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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJanuary 2015

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Section 1902(a)(4) of the Social Security Act, State Plan for Medical Assistance, Methods of Administration
Section 1903(m), Medicaid Managed Care Organization
29 Del.C. §7931, Division of Medicaid and Medical Assistance
42 CFR §483.1, Managed Care, Basis and scope
42 CFR §483.116, Solvency standards
State Medicaid Director Letter, December 30, 1997, An array of provisions including beneficiary protections, solvency standards and contract administration
1.2 Pursuant to Section 1902(a)(4) of Title XIX of the Social Security Act (42 U.S.C. §1396a(4)) and 42 C.F.R. §438.1 et. seq., the states are authorized to administer Medicaid through Medicaid managed care organizations (each an “MMCO”).
1.5 Pursuant to 18 Del.C. §7931(c), the Division of Medicaid and Medical Assistance (“DMMA”), which is under the direction and control of the Secretary of the Department of Health and Social Services (“DHSS”), is responsible for the performance of all of the powers, duties, and functions specifically related to Medicaid, which includes certification of MMCOs.
2.1.5 An opinion of Delaware counsel to the MMCO will be prima facie evidence that the criteria in this Section 2 are satisfied.
11.2 In the event of such decertification, DHSS shall notify the MMCO of the proposed decertification in accordance with 29 Del.C. §§10122 and 10131. If the MMCO requests a hearing on the proposed decertification, DHSS shall appoint a hearing officer to preside over the hearing.
11.3.7 If the MMCO fails to appear at the decertification hearing after receiving the notice required by 29 Del.C. §10122 and 10131, the hearing officer may proceed to hear and determine the validity of the proposed decertification.
Last Updated: December 31 1969 19:00:00.
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