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2025.02 - Provider Bulletin - New Services added to Home & Community Based Services Medicaid Waiver Programs - COPE
Effective date
Oct 1, 2024
Identified
Jun 20, 2026
Summary
Effective 10/1/2024, DSS added the COPE/Confident Caregiver services to the Connecticut Home Care Program for Elders, Personal Care Assistance, Acquired Brain Injury I and II, and Autism Medicaid waivers. Only Home Health Agencies licensed by the Connecticut Department of Public Health and enrolled under CMAP can bill these services, and the RN (S0274) and OT (S5108) rates are $31.16 per 15 minutes through 6/30/2025 and $28.33 per 15 minutes from 7/1/2025 forward. Prior authorization is required for all COPE/Confident Caregiver services.
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What to do
Action · 10 steps
01Already effective 10/1/2024: Bill COPE/Confident Caregiver services only as Home Health Agency claims, and only after the agency has completed the enrollment and credentialing steps and its staff have completed training.
02Each agency must obtain COPE/Confident Caregiver certification.
03Agency OTs and RNs must complete the self-paced online training before rendering these 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 licensure and CMAP enrollment, the agency signs and returns the attestation letter, and DSS refers the agency to Drexel University at COPE@Drexel.edu for training.
05Upload the signed attestation letter under the active provider ID on the Gainwell secure web portal, and keep it associated with the re-enrollment file, because verification of qualifications and credentialing is required every two years.
06Through 6/30/2025, bill procedure codes S0274 and S5108 with the V1 modifier associated to the procedure code on the claim, because failure to do so will result in a claim denial.
07These 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.
08Prior authorization is required for all COPE/Confident Caregiver 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.
09Each service may not be authorized to the same participant more than once within a calendar year, and COPE/Confident Caregiver and CAPABLE services cannot be provided to a participant at the same time.
10Training costs were covered by DSS through 6/30/2025, and providers joining after 6/30/2025 are responsible for training and certification costs.
Codes mentioned
S0274S5108
Original notice
2025.02 - Provider Bulletin - New Services added to Home & Community Based Services Medicaid Waiver Programs - COPE
ctdssmap.com · Always check the source before changing claims.
Related changes
See all Connecticut Medicaid (HUSKY Health) changes →DSS Important Message - 10% Rate Add-On Extended for COPE, Confident Caregiver, and CAPABLE Services through 09.30.2025MediumEffective Oct 1, 2025 · ReimbursementUpdate on Care of Older People in their Environment - Confident CaregiverMediumEffective Sep 1, 2025 · Provider BulletinSign up to become a Care of Older People in their Environment - Confident Caregiver providerMediumEffective Sep 1, 2025 · Provider BulletinBrowse every Connecticut Medicaid (HUSKY Health) change in the policy list