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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsNovember 2015

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Section 1905(r) of the Social Security Act, Early and Periodic Screening, Diagnostic, and Treatment Services
42 CFR §441 Subpart B, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) of Individuals under Age 21
42 CFR §440.60, Medical or other remedial care provided by licensed practitioners
42 CFR §440.130, Diagnostic, screening, preventive, and rehabilitative services
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
State Medicaid Manual, Section 5010, Early and Periodic Screening, Diagnostic, and Treatment Services
The purpose of this notice is to clarify service descriptions, reimbursement methodologies, and provider qualifications for rehabilitative mental health services under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) State Plan and to request comments from the public.
The proposed Medicaid Rehabilitative Mental Health Services SPA clarifies coverage for outpatient and residential mental health services for children under the Medicaid program including care by unlicensed practitioners and Evidence-Based Practices (EBPs). If implemented as proposed, the coverage and reimbursement methodology plan amendments will accomplish the following, effective July 1, 2016:
In accordance with the federal public notice requirements established at Section 1902(a)(13)(A) of the Social Security Act and 42 CFR 447.205 and the state public notice requirements of Title 29, Chapter 101 of the Delaware Code, Delaware Health and Social Services (DHSS)/Division of Medicaid and Medical Assistance (DMMA) gives public notice and provides an open comment period for thirty (30) days to allow all stakeholders an opportunity to provide input to the methods and standards governing payment methodology for rehabilitative mental health services under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Comments must be received by 4:30 p.m. on December 1, 2015.
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2c 2d Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
4) 3) Medical Equipment and Supplies per 42 CFR 440.70
5) 4) Orthotics and Prosthetics
6) 5) Chiropractic Services
8) 6) Any other services as required by §6403 of OBRA ’89 as it amended §1902(a)(43), §1905(a)(4)(B) and added a new §1905(r) to the Act.
Page 2e Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.1 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.2 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.3 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
B. Individual supportive counseling, solution focused interventions, emotional and behavioral management, and problem behavior analysis with the individual, with the goal of assisting the individual with developing and implementing social, interpersonal, self care, daily living and independent living skills to restore stability, to support functional gains, and to adapt to community living.
Page 2e.4 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.5 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
2. Psychosocial Rehabilitation (PSR) Services are designed to assist the individual compensate for or eliminate functional deficits and interpersonal and/or environmental barriers associated with his or her mental illness. Activities included must be intended to achieve the identified goals or objectives as set forth in the individual’s individualized treatment plan. The intent of psychosocial rehabilitation is to restore the fullest possible integration of the individual as an active and productive member of his or her family, community, and/or culture with the least amount of ongoing professional intervention. These services provide the training and support necessary to ensure engagement and active participation of the youth in the treatment planning process and with the ongoing implementation and reinforcement of skills learned throughout the treatment process. The structured, scheduled activities provided by this service emphasize the opportunity for the youth to expand the skills and strategies necessary to move forward in meeting his or her personal life goals and to support his or her transition into adulthood. PSR is a face-to-face intervention with the individual present with all activities directly related to goals on the Medicaid individual’s rehabilitation treatment plan. Services may be provided individually or in a group setting. PSR contacts may occur in community or residential locations where the individual lives, works, attends school, and/or socializes. PSR components include:
Page 2e.6 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
3. Crisis Intervention (CI) services are provided to an individual who is experiencing a psychiatric crisis, designed to interrupt and/or ameliorate a crisis experience including a preliminary assessment, immediate crisis resolution and de-escalation, and referral and linkage to appropriate community services to avoid more restrictive levels of treatment. The goals of Crisis Intervention are symptom reduction, stabilization, and restoration to a previous level of functioning. All activities must occur within the context of a potential, or actual, or perceived psychiatric crisis.
Page 2e.7 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Activities include:
Page 2e.8 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
3. Crisis Intervention Services Continued
Page 2e.9 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
4. Family Peer Support Services (FPSS) are an array of formal and informal services and supports provided to families caring for/raising a child who is experiencing social, emotional, medical, developmental, substance use and/or behavioral challenges in their home, school, placement, and/or community. FPSS provide a structured, strength-based relationship between a Family Peer Advocate (FPA) and the parent/family member/caregiver for the benefit of the child/youth.
Page 2e.10 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Provider Qualifications: A Certified Peer is an individual who has self-identified as a beneficiary or survivor of mental health and/or substance use disorder (SUD) services, is at least 21 years of age, and meets the qualifications set by the state including specialized peer specialist training, certification and registration. The training provided/contracted by DHSS or its designee shall be focused on the principles and concepts of peer support and how it differs from clinical support.
Page 2e.11 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.12 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Supervisors must also be aware of and sensitive to the cultural needs of the population of focus and how to best meet those needs, and be capable of training staff regarding these issues.
Page 2e.13 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Treatment must:
Page 2e.14 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.15 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
5. Rehabilitative Residential Treatment Continued
Page 2e.16 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.17 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.18 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
Page 2e.19 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.20 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.21 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
7. Rehabilitative Services - 42 CFR 440.130(d) Continued
Page 2e.22 Addendum
4.b. Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Services Continued
REVISION: Attachment 4.19-B
STATE: DELAWARE
The fee development methodology will build fees considering each component of provider costs as outlined below. These reimbursement methodologies will produce rates sufficient to enlist enough providers so that services under the State Plan are available to beneficiaries at least to the extent that these services are available to the general population, as required by 42 CFR 447.204. These rates comply with the requirements of Section 1902(a)(3) of the Social Security Act and 42 CFR 447.200, regarding payments and are consistent with economy, efficiency, and quality of care. Provider enrollment and retention will be reviewed periodically to ensure that access to care and adequacy of payments are maintained. The Medicaid fee schedule will be equal to or less than the maximum allowable under the same Medicare rate, where there is a comparable Medicare rate. Room and board costs are not included in the Medicaid fee schedule.
Page 19.1 Addendum
STATE:DELAWARE
Last Updated: December 31 1969 19:00:00.
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