department of health and social services
Division of Social Services
FINAL
ORDER
Organizational Structure and Description of the Division of Medicaid and Medical Assistance (DMMA)
Nature of the Proceedings
Delaware Health and Social Services (“Department”)/ Division of Medicaid and Medical Assistance initiated proceedings to amend the Title XIX Medicaid State Plan regarding the organizational structure and description of the Division of Medicaid and Medical Assistance (DMMA). The Department’s proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10113 and its authority as prescribed by 31 Delaware Code Section 512.
Nature of the Exempt Regulation
Citations:
Amending the Following Title XIX Medicaid State Plan Pages:
Background
Historically, Medicaid has not had stand-alone divisional status; it had been part of the Division of Social Services. The Delaware Legislature approved the Delaware Health and Social Services’ reorganization plan as part of the State Fiscal Year 2006 Budget (House Bill No. 300). Effective July 1, 2005, this reorganization involved separating Medicaid and other medical assistance programs from the Division of Social Services (DSS) and created a new Division of Medicaid and Medical Assistance (DMMA). The DMMA is responsible for managing Medicaid as well as the other medical assistance programs that had been administered by DSS. Program and policy development for Medicaid, the Delaware Healthy Children Program (DHCP), the Delaware Prescription Assistance Program (DPAP), the Non-Citizen Healthcare Program, and the Chronic Renal Disease Program resides in DMMA. Responsibility for medical and financial eligibility for Medicaid Long Term Care programs reside in DMMA. The Nursing Facility Reimbursement unit and the nurses who approve Private Duty Nursing and PPEC services for children reside in DMMA. It is important to note that the Medicaid Long Term Care financial eligibility staff continue to determine eligibility for Food Stamps for their recipients.
Other units that support the medical assistance programs, such as SURs, TPL/ER, Quality Management, Managed Care and Diamond State Partners staff, resides in DMMA. Responsibility for Medicaid eligibility associated with Temporary Assistance for Needy Families (TANF) and other poverty-related groups remains in DSS. DSS continues to administer Food Stamps, Temporary Assistance for Needy Families (TANF), General Assistance and Child Care.
Summary of Proposed Amendment
The agency submitted an amendment to the Centers for Medicare and Medicaid Services (CMS) on September 19, 2005 to update the organizational charts in the Title XIX Medicaid State Plan.
Findings of Fact
The Department finds that these changes are exempt from the procedural requirements of the Administrative Procedures Act (Title 29 Chapter 101).
THEREFORE, IT IS ORDERED, that the proposed revision regarding the organizational structure and description of the Division of Medicaid and Medical Assistance (DMMA) be adopted informally as an exempt regulation and shall become effective November 10, 2005.
Vincent P. Meconi, Secretary, DHSS, October 13, 2005
DMMA EXEMPT REGULATION #05-58a
REVISION:
Page 2
STATE: DELAWARE
Citation 1.1 Designation and Authority
42 CFR 431.10
AT-79-29 (a) Department of Delaware Health
and Social Services is the single
State agency designated to
administer or supervise the
administration of the Medicaid
program under title XIX of the
Social Security Act. (All
references in this plan to “the
Medicaid agency” mean the
agency named in this paragraph.)
ATTACHMENT 1.1-A is a
certification signed by the State
Attorney General identifying the
single State agency and citing the
legal authority under which it
administers or supervises
administration of the program.
DMMA EXEMPT REGULATION #05-58b
Page 7
Revision: HCFA-AT-80-38 (BPP)
May 22, 1980
STATE: DELAWARE
Citation 1.2 Organization for Administration
42 CFR 431.11
AT-79-29 (a) ATTACHMENT 1.2-A contains a
description of the organization and
functions of the Medicaid Agency and
an organization chart of the agency.
(b) Within the State agency, the
MEDICAL ASSISTANCE
PROGRAM DIVISION OF
MEDICAID & MEDICAL
ASSISTANCE has been
designated as the medical
assistance unit.
ATTACHMENT 1.2-B contains a
description of the organization
and functions of the medical
assistance unit and an
organization chart of the unit.
(c) ATTACHMENT 1.2-C contains a
description of the kinds and
numbers of professional medical
personnel and supporting staff
used in the administration of the
plan and their responsibilities.
(d) Eligibility determinations are
made by State or local staff of an
agency other than the agency
named in paragraph 1.1(a).
ATTACHMENT 1.2-D contains a
description of the staff designated
to make such determinations and
the functions they will perform.
Not applicable. Only staff of
the agency named in paragraph
1.1(a) make such determinations.
DMMA EXEMPT REGULATION #05-58c
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
STATE OF DELAWARE
Attachment 1.2-A
Organization and Function of the State Agency
The Department Of Delaware Health and Social Services (DHSS) is the single State agency for the administration of Medicaid. The Medical Assistance Unit Division of Medicaid & Medical Assistance (DMMA) within the Division of Social Services (DSS) DHSS has direct responsibility for administering the Medicaid program.
The Director of DSS DMMA reports to the Secretary of DHSS. The Director of the Medical Assistance Program, who is also the Deputy Director of DSS, reports to the Director of DSS.
DMMA EXEMPT REGULATION #05-58d
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
STATE OF DELAWARE
Attachment 1.2-B
Organization and Function of the Medical Assistance Unit
The Medical Assistance Unit Division of Medicaid & Medical Assistance (DMMA) is a separate unit Division under the Director of the Division of Social Services Secretary of Department of Delaware Health and Social Services.
The unit DMMA consists of management, professional, technical, clerical and medical personnel, and includes a Medicaid Director, program administrators, and support personnel. The Unit DMMA has responsibility for all Medicaid services in the State.
Medicaid claims processing is contracted out to a Fiscal Agent. There are Medicaid Eligibility Determination Units in each of the counties of the State, which carry out functions related to long-term care and non-grant medical assistance.
DMMA EXEMPT REGULATION #05-58e
STATE PLAN UNDER TITLE XIX OF THE SOCIAL SECURITY ACT
STATE OF DELAWARE
Attachment 1.2-D
Description of Staff Designated to Make Eligibility Determinations
The Division of Medicaid & Medical Assistance (DMMA) is responsible for managing Medicaid as well as the other medical assistance programs. Program and policy development for Medicaid, the Delaware Healthy Children Program (DHCP), the Delaware Prescription Assistance Program (DPAP), the Non-Citizen Health care Program, and the Chronic Renal Disease Program (CRDP) resides in DMMA. Responsibility for medical and financial eligibility for Medicaid Long Term Care (LTC) programs resides in DMMA.
Responsibility for Medicaid eligibility associated with Temporary Assistance for Needy Families (TANF) and other poverty-related groups remains in DSS.
The Social Security Administration (SSA) is responsible for making eligibility determinations for Supplemental Security Income (SSI) for Aged, Blind or Disabled recipients. DMMA is responsible for issuing a Medicaid Identification Card to the SSI recipient. Medicaid eligibility information for SSI recipients is transmitted through the State Data Exchange (SDX) System.
