DEPARTMENT OF HEALTH AND SOCIAL SERVICES

Division of Medicaid and Medical Assistance

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

NOTICE

Delaware Diamond State Health Plan

1115 Demonstration Waiver Extension Request

In compliance with federal public notice requirements of 42 U.S.C. §1315(d) and 42 CFR Part 431, Subpart G, as well as the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code), and under the authority of Title 31 of the Delaware Code, Chapter 5, Section 512, Delaware Health and Social Services (DHSS) / Division of Medicaid and Medical Assistance (DMMA) gives notice of its intent to file an application with the Centers for Medicare and Medicaid Services (CMS) to request an 18-month extension of the Diamond State Health Plan (DSHP) 1115 Demonstration Waiver, which is currently approved through December 31, 2018. The requested extension period is from January 1, 2019 through June 30, 2020. DHSS/DMMA is not requesting any changes to the DSHP 1115 Demonstration Waiver for the 18-month extension period.

Purpose

The purpose of this posting is to provide public notice and receive public input for consideration regarding Delaware's Diamond State Health Plan (DSHP) 1115 Waiver extension request.

DSHP 1115 Waiver Program Description, Goals and Objectives

Delaware's DSHP 1115 Demonstration Waiver was initially approved in 1995, and implemented on January 1, 1996. The original goal of DSHP 1115 Waiver was to improve the health status of low-income Delawareans by expanding access to healthcare to more individuals throughout the state; creating and maintaining a managed care delivery system with an emphasis on primary care; and controlling the growth of healthcare expenditures for the Medicaid population.

In order to achieve this goal, the DSHP 1115 Waiver was designed to mandatorily enroll eligible Medicaid recipients into managed care organizations (MCOs) and create efficiencies in the Medicaid program. Initial savings achieved under managed care enabled the expansion of coverage to certain individuals who would otherwise not be eligible for Medicaid, leading up to Medicaid expansion under the Affordable Care Act in 2014. Since 2012, the DSHP 1115 Waiver provides long-term services and support (LTSS) to eligible individuals through DSHP-Plus, as well as enhanced behavioral health services and supports for targeted Medicaid beneficiaries through a voluntary program begun in 2015 called Promoting Optimal Mental Health for Individuals through Supports and Empowerment (PROMISE). Most individuals enrolled in Medicaid and CHIP are enrolled in the DSHP 1115 Waiver and in MCOs. A limited number of benefits, such as children's dental and non-emergency transportation, are delivered through fee-for-service. PROMISE benefits are delivered through the fee-for-service PROMISE program administered through the Division of Substance Abuse and Mental Health (DSAMH). A complete description of the current DSHP 1115 Waiver is available at: http://dhss.delaware.gov/dhss/dmma/medicaid.html

Delaware's goal today in operating the DSHP 1115 Waiver demonstration is to improve the health status of low-income Delawareans by:

• Improving access to health care for the Medicaid population, including increasing options for those who need long-term care (LTC) by expanding access to HCBS;

• Rebalancing Delaware's LTC system in favor of HCBS;

• Promoting early intervention for individuals with, or at-risk, for having, LTC needs;

• Increasing coordination of care and supports;

• Expanding consumer choices;

• Improving the quality of health services, including LTC services, delivered to all Delawareans;

• Creating a payment structure that provides incentives for resources to shift from institutions to community-based LTSS services where appropriate;

• Improving coordination and integration of Medicare and Medicaid benefits for full-benefit dual eligibles;

• Expanding coverage to additional low-income Delawareans; and

• Improving overall health status and quality of life of individuals enrolled in PROMISE.

Delaware will continue working towards this goal to improve the health status of low-income Delawareans during the DSHP 1115 Waiver extension. Delaware is not proposing any changes to the DSHP 1115 Waiver eligibility, benefits, delivery system, cost-sharing, hypotheses, evaluation parameters, or waiver and expenditure authorities during the extension period. Delaware is requesting continuation of the existing DSHP 1115 Waiver special terms and conditions for the extension period. The extension period will permit DHSS/DMMA to plan and prepare a comprehensive application for a five-year renewal of the 1115 Waiver in a manner that reflects Delaware's vision for Medicaid and CHIP in 2020.

Public Comment Submission Process

As required by 42 CFR Part 431, Subpart G, DHSS/DMMA must provide opportunity for public comment on the DSHP 1115 Waiver extension request. Per Del. Code, Title 29, Ch. 101 §10118(a), the opportunity for public comment shall be held open for a minimum of 30 days after the proposal is published in the Register of Regulations.

The public is invited to review and comment on the proposed DSHP 1115 Waiver extension. Comments must be received by 4:30 p.m. on December 1, 2017. Comments may be submitted in the following ways:

This public notice is posted on the DHSS/DMMA website at: http://dhss.delaware.gov/dhss/dmma/medicaid.html

Comments and input may be submitted in the following ways:

By email: Nicole.M.Cunningham@state.de.us

By fax: 302-255-4413 to the attention of Nicole Cunningham

By mail: Nicole Cunningham

Division of Medicaid and Medical Assistance

Planning, Policy & Quality Unit

1901 North DuPont Highway

P.O. Box 906

New Castle, Delaware 19720-0906

Hardcopies of the public notice may also be obtained by contacting Nicole Cunningham at the address above.

Any public feedback received will be summarized including any changes that will be made as a result of the public comment to the proposed 1115 DSHP Waiver Extension that will be submitted to CMS.

Stephen M. Groff 10/6/17

Director

Division of Medicaid and Medical Assistance

21 DE Reg. 444 (11/01/17) (Gen. Notice)