An Act To Amend Title 19 Of The Delaware Code Relating To Workers Compensation.
Summary
SB 164 amends Delaware’s workers’ compensation law, specifically the section governing the health-care payment system used to reimburse medical treatment for work-related injuries. The bill updates the statutory language to reflect that the General Assembly’s original cost-reduction targets and implementation dates have already been established, while preserving the structure of the payment system, including publication requirements, fee schedules, and oversight procedures. It continues to tie reimbursement levels to a fee schedule based on Medicare-related payment methodologies such as RBRVS, MS-DRG, and APC, adjusted geographically to support provider participation.
The bill also retains the statutory caps on reimbursement for workers’ compensation medical services, including the general limit of the lesser of actual charges or the fee schedule amount, and the procedure-specific ceiling that no service may be reimbursed above a percentage of Medicare, with higher allowances for radiology and surgery. It keeps the requirement for an independent actuary to verify compliance and preserves the Secretary of Labor’s authority to promulgate a fee schedule by regulation if the Oversight Panel does not complete a compliant one. The act is set to take effect on January 31, 2026.
Impact
SB 164 would amend Title 19 of the Delaware Code by revising the workers’ compensation health-care payment system provisions in Section 2322B. Its practical effect is to maintain and clarify the statutory framework for medical reimbursement in workers’ compensation cases, including fee schedule development, publication, actuarial review, and fallback regulatory authority. The bill continues Delaware’s use of Medicare-based benchmarks and percentage caps to control medical costs paid through the workers’ compensation system, affecting hospitals, ambulatory surgical centers, physicians, and other health-care providers that treat injured workers.
Sentiment
The bill appears to have broad support and little visible opposition. It passed the Senate on third reading by a vote of 18-0 and the House on third reading by a vote of 40-0, indicating unanimous approval in both chambers. No committee transcript is available, but the voting record suggests the measure was viewed favorably and as a noncontroversial update to existing workers’ compensation reimbursement rules.
Contention
No specific points of contention are documented in the available materials. The statutory language itself suggests the main policy issue underlying the section is balancing lower workers’ compensation medical costs against provider reimbursement levels and access to care, especially through Medicare-based caps and fee schedule reductions. The bill preserves a limited exception for radiology and surgery reimbursement and an actuarial review process, which are the kinds of provisions that typically address concerns from health-care providers about underpayment and from employers or insurers about cost containment.