department of health and social services

Division of Medicaid and Medical Assistance

proposed

PUBLIC NOTICE

Diamond State Health Plan 1115 Demonstration Waiver

In compliance with the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code) and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, and, in compliance with State Notice procedures as set forth in the Federal Register, September 27, 1994, Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) intends to submit an application to the Centers for Medicare and Medicaid Services (CMS) for renewal of its 1115 Demonstration Waiver entitled, the Diamond State Health Plan, for the period from January 1, 2007 through December 31, 2009.

Any person who wishes to make written suggestions, compilations of data, testimony, briefs or other written materials concerning extension of the Diamond State Health Plan 1115 Demonstration Waiver must submit same to Sharon L. Summers, Policy and Program Development Unit, Division of Medicaid and Medical Assistance, 1901 North DuPont Highway, P.O. Box 906, New Castle, Delaware 19720-0906 or by fax to (302) 255-4454 by July 31, 2006. The waiver application will be made available upon request.

The action concerning the determination of whether to adopt the proposed regulation will be based upon the results of Department and Division staff analysis and the consideration of the comments and written materials filed by other interested persons.

Summary of Proposed Changes

Statutory Authority

Social Security Act §1115, Demonstration Projects

42 CFR §441, Subpart G, Home and Community-Based Services Waiver Requirements

Background

The Diamond State Health Plan (DSHP) implemented a mandatory Medicaid managed care program statewide on January 1, 1996. Using savings achieved under managed care, Delaware expanded Medicaid health coverage to additional low-income adults in the State with incomes less than 100% of the Federal Poverty Level (FPL).

Goals of the DSHP are to improve and expand access to healthcare to more adults and children throughout the State, create and maintain a managed care delivery system emphasizing primary care, and to strive to control the growth of healthcare expenditures for the Medicaid population.

The current demonstration project #11-W-0063/3 expires on December 31, 2006. To assure the continuation of the DSHP, the Division of Medicaid and Medical Assistance has submitted a three-year extension request for the DSHP 1115 Waiver to the CMS for the period January 1, 2007 through December 31, 2009.

Summary of Proposal

DMMA is announcing a thirty-day comment period on the DSHP 1115 Waiver Extension request submitted to CMS.

The application to renew documents how the State has met its goals of improving access to services, expanding coverage to additional populations and substantially improving quality of care for eligible individuals enrolled in the Diamond Sate Health Plan (DSHP). The State intends no changes to the DSHP during the renewal period. The waiver application will be made available upon request.

The provisions of this waiver are subject to approval by the Centers for Medicare and Medicaid Services (CMS).