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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsMarch 2013

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On December 1, 2012 (Volume 16, Issue 6), DHSS published in the Delaware Register of Regulations its notice of proposed regulations, pursuant to 29 Del.C. §10115. It requested that written materials and suggestions from the public concerning the proposed regulations be delivered to DHSS by December 31, 2012, after which time the DHSS would review information, factual evidence and public comment to the said proposed regulations.
Aetna, Larry Lewis, Jr., Director, State Government Affairs:
6.1 SBHC are required to implement and maintain a third-party insurance billing process for services provided at the SBHC.
Comment: For purposes of effective adjudication Aetna suggest that a claim for services shall provide: (i) detailed and descriptive medical and patient data, (ii) a corresponding referral (whether in paper or electronic format), if required for the applicable claim, (iii) whether submitted via an electronic transaction using permitted standard code sets (e.g., CPT-4, ICD-10 or its successor standard, HCPCS) as required by the applicable Federal or state regulatory authority (e.g., U.S. Dept. of Health & Human Services, U.S. Dept. of Labor, state law or regulation) or otherwise, all the data elements of the UB-04 or CMS-1500 (or successor standard) forms (including but not limited to Member identification number, national provider identifier (“NPI”), date(s) of service, complete and accurate breakdown of services).
Agency Response: The Agency appreciates and acknowledges these comments. The Agency will not include details for billing claims within the regulation. The Agency recommends that the requirements for submitting billing claims be established with the School-Based Health Center medical vendors directly.
6.2 SBHC shall not charge co-pays or any other out-of-pocket fees for use of SBHC services.
Comment: Is it anticipated carriers should recovery the uncollected member out-of-pocket expense from the plan sponsor for employer sponsored plans?
Agency Response: The Agency appreciates and acknowledges these comments. However, the Agency will not advise on billing practices.
At a minimum, this section should be revised as follows:
Agency Response: The Agency appreciates and acknowledges these comments.
Agency Response: The Agency appreciates and acknowledges these comments. The Agency agrees to make the revision in 1.0 to read §3365 and 3517G
Agency Response: The Agency appreciates and acknowledges these comments. The Agency agrees to revise the first sentence of 2.0 to read “The following words and terms, when used in this regulation, shall have the following meaning unless the context clearly indicates otherwise.”
Agency Response: The Agency appreciates and acknowledges these comments. The Agency agrees to revise the third sentence of 3.1 to read “SBHCs do not supplant the primary care provider, but rather serve to coordinate care between students and their primary care provider, as well as increase access to services.”
Agency Response: The Agency appreciates and acknowledges these comments.
Sixth, there is no provision authorizing a student who has reached the age of majority to “self-enroll”. See Title 14 Del.C. §3101(7) and Title 13 Del.C. §707. This should be addressed in the regulation.
Agency Response: The Agency appreciates and acknowledges these comments. The Agency agrees to add a second sentence to 4.1 that states “A student of the age of 18 years or more may consent for himself or herself”.
THEREFORE, IT IS ORDERED, that the proposed State of Delaware Regulations Governing School-Based Health Centers are adopted and shall become effective March 11, 2013, after publication of the final regulation in the Delaware Register of Regulations.
These regulations are intended to implement the provisions of 18 Del.C. §3365 and 3517G, school-based health centers. These regulations apply to medical vendors who provide services at school-based health centers and health insurance plans who reimburse for covered medical services. These regulations define: (1) services offered in a school-based health center; (2) criteria for recognition as a school-based health center; (3) interactions with primary care providers; and (4) criteria for health promotion.
The following [words and] terms, when used in [these this] regulations, [should shall] have the following meaning unless the context clearly indicates otherwise:
Agency” means the Division of Public Health, Bureau of Adolescent and Reproductive Health, school-based health center program.
Parent” means the parent or legal guardian authorized to enroll a student in the school-based health center.
School-based health center” means a health care clinic located in or near a school facility that is organized through school and health provider relationships that provides services designated in section 4.0 of this regulation.
Student” means a child or adolescent who is enrolled in school.
3.1 School-based health centers (SBHC) are designed to reduce risk behaviors and improve health among children and adolescents through health promotion and education, early intervention, and preventive care. These services include physical examinations, treatment of minor acute medical conditions, counseling and community referrals. SBHC[s] do not supplant the primary care provider, but rather serve to coordinate care between students and their primary care provider, as well as increase access to services.
4.1 [In order to obtain services at the SPHC, aA] minor student must be enrolled in the SBHC by his or her parent/guardian [in order to obtain services at the SBHC or relative caregiver acting pursuant to an Affidavit of Establishment of Power to Consent to Medical Treatment of Minors in accordance with Title 13 Del.C. §708. A student of the age of 18 years or more may consent for himself or herself].
[6.3 Any services provided by SBHCs pursuant to a student’s Individualized Education Program (IEP) are not subject to third-party billing. The following services shall be exempt from third-party billing:
Last Updated: December 31 1969 19:00:00.
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