16 Del. Admin. Code § 13000-13520

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

Section 13000-13520 - State Office Administrative Staff

The State Office Administrative Staff is responsible for ongoing program and policy issues to assure that the Medicaid program meets Federal and State rules and regulations. These responsibilities include:

A. developing and maintaining policy and procedure manuals for eligibility staff, medical providers, and administrative staff,

B. developing the annual Medicaid budget and tracking expenditures,

C. developing contracts with, and enrolling, medical providers,

D. determining appropriate service coverage issues,

E. researching, evaluating and reporting on fiscal and operational impacts of proposed Federal and State program initiatives,

F. recommending and implementing fee structures,

G. monitoring fiscal agent activities,

H. auditing and performing utilization reviews of medical providers including imposing provider sanctions

I. monitoring the liability of other health insurance plans to pay for medical costs incurred by Medicaid recipients and recovering funds from these plans and the administration of a long term care estate recovery program,

J. planning and implementing new programs,

K. contracting with, and overseeing, other State and private agencies for auditing and monitory various facets of the Medicaid program as required by Federal law.

Distinct units within the State Office include:

A. the Administrative Support Unit which oversees:

1. the Surveillance and Utilization Review Unit (SUR)

2. the Budget/Data Management Unit (BDMU)

B. the Third Party Liability Unit (TPL)

C. the Claims Resolution and Medical Policy Unit

D. the Program Implementation Unit (PIU)

E. the Managed Care Unit

16 Del. Admin. Code § 13000-13520