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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsJuly 2018

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* Please Note: The Final Regulation for Reimbursement Methodology for FQHCs that was published in the June 1, 2018 issue of the Delaware Register of Regulations (21 DE Reg. 975) contained three errors. The submitted Final Order for the regulation erroneously contained the language "effective for services provided on and after April 1, 2018" under the "Summary of Proposal" section of the Order rather than the correct date of July 1, 2018. The text of the regulation contained a typographical error by failing to indicate a deletion of the word "correct" in the second paragraph. In addition, the submitted Final Order regulation erroneously contained the Effective Date of "April 1, 2017" rather than the correct date of July 1, 2018. The Final Order and regulation are reprinted below with the corrections.
The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the April 2018 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by May 1, 2018 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
Effective for services provided on and after [April July] 1, 2018 Delaware Health and Social Services/ Division of Medicaid and Medical Assistance proposes to amend Title XIX Medicaid State Plan regarding the reimbursement methodology for Federally Qualified Health Centers (FQHCs), specifically, to align DMMA reimbursement policy with the costs of operating Delaware FQHCs.
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 were to have been received by 4:30 p.m. on May 1, 2018.
Comment: One commenter inquired if DMMA was establishing rates for assisted living.
Agency Response: The revised reimbursement methodology for FQHCs does not apply to rates for assisted living via Delaware Medicaid, nor does DMMA establish such rates.
Comment: Another commenter had three separate comments.
Agency Response: Per the Centers for Medicare and Medicaid Services:
Agency Response: Per the proposed reimbursement methodology revision, "The Delaware Medicaid Program will verify that the FQHC has received at least the PPS correct rate for every visit. If there is a discrepancy in payment amounts, DE will make a wraparound payment to the FQHC within 90 days." To clarify, if a discrepancy in payment amounts is observed and verified, the 90-day resolution timeframe commences from the date that the claim is submitted.
Agency Response: DMMA recommends allowing for at least one month of lead time to allow for the auditing component of the "per-visit cost" method. Therefore, it is recommended that the FQHC submit their cost report to DMMA by no later than June 1, given a rate effective date of July 1.
The Centers for Medicare and Medicaid Services (CMS) requires that Federally Qualified Health Centers (FQHCs) be reimbursed in compliance with the Benefits Improvement and Protection Act (BIPA) of 2000. Effective January 1, 2001 July 1, 2018, Delaware will pay 100% of reasonable cost based on an average of the Fiscal Year 1999 and 2000 audited cost report reimburse each FQHC per-visit through one of the following two (2) methodologies, whichever nets the greater result:
The Medicaid Managed Care Organizations are contractually required to include the same service array and the same payment methodology as the State Medicaid FFS contracts with FQHCs. The Medicaid FFS rate is a prospective payment system (PPS) rate paid per FQHC visit. The Delaware Medicaid Program will verify that the FQHC has received at least the PPS [correct] rate [as calculated by methodology option one (above)] for every visit. If there is a discrepancy in payment amounts, DE will make a wraparound payment to the FQHC within 90 days [following the date the claim was submitted].
The Delaware Medical Assistance Program (DMAP) requires that a new provider submit an estimated cost report so that a rate based on reasonable costs can be established. [It is recommended that the FQHC submit their annual cost report to the DMAP at least one month (30 days) prior to the July 1 rate effective date in order to allow for sufficient lead time to conduct the above-mentioned independent audit, as well as to reduce the need for retroactive rate adjustments to the facilities.]
Medicaid will ensure 100% percent cost payments regardless of the payment mechanism.
The rate year for FQHC services is July 1 through June 30.
The payment methodology for FQHCs will conform to section 702 of the BIPA 2000 legislation.
Effective Date [April July] 1, [20172018]
Last Updated: December 31 1969 19:00:00.
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