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DE Dept of Labor Message 6.27.13

Delaware Office of Workers’ Compensation (OWC)
Health Care Payment System (HCPS)

Please do not respond to this ListServ e-mail. 
If you have any additional questions, feel free to call (302-761-8200) or e-mail
hcpaymentquestions@state.de.us ) the Delaware Office of Workers’ Compensation, Medical Component.

 

Governor Markell Signs HB175 into Law, Effective 6/27/13

House Bill 175 (see attached) includes an array of changes impacting Delaware workers’ compensation and some will take effect immediately with today’s signing by the Governor. These changes involve the Delaware Office of Workers’ Compensation (OWC) – Sections 2-4 of HB175, as well as the Department of Insurance (DOI) (Sections 1, 5,-8 of HB175). Section 9 of HB175 also continues the existence of the Workers’ Compensation Task Force. The second attachment is an electronic copy of the Workers’ Compensation Act booklet, revised to incorporate today’s changes to the Delaware Code.

Please note, this email only addresses the statute changes within the purview of OWC. Contact information for the Department of Insurance is available on their web page athttp://www.delawareinsurance.gov/contact.shtml.

Wherever regulation changes are required to add more specific details to the overall statutory revision, those changes must occur pursuant to the Administrative Procedures Act (APA). In the next few days, I will send out another detailed e-mail with a link to the proposed regulations, as soon as they are published and available to the public. In the following list, I itemize the changes to the HCPS statute by the sections identified in HB175 and note where regulation changes will apply, pursuant to the APA.

Section 2 of HB175 – Changes to 19 Del. C. §2322B – “Procedures and requirements for promulgation of health care payment system”

·   19 Del. C. §2322B(3)(i) – Pathology, laboratory, radiological services, and durable medical equipment fees will be reduced by 15% in the itemized fee schedule. “85% of 90% of the 75th percentile of actual charges” denotes the statistical methodology used to calculate the 15% reduction to the current fee schedule. 
        o  Per the Administrative Procedures Act, the regulation change process is moving forward.
·   19 Del. C. §2322B(3)(ii) – Medical codes currently itemized in the fee schedule as being paid at POC85, will be populated with fees based on Relative Value Units, wherever possible. 
        o  Per the Administrative Procedures Act, the regulation change process is moving forward.
·   19 Del. C. §2322B(3)(v) – All the January inflationary adjustments, including those items in this section, are frozen for two years and will not be recouped when the adjustments resume. Barring any further changes to the statute, the freeze will end with the January 31, 2016 fee schedule update. Only the medical codes will be updated to the current versions. 
        o  This freeze does not require a regulation change.
·   19 Del. C. §2322B(5) – Removes the 11/1/08 anchor date for fees not available in the HCPS. 
        o  This revision does not require a regulation change.
·   19 Del. C. §2322B(7) – Requires the HCAP to implement a cap on Anesthesia fees. 
        o  Per the Administrative Procedures Act, the regulation change process is moving forward.
·   19 Del. C. §2322B(8) – Hospital Fees 
        o  Removes the “Medical” inflationary adjustment based on the CPI-U, U.S. City Average. The intent is for hospitals to have the same inflationary adjustment as other providers. 
        o  All the January inflationary adjustments, including hospitals, are frozen for two years and will not be recouped when the adjustments resume. Barring any further changes to the statute, the freeze will end with the January 31, 2016 fee schedule update. 
        o  These revisions do not require regulation changes.
·   19 Del. C. §2322B(9) – 
        o  Directs the Health Care Advisory Panel (HCAP) to develop by January 1, 2014, a maximum allowable fee schedule for Ambulatory Surgery Centers (ASC) that will result in stable charges and be cost neutral with respect to medical costs. 
              •When the HCAP develops the new ASC fee schedule, that regulation change must adhere to the provisions of the Administrative Procedures Act. 
        o  All the January inflationary adjustments, including ASCs, are frozen for two years and will not be recouped when the adjustments resume. 
              •The inflationary freeze does not require a regulation change.
·   19 Del. C. §2322B(10)(a) – Removes the anchor date for medical codes and bundling. 
        o  The other fee schedule revisions require regulation changes, per the Administrative Procedures Act. This update to the itemized fee schedule will occur when those regulations become final.
·   19 Del. C. §2322B(10)(f) – Authorizes the HCAP to adopt and recommend the regulations for the DE Workers’ Compensation Health Care Payment System. This revision does not require a regulation change.
·   19 Del. C. §2322B(11) – Directs the HCAP to specifically limit drug screening absent pre-authorization and per-procedure reimbursements for drug testing. Per the Administrative Procedures Act, the regulation change process is moving forward.
·   19 Del. C. §2322B(12) – Directs the HCAP to develop a formulary and fee methodology for pharmacy services, prescription drugs and other pharmaceuticals that discounts AWP, bans repackaging fees, and adopts a preferred drug list. Per the Administrative Procedures Act, the regulation change process is moving forward.
·   19 Del. C. §2322B(14) – All the January inflationary adjustments to the DE Workers’ Compensation Health Care Payment System are frozen for two years and will not be recouped when the adjustments resume. Barry any further changes to the statute, the freeze will end with the January 31, 2016 fee schedule update. This revision does not require a regulation change.
 
Section 3 of HB175 – Changes to 19 Del. C. §2322E – “Development of Consistent Forms for Health Care Providers”
·   19 Del. C. §2322E(d) – Changes the trigger for completion of the “Employer’s Modified Duty Availability Report” to “within 14 days of the issuance of an Agreement As To Compensation to an employee for any period of total disability.” The insurance carrier is responsible for sending the report to the employer for completion and is “independently responsible” for distributing the report to the health care provider/physician most responsible for the injured workers’ care. Per the Administrative Procedures Act, the regulation change process is moving forward.
 
Section 4 of HB175 – Changes to 19 Del. C. §2361 – “Limitation Periods for Claims”
·   19 Del. C. §2361(c) – Adds the 45 day Utilization Review determination appeal deadline into the statute. The UR appeal deadline was just in the regulations until a recent Superior Court appeal decision did not uphold the regulation. This addition gives the 45 day UR appeal deadline statutory authority and does not require a regulation change.
 

These statutory changes stemming from HB175 are the only ones that fall within the purview of the Delaware Department of Labor, Office of Workers’ Compensation. Please review the attached House Bill 175 (or review it with your attorney) and make the appropriate adjustments. Stay tuned for the next ListServ e-mail, which will give you more detail on the regulation changes.

Please call (302-761-8200) or e-mail hcpaymentquestion@state.de.us, if you have questions concerning this message.

Sincerely,

Donna Forrest
Medical Component Manager, Delaware Office of Workers’ Compensation
4425 N. Market St., 3rd Floor, Wilmington, DE 19802
Phone: 302-761-8200 Fax: 302-761-6601 hcpaymentquestions@state.de.us
HCPS web page: http://dowc.ingenix.com/DWC.asp   nbsp;OWC Facebook Page: http://www.facebook.com/#!/DelawareOWC

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