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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJanuary 2019


Regulatory Flexibility Act Form

Authenticated PDF Version

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.
6.b. Optometrists’ Services
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.
13.1 Member Eligibility
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
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;
Last Updated: December 31 1969 19:00:00.
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