State Rates & DSS Information

Notice of Proposed Medicaid Waiver
Renewal of Selective Provider Contracting Waiver
Pursuant to Section 1915(b)(4) of the Social Security Act for
Early Intervention Services (EIS) Pursuant to Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Qualified Program Waiver

Click the link below to open a public notice about the EPSDT EIS 1915 (b)(4) waiver renewal application
CT 1915(b)(4) Waiver – EIS Pursuant to EPSDT – Waiver Renewal – Website Notice – 05-20-19
Posted May 20, 2019

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Below are the state rates for Birth to Three Early Intervention (EI) services as of 10/1/17

Evaluation:  $180 per unit where one unit equals one person completing an evaluation regardless of the time required – max 2 units per day and 4 units per calendar year without prior authorization (PA) from the OEC.

Assessment: $120 per hour billable in 15 minute units – max 8 units per calendar year without PA

IFSP meetings: $120 per hour billable in 15 minute units  – max 40 units per calendar year without PA

NOTE: All PA requests must be emailed to CTBirth23@ct.gov.

EI Treatment Service (EITS)  – max 32 units per day no PA permitted

Professional Rates: $120 per hour if only six 15 minute units are billed per practitioner per day.  If more than six units are billed per practitioner per day all the units in the day a paid using $96 per hour.

Para professional Rates: $84 per hour if only six 15 minute units are billed per practitioner per day.  If more than six units are provided per practitioner per day all the units in the day a paid using $48 per hour.

General Administrative Payment: $100 per child for the program with an IFSP on the 1st of the billing month that plans for less than 9 hours of service per month and as long as at least one service was provided during the billing month.  GAPs for children that transfer programs are paid to the program with the IFSP on the 1st of the month as long as a service was provided by the sending program before the transfer.  Receiving programs will be paid the GAP in the following month, as long as all the requirements for a GAP are in place.

For more details please review the Payment Procedure and the rates posted at ct.gov/dss/birthtothree.

NOTE: Beginning with Dates of Service July 1, 2017 the Birth to Three System contracted with Public Consulting Group to submit claims for Early Intervention Services to commercial insurance.  Birth to Three System does not require the use of the codes or modifiers listed on the DSS Medicaid fee schedule for commercial claims. In addition, the Birth to Three System does not require the use of specific CPT, HCPCS codes or modifiers for commercial claims.  The Birth to Three System recognizes the contractor’s use industry standard modifier to identify the Birth to Three claims. Currently the TL “Early Intervention/individualized family service plan (IFSP)” is placed on all early intervention claims by PCG and submitted in an 837 EDI transaction. Birth to Three also requests that the Contractor use the Level I (CPT) and Level II (HCPCS) code sets which best reflect the services provided by the Early Intervention professional.

 

 

Here is the link to the DSS webpage established for Birth to Three.

ct.gov/dss/birthtothree

The the State Plan Amendment was approved effective 10/1/17.

NOTE: Beginning with Dates of Service July 1, 2017 the Birth to Three System contracted with Public Consulting Group to submit claims for Early Intervention Services to commercial insurance.  Birth to Three System does not require the use of the codes or modifiers listed on the DSS Medicaid fee schedule for commercial claims. In addition, the Birth to Three System does not require the use of specific CPT, HCPCS codes or modifiers for commercial claims.  The Birth to Three System recognizes the contractor’s use industry standard modifier to identify the Birth to Three claims. Currently the TL “Early Intervention/individualized family service plan (IFSP)” is placed on all early intervention claims by PCG and submitted in an 837 EDI transaction. Birth to Three also requests that the Contractor use the Level I (CPT) and Level II (HCPCS) code sets which best reflect the services provided by the Early Intervention professional.

The “Special Services – Birth to Three Yrs” Fee Schedule is already online at the following website:

www.ctdssmap.com.

From this web page, go to “Provider”, then to “Provider Fee Schedule Download”.

Click on the “I Accept” button and scroll down to the fee schedule you are interested in viewing:

“Special Services – Birth to Three Yrs”

 

DSS Audit Protocol – with Birth to Three Procedure References

(procedure reference is listed in red in the left box on document)

 

Last updated 06/21/2018

 

 

 

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