DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Division of Social Services

Statutory Authority: 31 Delaware Code, Section 512 (31 Del.C. §512)

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:

• 42 CFR §431.11, Organization for Administration

• 29 Del.C. §10111, Organization regulations; rules of procedure

• 29 Del.C. §10113, Adoption of Regulations; exemptions

Amending the Following Title XIX Medicaid State Plan Pages:

• Pages 2 and 7;

• Attachment 1.2-A and Attachment 1.2-A, Page 1;

• Attachment 1.2-B and Attachment 1.2-B, Page 1;

• Attachment 1.2-C; and,

• Attachment 1.2-D (new page).

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.

x 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.

9 DE Reg. 802 (11/01/05) (Final)