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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsAugust 2016

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Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance (DMMA) initiated proceedings to amend the Delaware Title XIX Medicaid State Plan regarding Covered Outpatient Drugs for the Categorically Needy, specifically, to clarify covered non-prescription drug products. The Department’s proceedings to amend its regulations were initiated pursuant to 29 Del.C. §10114 and its authority as prescribed by 31 Del.C. §512.
The Department will publish its notice of proposed regulation simultaneously with this emergency regulation, pursuant to 29 Del.C. §10115, in the August 2016 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by August 31, 2016 at which time the Department will receive information, factual evidence and public comment to the said proposed changes to the regulations.
1927(d)(2) of the Social Security Act, Limitations on coverage of drugs, drugs subject to exclusion
1935(d)(2) of the Social Security Act, Coverage of certain excludable drugs
Center for Medicaid and CHIP Services (CMCS) Informational Bulletin 060116, Medicaid Benefits Available for the Prevention, Detection and Response to the Zika Virus
Del.C., Title 29, Ch. 101, §10119, Administrative Procedures, Emergency Regulations
THEREFORE, IT IS ORDERED, that to protect Medicaid beneficiaries against the Zika virus, the amendment to the Medicaid State plan modifying provisions regarding nonprescription drugs, specifically, to provide nonprescription drugs, such as mosquito repellant as a preventative measure to protect Medicaid beneficiaries against the Zika virus, be adopted on an emergency basis without prior notice or hearing, effective July 1, 2016.
Pursuant to 1927(d)(2) and 1935(d)(2) of the Social Security Act, the Medicaid Agency provides coverage for the following excluded or otherwise restricted drugs or classes of drugs, or their medical uses to all Medicaid recipients, including full benefit dual eligible beneficiaries under the Medicare Prescription Drug Benefit - Part D.
The following excluded drugs are covered:
(a) 1.) Agents when used for anorexia, weight loss, and weight gain. Products in these categories require prior
authorization; see specific drug categories below:
a.) Megestrol Acetate,
b.) Somatropin, and
c.) Lipase Inhibitor
(b) Agents when used to promote fertility; see specific drug categories below:
(c) Agents when used for cosmetic purposes or hair growth; see specific drug categories below:
(d) Agents when used for the symptomatic relief cough and colds; see specific drug categories below:
(e) Prescription vitamins and mineral products, except prenatal vitamins and fluoride; see specific drug categories
(f) Nonprescription drugs; see specific drug categories below.
2.) Nonprescription drugs, prescription vitamins and mineral products (except prenatal vitamins and fluoride), and other over-the-counter products, such as agents used for the symptomatic relief of cough and colds, as listed in the Delaware Medicaid and Medical Assistance (DMMA) Pharmacy Provider Manual Appendix A - Covered Over-the-Counter Drugs.
Citation (s) Provision (s)
1927(d)(2) and 1935(d)(2) ¨ (g) covered outpatient drugs which the manufacturer
Last Updated: December 31 1969 19:00:00.
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