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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsApril 2018

Regulatory Flexibility Act Form

Authenticated PDF Version

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 proposed regulation. Comments must be received by 4:30 p.m. on May 1, 2018.
The Centers for Medicare and Medicaid Services (CMS) requires that Federally Qualified Health Centers (FQHCs) be reimbursed in compliance with the Benefits Improvement and Protection Act (BIPA) of 2000. Effective January 1, 2001 July 1, 2018, Delaware will pay 100% of reasonable cost based on an average of the Fiscal Year 1999 and 2000 audited cost report reimburse each FQHC per-visit through one of the following two (2) methodologies, whichever nets the greater result:
The Medicaid Managed Care Organizations are contractually required to include the same service array and the same payment methodology as the State Medicaid FFS contracts with FQHCs. The Medicaid FFS rate is a prospective payment system (PPS) rate paid per FQHC visit. The Delaware Medicaid Program will verify that the FQHC has received at least the PPS correct rate for every visit. If there is a discrepancy in payment amounts, DE will make a wraparound payment to the FQHC within 90 days.
The Delaware Medical Assistance Program (DMAP) requires that a new provider submit an estimated cost report so that a rate based on reasonable costs can be established. Any new FQHC will be capped at 100% of the highest rate that Medicaid pays to a FQHC for the initial rate year.
Medicaid will ensure 100% percent cost payments regardless of the payment mechanism.
The rate year for FQHC services is July 1 through June 30.
The payment methodology for FQHCs will conform to section 702 of the BIPA 2000 legislation.
Last Updated: December 31 1969 19:00:00.
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