DEPARTMENT OF HEALTH AND SOCIAL SERVICES
Division of Medicaid and Medical Assistance
GENERAL NOTICE
Delaware Diamond State Health Plan
1115 Demonstration Waiver Amendment
In compliance with the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code) and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) intends to submit two requests to the Centers for Medicare and Medicaid Services (CMS) to amend Delaware's Section 1115 Diamond State Health Plan Demonstration Waiver.
Purpose
The purpose of this posting is to provide public notice and receive public input for consideration regarding Delaware's 1115 Diamond State Health Plan (DSHP) Waiver amendments. Delaware is proposing two amendments to the 1115 waiver that will be submitted to CMS at the same time. These amendments cover two separate populations. Amendment 1 addresses DDDS Lifespan Waiver enrollees in Managed Care. Amendment 2 addresses Out-of-State Former Foster Care Youth.
Background
Delaware's 1115 DSHP Waiver demonstration was initially approved in 1995, and implemented on January 1, 1996. The demonstration mandatorily enrolls eligible Medicaid recipients into managed care organizations (MCOs) to create efficiencies in the Medicaid program and enable the expansion of coverage to certain individuals who would otherwise not be eligible for Medicaid. Beginning January 1, 2014, DSHP expanded eligibility for individuals with incomes up to and including 133 percent of the Federal Poverty Level (FPL). The demonstration also provides long-term care services and support (LTSS) to eligible individuals through a mandated managed care delivery system, entitled DSHP-Plus. Beginning January 1, 2015, the state implemented Promoting Optimal Mental Health for Individuals through Supports and Empowerment (PROMISE), a voluntary program that provides enhanced behavioral health services and supports for targeted Medicaid beneficiaries.
Additionally, On May 25, 2017, CMS approved an amendment to Delaware's Home and Community-Based Services (HCBS) 1915(c) waiver that serves individuals with intellectual and developmental disabilities (IDD). The waiver was rebranded as the Divisions of Developmental Disability Services (DDDS) Lifespan Waiver and amended to allow Delaware to expand the waiver's target criteria to enroll individuals who live with their family. The amendment also added HCB services designed to meet the needs of families who support a loved one with intellectual and developmental disabilities in the family home.
Overview and Summary of Proposed 1115 DSHP Waiver Amendments
Proposed Amendment 1: DDDS Lifespan Waiver enrollees in Managed Care
Under the current design of the 1115 DSHP Waiver, individuals enrolled in the 1915(c) Lifespan Waiver are excluded from the 1115 waiver as a result of a state policy decision made at the time the 1115 waiver was implemented in 1996. All benefits for individuals enrolled in the 1915(c) Lifespan Waiver, both waiver and non-waiver, are paid as fee for service. When an individual enrolls in the 1915(c) Lifespan Waiver, they are dis-enrolled from the 1115 waiver and are, therefore, also dis-enrolled from their Managed Care Organization. Individuals who are not enrolled in the 1915(c) waiver but have a diagnosis of IDD and live in their homes or family home, are enrolled in the in the 1115 Waiver-Managed Care program. Under this amendment, Delaware desires to enable individuals to remain enrolled in the 1115 DSHP Waiver in order to receive their State Plan benefits from a managed care organization if they also choose to enroll in the DDDS Lifespan waiver. If Delaware does not amend the 1115 waiver, new enrollees in the DDDS Lifespan 1915(c) waiver who have previously been enrolled in the 1115 waiver will be forced to dis-enroll from the Managed Care Organization. This amendment is needed to avoid unnecessarily disrupting the lives of prospective DDDS Lifespan waiver enrollees who live with their family. These individuals have established relationships with the Managed Care Organizations and their network of providers to whom they have become accustomed.
Proposed Amendment 2: Out-of-State Former Foster Care Youth
On November 21, 2016, CMS published the final rule clarifying that states can provide coverage to former foster care youth who were in Medicaid and foster care in a different state with income up to 133 percent of the federal poverty level (FPL) under the new adult group identified in the ACA. Additionally, states can use 1115 demonstration authority to provide coverage for former foster care youth who were in foster care under the responsibility of other states and have income higher than 133 percent of the FPL. States that provide coverage under the new adult group have the option of covering former foster care youth with MAGI-based income above 133 percent of the FPL, under the eligibility group described in section 1902(a)(10)(ii)(XX) of the Act and implementing regulations at 42 CFR 435.218.
Delaware currently provides coverage to former foster care youth under the age of 26, not otherwise mandatorily eligible, who were on Medicaid and in foster care in Delaware when they turned age 18 or "aged out" of foster care. Delaware also currently provides coverage to individuals with income up to 133 percent of FPL under the new adult group identified in the ACA. The purpose of this amendment is to provide coverage on a state-wide basis to former foster care youth who currently reside in Delaware and were in foster care and enrolled in Medicaid at age 18 or when they "aged out" of the system in a different state.
Public Comment Submission Process
As required by 42 CFR Part 441.304, DHSS/DMMA must establish and use a public input process for any changes in the services or operation of the waiver. Per Del. Code, Title 29, Ch. 101 §10118 (a), The opportunity for public comment shall be held open for a minimum of 30 days after the proposal is published in the Register of Regulations. The opportunity for public written comment shall be extended for a minimum of 15 days after the final public hearing when 1 or more public hearings are held on the proposal. The public is invited to review and comment on the proposed Lifespan Waiver Amendment. Comments must be received by 4:30 p.m. on September 11, 2017. Comments may be submitted in the following ways:
This public notice and the Amendment are posted DHSS/DMMA website at: http://dhss.delaware.gov/dhss/dmma/
Comments and input may be submitted in the following ways:
By email: Nicole.M.Cunningham@state.de.us
By fax: 302-255-4413 to the attention of Nicole Cunningham
By mail: Nicole Cunningham
Division of Medicaid and Medical Assistance
Planning, Policy & Quality Unit
1901 North DuPont Highway
P.O. Box 906
New Castle, Delaware 19720-0906
Public Hearings
Notice will be published regarding the amendments in the August 1, 2017 Delaware Register of Regulations. The comment period begins on August 1, 2017 and ends on September 11, 2017.
This timeframe allows an additional period of 15 days for the public to comment after the last public meeting. Following the comment period, the State reviews, considers, and responds to all comments received.
1. NEW CASTLE COUNTY
Date: August 25, 2017
TIME: 2:30 PM - 3:30 PM
LOCATION: DDDS Fox Run Center
2540 Wrangle Hill Road
Suite 200, Bear, DE 19701
2. KENT COUNTY
Date: August 22, 2017
TIME: 2:30 PM - 3:30 PM
LOCATION: Legislative Hall
411 Legislative Avenue
Dover, DE 19901
SUSSEX COUNTY
Date: August 22, 2017
TIME: 10:45 AM - 11:45 AM
LOCATION: Thurman Adams State Svc Center
546 S. Bedford St.
Georgetown, DE 19947
Any public feedback received will be summarized including any changes that will be made as a result of the public comment to the proposed 1115 DSHP Waiver Amendments that will be submitted to CMS.
If you require special assistance or auxiliary aids and/or services to participate in the public hearing (e.g., sign language or wheelchair accessibility), please call the following contact at least ten (10) days prior to the hearing for arrangements:
Lauren Gunton at (302) 255-9561
The prompt submission of requests helps to ensure the availability of qualified individuals and appropriate accommodations in advance.
July 10, 2017
Stephen M. Groff Date
Director
Division of Medicaid and Medical Assistance
