01Already effective 10/1/2024: Bill CAPABLE services only as Home Health Agency claims, and only after the agency has completed enrollment, licensing and staff training.
02Each agency must obtain a CAPABLE license.
03OTs and RNs employed by the agency, and contracted Handy workers, must complete the self-paced online training before rendering CAPABLE services, and the agency keeps each staff member's training completion certificate.
04To start credentialing, the agency contacts the DSS Community Options (CO) Unit at DSSCOPECAPABLEattestation@ct.gov; after DSS verifies DPH licensure and CMAP enrollment, DSS refers the agency to the CAPABLE National Center at CAPABLEInfo@CAPABLEnationalcenter.org, and the agency signs an agreement with the CAPABLE National Center to become a licensed CAPABLE site.
05Upload the CAPABLE license under the active provider ID on the Gainwell secure web portal, and keep the most current license associated with the enrollment file, because verification of CAPABLE provider qualifications and credentialing is required every two years.
06Through 6/30/2025, bill CAPABLE procedure codes with the V1 modifier associated to the procedure code on the claim, because failure to do so will result in a claim denial.
07Prior authorization is required for all CAPABLE services: the Access Agency creates the care plan, refers the participant, and enters or uploads the PA, and for Autism waiver clients the PA comes from the DSS Autism Waiver Case Manager or Case Management Supervisor.
08Each service may not be authorized to the same participant more than once within a calendar year, and CAPABLE and COPE/Confident Caregiver services cannot be provided to a participant at the same time.
09CAPABLE services are not subject to EVV and may be billed through the secure web account, vendor software, a contracted billing service or a clearinghouse; paper claims are not allowed.
10Training costs were covered by DSS through 6/30/2025, and providers joining after 6/30/2025 are responsible for CAPABLE training and licensure costs.
11For enrollment, billing or fee schedule questions, contact Gainwell Technologies Provider Assistance Center, Monday through Friday from 8:00 a.m. to 5:00 p.m., at 1-800-842-8440.