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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsFebruary 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 Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services, specifically, coverage and reimbursement methodologies for rehabilitative mental health services. 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 published its notice of proposed regulation changes pursuant to 29 Del.C. §10115 in the November 2015 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by December 1, 2015 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
Section 1905(r) of the Social Security Act, Early and Periodic Screening, Diagnostic, and Treatment Services
42 CFR §441 Subpart B, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) of Individuals under Age 21
42 CFR §440.60, Medical or other remedial care provided by licensed practitioners
42 CFR §440.130, Diagnostic, screening, preventive, and rehabilitative services
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
State Medicaid Manual, Section 5010, Early and Periodic Screening, Diagnostic, and Treatment Services
any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts within the scope of their practice under State law, for the maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level.
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 to the methods and standards governing payment methodology for rehabilitative mental health services under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Comments were to be received by 4:30 p.m. on December 1, 2015.
Agency Response: Your comments raised issues that are outside the scope of this regulation. This regulation proposes to clarify existing rehabilitative mental health services and reimbursement methodology language; it involves no change in the definition of those eligible to receive mental health services benefit under the Medicaid Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, and the mental health services benefit available to eligible recipients remains the same. No change was made to the regulation as a result of this comment.
Agency Response: DMMA thanks the Council for its comment. The provision was struck because it is duplicative with another section of the State Plan. SPA TN 13-0018 includes services for Other Licensed Practitioners for all ages in a statewide and comparable manner. No change was made to the regulation as a result of this comment.
Agency Response: DMMA agrees with your request to provide clarity on telemedicine usage and has amended the language to do so.
Agency Response: DMMA respectfully disagrees with the Council's comment. The proposed regulations are in accordance with the requirements of 45 CFR Part 91. Age considerations in the proposed regulation fall under the exceptions to 45 CFR Part 91 regarding the "Normal operation or statutory objective of any program or activity" and are thus permissible under Part 91.
THEREFORE, IT IS ORDERED, that the proposed regulation to amend Delaware Title XIX Medicaid State Plan regarding Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services, specifically, coverage and reimbursement methodologies for rehabilitative mental health services, is adopted and shall be final effective February 11, 2016.
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2c 2d Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
4) 3) Medical Equipment and Supplies per 42 CFR 440.70
5) 4) Orthotics and Prosthetics
6) 5) Chiropractic Services
8) 6) Any other services as required by §6403 of OBRA ’89 as it amended §1902(a)(43), §1905(a)(4)(B) and added a new §1905(r) to the Act.
Page 2e Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.1 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.2 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
A unit of service is defined according to Healthcare Common Procedure Coding System (HCPCS) approved code set unless otherwise specified. [Any Rehabilitative service may be provided via telemedicine consistent with the specifications, conditions, and limitations set by the Delaware Medical Assistance Program (DMAP) as outlined on ATTACHMENT 3.1-A Introductory Page 1.]
Page 2e.3 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
B. Individual supportive counseling, solution focused interventions, emotional and behavioral management, and problem behavior analysis with the individual, with the goal of assisting the individual with developing and implementing social, interpersonal, self care, daily living and independent living skills to restore stability, to support functional gains, and to adapt to community living.
Page 2e.4 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.5 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
2. Psychosocial Rehabilitation (PSR) Services are designed to assist the individual compensate for or eliminate functional deficits and interpersonal and/or environmental barriers associated with his or her mental illness. Activities included must be intended to achieve the identified goals or objectives as set forth in the individual’s individualized treatment plan. The intent of psychosocial rehabilitation is to restore the fullest possible integration of the individual as an active and productive member of his or her family, community, and/or culture with the least amount of ongoing professional intervention. These services provide the training and support necessary to ensure engagement and active participation of the youth in the treatment planning process and with the ongoing implementation and reinforcement of skills learned throughout the treatment process. The structured, scheduled activities provided by this service emphasize the opportunity for the youth to expand the skills and strategies necessary to move forward in meeting his or her personal life goals and to support his or her transition into adulthood. PSR is a face-to-face intervention with the individual present with all activities directly related to goals on the Medicaid individual’s rehabilitation treatment plan. Services may be provided individually or in a group setting. PSR contacts may occur in community or residential locations where the individual lives, works, attends school, and/or socializes. PSR components include:
Page 2e.6 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
3. Crisis Intervention (CI) services are provided to an individual who is experiencing a psychiatric crisis, designed to interrupt and/or ameliorate a crisis experience including a preliminary assessment, immediate crisis resolution and de-escalation, and referral and linkage to appropriate community services to avoid more restrictive levels of treatment. The goals of Crisis Intervention are symptom reduction, stabilization, and restoration to a previous level of functioning. All activities must occur within the context of a potential, or actual, or perceived psychiatric crisis.
Page 2e.7 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Activities include:
Page 2e.8 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
3. Crisis Intervention Services Continued
Page 2e.9 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
4. Family Peer Support Services (FPSS) are an array of formal and informal services and supports provided to families caring for/raising a child who is experiencing social, emotional, medical, developmental, substance use and/or behavioral challenges in their home, school, placement, and/or community. FPSS provide a structured, strength-based relationship between a Family Peer Advocate (FPA) and the parent/family member/caregiver for the benefit of the child/youth.
Page 2e.10 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Provider Qualifications: A Certified Peer is an individual who has self-identified as a beneficiary or survivor of mental health and/or substance use disorder (SUD) services, is at least 21 years of age, and meets the qualifications set by the state including specialized peer specialist training, certification and registration. The training provided/contracted by DHSS or its designee shall be focused on the principles and concepts of peer support and how it differs from clinical support.
Page 2e.11 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.12 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Supervisors must also be aware of and sensitive to the cultural needs of the population of focus and how to best meet those needs, and be capable of training staff regarding these issues.
Page 2e.13 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Treatment must:
Page 2e.14 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.15 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
5. Rehabilitative Residential Treatment Continued
Page 2e.16 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.17 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.18 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.19 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.20 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.21 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.22 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
REVISION: Attachment 4.19-B
STATE: DELAWARE
The fee development methodology will build fees considering each component of provider costs as outlined below. These reimbursement methodologies will produce rates sufficient to enlist enough providers so that services under the State Plan are available to beneficiaries at least to the extent that these services are available to the general population, as required by 42 CFR 447.204. These rates comply with the requirements of Section 1902(a)(3) of the Social Security Act and 42 CFR 447.200, regarding payments and are consistent with economy, efficiency, and quality of care. Provider enrollment and retention will be reviewed periodically to ensure that access to care and adequacy of payments are maintained. The Medicaid fee schedule will be equal to or less than the maximum allowable under the same Medicare rate, where there is a comparable Medicare rate. Room and board costs are not included in the Medicaid fee schedule.
Page 19.1 Addendum
STATE:DELAWARE
Last Updated: December 31 1969 19:00:00.
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