18 Del. Admin. Code § 1313-9.0

Current through Register Vol. 28, No. 5, November 1, 2024

Section 1313-9.0 - Additional Provisions for Arbitrations Conducted Pursuant to 18 Del.C. Sections 3370A and 3571S

9.1 Arbitrations conducted pursuant to 18 Del.C. §§ 3370A and 3571S shall reflect the objectives of those statutory provisions of protecting consumers from surprise bills and not creating incentives for providers to be out-of-network.

9.1.1 In addition to any other documentation required by this regulation, the parties to these arbitrations may present documentation or arguments during arbitration regarding how a particular award or request for reimbursement may incentivize providers to become out-of-network providers, and the Arbitrator shall consider such documentation and/or arguments in rendering a final decision.

9.1.2 Notwithstanding anything herein to the contrary, an arbitration award in favor of a provider that exceeds the opposing carrier's in-network reimbursement rate shall not be considered prima facie evidence of an incentive for providers to be out-of-network.

9.1.3 The provisions of this Regulation 1313 shall not apply to arbitration which is subject to Regulation 1316 as authorized in 18 Del.C. § 3349 (b) and 18 Del.C. § 3565 (b).

18 Del. Admin. Code § 1313-9.0

20 DE Reg. 372 (11/1/2016)
20 DE Reg. 457 (12/1/2016) (Final)