Medicaid State Plan Amendments

This plan amendment updates the Physician Supplemental Payment Methodology

This SPA updates language on the Delaware excluded drug coverage pages to reflect coverage of selective medications by referencing the state’s webpage and policy handbook resources instead of listing specific covered medications. Additionally, the SPA amends the Title XIX Medicaid State Plan regarding physician administered drug reimbursement rates.

Provides per diem increase of $10.00 for all nursing facilities.

Payment for Services: Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF-IID) Payment Changes

The State provides for coverage of a maximum of twelve reserve bed days for the first six calendar months and 12 days for the second six calendar months of the year for recipient residents of Title XIX nursing facilities for the purpose of therapeutic home visits. The absence must be specifically provided for in the patient's plan of care and physician prescribed.

One-time supplemental payment in the amount of $1.2M to privately-owned CDR hospitals with Medicaid inpatient utilization exceeding 50%. Only one hospital qualifies for this payment.

The Supplemental Payment to Further Support Acute Hospital Financial Stability and Prevent Possible Impacts to Acute Hospital Service Provision and Access will provide further support to hospitals that are at risk of closure or reduction of services due to financial needs.

The purpose of this SPA is to amend the standards for payment and reimbursement for nursing facilities in order to implement the patient driven payment model for case-mix classification and mandate use of the optional state assessment item set.

This SPA clarifies language regarding prior authority requirements and maximum benefits for skilled maintenance therapy.

This amendment proposes to cover the Chronic Disease Self-Management Program (CDSMP) for Arthritis for dates of service on or after October 1, 2023.