“This Act makes substantial changes to Titles 18 and 19 of the Delaware Code designed to control the level of workers' compensation premiums in Delaware. The most significant changes are (a) a 33% reduction in medical costs to the workers' compensation system, phased in over a period of three years; (b) absolute caps, expressed as a percentage of Medicare per-procedure reimbursements, on all workers' compensation medical procedures beginning on January 1, 2017; and (c) increased independence for the Ratepayer Advocate who represents ratepayers during the workers compensation rate approval process and for the committee that oversees the cost control practices of individual workers compensation insurance carriers.”
Some of the changes you will soon see are as follows:
· WORKERS' COMPENSATION OVERSIGHT PANEL. The Health Care Advisory Panel has become an expanded group of 24 stakeholder members now called the Workers' Compensation Oversight Panel (WCOP).
· RATEPAYER ADVOCATE. The Ratepayer Advocate moves from under the purview of the Department of Insurance to the WCOP. The Attorney General's office will soon publish on its web site at http://attorneygeneral.delaware.gov/executive/rfp.shtml a request for proposals (RFP), pursuant to the provisions in HB373.
· DATA COLLECTION.
o The WCOP will still receive data from the advisory organization designated by the Insurance Commissioner in order to identify cost drivers and guide policy formation.
o The WCOP “or its designee shall have the authority to demand directly from any person or entity providing health care services under this Chapter data sufficient for the Panel to carry out the duties described in this subsection.”
§ In the next week or so, the Office of Workers' Compensation will send out this mandatory data request to hospitals and ambulatory surgery centers in order to create the new fee schedules, which will be established by 10/01/2014 and effective on 1/31/2015.
· FEE SCHEDULES
o HB373 mandates significant revisions to the professional services, hospital, and ambulatory surgery center fee schedules.
§ DATA: In the next week or so, hospitals and ambulatory surgery centers should look for the mandatory data request mentioned above.
§ RATE CHANGE REPORTS: Hospitals and ambulatory surgery centers, who submitted a rate change report for the 2014 fee schedule will not have to submit a rate change report in 2015. Once the new fee schedules become effective on 01/31/15, the percent of charge methodology will only apply to services and treatment rendered prior to the 01/31/2015 effective date of the new schedules.
o PHARMACY. Last year's pharmacy changes will remain in effect. You will find that language in HA2 (see the link above).
o REDUCTION TIMELINE: The reductions mentioned in HB373 will be phased into the new itemized fee schedules over the next three years (January 2015, January 2016, and January 2017), beginning with the January 2015 fee schedule. The caps will become effective in the year 3, January 2017, iteration.
o Continue to use the current fee schedules until the new schedules are established and become effective on January 31, 2015.
· PROVIDER CERTIFICATION, UTILIZATION REVIEW, FORMS, BILLING, ETC.
o The provisions for these pieces of the HCPS remain the same.
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