Conn. Agencies Regs. § 17b-349e-9 - Service, payment and cost limitations; fees

(a) The department shall determine provider reimbursement and payment levels for the respite care services to be provided under the program. Reimbursement levels for services provided under the program shall not exceed the levels established under the Connecticut Home Care Program for Elders for similar services.

(b) An eligible individual may not receive more than three thousand five hundred dollars ($3,500) for respite care services or receive more than thirty days of out-of-home respite care services, other than adult day care, under the program in any fiscal year. An eligible individual may receive additional respite services not to exceed seven thousand five hundred dollars ($7,500) if the eligible individual has demonstrated to the sponsor agency a need for additional respite care services. A sponsor agency may consider various factors to determine if an eligible individual needs additional respite care services including, but not limited to, whether:

(1) The primary caregiver is experiencing a physical or mental impairment;

(2) the caregiver is not receiving any other respite services;

(3) the client is physically or emotionally abusive to the primary caregiver;

(4) the client is at risk for neglect or abuse; or

(5) the burden of care is significant.

(c) Service levels are subject to the limits of the funding allocations to an eligible individual's sponsor agency. In the event that it appears that all requests for services cannot be accommodated within funding allocations, then approval for services under the program may be limited. Priority for the receipt of services shall be determined by the sponsor agency on a case by case basis, giving primary consideration to the following factors:

(1) The eligible individual is not currently receiving any other respite care;

(2) the caregiver is experiencing physical or mental impairments and has primary responsibility for caring for the eligible individual;

(3) the eligible individual has been combative, non-compliant or physically or mentally abusive to the caregiver;

(4) respite care services are being requested for a specific event or commitment rather than for ongoing, periodic services; or

(5) the eligible individual lives alone.

(d) If an eligible individual's respite care service costs are covered in whole or in part by another state or federal government program or insurance contract, the government program or insurance carrier shall be the primary payer and the Connecticut Statewide Respite Care Program shall be the secondary payer.

(e) An eligible individual shall pay a copayment of twenty per cent of the cost of all respite care services to the sponsor agency as required, unless granted a reduction or a waiver of the copayment in accordance with subsection (f) of this section. The copayment shall be applied to the cost of program services.

(f) The sponsor agency may grant a reduction or waiver of the copayment to an eligible individual based upon demonstration of financial hardship by the applicant as determined by the sponsor agency.

Notes

Conn. Agencies Regs. § 17b-349e-9

Adopted effective March 11, 1999; Amended July 10, 2000; Amended July 2, 2012