Love Without Borders: Delaware Law Eliminates Provider Certification Requirement for Out-of-state Treatment

Special thanks to Tara Bustard, Andy Carmine and Walt Schmittinger for bringing to my attention that House Bill 166 was signed into law on Monday.  This is the long-awaited legislative remedy to the issues acknowledged by Wyatt v. Rescare and Vanvliet v. D&B Transportation (see my posts of 11/21/13 “DE Supreme Court Clarifies Emergency Treatment Exception……” and 11/21/14 “The Turkey Gravy Post”)……also known as “a flaw in the statute.”

In a nutshell:

HB 166 will allow injured workers to obtain medical treatment from out-of-state (meaning not licensed in DE but licensed in another state), non-comp-certified health care providers and mandates that such treatment will be paid for by the workers’ compensation carrier without the provider certification requirement (19 Del. Code Section 2322D) and without pre-approval from the employer/carrier (as was previously required).  In order to participate, such non-work-comp certified providers must be subject to all others aspects of the current Health Care Payment System to include proper billing procedures, compliance with the Practice Guidelines and participation in the Utilization Review process.

Heretofore, non-work comp certified providers were not subject to Utilization Review nor were they able to compel payment for any treatment which was not pre-approved by workers’ compensation carrier.  This circumstance was particularly onerous for injured workers who had relocated from Delaware as there was no incentive for an out-of-state provider to become certified under the Delaware Workers’ Compensation Health Care System.  Under the new law, providers impacted will accept payment at the lesser of the usual and customary, the other state’s maximum reimbursement allowance, Delaware’s maximum reimbursement allowance, or a negotiated contract amount.

HB 166 also permits the Workers’ Compensation Oversight Panel to realize the 2016 and 20176 mandated medical costs savings in the Delaware Workers’ Compensation System through any component of the Health Care Payment System and not just the Fee Schedule.  The Panel is also now empowered to create regulations related to the use of electronic billing.

Bottom line—This bill eliminates the burden that was placed on injured workers seeking treatment from non-Delaware-comp certified physicians, a burden that was especially obvious in cases where the injured worker had relocated such a distance that in-Delaware treatment  was not an option.  That such providers will now be accountable as to their treatment by being subject to the Delaware Practice Guidelines and to the Utilization Review process will provide carriers seeking to challenge such treatment with some means of cost-containment as to such treatment.

Okay, is this the driest post I have written in ages or what?  Lacking my customary sharp wit, irreverent humor and acerbic sarcasm?  Makes my heart heavy to think of it.

Oh well…..on a lighter note I am told that the Porcelain Throne case I reported on yesterday has been appealed to the Superior Court. Seriously? So what—we can overturn the Personal Comfort Doctrine in the First State? So you can relieve yourself on company time…..but do so at your own risk?

Doesn’t that beat all?

Irreverently yours,

Cassandra Roberts