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Delaware General AssemblyDelaware RegulationsMonthly Register of RegulationsAugust 2018

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(18 Del.C. §311 & 24 Del.C. §716(c))
At 21 DE Reg. 19 (July 1, 2017), the Department published a notice of its intent to codify proposed new Regulation 1318, Compensation for Chiropractic Services, and solicited written comments from the public for thirty (30) days as mandated by 29 Del.C. §10118(a).
The Department received several timely submitted comments, copies of which are on file with the Department. The Department did not hold a public hearing on the proposal. In response to the comments received, the Department redrafted the proposed new regulation, which was published at 21 DE Reg. 610 (February 1, 2018). The Department accepted written comments, suggestions, briefs, and compilations of data or other materials concerning the re-proposed regulation until the 5th day of March, 2018, which was thirty days from the date of publication.
The Department thereafter determined to further revise the proposed regulation. That proposal was published in the Register of Regulations at 21 DE Reg. 954 (June 1, 2017). The Department did not hold a public hearing on the re-proposal. The Department accepted written comments, suggestions, briefs, and compilations of data or other materials concerning the proposed amendment until the 2nd day of July, 2018, which was thirty days from the date of publication. The
The Commissioner finds that it is appropriate to adopt 18 DE Admin. Code 1318 as proposed in the June 1, 2018 Register of Regulations, for the reasons set forth above and in the proposal.
For the foregoing reasons, the Commissioner concludes that it is appropriate to adopt 18 DE Admin. Code 1318, as discussed in the above Findings of Fact.
The actions hereinabove referred to were taken by the Commissioner pursuant to 18 Del.C. §§311, 314, and 526A on the date indicated below. The effective date of this Order shall be ten (10) days from the date this Order is published in the Delaware Register of Regulations. The effective date of the Regulation shall be as stated in the text of the Regulation.
The 12th day of July, 2018
This regulation is adopted pursuant to 18 Del.C. §§102, 311 and 329 and 24 Del.C. §716 and promulgated in accordance with the Delaware Administrative Procedures Act, 29 Del.C. Ch. 101.
The following words and terms, when used in this regulation, should have the following meaning unless the context clearly indicates otherwise:
"Administrator" or "third party administrator" or "TPA" means "Administrator" or "third party administrator" or "TPA" as those terms are defined at 18 DE Admin. Code 1406-2.1.
"Carrier" means any entity that provides health insurance in this State. For the purposes of this regulation, carrier includes a health insurance company, health service corporation, health maintenance organization and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation. "Carrier" also includes any third-party administrator or other entity that adjusts, administers or settles claims in connection with health benefit plans.
"Chiropractic" means "Chiropractic" as defined in 24 Del.C. §701 and in 24 DE Admin. Code 700.
"Chiropractic care or services" means those practices that a licensed doctor of chiropractic is licensed to provide pursuant to 24 Del.C. Ch. 7 and 24 DE Admin. Code 700.
"Commissioner" means the Commissioner of the Delaware Department of Insurance.
"Doctor of chiropractic" means a person who is licensed to administer chiropractic care or services pursuant to 24 Del.C. Ch. 7 and 24 DE Admin. Code 700.
"Medically necessary" means the providing of health care services or products that a prudent physician would provide to a patient for the purpose of diagnosing or treating an illness, injury, disease or its symptoms in a manner that is:
"Physician" means, for purposes of this regulation, anyone who is licensed as a physician pursuant to 24 Del.C. Ch. 17 or as a doctor of chiropractic pursuant to 24 Del.C. Ch. 7.
Nothing in this regulation shall prohibit a carrier or a TPA from implementing reasonable and nondiscriminatory cost containment or managed care provisions as permitted by 24 Del.C. §716(b).
The provisions of this regulation may not be waived, voided, or nullified by contract.
This regulation shall not create a private cause of action for any person or entity other than the Commissioner against a carrier or its representative based upon a violation of 24 Del.C. §716 or any provision of this regulation.
This regulation shall become effective on January 1, 2019.
Last Updated: December 31 1969 19:00:00.
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