Regulations of Connecticut State Agencies
(a) Fees shall be the same for in state, border and out-of-state providers.
(b) Payment shall be made at the lowest of:
(1) the provider's usual and customary charge;
(2) the lowest Medicare rate;
(3) the amount in the applicable fee schedule as published by the department pursuant to section 4-67c of the Connecticut General Statutes; or
(4) the amount billed by the provider.
(c) Notwithstanding the provisions of the regulations of connecticut state agencies or any provisions of the department's Medical Services Policy, the department shall not pay any provider under sections 17b-262-337 through 17b-262-349, inclusive, of the Regulations of Connecticut State Agencies for a client seen at a freestanding clinic enrolled in Medicaid. Only the clinic may bill for such services. As an exception to the foregoing, a provider may bill for covered services for a client seen at an outpatient dialysis clinic or at an outpatient surgical facility. A provider who is enrolled with medicaid at a location separate from the clinic may bill the department for clients seen at the separate practice location.
(d) The department shall not pay interns or residents for their services nor shall the department pay for assistant surgeons in general or chronic disease hospitals staffed by interns and residents, unless the procedure is significantly complicated, open heart surgery for example, so as to justify a full surgeon acting as an assistant. If the surgery is performed by a resident or intern and the supervising surgeon assists, only the assistant's fee shall be paid to the surgeon. The regular surgical fee shall not be paid.
(e) If a resident or intern performs the surgery and the supervising surgeon is not present while the procedure is performed, no fee shall be paid to the surgeon even when the surgeon is on call.
(Adopted effective January 31, 2008)