Medicaid/Children's Health Insurance Program (CHIP)
Accountable Care Organization Program (Medicaid ACO Program)

!!! NEW !!!

Due to the ongoing COVID-19 response and related activities, DMMA is modifying the timeline and contracting requirements of the Medicaid ACO program for 2021 and subsequent years. In order to accommodate the extended Medicaid ACO application date of June 30, 2020 and provide sufficient time for ACO/MCO contract negotiations, DMMA is revising the Key Dates table in Section 3 of application and updating the contracting terms as follows:

Table 2: Key Dates

Key Dates for Medicaid ACOs Submitting Applications in 2020
ACO applications due	Tuesday, June 30, 2020 by 1:00pm ET
Approved ACOs announced/ACO authorization period commences	By September 30, 2020
ACO/MCO contract start date	July 1, 2021
ACO/MCO contract end date¹	December 31, 2024
ACO authorization end date (if not renewed	December 31, 2024

¹Subject to MCO continuing to have an MCO agreement with DMMA.

ACOs authorized in 2020 will be authorized for a period of four full calendar years (e.g., Medicaid ACOs authorized in 2020 will have authorization for calendar years 2021-2024).
Medicaid ACOs will be expected to enter into three and a half year total cost of care agreements beginning July 1, 2021 with Medicaid MCOs, provided that the MCO(s) maintain their MCO contracts with DMMA for the term of the agreement.
The two payment tracks described in Section 2.F are still applicable as described in the application; however, "Year 1" will now be the 18-month period of July 1, 2021 through December 31, 2022 to accommodate the later start of the Medicaid ACO program. Each ACO/MCO contract will have the option to use Track 1 or Track 2 for the entire 18-month period or divide the initial contracting period into a 6-month and 12-month period using an applicable Track for each period as mutually agreed to (e.g., Track 1 then Track 2, Track 1 for each period but with different total cost of care targets, Track 1 for entire period, etc.). DMMA is endeavoring to offer as much as flexibility as practical during the initial period.
Year 2, as noted in the payment tracks Section 2.F, will commence January 1, 2023 and each ACO/MCO agreement will be required to meet the requirements described in the application for Year 2 of the Medicaid ACO program.

Due to the ongoing COVID-19 response and related activities, DMMA is extending the due date for Medicaid ACO applications. Applications will now be due Tuesday, June 30, 2020 at 1:00pm ET. This due date may be extended further as circumstances require.

DMMA has added the Delaware Medicaid ACO Application Questions and Answers below.

A new opportunity available on our website. The Division of Medicaid & Medical Assistance (DMMA), under the direction of DHSS, has created 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 value based purchasing (VBP) arrangements which include downside financial risk for ACOs. The Medicaid ACO program is part of the strategies DMMA is pursuing to advance the adoption of participating Medicaid VBP models and total cost of care (TCOC) strategies. This Medicaid ACO Program builds off of the responses and information we received in response to a request for information on the design and development of Medicaid ACOs in Delaware.

The Medicaid ACO Program has been designed to allow qualified provider organizations to apply to become Medicaid ACOs and subsequently contract directly with our Medicaid managed care organizations (MCOs) in a TCOC payment arrangement. 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. We have implemented the program pursuant to section 80000 of Division of Social Services Manual (DSSM), Authorization and Regulation of Medicaid/CHIP Accountable Care Organizations. Under the statutory authority of 42 CFR 438.6(c)(i) and 29 Del.C. 7931, this regulation sets forth standards for the authorization and regulation of ACOs for Medicaid/CHIP beneficiaries in the State of Delaware.

We encourage you to review the application and if interested/meet requirements, submit a completed application following the instructions provided within the application. The application period will close at 1:00pm ET on April 24, 2020. Additional information on the opportunity and program is available within the application. We are excited to work with you to implement our Medicaid ACO program beginning with the calendar year 2021 MCO contract period.

ACO Application

DE ACO Application Appendix Participating Primary Care Provider Template

Delaware Medicaid ACO Application Questions and Answers

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.