Medicaid Benefits: Online Database

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Acute Care Services

Institutional and Clinic Services

Practitioner Services

Prescription Drugs

Physical Therapy and Other Services

Products and Devices

Transportation Services

Other Services

Long-Term Care Services

Community Based Care

Institutional Care

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Benefits by State: Delaware (October 2008) Notes

Acute Care Services

Is the Benefit Covered?	Copayment Requirement	Prior Approval Requirement	Coverage Limitations	Reimbursement Methodology	Populations Covered

Institutional and Clinic Services
Clinic Services, by an organized facility or clinic not part of a hospital: Freestanding Ambulatory Surgery Center
Yes				Prospective cost based rate per episode of care using Medicare payment rates as ceiling	CN
Clinic Services, by an organized facility or clinic not part of a hospital: Public Health and Mental Health Clinics
Yes			20 outpatient treatment days/year plus 3 days available for each unused inpatient psychiatric treatment day not used for residential treatment, all Mental Health clinics must be state-approved	Fee for service or negotiated rate	CN
Federally Qualified Health Center Services
Yes				Cost based payment, ancillary services paid fee for service	CN
Inpatient Hospital Services, other than in an Institution for Mental Diseases
Yes			30 inpatient psychiatric treatment days/year	Prospective payment/discharge or prospective per diem for psych, rehab and other special hospitals/units	CN
Outpatient Hospital Services
Yes				Cost based payment	CN
Rehabilitation Services: Mental Health and Substance Abuse
Yes			30 residential treatment days/year plus 2 days available for each unused inpatient psychiatric treatment day not used for outpatient treatment, approved treatment includes minimum of 1 hour/week face-to-face clinical contact	Fee for service or prospective cost based rate	CN
Rural Health Clinic Services
Yes				Cost based payment, ancillary services paid fee for service	CN
Practitioner Services
Certified Registered Nurse Anesthetist Services
Yes			Direct reimbursement limited to services provided without physician supervision	Fee for Service	CN
Chiropractor Services
No
Dental Services
No
Medical and Remedial Care - Other Practitioners

Medical/Surgical Services of a Dentist
Yes			Limited to extraction of bony impacted wisdom teeth	Fee for service	CN
Nurse Midwife Services
Yes				Fee for service	CN
Nurse Practitioner Services
Yes				Fee for service	CN
Optometrist Services
Yes			Limited to diagnosis and treatment of medical eye problems as permitted by law	Fee for service	CN
Physician Services
Yes				Fee for service	CN
Podiatrist Services
Yes			Diagnostic and surgical procedures only, except routine foot care covered only for specified systemic conditions	Fee for service	CN
Psychologist Services
Yes			20 outpatient visits/year included in limit with other mental health providers	Fee for Service	CN
Prescription Drugs
Prescription Drugs
Yes	$.50-$3/Rx depending on drug cost, up to $15/month		Rx must be generic unless DAW	AWP-14% by retail pharmacies, AWP-16% by non-traditional pharmacies, plus $3.65 dispensing fee for each	CN
Physical Therapy and Other Services
Occupational Therapy Services
Yes				Fee for service	CN
Physical Therapy Services
Yes				Fee for service	CN
Services for Speech, Hearing and Language Disorders
Yes				Fee for service	CN
Products and Devices
Dentures
No
Eyeglasses
Yes		Yes	Limited to aphakic or bandage lenses following cataract surgery	Fee for service	CN
Hearing Aids
No
Medical Equipment and Supplies
Yes				Fee for service, using Medicare payment ceilings when available	CN
Prosthetic and Orthotic Devices
Yes				Fee for service	CN
Transportation Services
Ambulance Services
Yes				Fee for service, additional payment for more than 10 miles	CN
Non-Emergency Medical Transportation Services
Yes	$1/trip			See service-specific FN	CN
Other Services
Diagnostic, Screening and Preventive Services
No
Early and Periodic Screening, Diagnosis and Treatment
See service-specific FN.
Extended Services for Pregnant Women

Family Planning Services
See service-specific FN.
Laboratory and X-Ray Services, outside Hospital or Clinic
Yes				Fee for service	CN
Targeted Case Management
No

Long-Term Care Services


Community Based Care
Home and Community Based Services Waiver
Yes		Services for the following populations: 1, 2, 4, 5 & 8 - See service-specific FN	Dependent upon the services provided	CN
Home Health Services, includes nursing services, home health aides, and medical supplies/equipment
Yes			Fee for service	CN
Hospice Care
Yes			Prospective rates based on Medicare methodology	CN
Personal Care Services
No
Private Duty Nursing Services
Yes	Yes	28 hours/week	Fee for service with capped payment/week	CN
Program of All-Inclusive Care for the Elderly
No
Institutional Care
Inpatient Hospital, Nursing Facility and Intermediate Care Facility Services In Institutions for Mental Diseases, age 65 and older
Yes		18 therapeutic leave days/year	Prospective cost based per diem	CN
Inpatient Psychiatric Services, under age 21
Yes			Prospective cost based per diem	CN
Intermediate Care Facility Services for the Mentally Retarded
Yes		7 hosp leave days/month, 18 therapeutic leave days/year	Prospective cost based per diem with limits	CN
Nursing Facility Services, other than in an Institution for Mental Diseases
Yes		7 hosp leave days/month, 18 therapeutic leave days/year	Prospective per diem based on cost and acuity, up to Medicare limits	CN
Religious Non-Medical Health Care Institution and Practitioner Services
No

Notes: This State has an approved Section 1115 Waiver from CMS under which it extended Medicaid eligibility to additional low-income adults through savings achieved by implementing a managed care program called the Diamond State Health Plan. This statewide managed care program utilizes both a capitated plan and an enhanced fee for service plan, the latter administered by the State and called Diamond State Partners. Most Medicaid beneficiaries, including the expansion population of adults age 19 and older with income at or below 100 percent of the federal poverty level, are required to enroll in one of the two managed care plans. The expansion population is not entitled to coverage of any services until the effective date of such enrollment. In addition to services provided through the managed care plans, beneficiaries receive certain wrap-around services on a fee for service basis. The wrap-around services covered for the expansion population are generally the same as those available to the traditional Medicaid population. The tables reflect services available through both the managed care plans and as a wrap-around benefit. The capitated plan may also provide additional services for its members.