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Delaware Children's Health Insurance Plans (DCHIP)

Medicaid & Medical Assistance Menu

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General Signatures and Introduction

State officials administering program
Introduction
Federal Requirements for Submission and Review of a Proposed SPA
Section description
Program Options
Medicaid Expansion- Medicaid SPA Requirements
Combination of Options

Section 1 - General Description and Purpose of the Children's Health Insurance Plans
and the Requirements

This section describes the program.

Program options
Assurances
Civil rights requirements
SPA effective and implementation dates

Section 2 - General Background and Description of State's Approach to Child Health
Coverage and Coordination

Provides general information related to the program including the extent and manner to which children in the state currently have creditable health coverage,
current state efforts to provide or obtain creditable health coverage for uninsured children and how the plan is designed to be coordinated with current health insurance,
public health efforts, or other enrollment initiatives.

2.1 Creditable coverage
2.2 Health Services Initiatives
2.3TC Tribal Consultation Requirements

Section 3 - Methods of Delivery and Utilization Controls

Describes the method of delivery including contracting standards; enrollee enrollment processes; enrollee notification and grievance processes; and plans for enrolling providers, among others.

3.1 Delivery Standards
3.1.1 Choice of Delivery System
3.1.2 Use of a Managed Care Delivery System for All or Some of the State's CHIP Populations
3.1.3 Nonemergency Medical Transportation PAHPs
3.2 General Managed Care Contract Provisions
3.3 Rate Development Standards and Medical Loss Ratio
3.4 Enrollment
3.5 Information Requirements for Enrollees and Potential Enrollees
3.6 Benefits and Services
3.7 Operations
3.8 Beneficiary Protections
3.9 Grievances and Appeals
3.10 Program Integrity
3.11 Sanctions
3.12 Quality Measurement and Improvement; External Quality Review

Section 4 - Eligibility Standards and Methodology

Describes the standards used to determine the eligibility of targeted low-income children for child health assistance under the plan.

4.0 Medicaid Expansion
4.1 Separate Program
4.1PW Pregnant Women Option
4.1LR Lawfully Residing Option
4.1DS Supplemental Dental
4.2 Assurances
4.3 Methodology
4.4 Eligibility screening and coordination with other health coverage programs

Section 5 - Outreach

Describes outreach activities.

5.1 Efforts to provide or obtain creditable health coverage
5.2EL Express Lane eligibility option
5.3 Strategies

Section 6 - Coverage Requirements for Children's Health Insurance

Describes the scope of coverage and benefits offered under the plan including the categories under which that coverage is offered.

6.1 Coverage options
6.2 Services covered
6.2DC Dental Coverage
6.2DS Supplemental Dental Coverage
6.2 MHPAEA
6.3 Assurances with respect to pre-existing medical conditions
6.4 Additional Purchase Options

Section 7 - Quality and Appropriateness of Care

Describes the methods (including monitoring) to be used to assure the quality and appropriateness of care and to assure access to covered services.

7.1 Quality and appropriateness of care
7.2 Methods used assure asses to care

Section 8 - Cost Sharing and Payment

Addresses the requirement of a State child health plan to include a description of its proposed cost sharing for enrollees.

8.1 Statement of cost-sharing imposed
8.2 Amount of cost-sharing
8.3 How the public will be notified of cost-sharing
8.4 Assurances with respect to cost-sharing
8.5 Description of procedures related to cost-sharing annual maximum
8.6 Description of procedures to ensure AI/AN children are excluded from cost sharing
8.7 Disenrollment protections
8.8 Expenditure limitations

Section 9 - Strategic Objectives and Performance Goals and Plan Administration

Addresses strategic objectives, the performance goals, and the performance measures the State has established for providing child health assistance to targeted low income children under the plan for maximizing health benefits coverage for other low income children and children generally in the state.

9.1 Strategic objectives
9.2 Performance goals
9.3 Performance measures
9.4 Annual Reports
9.5 Annual assessment and evaluation
9.6 Access to any records or information
9.7 Modify measures to meet national requirements
9.8 Comply with other provisions
9.9 Ensuring ongoing public involvement in program development
9.10 Provide a 1-year projected budget

Section 10 - Annual Reports and Evaluations

State assures compliance annual review and evaluation with requirements.

10.1 Annual Reports
10.2 Future reporting requirements
10.3 Comply with all applicable Federal laws and regulations
10.3DC Submit yearly the approved dental benefit package

Section 11 - Program Integrity

State assures services are provided in an effective and efficient manner through free and open competition or through basing rates on other public and private rates that are actuarially sound.

11.1 Procurement standards
11.2 Sanctions and penalties

Section 12 - Applicant and Enrollee Protections

Describes review process for eligibility and enrollment matters, health services matters (i.e., grievances), and for states that use premium assistance a description of how it will assure that applicants and enrollees are given the opportunity at initial enrollment and at each redetermination of eligibility to obtain health benefits coverage other than through that group health plan.