DE SCR156

Division of Medicaid and Medical Assistance (DMMA) requested to study and report on home care services for calendar years 2020-2023, with report due by March 31, 2025.

Report must analyze specific home care HCPCS codes including private duty nursing codes (S9123, S9124, G0299, G0300) and long-term services and supports codes (G0156, S5130, S5125, S5150, T1005) along with corresponding reimbursement rates.

Study must provide state and county-level data broken down by individual Managed Care Organizations (MCOs), including unduplicated recipients by age, claim values, authorized versus billed service units, and provider-specific volume metrics.

Report must track processing timelines including average and median days from beneficiary application to eligibility determination and from service approval to plan of care development and service start.

DMMA required to contract with a vendor to conduct the study and must publicly post the completed report upon completion.