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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsApril 2016

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Regulatory Flexibility Act Form

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§1905 of the Social Security Act (a)(4)(B), Early and Periodic Screening, Diagnostic, and Treatment Services
§1905 of the Social Security Act (a)(6), Remedial Care and any other type of remedial care (services of other licensed practitioners)
§1905 of the Social Security Act (r)(5), Other necessary health care, diagnostic service, and other measures as described in section 1905(a)
42 CFR §440.60(a), Medical or other remedial care provided by licensed practitioners
42 CFR §440.130(c), Diagnostic, screening, preventive, and rehabilitative services
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
In accordance with the federal public notice requirements established at Section 1902(a)(13)(A) of the Social Security Act and 42 CFR 447.205 and the state public notice requirements of Title 29, Chapter 101 of the Delaware Code, Delaware Health and Social Services (DHSS)/Division of Medicaid and Medical Assistance (DMMA) gives public notice and provides an open comment period for thirty (30) days to allow all stakeholders an opportunity to provide input on the agency's decision to increase the personal needs allowance for individuals institutionalized in long-term care facilities. Comments must be received by 4:30 p.m. on Monday May 2, 2016.
Federal Fiscal Year 20161

1

In accordance with section 4106 of the Affordable Care Act, Delaware Medicaid Covers and reimburses all preventative services assigned a grade of A or B by the United States Preventive Services Task Force (USPSTF), and all approved vaccines and their administration, recommended by the Advisory Committee on Immunization Practices (ACIP), and services to treat Autism Spectrum Disorder (ASD) without cost-sharing.
Preventative services are any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of their practice under State law and include all preventive services not otherwise covered under the State Plan pursuant to Section §1905(r)(5) of the Social Security Act, Early and Periodic Screening, Diagnostic, and Treatment Services, for other necessary health care, diagnostic services, treatment, and other measures described in section 1905(a) to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan. Preventive Services are reimbursed according to the methodologies for services described in Attachment 4.19-B. Methods and Standards for Establishing Payment Rates - Other Types of Care, of the State Plan.
Evaluations:
Prior to receiving a Functional Behavior Assessment, a Behavioral Support Plan, or ASD Treatment Services, the individual must receive the following evaluations:
Services to Treat (ASD) Pursuant to Act, (EPSDT) Services Continued
Evaluations Continued
Services to Treat (ASD) Pursuant to Act, (EPSDT) Services Continued
Autism Spectrum Disorder (ASD) Covered Services:
(2). Behavior Support Plan
Services to Treat (ASD) Pursuant to Act, (EPSDT) Services Continued
ASD Covered Services Continued
Services to Treat (ASD) Pursuant to Act, (EPSDT) Services Continued
ASD Covered Services - ASD Treatment Services Continued
(c.) ASD Service Delivery Continued:
Services to Treat (ASD) Pursuant to Act, (EPSDT) Services Continued
Autism Spectrum Disorder services must be provided by qualified practitioners, listed in the section below, that meet the requirements of the regulations cited above in this section and other applicable state law and regulations as per 42 CFR 440.6. Unlicensed practitioners may operate under the supervision of a licensed practitioner that is responsible for the work and work methods, regularly reviews the work performed, and is accountable for the results. Supervision must adhere to the requirements of the practitioners licensing board and the supervisory relationship must be documented in writing. Qualified practitioners must also be certified by the Behavior Analyst Certification Board (BACB) under one of the categories listed below, and must act within the scope of their certification, as determined by the BACB.
(a.) Licensed Practitioners --
Services to Treat (ASD) Pursuant to Act, (EPSDT) Services Continued
ASD Covered Services - ASD Treatment Services Continued
(1.) Any staff that is unlicensed and providing ASD services must be supervised by a licensed, Board-Certified Behavior Analyst (BCBA® or BCBA-D). The supervisory relationship must be documented in writing.
(c.) The provider who develops the behavioral plan of care should be the same provider who performed the behavior assessment, except in extenuating circumstances, such as if the provider changed employers, moved to another geographic area, or needed to collaborate with another provider with different expertise.
Medicaid shall not cover for program services or components of services that are of an unproven, experimental, of a research nature, or that do not relate to the individual's diagnosis, symptoms, functional limitations or medical history.
Last Updated: December 31 1969 19:00:00.
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