Medicaid Benefits: Online Database

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Acute Care Services

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Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Connecticut (October 2008) 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

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

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


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 1, 2, 4 & 8 - See service-specific FN	Dependent upon the services provided	CN & MN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
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.