Delaware Revises WC Regulations


Wilmington, DE (CompNewsNetwork) - Effective June 13, 2011, the Department of Labor (DOL) will make the following changes to 19 De Admin Code 1341 (the “regulations”) the Delaware Workers' Compensation Health Care Payment System (HCPS):


The DOL added a 7th health care practice guideline to the regulations – Lower Extremities (19 DE Admin Code 1342, Part G).  The current list of health care practice guidelines – carpal tunnel, chronic pain, cumulative trauma disorder, low back, shoulder (all effective 5/23/08), as well as cervical (effective 6/1/09), and lower extremities (effective 6/13/11) – is available.


The DOL revised sections of the Workers' Compensation Regulations (19 De Admin Code 1341).

The regulatory revisions required changes to the following “forms,” which also go into effect on June 13, 2011:

· Health Care Provider Application for Certification

· Request for Utilization Review

· Physician's Report of Workers' Compensation Injury

· Employer's Modified Duty Availability Report

The following list itemizes and summarizes the regulatory changes to 19 De Admin Code 1341.

3.0 Health Care Provider Certification

3.1.4 Added a detail to line 6 and deleted a detail from line 9.

3.2 Changed who received the completed certification application – from “Mr. John F. Kirk, III” to “Ms. Donna Forrest.” 

4.2 HCPCS (Healthcare Common Procedure Coding System) (Level II)

Changed the wording in line 3 and 4 to include Current Dental Terminology (CDT) codes for dental offices.

4.7 Dental Services

The itemized fee schedule pricing does not include any dental items, so this update removes references (4.7.1) to the methodology (i.e. 90% of the 75th percentile) used to determine the itemized fee schedule. This just removes unnecessary language. 

5.0 Utilization Review

5.1 Added to last sentence, “Without the employer or its insurance carrier obtaining legal representation, or incurring the costs associated with legal involvement in the utilization review process.” 

5.4.3 – 5.4.4  Added language that requires an answer (approve or deny, send to UR) for surgery preauthorization requests.  If a certified health care provider performs surgery without ever requesting preauthorization, this added preauthorization language does not take away that certified provider's right to prompt payment (or a payers right to challenge the surgery through the UR process), pursuant to 19 Del.C. §2322F(d).  

  Changed the language to clarify the clock starts ticking on the turnaround time for the UR when the company performing the review receives the information.

And more. 

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