16 Del. Admin. Code § 80000-1.0

Current through Register Vol. 28, No. 7, January 1, 2025

Section 80000-1.0 - Authority and Purpose

1.1 This regulation is promulgated pursuant to Section 7931(e) of Title 29, Delaware Code.

1.2 Pursuant to 42 CFR 438.6(c)(1), states may require a Medicaid Managed Care Organization (MMCO) to implement value-based purchasing (VBP) models for provider reimbursement and to participate in Medicaid-specific delivery system reform initiatives.

1.3 Pursuant to 29 Del.C. § 7931(c), the Division of Medicaid and Medical Assistance ("DMMA"), which is under the direction and control of the Secretary of the Department of Health and Social Services ("DHSS"), is responsible for the performance of all of the powers, duties, and functions specifically related to Medicaid. This includes regulation and administration of MMCO activity, such as contracting with Accountable Care Organizations (ACOs).

1.4 The purpose of these regulations is to set forth standards for the authorization and regulation of ACOs for Medicaid/CHIP beneficiaries in the State of Delaware to improve health outcomes while reducing costs through VBP arrangements which include downside financial risk for participating ACOs.

16 Del. Admin. Code § 80000-1.0

23 DE Reg. 659( 2/1/2020) (final)