Regulatory Flexibility Act Form
Any person who wishes to make written suggestions, compilations of data, testimony, briefs or other written materials concerning the proposed new regulations must submit same to, Planning, Policy and Quality Unit, Division of Medicaid and Medical Assistance, 1901 North DuPont Highway, P.O. Box 906, New Castle, Delaware 19720-0906, by email to Nicole.M.Cunningham@state.de.us, or by fax to 302-255-4413 by 4:30 p.m. on January 31, 2019. Please identify in the subject line: Chiropractic Services.
The purpose of this notice is to advise the public that Delaware Health and Social Services (DHSS)/Division of Medicaid and Medical Assistance (DMMA) is proposing to amend Title XIX Medicaid State Plan and the DMMA Provider Policy Specific Manual regarding chiropractic services, specifically, to remove annual numerical limitations placed on chiropractic care visits for the purpose of treating back pain.
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 on the proposed regulation. Comments must be received by 4:30 p.m. on January 31, 2019.
Also, there may be additional provider manuals that may require updates as a result of these changes. The applicable Delaware Medical Assistance Program (DMAP) Provider Policy Specific Manuals and/or Delaware Medical Assistance Portal will be updated. Manual updates, revised pages or additions to the provider manual are issued, as required, for new policy, policy clarification, and/or revisions to the DMAP program. Provider billing guidelines or instructions to incorporate any new requirement may also be issued. A newsletter system is utilized to distribute new or revised manual material and to provide any other pertinent information regarding DMAP updates. DMAP updates are available on the Delaware Medical Assistance Portal website: https://medicaid.dhss.delaware.gov/provider
STATE/TERRITORY: DELAWARE
that the chiropractor is legally authorized by the State to perform. Services may be subject to prior authorization and/or
1. Evaluation and management services;
2. Diagnostic x-rays; and
3. Chiropractic manipulative treatment.
utilization criteria below:
Practitioner www.dmap.state.de.us Provider Policy Manual
13.1 Member Eligibility
13.1.1 Providers must verify member eligibility by logging into the Delaware Medical Assistance Portal for Providers at https://Medicaid.dhss.delaware.gov/ or by using the Voice Response System (VRS) by calling 1-800-999-3371.
13.2.2 “Manual” manipulation of spine for treatment of spinal subluxation-one manipulation per member per day and a maximum of twenty (20) manipulations during a rolling twelve month period.
Chiropractic services are furnished in accordance with 42 CFR 440.60(b) and include only services that are provided by a chiropractor who is licensed by the State, and consists of treatment by means of manual manipulation of the spine that the chiropractor is legally authorized by the State to perform.
13.2.3 Necessity for Treatment
The patient must have a significant health problem in the form of a neuromusculoskeletal condition necessitating treatment, and the manipulative services rendered must have a direct therapeutic relationship to the patient’s condition and provide reasonable expectation of recovery or improvement of function. The patient must have a subluxation of the spine as demonstrated by x-ray or back pain necessitating treatment as demonstrated by physical examination, as described below.
13.2.3.1 X-ray of complete spine only to document medical necessity for spinal subluxation; the x-ray must be taken within twelve (12) months of the date of service
X-ray may be used to diagnose spinal subluxation. If x-ray is used for this purpose, it must have been taken reasonably close to (within 12 months prior or 3 months following) the beginning of treatment. Coverage of spinal x-rays is limited to one set of spinal x-rays for a member in a rolling twelve-month period.
Additional X-rays may be taken within the same calendar year in order to document a new condition or an exacerbation/re-injury.
X-rays used to determine progress are limited to one study per calendar year. Progress X-ray studies, beyond the first in a calendar year, may be pre-authorized.
13.2.3.2 Physical exam to document spinal subluxation, back pain, or to determine progress; once in a rolling twelve-month period; evaluation must be demonstrated by meeting two of the following four criteria, one of which must be “13.2.3.4” below;
13.3 Non-Covered Services
