Learn About Delaware SBL
The Delaware SBL
The Delaware SBL became effective in 2016. The relevant provisions include: a requirement that carriers pay for OON ER services at “the highest allowable charge,” with establishment of an arbitration process to resolve disputes and a 60-day timeline for pursuing arbitration. Delaware Code Titles 18, Chapter 35.
Regarding bifurcation, according to CMS,
Delaware does not have an applicable All-Payer Model Agreement that would determine the out-of-network rate. Based on the survey response and CMS communications with Delaware Department of State Division of Professional Regulation, Delaware Department of Health and Social Services, and Delaware Department of Insurance staff, and CMS research, CMS understands that 18 Del. Code §§ 3349 and 3565 are specified state laws that will apply for purposes of determining the out-of-network rate with respect to covered emergency services furnished to individuals with certain health insurance coverage in Delaware by non-network providers.
Letter from CMS to Governor of Delaware, dated January 31, 2022.
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