Reimbursement and Certificate of Need

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Reimbursement and Certificate of Need (CON) is Responsible for:

Certificate of Need (CON)
CON is a formal statement by the Department approving, denying, or modifying a health care facility request to undertake an expansion or reduction in services. The CON process is an attempt to prevent an oversupply and excess of expenditures.

Community Living Arrangements (CLA)
The majority of CLA residences are enrolled under a Medicaid Home and Community Based Waiver administered by DSS. Reimbursement and CON is responsible for seeking federal reimbursement for Medicaid services provided to eligible residences. 

Continuing Care Facility (CCF)
Conducting investigations to determine whether a CCF has complied with statutorily provisions governing the management of the continuing care retirement community. Reviewing required CCF filing of disclosure statements and annual financial documents.

Federally Qualified Health Center (FQHC)
Establishing reimbursement methodologies for Federally Qualified Health Centers (FQHC).

Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID)
Establishing reimbursement methodologies for ICF/IIDs, and development of Medicaid State Plan Amendments that are necessary to obtain Federal matching funds.

Medicaid Birth to Three
Reimbursement and Certificate of Need (CON) is Responsible for the administration and adherence to all Medicaid requirements associated with the Birth to Three program.

Medicaid Home Health Agency (HHA) Reimbursement
Determining increases to the standard fee schedule for Home Health Agencies (HHA) that can demonstrate and substantiate 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.

Medicaid Hospital Reimbursement
Establishing Medicaid reimbursement methodologies for inpatient services, outpatient hospital services, Disproportionate Share Hospital (DSH) payments and hospital supplemental payments. Reimbursement and CON is also responsible for Medicaid State Plan Amendments that are necessary to obtain Federal matching funds.

Medicaid Nursing Home Reimbursement
Establishing Medicaid reimbursement methodologies for Medicaid nursing homes, and development of Medicaid State Plan Amendments that are necessary to obtain Federal matching funds.

Medicaid School Based Child Health (SBCH) Program
Reimbursement and CON is responsible for administering the SBCH program which allows school districts to seek federal reimbursement for Medicaid services provided to eligible students.

Opioid Treatment Providers (Methadone Treatment)
Reimbursement and CON is responsible for establishing reimbursement methodologies for Opioid Treatment Providers.

Residential Care Homes (RCH)
Reimbursement and CON is responsible for establishing reimbursement methodologies for Residential Care Homes (RCH). 

Medicaid Hospital Reimbursement
Reimbursement and Certificate of Need (CON) establishes Medicaid reimbursement methodologies and rates for inpatient services, outpatient hospital services, Disproportionate Share Hospital (DSH) payments and hospital supplemental payments.

Nursing Home Rate Setting Overview
Under the Connecticut Medicaid program, payment rates for nursing homes are set on a cost-based prospective basis in accordance with Section 17b-340 of the Connecticut General Statutes and Section 17-311-52 of the Regulations of Connecticut State Agencies. The federal government provides states discretion in determining the method used to pay for nursing facility services. The state's reimbursement methodology, however, must be approved by the Centers for Medicare and Medicaid Services (CMS) within the federal Department of Health and Human Services. The annual rate period for nursing homes is July 1 through June 30, unless modified by the legislature. The cost reporting period, however, is October 1 through September 30. Every Medicaid nursing home must complete an "Annual Report of Long-Term Care Facility" which is annually due before February 15th.

Residential Care Home (RCH) Rate Schedule
The annual rate period is July 1 through June 30, unless modified by the legislature. There are 101 RCH facilities with a total capacity of approximately 2,750 licensed beds that provide services to approximately 2,100 AABD eligible residents. The average rate is approximately $93.00 per day and rates range from a minimum of $35.54 to $140.91 per day. In SFY 2014, AABD program expenditures for RCH services were approximately $40 million. If a facility does not file a cost report, it receives the minimum rate per Sec. 17-311-54 state regulations.