DEPARTMENT OF HEALTH AND SOCIAL SERVICES
Statutory Authority: 31 Delaware Code, Ch. 5, Section 512 (31 Del.C. §512)
Title XXI Delaware Healthy Children State Program
In compliance with the State's Administrative Procedures Act (APA - Title 29, Chapter 101 of the Delaware Code), and with 42CFR §447.205, 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) is proposing to amend the Division of Social Services Manual related to the Delaware Prescription Assistance Program (DPAP).
Any person who wishes to make written suggestions, compilations of data, testimony, briefs or other written materials concerning the proposed new regulations must submit same to Sharon L. Summers, Policy and Program Development Unit, Division of Medicaid and Medical Assistance, 1901 North DuPont Highway, P.O. Box 906, New Castle, Delaware 19720-0906 or by fax to (302) 255-4454 by October 2, 2006.
The action concerning the determination of whether to adopt the proposed regulation will be based upon the results of Department and Division staff analysis and the consideration of the comments and written materials filed by other interested persons.
SUMMARY OF PROPOSED AMENDMENT
• Legal basis of the State Children’s Health Insurance Program (SCHIP): Title XXI of the Social Security Act
• The Code of Federal Regulations (CFR) specifically dealing with the SCHIP: Title 42, Part 457
• 16 Delaware Code, Section 9909
• House Bill #235, 143rd General Assembly (signed into State law on July 10, 2006)
The Balanced Budget Act of 1997, enacted on August 5, 1997, established the "State Children's Health Insurance Program" by adding a new Title XXI to the Social Security Act. The purpose of this program is to provide funds to States to enable them to initiate and expand the provision of child health assistance to uninsured, low-income children in an effective and efficient manner that is coordinated with other sources of health benefits coverage for children. Delaware's CHIP program called the Delaware Healthy Children Program (DHCP) is authorized under Title 19, Chapter 99, and Section 9905 of the Delaware Code.
Summary of Proposal
This amendment is needed to implement House Bill (HB) #235, 143rd General Assembly, which extends the Delaware Healthy Children Program to include dental health services for children enrolled in the program.
Dental services for this population will mirror Title XIX (Medicaid) EPSDT dental services in amount, duration and scope to help ensure continuity of care.
The proposed amendment to the state plan is subject to approval by the Centers for Medicare and Medicaid Services (CMS).
DMMA PROPOSED REGULATION #06-33
Title XXI Delaware Healthy Children Program
6.2. The state elects to provide the following forms of coverage to children: (Check all that apply.
If an item is checked, describe the coverage with respect to the amount, duration
and scope of services covered, as well as any exclusions or limitations).
(Section 2110(a)) (42 CFR 457.490)
The following services marked with an [X] are covered by the Delaware Healthy Children Program
either as part of a basic MCO benefit package when medically necessary or as a “wrap-around”
service - exceptions/limitations noted:
(Break In Continuity of Sections)
6.2.12. [X] Durable medical equipment and other medically-related or remedial devices
(such as prosthetic devices, implants, eyeglasses, hearing aids, dental
devices, and adaptive devices) (Section 2110(a)(12))
dental devices are not provided as part of the basic benefit or wrap-around services
dental devices are provided as “wrap-around” services with the same
limitations as the Title XIX EPSDT dental program.
(Break In Continuity of Sections)
6.2.17. [X] Dental services (Section 2110(a)(17)) – included as “wrap-around” services
with the same limitations as the Title XIX EPSDT dental program.
10 DE Reg. 444 (09/01/06) (Prop.)