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Delaware Takes on High Prescription Drug Costs by Leveraging Public Purchasers
/in Policy Delaware Blogs Administrative Actions, Cost, Payment, and Delivery Reform, Health System Costs, Medicaid Managed Care, Newly-Enacted Laws, Prescription Drug Pricing, State Rx Legislative Action /by Trish RileyDelaware’s state Legislature has established the Interagency Pharmaceuticals Purchasing Study Group to recommend steps to leverage bulk purchasing of drugs to effectively negotiate lower prices by using interagency and multistate purchasing contracts, and other approaches. The measure easily passed the House on a voice vote and unanimously passed the Senate.
The study group has an ambitious agenda and must report its findings and recommendations to Gov. John Carney Jr. and the state legislature by Dec. 31, 2109.
Health care spending in Delaware exceeds the national average and has historically outpaced inflation and the state’s economic growth. The bill’s authors wrote, “… a major cause of skyrocketing prescription drug prices is bargaining asymmetry, by which the pharmaceutical industry, often wielding monopoly power, is left unchecked, in the absence of a strong counter-party at the bargaining table.”
Lawmakers noted that, “establishing a single-purchaser for the highest-cost prescription drugs will move Delaware one step closer to a comprehensive solution for affordable and accessible health care for all.”
The study group will be co-chaired by a state representative appointed by the Speaker of the House and a state senator appointed by the senate’s President Pro Tempore. Two more lawmakers will be appointed to achieve bipartisan representation, and the following additional members or their designees will be appointed:
- Controller General
- Secretary, Department of Health and Social Services
- Director, Office of Management and Budget
- Commissioner, Department of Corrections
- Secretary, Department of Services for Children, Youth, and their Families
- Director, Division of Medicaid and Medical Assistance
- Director, Division of Public Health
- Secretary, Department of Human Resource
- Administrator, Delaware Veterans Home
- One member of the State Employee Benefits Committee
Delaware joins California and New Mexico and other states leading the way to leverage and combine their collective purchasing power to lower drug spending. The National Academy for State Health Policy will continue to report on their progress.
For more information about what states are doing to harness their purchasing power to curb health care costs, read: Cross-Agency Strategies to Curb Health Care Costs: Leveraging State Purchasing Power, April 2019.
Delaware
/in Policy Delaware /by NASHP StaffIn Delaware:
- As of July 1, 2011, there were 200,810 beneficiaries enrolled in the state’s Medicaid program, 161, 655 of whom were enrolled in a managed care program known as Diamond State Health Plan. (now known as Diamond State Partners).
- Physical, behavioral, and dental benefits are provided through two Medicaid-only managed care organizations.
- Severely disabled children who require a nursing home level of care but do not qualify for Medicaid due to their parents income can receive Medicaid services through the state’s Children’s Community Alternative Disability Program.
As of 2013, 111,655 individuals were eligible for Delaware’s Early Periodic Screening, Diagnostic and Treatment Benefit (EPSDT). According to 416 data from 2013, the state achieved an EPSDT screening ratio of 80% and a participant ratio of 60%. 48,665 children received dental services of any kind, with 46,197 receiving preventive dental services.
Last updated September 2014
| Medical Necessity |
According to Delaware’s Administrative Code, medical necessity means providing health care services or products that a prudent physician would provide to a patient for the purpose of diagnosing or treating an illness, injury, disease or its symptoms in a manner that is:
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| Initiatives to Improve Access |
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| Reporting & Data Collection |
Delaware’s Medicaid and CHIP Managed Care Quality Strategy details the state’s approach to quality measurement and reporting. The strategy requires managed care organizations (MCOs) to submit quarterly reports that include information on:
MCOs also report annually on a variety of HEDIS measures, including metrics pertaining to children:
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| Behavioral Health |
Delaware’s Medicaid program encourages managed care organizations (MCOs) to community providers of mental health and substance abuse services. Children through age 18 can receive 30 units of outpatient counseling services per year through their managed care plan; additional services are then provided through the state’s Department of Children Youth and Their Families.
As part of the state’s ABCD Screening Academy, Delaware Medicaid improved the delivery of child development services by promoting awareness of the importance of developmental screening among Medicaid MCOs, implementing the Parents Evaluation of Developmental Status (PEDS) developmental screening tool in all ABCD demonstration sites, and hosting an ABCD Stakeholder Forum to promote structured developmental screening throughout the state.
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| Support to Providers and Families |
Support to Providers
Delaware Medicaid publishes a regularly updated General Policy Manualand Practitioner Provider Specific Policy Manual containing information on the EPSDT program. The manuals include information on periodicity schedules, medical necessity, required services, and other guidelines.
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| Care Coordination |
Medicaid beneficiaries enrolled in the Diamond State Health Plan receive care coordination services that emphasize early intervention and continuity of care through partnerships with providers in the community.
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| Oral Health |
An overview of the state of children’s dental care in Delaware can be found in the report “Delaware Smiles: The Oral Health of Delaware’s Children,”published by the Division of Public Health.
Delaware Oral Health Coalition
In an effort to ensure that all people in Delaware can access affordable oral health services, the state established the Delaware Oral Health Coalition, of which the state Medicaid program is a member. Coalition stakeholders gather to discuss innovative actions that can be taken by the state, potential partnerships to influence change, and collaborative opportunities for service delivery, health promotion, and research.
Department of Public Health Dental Clinics
The Department of Public Health operates dental clinics that provide EPSDT dental screenings. If Medicaid eligible children require services that fall outside of the range of activities provided in these clinics, the Department of Public Health will arrange treatment referrals to private dentists and bills these referrals to the Delaware Medicaid Agency.
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Delaware – EPSDT
/in Policy Delaware /by NASHPUnder construction–NASHP is continuing to populate this resource so please check back!
If you have any resources about the Medicaid benefit for children and adolescents in your state that you would like to share, please email kmooney@nashp.org
Delaware
/in Policy Delaware /by NASHPNASHP’s Accountable Care Activity map is a work in progress; state activity pages will be launched in waves throughout Fall 2012.
At this time, we have no information on accountable care activity that meets the following criteria: (1) Medicaid or CHIP agency participation (not necessarily leadership); (2) explicitly intended to advance accountable or integrated care models; and (3) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
If you have information about accountable care activity in your state, please email skinsler@nashp.org.
Last updated: October 2012
Transitioning to Managed Care: Medicaid Managed Care in Mental Health
/in Policy Reports Chronic and Complex Populations /by NASHPThis report reflects the discussion of nine states participating in “Transitioning to Managed Care: Medicaid Managed Care in Mental Health.” The symposium was funded by the Henry J. Kaiser Family Foundation and the federal Health Care Financing Administration (HCFA).
| 1997.Jun_.kaiser.hcfa_.transitioning.managed.care_.medicaid.mental.health.pdf | 1.7 MB |
Delaware – Medical Homes
/in Policy Delaware /by NASHPWe have no information on medical home activity that meets the following criteria: (1) program implementation (or major expansion or improvement) in 2006 or later; (2) Medicaid or CHIP agency participation (not necessarily leadership); (3) explicitly intended to advance medical homes for Medicaid or CHIP participants; and (4) evidence of commitment, such as workgroups, legislation, executive orders, or dedicated staff.
Last Updated: April 2014
Delaware
/in Policy Delaware /by EBPHIT_AdminNo HIE Strategic Plan available yet.
Delaware
/in Policy Delaware /by NASHP StaffDelaware’s ABCD Screening Academy Project built on Delaware’s Early Childhood Comprehensive Systems (ECCS) plan to promote positive child physical and mental health. Per the ABCD Screening Academy formula, the Delaware team established a statewide stakeholder’s group, selected and piloted a screening tool within selected demonstration sites and promoted structured screening with managed care partners who serve the Medicaid population.
Specifically, the ABCD Screening Academy project in Delaware improved the delivery of child development services by:
- Promoting a heightened awareness of the importance of developmental screening among managed care companies which serve the Medicaid population.
- Implementing the use of the PEDS (Parents Evaluation of Developmental Status) as a developmental screening tool in all of the ABCD demonstration sites.
- Spreading the use of objective, validated screening tools as part of well child care by hosting an ABCD Stakeholder’s Forum dedicated to promoting structured developmental screening throughout the state.
- Sustaining ABCD activities through funding requests to replicate the ABCD Screening Academy initiative and a second grant proposal for Project LAUNCH, which proposing to use a statewide public health approach to promote universal screening by providers.
| Title | Description | Date Published |
Activity |
| Number of Infant Screenings by Pilot Site |
(Delaware ABCD Screening Academy Project) Table showing number of infant screenings by pilot site between January and June. | December 2008 | Gauging Success: Measurement and Evaluation |
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