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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsNovember 2017

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Delaware Health and Social Services ("Department") / Division of Medicaid and Medical Assistance initiated proceedings to amend Title XIX Medicaid State Plan regarding Inpatient Psychiatric Hospital Services for Individuals under Age 21, specifically, to clarify reimbursement methodology for psychiatric residential treatment facilities (PRTFs). 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 2017 Delaware Register of Regulations, requiring written materials and suggestions from the public concerning the proposed regulations to be produced by October 2, 2017 at which time the Department would receive information, factual evidence and public comment to the said proposed changes to the regulations.
Section 1905(r) of the Social Security Act, Early and Periodic Screening, Diagnostic, and Treatment Services
Section 1905(a)(16), Inpatient Psychiatric Hospital Services for Individuals under Age 21
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
This benefit, Inpatient Psychiatric Hospital Services for Individuals under Age 21, hereinafter referred to as "Psych under 21," is a service most states have chosen to provide as an optional benefit. Services are provided in psychiatric hospitals or psychiatric units in a hospital, or psychiatric facilities for which states may define accreditation requirements, subject to requirements at 42 CFR 441 Subpart D. Among the requirements for this service is certification of need for inpatient care, and a plan of care for active treatment, developed by an interdisciplinary team.
First, both commenters offered grammatical suggestions.
Agency Response: DMMA has revised the policy to include the suggested changes.
Second, both commenters referenced that the deletion of the "add on" for "activities in the plan of care but not in the per diem" is not revenue neutral. And if new third bullet only applied to out-of-state facilities, the deletion creates a lower reimbursement methodology for out-of-state facilities versus in-state facilities. The suggestion was made to amend the new third bullet to authorize an "add on" for "activities in the plan of care but not in the per diem".
Agency Response: DMMA appreciates the comment and agrees with the commenters. The third bullet was revised to include the "add on" for "activities in the plan of care but not in the per diem".
THEREFORE, IT IS ORDERED, that the proposed regulation to amend Title XIX Medicaid State Plan regarding Inpatient Psychiatric Hospital Services for Individuals under Age 21, specifically, to clarify reimbursement methodology for psychiatric residential treatment facilities (PRTFs), is adopted and shall be final effective November 11, 2017.
FINAL ATTACHMENT 4.9-A.3
State: DELAWARE
1. Psychiatric Residential Treatment Facility (PRTF) Reimbursement
The [facilities facility’s] usual and customary charge to privately insured or private-pay beneficiaries; or
[If an out of state facility, Tt]he lesser of a negotiated per diem reimbursement rate, the [facilities facility’s] usual and customary charge, or the Delaware Medicaid per diem rate. [For plan of care activities not included in the per diem, additional fee-for-service reimbursement using the Delaware Medicaid fee schedule is available.]
Last Updated: December 31 1969 19:00:00.
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