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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsNovember 2013

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Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance (DMMA) initiated proceedings to amend existing provisions in the Delaware Medical Assistance Program (DMAP) Manual specifically, the General Policy Provider Manual regarding Medicaid Provider Screening Requirements and Provider Enrollment Fee and Program Integrity. 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 2013 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by September 30, 2013 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
Patient Protection and Affordable Care Act (Pub. L. No. 111-148 as amended by the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152)), together known as the Affordable Care Act. Specifically, Section 6401, Provider Screening and Other Enrollment Requirements Under Medicare, Medicaid, and CHIP; and Section 6501, Termination of Provider Participation Under Medicaid If Terminated Under Medicare or Other State Plan
Section 6401 and Section 6501 of the Affordable Care Act mandate provider screening and enrollment requirements that State Medicaid agencies must implement. Please refer to 42 CFR 455 Subpart E – Provider Screening and Enrollment for the complete set of rules and regulations. Delaware Medicaid must implement these requirements to comply with Federal law.
Agency Response: DMMA appreciates your comment and has considered your recommendation. The change to proposed §1.39.2.5 to incorporate this limitation is indicated by bracketed, bold type on the final order regulation.
Agency Response: DMMA appreciates your comment and has considered your recommendation. The change to proposed §1.39.2.4 regarding exceptions to the requirement to terminate a provider is indicated by bracketed, bold type on the final order regulation.
THEREFORE, IT IS ORDERED, that the proposed regulation to amend the Delaware Medical Assistance Program (DMAP) Manual specifically, the General Policy Provider Manual regarding Medicaid Provider Screening Requirements and Provider Enrollment Fee and Program Integrity is adopted and shall be final effective November 10, 2013.
[Providers may appeal denial and termination decisions as a result of ACA provider screening and enrollment requirements. Denial and termination decisions following provider screening and enrollment procedures are appealable; however, the scope of the appeal is limited to whether the provider was terminated by Medicare or the initiating state Medicaid or CHIP program. The appeal does not provide an opportunity for the provider to contest the basis of the termination by Medicare or other state’s Medicaid or CHIP program.] Refer to Section 6.0 Appendix A in the General Policy Provider Manual for information regarding provider appeals.
Last Updated: December 31 1969 19:00:00.
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