CHAPTER 143
FORMERLY
SENATE BILL NO. 160
AN ACT TO AMEND TITLE 19 OF THE DELAWARE CODE RELATING TO WORKERS' COMPENSATION.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE :
Section 1. AMEND Chapter 23, Title 19 of the Delaware Code by deleting paragraphs (1) and (2) of §2322B(h) in their entirety, and by substituting in lieu thereof the following:
“(1) Hospital fees billed for inpatient and outpatient services provided to injured workers pursuant to this chapter shall be reimbursed at a rate equal to eighty-five percent (85.0%) of each hospital’s actual charges for such services as of October 31, 2006, subject to adjustment as provided in this subsection. Verification that such billing is performed in compliance with this subsection shall be provided by each hospital to the Office of Workers’ Compensation within sixty (60) days of the completion and issuance of audited financial statements to the hospital by its independent financial auditors. Such verification shall be subject to further review or audit by the Department of Insurance. Reasonable costs of such review or audit for purposes of this section shall be reimbursed to the Department of Insurance by the hospital whose billing is audited.
(2) On the effective date of the regulation provided for in subsection (n) of this section, and each year thereafter, the Department of Labor shall make an automatic adjustment to each hospital’s reimbursement rates, as derived pursuant to paragraph (1) of this subsection, for procedures, treatments or services in effect in January of that year. The amount payable to each hospital pursuant to paragraph (1) of this subsection shall be adjusted annually by the Department of Labor in accordance with the Consumer Price Index-Urban, U.S. City Average for Medical Care, as published by the United States Bureau of Labor Statistics. The adjustment factor adopted by this paragraph shall be reviewed by the Health Care Advisory Panel three (3) years after the effective date of this section, and the Panel shall make a recommendation concerning the continued use the Consumer Price Index for medical care, or the adoption of a different index for cost adjustments in fees for hospital services.”
Section 2. AMEND Chapter 23, Title 19 of the Delaware Code by deleting subsection (i) of §2322B, Title 19, Delaware Code in its entirety and substituting in lieu thereof the following new subsection (i) to read as follows:
(i) Ambulatory Surgical Treatment Center (“ASTC”) fees developed in the health care payment system shall be determined in accordance with the following provisions:
(1) Fees billed for services provided to injured workers pursuant to this chapter by an ASTC shall be reimbursed at a rate equal to eighty-five percent (85.0%) of each ASTC’s actual charges for such services as of October 31, 2006, subject to annual adjustment as provided in this subsection. Verification that such billing is performed in compliance with this subsection shall be provided by each ASTC to the Office of Workers’ Compensation within sixty (60) days of the completion and issuance of audited financial statements to the ASTC by its independent financial auditors. Such verification shall be subject to further review or audit by the Department of Insurance. Reasonable costs of such review or audit for purposes of this section shall be reimbursed to the Department of Insurance by the ASTC whose billing is audited. The ASTC fee determination mechanism adopted pursuant to this subsection shall apply to all services provided after the effective date of the regulation provided for in subsection (h) of this section, regardless of the date of injury.
(2) On the effective date of the regulation provided for in subsection (n) of this section, and each year thereafter, the Department of Labor shall make an automatic adjustment to each ASTC’s reimbursement rates, as derived pursuant to paragraph (1) of this subsection, for procedures, treatments or services in effect in January of that year. The amount payable to each ASTC pursuant to paragraph (1) of this subsection shall be adjusted annually by the Department of Labor in accordance with the Consumer Price Index-Urban, U.S. City Average for Medical Care, as published by the United States Bureau of Labor Statistics. The adjustment factor adopted by this paragraph shall be reviewed by the Health Care Advisory Panel three (3) years after the effective date of this section, and the Panel shall make a recommendation concerning the continued use the Consumer Price Index for medical care, or the adoption of a different index for cost adjustments in fees for ASTC services.”