16 Del. Admin. Code § 80000-4.0

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

Section 80000-4.0 - Duties and Obligations

4.1 Each ACO seeking approval from DHSS shall demonstrate to the satisfaction of DHSS that:

4.1.1 The ACO has an organizational/governance structure that will have sufficient authority to ensure the delivery of high quality, cost-effective care to its attributed Medicaid/CHIP members, as determined by DHSS.

4.1.2 The ACO has demonstrated the capability to offer a comprehensive array of coordinated primary care services, specialty care services, and the ability to provide access, either directly or through affiliations/contractual relationships, to behavioral health, acute care, community and social support, long term care, and oral health providers, and other organizations as determined by DHSS or as required in the ACO Contract.

4.1.3 The ACO has a plan to support care coordination across the continuum of care, including services that address health-related social needs, within and outside the ACO.

4.1.4 The ACO has an electronic health records ("EHR") system in place and has the capability to exchange data with MMCOs and DHSS, and other designated entities such as the Delaware Health Information Network (DHIN).

4.1.5 The ACO has a plan in place to monitor, report, and improve patient health outcomes and quality.

4.1.6 The ACO attests that it will not limit beneficiary provider choice and access to providers that are outside the ACO.

4.1.7 Any additional requirements that DHSS determines necessary to meet the goals of improving health outcomes and patient experience, while reducing costs.

16 Del. Admin. Code § 80000-4.0

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