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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJuly 2016

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§1905 of the Social Security Act (a)(4)(B), Early and Periodic Screening, Diagnostic, and Treatment Services
§1905 of the Social Security Act (a)(6), Remedial Care and any other type of remedial care (services of other licensed practitioners)
§1905 of the Social Security Act (r)(5), Other necessary health care, diagnostic service, and other measures as described in section 1905(a)
42 CFR §440.60(a), Medical or other remedial care provided by licensed practitioners
42 CFR §440.130(c), Diagnostic, screening, preventive, and rehabilitative services
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
DMMA published a proposed regulation in the April 2016 Delaware Register. Due to the extensive comments received, and subsequent changes to the proposed regulation, DMMA has chosen to re-publish this rule as proposed.
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 agency's decision to establish coverage and reimbursement for treatment services for Medicaid recipients up to twenty-one (21) years of age who have a diagnosis of Autism Spectrum Disorder. Comments must be received by 4:30 p.m. on August 1, 2016.
In accordance with section 4106 of the Affordable Care Act, Delaware Medicaid Covers and reimburses all preventative services assigned a grade of A or B by the United States Preventive Services Task Force (USPSTF), and all approved vaccines and their administration, recommended by the Advisory Committee on Immunization Practices (ACIP), and behavioral interventions to treat Autism Spectrum Disorder (ASD) without cost-sharing.
Preventative services are any medical or remedial services recommended by a physician or other licensed practitioner of the healing arts acting within the scope of their practice under State law and include all preventive services not otherwise covered under the State Plan pursuant to Section §1905(r)(5) of the Social Security Act, Early and Periodic Screening, Diagnostic, and Treatment Services, for other necessary health care, diagnostic services, treatment, and other measures described in section 1905(a) to correct or ameliorate defects and physical and mental illnesses and conditions discovered by the screening services, whether or not such services are covered under the State plan. Preventive Services are reimbursed according to the methodologies for services described in Attachment 4.19-B. Methods and Standards for Establishing Payment Rates – Other Types of Care, of the State Plan.
13.c. Preventive Services Continued
Behavioral Interventions to Treat Autism Spectrum Disorder (ASD) Pursuant to Act, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services
Required Evaluation:
13.c. Preventive Services Continued
Behavioral Interventions to treat (ASD) Pursuant to Act, (EPSDT) Services Continued
13.c. Preventive Services Continued
13.c. Preventive Services Continued
ASD Covered Services Continued
(1.) Be person-centered and based upon individualized goals over a specific timeline;
13.c. Preventive Services Continued
ASD Covered Services – ASD Treatment Services Continued
(c.) ASD Service Delivery Continued:
13.c. Preventive Services Continued
Behavioral Interventions to treat (ASD) Pursuant to Act, (EPSDT) Services Continued
ASD Covered Services – ASD Treatment Services Continued
13.c. Preventive Services Continued
Behavioral Interventions to treat (ASD) Pursuant to Act, (EPSDT) Services Continued
ASD Covered Services – Qualified Providers Continued
Last Updated: December 31 1969 19:00:00.
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