Delaware Code Title 19 Sec. 2322D – Certification of health-care providers
(a) (1) Certification shall be required for a health-care provider to provide treatment to an employee, pursuant to this chapter, without the requirement that the health-care provider first preauthorize each health-care procedure, office visit or health-care service to be provided to the employee with the employer or insurance carrier. Any health-care provider who is not licensed by the State of Delaware to provide medical services may elect to become certified under this section, and thereby obtain the same rights and obligations under this chapter as a certified health-care provider who is licensed by the State of Delaware to provide health-care services. The provisions of this subsection shall apply to all treatments to employees provided after the effective date of the rule provided by subsection (c) of this section, regardless of the date of injury. A health-care provider shall be certified only upon meeting the following minimum certification requirements:
a. Have a current license to practice, as applicable;
b. Meet other general certification requirements for the specific provider type;
c. Possess a current and valid Drug Enforcement Agency (“DEA”) registration, unless not required by the provider’s discipline and scope of practice;
d. Have no previous involuntary termination from participation in Medicare, Medicaid or the Delaware workers’ compensation system, which shall be determined to be inconsistent with certification under regulations adopted pursuant to subsection (c) of this section;
e. Have no felony convictions in any jurisdiction, under a federal-controlled substance act or for an act involving dishonesty, fraud or misrepresentation, which shall be determined to be inconsistent with certification under regulations adopted pursuant to subsection (c) of this section; and
f. Provide proof of adequate, current professional malpractice and liability insurance.
(2) The certification rules shall require that any health care provider to be certified agree to the following terms and conditions:
a. Compliance with Delaware workers’ compensation laws and rules;
b. Maintenance of acceptable malpractice coverage;
c. Completion of State-approved continuing education courses in workers’ compensation care every 2 years;
d. Practice in a best-practices environment, complying with practice guidelines and Utilization Review Accreditation Council (“URAC”) utilization review determinations;
e. Agreement to bill only for services and items performed or provided, and medically necessary, cost-effective and related to the claim or allowed condition;
f. Agreement to inform an employee of that employee’s liability for payment of noncovered services prior to delivery;
g. Acceptance of reimbursement and not unbundled charges into separate procedure codes when a single procedure code is more appropriate; and
h. Agreement not to balance bill any employee or employer. Employees shall not be required to contribute a copayment or meet any deductibles.
Terms Used In Delaware Code Title 19 Sec. 2322D
- Department: means the Department of Labor. See Delaware Code Title 19 Sec. 2301
- Employee: means every person in service of any corporation (private, public, municipal or quasi-public), association, firm or person, excepting those employees excluded by this subchapter, under any contract of hire, express or implied, oral or written, or performing services for a valuable consideration, excluding spouse and minor children of a farm employer unless the spouse or minor child is a bona fide employee of a farm employer and is named in an endorsement to the farm employer's contract of insurance, and excluding any person whose employment is casual and not in the regular course of the trade, business, profession or occupation of his or her employer, and not including persons to whom articles or materials are furnished or repaired, or adopted for sale in the worker's own home, or on the premises not under the control or management of the employer. See Delaware Code Title 19 Sec. 2301
- Employer: includes all those who employ others unless they are excluded from the application of this chapter by any provision of this subchapter, and if the employer is insured, the term shall include the insurer as far as practicable; employer shall also include the governing body for which employable relief recipients are assigned work under §§ 901-905 of Title 31. See Delaware Code Title 19 Sec. 2301
- Fraud: Intentional deception resulting in injury to another.
- Insurance carrier: means any insurance corporation, mutual association or company or interinsurance exchange which insures employers against liability under this chapter or against liability at common law for accidental injuries to employees. See Delaware Code Title 19 Sec. 2301
- Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
- Oversight: Committee review of the activities of a Federal agency or program.
- State: means the State of Delaware; and when applied to different parts of the United States, it includes the District of Columbia and the several territories and possessions of the United States. See Delaware Code Title 1 Sec. 302
(b) Notwithstanding the provisions of this section, any health care provider may provide services during 1 office visit, or other single instance of treatment, without first having obtained prior authorization, and receive reimbursement for reasonable and necessary services directly related to the employee’s injury or condition at the health care provider’s usual and customary fee, or the maximum allowable fee pursuant to the workers’ compensation health care payment system adopted pursuant to § 2322B of this title, whichever is less. The provisions of this subsection are limited to the occasion of the employee’s first contact with any health care provider for treatment of the injury, and further limited to instances when the health care provider believes in good faith, after inquiry, that the injury or occupational disease was suffered in the course of the employee’s employment. The provisions of this subsection shall apply to all treatments to injured employees provided after the effective date of the rule provided by subsection (c) of this section, regardless of the date of injury.
(c) Subject to the foregoing provisions, complete rules and regulations relating to provider certification shall be approved and proposed by the Workers’ Compensation Oversight Panel. Regulations arising from the Panel’s work shall be adopted by regulation of the Department of Labor pursuant to Chapter 101 of Title 29.
76 Del. Laws, c. 1, § ?13; 70 Del. Laws, c. 186, § ?1; 79 Del. Laws, c. 312, § ?2; 80 Del. Laws, c. 124, § ?3;