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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsOctober 2016

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Regulatory Flexibility Act Form

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42 CFR §440.169, Case management services, general provisions
42 CFR §441.18, Case management services, specific requirements
42 CFR §441.301(c)(1)(2)(3), Contents of a waiver request, Person-Centered Services
42 CFR §441.301(c)(4), Contents of a waiver request, Home and Community-Based Settings
42 CFR §447.205, Public notice of changes in statewide methods and standards for setting payment rates
§1902(a)(23) of the Social Security Act, Freedom of choice of qualified providers
§1903(c) of the Social Security Act, FFP for case management included in an individualized education program or individualized family service plan
§1915(c) of the Social Security Act, Home and community-based services
§1915(g)(1) of the Social Security Act, location and comparability of case management services
16 DE Admin. Code 2100 Division of Developmental Disabilities Services (DDDS) Eligibility Criteria
On July 25, 2000, the Center for Medicare and Medicaid Services (CMS) issued a State Medicaid Director Letter (SMDL) providing policy changes and clarification giving states more flexibility to serve people with disabilities in different settings. This SMDL provided clarification regarding the use of Case Management to assist states to overcome barriers to community transition. Case management services are defined under section 1915(g)(2) of the Social Security Act (the Act) as "services which will assist individuals, eligible under the plan, in gaining access to needed medical, social, educational, and other services." Case management services are often used to foster the transitioning of a person from institutional care to a more integrated setting or to help maintain a person in the community. There are several ways that case management services may be furnished under the Medicaid program. Home and Community-Based Services (HCBS) Case Management may be furnished as a service under the authority of section 1915(c) when this service is included in an approved HCBS waiver. Persons served under the waiver may receive case management services while they are still institutionalized, for up to 180 consecutive days prior to discharge. This case management service may be provided under the optional Targeted Case Management (TCM) authority of section 1915(g)(2) of the Social Security Act. TCM, defined in section 1915(g) of the Act, may be furnished as a service to institutionalized persons who are about to leave the institution, to facilitate the process of transition to community services and to enable the person to gain access to needed medical, social, educational and other services in the community. TCM may be furnished during the last 180 consecutive days of a Medicaid eligible person's institutional stay if provided for the purpose of community transition. States may specify a shorter time period or other conditions under which TCM may be provided.
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 establish coverage and reimbursement methodologies for targeted case management services for individuals with intellectual disabilities. Comments must be received by 4:30 p.m. on October 31, 2016.
1. Meet the eligibility requirements set forth in 16 DE Admin. Code 2100 Division of Developmental Disabilities Services (DDDS) Eligibility Criteria; and,
1. Meet the eligibility requirements set forth in 16 DE Admin. Code 2100 Division of Developmental Disabilities Services (DDDS) Eligibility Criteria; and,
Last Updated: December 31 1969 19:00:00.
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