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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsDecember 2014

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Delaware Health and Social Services/Division of Medicaid and Medical Assistance proposes to amend the Title XIX Medicaid State Plan regarding Methods and Standards for Establishing Payment Rates, specifically, Primary Care Service Payment. This amendment will extend the primary care physician services rate increase required by the Health Care and Education Reconciliation Act of 2010 (HCERA), Section 1202 (Pub. L. No. 111-152) (42 U.S.C. §1396a(a)(13), that sunsets on December 31, 2014.
§1905 of the Social Security Act (a)(5(A), Definitions, Physicians’ Services
42 CFR §440.50, Physicians’ Services and Medical and Surgical Services of a Dentist
42 CFR §447.400, Primary care services furnished by physicians with a specified specialty or subspecialty
42 CFR §447.405, Amount of required minimum payments
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
In accordance with 42 CFR §447.410, Delaware submitted a State Plan Amendment (SPA) to reflect the fee schedule rate increases for eligible primary care physicians under section 1902(a)(13)(A) of the Social Security Act. The purpose of this requirement is to assure that when States make the increased reimbursement to providers, they have State Plan authority to do so and they have notified providers of the change in reimbursement as required by Federal regulations.
Statutory Authority and Payment Methodology for Changes to the Medicaid State Plan
STATE: DELAWARE
STATE: DELAWARE
f. The DMAP will make payment under this SPA for the following codes which have been added to the fee schedule since July 1, 2009 (codes and date added specified).
g. DMAP did not make payment as of July 1, 2009 for the following codes and will not make payment for those codes under this SPA (codes specified).
STATE: DELAWARE
STATE: DELAWARE
This reimbursement methodology applies to services delivered on or after January 1, 2015. The fee schedule and any annual/periodic adjustments to the fee schedule are available on the Delaware Medical Assistance Program (DMAP) website at:
This reimbursement methodology applies to services delivered on or after January 1, 2015.
Last Updated: December 31 1969 19:00:00.
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