Delaware Regulations

The Delaware Health and Social Services (“Department”) / Division of Medicaid and Medical Assistance submitted proposal DE 3290 to amend Title XXI CHIP Plan regarding MHPAEA specifically, to align the Delaware CHIP Plan with new Federal Requirements. The purpose of the proposed regulation was to ensure that coverage provided to CHIP beneficiaries for mental health and substance use disorders was no more restrictive than coverage for medical/surgical conditions. The final order for 21 DE Reg. 805 was issued on April 4, 2018 via DE 3357.
The regulation covers how the state determines whether each covered benefit is a medical/surgical, mental health, or substance use disorder. It categorizes each benefit as inpatient, outpatient, emergency care, and a prescription drug. The regulation also lists the annual and aggregate lifetime dollar limits for benefits covered under the State child health plan. In addition it ensures that NQTLs comply with parity requirements and that information on medical necessity criteria and denials of payment or reimbursements are available. Attachments cover benefits by classification, NQTL analysis, and cost-sharing methodology.