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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJanuary 2017

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The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the November 2016 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by December 1, 2016 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
Social Security Act §1915(c), Home and community-based services
42 CFR §435.217, Individuals receiving home and community-based services
42 CFR §435.726(a) and (b), Post-eligibility treatment of income of individuals receiving home and community-based services furnished under a waiver: Application of patient income to the cost of care.
Agency Response: While the patient pay amount is not required to be paid to any particular provider type, the payments to the waiver residential providers tend to be the largest payments and are, therefore, the logical service to which to apply the patient payment. Splitting the patient payment across multiple providers would add administrative burden for both the state and for the providers. As long as the monthly payment to the residential provider is sufficiently large to accommodate the entire patient pay amount, it will be deducted from the payment to the residential provider.
Agency Response: The Council is correct in pointing out that DDDS is the representative payee for many waiver recipients. For those individuals, DDDS will distribute the patient payment to the provider acting on behalf of the waiver member. The change in the regulation clarifies that it is the provider's responsibility to ensure that the patient pay is collected for each individual. The regulation does not prohibit DDDS from acting on behalf of the individual in its capacity as representative payee. For those individuals for whom DDDS is not the representative payee, the provider will work directly with the individual or his or her guardian or non-DDDS representative payee to ensure that they receive the patient payment amount.
THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Delaware Social Services Manual (DSSM) regarding Patient Pay Calculations, specifically, to change the entity responsible for the collection of the patient pay amount for Division of Developmental Disabilities Services (DDDS) waiver recipients, is adopted and shall be final effective January 11, 2017.
For DDDS Waiver recipients, the patient pay amount is paid to the Division of Developmental Disabilities. Individuals receiving Residential Habilitation funded by the DDDS waiver will submit their patient pay amount directly to the provider of Residential Habilitation.
Last Updated: December 31 1969 19:00:00.
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