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CHAPTER 319jj
MEDICARE ASSIGNMENT
Table of Contents
Sec. 17b-550. (Formerly Sec. 17a-390). Definitions.
Sec. 17b-551. (Formerly Sec. 17a-391). Eligibility.
Sec. 17b-552. (Formerly Sec. 17a-392). Limitation of charges. Civil penalty. Regulations.
Sec. 17b-553. (Formerly Sec. 17a-393). Posting of policy relating to Medicare payments and processing.
Sec. 17b-554. (Formerly Sec. 17a-394). Regulations.
Secs. 17b-555 to 17b-596.
As used in sections 17b-550
to 17b-554, inclusive:
(1) "Department" means the Department of Social Services;
(2) "Commissioner" means the Commissioner of Social Services;
(3) "Medicare assignment" means acceptance by a health care provider of the Medicare-determined reasonable charge as payment in full for services rendered to persons
enrolled in the Medicare insurance program;
(4) "Income" means adjusted gross income as determined for purposes of the federal
income tax plus any other income of such person not subject to federal taxation;
(5) "Program" means the Connecticut Medicare assignment program otherwise
known as CONNMAP;
(6) "Resident" means a person legally domiciled within the state for a period of not
less than one hundred eighty-three days immediately preceding the date of application
for inclusion in the program. Mere seasonal or temporary residences within the state,
of whatever duration, shall not constitute domicile;
(7) "Health care provider" means a person who provides care, treatment, service
or equipment covered by Medicare Part B under Title XVIII of the Social Security Act,
as amended.
(P.A. 87-356, S. 2, 10; P.A. 89-135, S. 2, 6; P.A. 93-262, S. 1, 87.)
History: P.A. 89-135 deleted obsolete definitions of "physician", "state society", "participating physician" and "Medicare intermediary", added the definition of health care provider and substituted reference to health care providers for
reference to physicians in definition of "Medicare assignment"; Sec. 17-560 transferred to Sec. 17a-390 in 1991; P.A. 93-
262 authorized substitution of commissioner and department of social services for commissioner and department on aging,
effective July 1, 1993; Sec. 17a-390 transferred to Sec. 17b-550 in 1995.
Eligibility for participation
in the program shall be limited to a resident who is enrolled in Medicare Part B whose
annual income does not exceed one hundred sixty-five per cent of the qualifying income
level established in the ConnPACE program, pursuant to subsection (a) of section 17b-
492 or if such resident has a spouse, the combined income of such resident and his
spouse does not exceed one hundred sixty-five per cent of the qualifying income level
established in the ConnPACE program, pursuant to subsection (a) of section 17b-492.
(P.A. 87-356, S. 4, 10; P.A. 90-185.)
History: P.A. 90-185 substituted one hundred sixty-five per cent for one hundred fifty per cent; Sec. 17-562 transferred
to Sec. 17a-391 in 1991; Sec. 17a-391 transferred to Sec. 17b-551 in 1995.
Sec. 17b-552. (Formerly Sec. 17a-392). Limitation of charges. Civil penalty.
Regulations. (a) A health care provider shall limit charges for care, treatment, service
or equipment covered by Medicare Part B under Title XVIII of the Social Security Act,
as amended, provided to a Medicare beneficiary who meets the eligibility requirements
specified in section 17b-551, to the reasonable charge for the care, treatment, service
or equipment provided as determined by the United States Secretary of Health and
Human Services. No health care provider shall collect from such qualified beneficiary
any amount in excess of the approved reasonable charge. Any violation of this subsection
shall constitute grounds for the assessment of a civil penalty in accordance with subdivision (6) of subsection (a) of section 19a-17. Any complaint alleging a violation of this
section shall be made to the Department of Public Health or the appropriate professional
licensing board or commission.
(b) The Commissioner of Social Services shall adopt regulations in accordance with
the provisions of chapter 54, necessary to administer the program and to determine
eligibility in accordance with the provisions of section 17b-551.
(c) All health care providers shall accept the identification card issued for the Conn:CHY:PACE program pursuant to sections 17b-490 to 17b-498, inclusive, as a substitute for
a Medicare assignment card.
(P.A. 87-356, S. 5, 10; 87-589, S. 35, 87; P.A. 89-135, S. 3, 6; P.A. 90-230, S. 26, 101; P.A. 91-190, S. 3, 9; P.A. 93-
262, S. 1, 87; 93-381, S. 9, 39; P.A. 95-257, S. 12, 21, 58.)
History: P.A. 87-589 made technical change in Subsec. (g); P.A. 89-135 removed language pertaining to the medical
courtesy card program and added requirement for health care providers to limit charges to the amount specified by the
Secretary of Health and Human Services and provided for the adoption of regulations; P.A. 90-230 substituted "Medicare
assignment card" for "medical courtesy card" in Subsec. (f); Sec. 17-563 transferred to Sec. 17a-392 in 1991; P.A. 91-190
deleted former Subsecs. (c) to (e), inclusive, which had established an advisory committee for the Medicare assignment
program and set forth its duties, including the submittal of an annual report to the department with findings and recommendations for modifications to the program, legislation or regulations, and relettered Subsec. (f) as Subsec. (c); P.A. 93-262
substituted commissioner and department of social services for commissioner and department on aging, effective July 1,
1993; P.A. 93-381 replaced department of health services with department of public health and addiction services, effective
July 1, 1993; Sec. 17a-392 transferred to Sec. 17b-552 in 1995; P.A. 95-257 replaced Commissioner and Department of
Public Health and Addiction Services with Commissioner and Department of Public Health, effective July 1, 1995.
Sec. 17b-553. (Formerly Sec. 17a-393). Posting of policy relating to Medicare
payments and processing. Each health care provider who is assigned a Medicare provider number shall post in a prominent location a clearly legible sign stating his office
policy related to Medicare payments and processing.
(P.A. 87-356, S. 6, 10; P.A. 89-135, S. 4, 6.)
History: P.A. 89-135 substituted "health care provider" for "physician"; Sec. 17-564 transferred to Sec. 17a-393 in
1991; Sec. 17a-393 transferred to Sec. 17b-553 in 1995.
The department may adopt
emergency regulations, in accordance with chapter 54, to implement the provisions of
sections 17b-550 to 17b-554, inclusive.
(P.A. 87-356, S. 8, 10.)
History: Sec. 17-565 transferred to Sec. 17a-394 in 1991; Sec. 17a-394 transferred to Sec. 17b-554 in 1995.
Reserved for future use.
Note: Chapters 319kk and 319ll are also reserved for future use.
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