A Local Earthquake Heralds Changes to the Delaware Work Comp Health Care Payment System

A Local Earthquake Heralds Changes to the Delaware Work Comp Health Care Payment System

Okay so where were you when you heard the news? Or felt the rumble?  The advisory below from the Department of Labor arrived amidst a local earthquake.  While this is not an oddity in some states, here in the First State we like to think we are standing firm upon the rock [Psalm 40:2] and that a shake and shimmy of a building is not to be expected.

As for me-- I was with my sister-in-law Nancy, and respected colleagues Dennis Menton and Paula Witherow.  I did think the Rapture had come and I was being carried home.  Had that been the case, at least I would have gone with the "A" team.  I guess God was just teasing me.....or as Kris Starr states on his current Facebook post, this was "a Jesus dress rehearsal".

So back to the latest from the Department of Labor:

Effective August 17, 2011 – Changes to DE Workers’ Compensation Health Care Payment System

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.

Effective August 17, 2011, the Governor signed SB108 into law.  This statutory change impacts out-of-state provider fees – 19 Del.C. §2322B(6),  and employer forms – 19 Del.C. §2322E(d).

EMPLOYER FORMS:

Prior to 8/17/2011, the statute required employers to complete the “Employer’s Modified Duty Availability Report” (a.k.a. the “Employer’s Form”) within “14 days of receiving a notice of injury.”

Now, employer’s complete their form within 14 days of receiving the “Physician’s Report of Workers’ Compensation Injury” (a.k.a. the “Physician’s Form”).  This change allows employers to know the injured worker’s physical limitations before identifying available modified duty positions that could more quickly return the employee to work.  Employer’s who regularly use this form report significant reductions in an injured workers time away from work.

       – Pursuant to 19 Del.C. §2322E(d),

“(d)  Within 14 days of receiving the initial ‘Physician’s Report of Workers’ Compensation Injury’, the employer shall provide to the health care provider/physician who issued the aforementioned report and to the employer’s insurance carrier, if applicable, a report of the modified-duty jobs which may be available to the employee.  The health care provider portion of the employer’s modified duty availability report must be signed and returned by the health care provider within 14 days of the next date of service after receipt of the form from the employer, but not later than 21 days from the health care provider’s receipt of such form.”

Employers may find the new forms on the Department of Labor web site at http://dowc.ingenix.com/info.asp?page=forms

OUT-OF-STATE PROVIDER FEES:

Prior to 8/17/2011, no provision existed to coordinate fees for out-of-state health care providers, who also treated patients in Delaware.

Now, Health care providers, who are licensed or permitted to render such procedure, treatment or service within the State of Delaware, but perform such procedure, treatment or service outside of the State of Delaware, shall be reimbursed based on the amount set forth in the Delaware Workers’ Compensation Health Care Payment System.

       – Pursuant to 19 Del.C. §2322B(6),

“(6)  The health care payment system shall include provisions for health care treatment and procedures performed outside of the State of Delaware.  If any procedure, treatment or service is rendered by a health care provider, hospital or Ambulatory Surgery Center, who is licensed or permitted to render such procedure, treatment or service within the State of Delaware, but performs such procedure, treatment or service outside of the State of Delaware, the amount of reimbursement shall be the amount as set forth in the health care payment system.  In the event that a procedure, treatment or service is rendered outside the State of Delaware by a health care provider, hospital or Ambulatory Surgery Center, not licensed or permitted to render such procedure, treatment or service within the State of Delaware, the amount of reimbursement shall be the greater of:

a.  The amount set forth in the workers’ compensation health care payment system or a fee schedule adopted by the state in which the procedure, treatment or service is rendered, if such a schedule has been adopted; or

b.  The amount that would be authorized by the payment system adopted pursuant to this chapter if the service or treatment were performed in the geozip where the injury occurred or where the employee was principally assigned.   Charges for a procedure, treatment or service outside the State of Delaware shall be subject to the instructions, treatment guidelines, and payment guides and policies in the health care payment system.”

 Again, please feel free to e-mail (hcpaymentquestions@state.de.us) or call (302-761-8200) the Office of Workers’ Compensation, Medical Component, if you have any additional questions.

Thanks to Donna Forrest at the DOL for this update!

Irreverently yours,
Cassandra Roberts

Delaware Detour & Frolic   Visit Delaware Detour & Frolic, a law blog by Cassandra Roberts

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Nutella Grace and Jocelyn
Nutella Grace and daughter Jocelyn survive the earthquake at home.......