Medicaid Chemical Maintenance Clinics

Overview

 

Medicaid covers a variety of medications for use in the treatment of substance use disorders. This page features cost report and reimbursement information for chemical maintenance treatment clinics (methadone).

Connecticut State Plan Amendment (SPA) No. 18-016 was approved on June 21, 2018 with an effective date of February 1, 2018. This SPA amends Attachment 4.19-B of the Medicaid State Plan in order to make various changes to the reimbursement of chemical maintenance clinics including: pro-rating the weekly rate to account for weeks in which services are provided on fewer than seven days in the week, specifying in detail the services that are included in the rate, and providing for specific types of documentation regarding the services that are provided. The SPA also removes references to specific provider locations, establishes provisions for merged clinics and newly licensed clinics, and authorizes payment for take-home doses in compliance with federal guidelines

Medicaid Provider Bulletin regarding billing and payment can be found at the HUSKY Health website.

State of Connecticut regulations regarding payment of Behavioral Health Clinic Services can be found at Connecticut eRegulation.

Cost reports will be submitted to the Department annually and no later than 180-days after the end of the provider's fiscal year. If a provider fails to submit a complete and accurate cost report on or before the deadline, the Department will notify the provider and the provider has thirty days from the date the notice to submit a complete and accurate cost report. The commissioner may reduce the applicable rate for chemical maintenance services for a provider that fails to submit a complete and accurate cost report by an amount not to exceed ten percent (10%) of such rate.

Cost Report

Cost Report Guidelines

Please submit cost report questions to: con-ratesetting.dss@ct.gov