DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Division of Medicaid and Medical Assistance

Statutory Authority: 31 Delaware Code, Ch. 5, Section 512 (31 Del.C. §512)

FINAL

REGULATORY IMPLEMENTING ORDER

BEFORE DELAWARE HEALTH AND SOCIAL SERVICES

In The Matter Of:

Revision of the Regulation of Delaware's Title XXI Delaware Healthy Children Program State Plan 6.2.12 and 6.2.17

Nature of the Proceedings:

Delaware Health and Social Services (“Department”) / Division of Medicaid & Medical Assistance (DMMA) initiated proceedings to amend the Title XXI Delaware Healthy Children Program (DHCP) State Plan as it relates to dental services. The Department’s proceedings to amend its regulations were initiated pursuant to 29 Delaware Code Section 10114 and its authority as prescribed by 31 Delaware Code Section 512.

The Department published its notice of proposed regulation changes pursuant to 29 Delaware Code Section 10115 in the September 2006 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by October 2, 2006 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.

SUMMARY OF PROPOSED AMENDMENT

Statutory Authority

• Legal basis of the State Children’s Health Insurance Program (SCHIP): Title XXI of the Social Security Act

• The Code of Federal Regulations (CFR) specifically dealing with the SCHIP: Title 42, Part 457

• 16 Delaware Code, Section 9909

• House Bill #235, 143rd General Assembly (signed into State law on July 10, 2006)

Background

The Balanced Budget Act of 1997, enacted on August 5, 1997, established the “State Children’s Health Insurance Program” by adding a new Title XXI to the Social Security Act. The purpose of this program is to provide funds to States to enable them to initiate and expand the provision of child health assistance to uninsured, low-income children in an effective and efficient manner that is coordinated with other sources of health benefits coverage for children. Delaware’s CHIP program called the Delaware Healthy Children Program (DHCP) is authorized under Title 19, Chapter 99, and Section 9905 of the Delaware Code.

Summary of Proposal

This amendment is needed to implement House Bill (HB) #235, 143rd General Assembly, which extends the Delaware Healthy Children Program to include dental health services for children enrolled in the program.

Dental services for this population will mirror Title XIX (Medicaid) EPSDT dental services in amount, duration and scope to help ensure continuity of care.

The proposed amendment to the state plan is subject to approval by the Centers for Medicare and Medicaid Services (CMS).

SUMMARY OF COMMENTS RECEIVED WITH AGENCY RESPONSE

The Governor’s Advisory Council for Exceptional Citizens (GACEC) and the State Council for Persons with Disabilities (SCPD) endorse the proposed regulation.

Agency Response: DMMA appreciates the endorsement.

Findings of Fact:

The Department finds that the proposed changes as set forth in the September 2006 Register of Regulations should be adopted.

THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Title XXI Delaware Healthy Children Program (DHCP) State Plan as it relates to dental services is adopted and shall be final effective November 10, 2006.

Vincent P. Meconi, Secretary, DHSS. 10/12/06

DMMA FINAL ORDER REGULATION #06-48

REVISIONS:

Title XXI Delaware Healthy Children Program

6.2. The state elects to provide the following forms of coverage to children: (Check all that apply.

If an item is checked, describe the coverage with respect to the amount, duration

and scope of services covered, as well as any exclusions or limitations).

(Section 2110(a)) (42 CFR 457.490)

The following services marked with an [X] are covered by the Delaware Healthy Children Program

either as part of a basic MCO benefit package when medically necessary or as a “wrap-around”

service - exceptions/limitations noted:

(Break In Continuity of Sections)

6.2.12. [X] Durable medical equipment and other medically-related or remedial devices

(such as prosthetic devices, implants, eyeglasses, hearing aids, dental

devices, and adaptive devices) (Section 2110(a)(12)) dental devices

are not provided as part of the basic benefit or wrap-around services

dental devices are provided as “wrap-around” services with the same

limitations as the Title XIX EPSDT dental program.

(Break In Continuity of Sections)

6.2.17. [X] Dental services (Section 2110(a)(17)) included as “wrap-around” services

with the same limitations as the Title XIX EPSDT dental program.

10 DE Reg. 865 11-01-06