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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJuly 2015

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Delaware Health and Social Services ("Department") / Division of Medicaid and Medical Assistance (DMMA) initiated proceedings to amend the Delaware Title XIX Medicaid State Plan regarding State Plan Rehabilitative Services, specifically, Coverage and Reimbursement for Community Support Services. The Department's proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the December 1, 2014 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by December 31, 2014 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
§1905 of the Social Security Act (a)(13), Other diagnostic, screening, preventive, and rehabilitative services
42 CFR §440.130(d), Diagnostic, screening, preventive, and rehabilitative services
42 CFR §440.60, Medical or other remedial care provided by licensed practitioners
42 CFR §440.225, Optional services
42 CFR §440.20, Outpatient hospital services and rural health clinic services
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
In accordance with public notice requirements established at 42 CFR 447.205, Section 1902(a)(13)(A) of the Social Security Act, and Title 29, Chapter 101 of the Delaware Code, Delaware Health and Social Services (DHSS)/Division of Medicaid and Medical Assistance (DMMA) is seeking public comment on the draft Community Support Service State Plan Amendment.
While individuals with a TBI diagnosis could have qualified under the "Community Support Service" eligibility standard, that diagnosis is non-qualifying under PROMISE. SCPD has requested reconsideration of DMMA's exclusion of TBI as a qualifying diagnosis under PROMISE. See attachments. Apart from TBI, there may be a host of other classes of individuals who would have been eligible under the "Community Support Service Program" but who will be barred from PROMISE based on a non-qualifying diagnosis, including the following:
Second, DMMA indicates that PROMISE is intended to cover individuals qualifying under the DOJ-Delaware settlement. At p. 430. The population of individuals covered by the Settlement Agreement is not limited to certain diagnoses. See attached pages from Settlement Agreement. As a result, while an individual in DPC with a diagnosis of intermittent explosive disorder will qualify for services under the Settlement Agreement, DHSS will have to spend 100% State funds for the individual's community programming since the person lacks a qualifying diagnosis to be eligible for PROMISE. Alternatively, the individual will be relegated to a narrow scope of services offered by an MCO. See attached Waiver Amendment, p. 9. Query whether these results are fiscally and clinically prudent.
Agency Response: DMMA carefully considered your comments and believe that individuals with Acquired Brain Injury (ABI) are eligible for PROMISE if they meet the stated criteria for the PROMISE program. Individuals with ABI who are not eligible for PROMISE continue to be eligible for Home and Community-Based Services (HCBS) supports under the Diamond State Health Plan Plus program. Individuals with Acquired Brain Injury that are not eligible for PROMISE are still eligible for services through DSAAPD.
THEREFORE, IT IS ORDERED, that the proposed regulation to amend Delaware Title XIX Medicaid State Plan regarding State Plan Rehabilitative Services specifically, Coverage and Reimbursement for Community Support Services to remove all State Plan coverage and reimbursement provisions related to community support services at Attachment 4.19-B Page 4, is adopted and shall be final effective June 10, 2015.
STATE: DELAWARE
1) Community Support Service Programs
Last Updated: December 31 1969 19:00:00.
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