Sec. 17b-262-341. Services covered and limitations

The department shall pay providers:

(1) only for those procedures listed in the department's fee schedule for providers that are medically necessary and medically appropriate to treat the client's condition;

(2) for provider services provided in an office, a general hospital, the client's home, a chronic disease hospital, nursing facility, icf/mr or other medical care facility;

(3) for laboratory services provided by a provider in compliance with the provisions of the Clinical Laboratory Improvement Amendments (CLIA) of 1988;

(4) for medical and surgical supplies used by a provider in the course of treatment of a client;

(5) for drugs and devices administered by a provider;

(6) for a second opinion for surgery when requested voluntarily by the client or when required by the department. The department shall pay for a second opinion according to the established fees for consultation;

(7) for family planning, abortion and hysterectomy services as described in section 17b-262-348(s) of the Regulations of Connecticut State Agencies;

(8) for Early and Periodic Screening, Diagnostic and Treatment services, including treatment services which are indicated following screening not otherwise covered, provided that prior authorization is obtained;

(9) for surgical services necessary to treat morbid obesity when another medical illness is caused by, or is aggravated by, the obesity. Such illnesses shall include illnesses of the endocrine system or the cardio-pulmonary system, or physical trauma associated with the orthopedic system. For the purposes of this section, "morbid obesity" means "morbid obesity" as defined by the International Classification of Diseases (ICD), as amended from time to time;

(10) for family planning services for clients of childbearing age, including minors who can be considered sexually active, and who desire the services;

(11) for sterilization for clients who are at least 21 years of age at the time of informed consent; and

(12) for a hysterectomy performed during a period of retroactive eligibility as described in 42 CFR 441.255(e).

(Adopted effective January 31, 2008)