18 Del. Admin. Code § 1317-3.0

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

Section 1317-3.0 - Network Disclosure Requirements by Facility-Based Providers

3.1 When a facility-based provider schedules a procedure, seeks prior authorization from a health insurer for the provision of non-emergency covered services to a covered person, or prior to the provision of any non-emergency covered services, the facility shall ensure that the covered person has received a timely, written out-of-network disclosure required by 18Del.C. §§ 3370A or 3571S, as applicable, in the form attached hereto as Appendix 1 (the "facility-based provider disclosure"). The provision of the facility-based provider disclosure shall be considered timely if it is provided to the covered person within (3) business days after such procedure is scheduled if the medical necessity of a procedure allows such time, and if not, in as timely a manner as possible.

3.2 The facility-based provider shall, prior to the provision of services, obtain from the covered person a signed copy of the written consent form included with the facility-based provider disclosure. A copy of the completed form, including the signed written consent, should be given to the covered person, and the original placed in his or her medical file.

3.3 The facility-based provider disclosure shall not be required if the facility and all facility-based providers participate in the covered person's network.

3.4 If a covered person requests from an out-of-network provider an estimate of the range of charges for any out-of-network services for which the covered person may be responsible, the out-of-network provider shall provide the estimate in writing to the covered person within three business days of the request if the medical necessity of a procedure allows such time, and if not, in as timely a manner as possible. Failure to provide such estimate within the required timeframe shall be considered a failure to comply with the disclosure requirements set forth in this Section 3.0 and shall result in the balance billing prohibition set forth in Section 6.0.

18 Del. Admin. Code § 1317-3.0

20 DE Reg. 645 (2/1/2017) (Final)