16 Del. Admin. Code § 70000-1

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

Section 70000-1 - Authority and Purpose

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

1.2 Pursuant to Section 1902(a)(4) of Title XIX of the Social Security Act (42 U.S.C. § 1396 a(4)) and 42 C.F.R. § 438.1et. seq., the states are authorized to administer Medicaid through Medicaid managed care organizations (each an "MMCO").

1.3 Pursuant to 42 C.F.R. § 438.116(a), an MMCO shall provide assurances satisfactory to the State showing that its provision against the risk of insolvency is adequate to ensure that its Medicaid enrollees will not be liable for its debts if the MMCO becomes insolvent.

1.4 Pursuant to 42 C.F.R. § 438.116(b)(1), in order to make the required showing under Section 438.116 (a), an MMCO must either meet state solvency requirements for a private health maintenance organization, or be licensed or certified by the State as a risk bearing entity.

1.5 Pursuant to18Del.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, which includes certification of MMCOs.

1.6 The purpose of these regulations is to set forth standards for the certification of MMCOs as risk bearing entities.

16 Del. Admin. Code § 70000-1

18 DE Reg. 693( 3/1/2015) (Final)