services for Speech, Hearing and Language Disorders
  No          
Products and Devices
Dentures
  Yes       1 full upper and/or lower denture or 1 partial denture/5 years, 1 reline/2 years   Fee for service   CN & MN
Eyeglasses
  Yes     Specified services   Special lenses covered when specified criteria met   Fee for service   CN & MN
Hearing Aids
  Yes     New or replacement hearing aid   Binaural hearing aids not covered   Acquisition cost up to $160   CN & MN
Medical Equipment and Supplies
  Yes     Specified med equipment and med supply items     Fee for service   CN & MN
Prosthetic and Orthotic Devices
  Yes     Yes   Orthotic and corrective arch supports once/2 years   Fee for service   CN & MN
Transportation Services
Ambulance Services
  Yes         Fee for service   CN & MN
Non-Emergency Medical Transportation Services
  Yes     Yes     See service-specific FN   CN & MN
Other Services
Diagnostic, Screening and Preventive Services
  Yes         Fee for service   CN & MN
Early and Periodic Screening, Diagnosis and Treatment
  See service-specific FN.          
Extended Services for Pregnant Women
  See service-specific FN          
Family Planning Services
  See service-specific FN.          
Laboratory and X-Ray Services, outside Hospital or Clinic
  Yes         Fee for service   CN & MN
Targeted Case Management
  Yes         Negotiated rate   CN & MN


Long-Term Care Services

Is the Benefit Covered? Copayment Requirement Prior Approval Requirement Coverage Limitations Reimbursement Methodology Populations Covered

Community Based Care
Home and Community Based Services Waiver
  Yes       Services for the following populations: 2, 4 & 8 - See service-specific FN   Dependent upon the services provided   CN & MN
Home Health Services
  Yes     Therapies after first visit, continued nursing care after second visit   2 skilled nurse visits/week, 20 hours home health aide services/week   Fee for service, enhanced payment for complex care   CN & MN
Hospice Care
  No          
Personal Care Services
  No          
Private Duty Nursing Services
  No          
Program of All-Inclusive Care for the Elderly
  No          
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
  Yes       15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid   Prospective cost based per diem or cost based payment   CN & MN
Inpatient Psychiatric Services, under age 21
  Yes         Cost based payment   CN & MN
Intermediate Care Facility Services for the Mentally Retarded
  Yes       15 hosp leave days/hospitalization, 36 therapeutic leave days/year   Prospective cost based per diem with limits   CN & MN
Nursing Facility Services, other than in an Institution for Mental Diseases
  Yes       15 hosp leave days/hospitalization, 21 therapeutic leave days/year, facility must have fewer than 3 vacancies to be paid   Prospective per diem based on cost, with limits   CN & MN
Religious Non-Medical Health Care Institution and Practitioner Services
  No          



Notes: This State has added the optional Medicaid buy-in group of disabled adults permissible through the Ticket to Work and Work Incentives Improvement Act (TWWIIA) in a program called Medicaid for the Employed Disabled. These beneficiaries are allowed to continue Medicaid coverage, and receive full benefits, if their income is at or below 250 percent of the federal poverty level (FPL). Beneficiaries in this group with income above 200 percent of the FPL pay a monthly premium.