MEDICAID ACO APPLICATION FOR MCO CONTRACT PERIOD BEGINNING JANUARY 1, 2022

In 2020, the Division of Medicaid & Medical Assistance (DMMA), under the direction of DHSS, continued its work toward TCOC APMs by creating a Medicaid/Children's Health Insurance Program (CHIP) Accountable Care Organization Program (Medicaid ACO Program) for the purpose of improving health outcomes while reducing costs through VBP arrangements which include downside financial risk for participating ACOs.

ACOs are group arrangements in which health care practitioners (e.g., hospitals, physicians, other health care providers) agree to assume responsibility for the quality, outcomes, and cost of health care for a designated group of patients. Through VBP arrangements based on a TCOC calculation, ACOs are financially incentivized to coordinate patient care across care settings, address behavioral health and social needs and improve patient experience. DMMA seeks a Medicaid ACO Program with a strong foundation in supporting a robust primary care system within the State.

The Medicaid ACO Program allows qualified provider organizations to apply to become Medicaid ACOs and contract with Medicaid managed care organizations (MCOs) in a TCOC arrangement. In September 2020, DMMA authorized four health care provider groups to serve as Medicaid ACOs and additional organizations may apply for Medicaid ACO authorization on an annual basis. DMMA believes that by working together, Medicaid ACOs and MCOs can better coordinate care for Delaware's Medicaid and CHIP members, providing better health outcomes and lower costs.

2021 MEDICAID ACO CYCLE KEY EVENTS KEY DATES

The Medicaid ACO application period for participation in the Medicaid MCO contract period starting on January 1, 2022 will run from March 1, 2021 to April 23, 2021. Key dates in this application process are shown below:

ACO application released March 1, 2021
Questions on application due March 12, 2021 by 1:00 pm ET
Responses to questions Approximately March 26, 2021
ACO applications due April 23, 2021 by 1:00 pm ET
Approved ACOs announced/ACO authorization period commences By June 30, 2021
ACO/MCO contract start date January 1, 2022
ACO/MCO contract end date1 December 31, 2024
ACO authorization end date (if not renewed) December 31, 2024

Please submit your questions to ACO@delaware.gov

Click Here to Download the March 2021 ACO Application

Click Here to Download Appendix 1: Participating Primary Care Provider List Template of the March 2021 ACO

Medicaid Adult Dental Benefit

Update 10/12/2020

Several updates have been made to the Adult Dental Fee Schedule. These updates include coverage of D1206 (Topical Application of Fluoride Varnish) and D1208 (Topical Application of Fluoride-Excluding Fluoride Varnish). A provider may bill one or the other of these fluoride codes 1x every 12 months. Additionally, clarification was made to the note on D0120.

Senate Substitute 1 for Senate Bill 92, enacted in 2019, directs the Division of Medicaid and Medical Assistance (DMMA) to establish an adult dental benefit. Adult dental coverage is optional for state Medicaid programs, but most offer at least an emergency dental benefit. It has been a long-standing priority of DMMA to offer preventive and restorative dental treatment for our adult population to address negative health outcomes associated with the lack of oral health care. The benefit will enable Medicaid-enrolled adults to receive up to $1,000 of dental care per year. An additional $1,500 may be available for qualifying emergency or supplemental care when medically necessary.

Unfortunately, we will be unable to meet the April 1, 2020, implementation date included in the legislation. We are working closely with the Centers for Medicare and Medicaid Services, but estimate an additional six months will be needed to receive all the necessary federal approvals and complete the subsequent administrative tasks necessary to begin the program. The projected implementation date is now October 1, 2020. The full benefit will be available upon the implementation of the program.

We apologize for the inconvenience this will cause to our beneficiaries who are waiting for these critically needed services and assure you that we will continue to move forward as quickly and expeditiously as possible.

We want to express our appreciation for the continued support and collaboration of Governor Carney, Lt. Governor Hall-Long, members of the General Assembly, the Dental Society, and other stakeholders.

If you have questions you can reach us by emailing: MedicaidInfo@delaware.gov

Medicaid Adult Dental Services

Correction Posted 10/06/2020

An announcement posted on the State of Delaware/DHSS website announcing Medicaid's new adult benefit contained incorrect information regarding the age group for adult dental benefits.

This announcement indicated that beginning October 1, 2020 individual's age 19-65 who are enrolled in managed care would receive their adult dental services through their managed care organization. This information is incorrect.

The adult dental benefit begins at age 21 not 19 as described in this announcement. Adults age 19-20 will continue to receive their dental benefits through the FFS program.

There is no age limit on who can receive adult dental services. Adults over the age of 65 may receive adult dental services.