This Act is a Substitute for House Bill No. 449. Like House Bill No. 449, this Substitute Act comprehensively amends Chapter 38 of Title 24 of the Delaware Code, the Dietitian/Nutritionist Licensure Act, to modernize the regulation of dietitians and nutritionists in this State by doing all of the following: (1) Replacing the single “licensed dietitian/nutritionist” license with 2 distinct licensure categories—“licensed dietitian” and “licensed nutritionist”—each with its own defined scope of practice, educational pathway, supervised practice requirements, examination standards, and protected professional titles. Licensed dietitians are authorized to provide medical nutrition therapy for complex and non-complex disease states and medical conditions, including in inpatient and high-acuity settings, while licensed nutritionists are authorized to provide medical nutrition therapy for non-complex conditions in low-acuity outpatient settings. (2) Updating the definitions in Chapter 38 of Title 24 to add defined terms, including “medical nutrition therapy”, “complex”, “non-complex”, “practice of dietetics”, “practice of nutrition”, “nutrition care process”, “therapeutic diet”, “qualified supervisor”, “telehealth”, and “registered dietitian”. (3) Raising the minimum educational requirement for licensed dietitian applicants from a baccalaureate degree to a master’s degree with a program accredited by the Accreditation Council for Education in Nutrition and Dietetics, increases the required supervised practice experience from 900 to 1,000 hours, and modernizes examination requirements by tying them to the Commission on Dietetic Registration. This Substitute Act establishes a parallel licensure pathway for licensed nutritionists based on a master’s or doctoral degree in nutrition with a supervised practice experience of at least 1,000 hours and passage of the certified nutrition specialist examination administered by the Board for Certification of Nutrition Specialists. (4) Amending the composition of the State Board of Dietetics/Nutrition to include 2 licensed dietitian members, 1 licensed dietitian or licensed nutritionist member, 1 Delaware-licensed physician, and 1 public member. It updates the licensure renewal section to require that continuing education hours for licensed dietitians meet the standards of the Commission on Dietetic Registration, and that continuing education hours for licensed nutritionists meet the standards of the Board for Certification of Nutrition Specialists. (5) Revising the licensure required section (§ 3810 of Title 24) to establish protected titles for both licensed dietitians and licensed nutritionists, to clarify who may engage in the practice of medical nutrition therapy, and to update the exemptions from licensure requirements. Exemptions are updated or added for students and trainees in supervised practice programs; persons providing general non-medical nutrition information; out-of-state practitioners providing services via telehealth; persons providing wellness, health coaching, and non-medical weight control services; WIC program employees; and others providing non-discretionary support activities under direct supervision. (6) Adding a new § 3814 of Title 24 authorizing the Board to issue provisional licenses to applicants who have completed education and supervised practice requirements but have not yet passed their licensure examination. (7) Providing that existing Delaware licensed dietitian nutritionists who hold the registered dietitian credential will be grandfathered as licensed dietitians and those who do not hold that credential will be grandfathered as licensed nutritionists, without additional requirements. (8) Making conforming amendments throughout Chapter 38 of Title 24 to replace outdated titles, organizational references, and scope of practice language consistent with the dual licensure structure created by this Act. (9) Making technical corrections to conform Chapter 38 of Title 24 to the standards of the Delaware Legislative Drafting Manual. This Substitute Act differs from House Bill No. 449 by making all of the following changes recommended by the Division of Professional Regulation: (1) Removing antiquated language prohibiting an individual appointed to fill a vacancy from serving on the Board for only 1 additional full term. (2) Providing that the actions that require the affirmative vote of 3 members of the Board are related to disciplinary actions under § 3811(b) of Title 24. (3) Removing a requirement that an applicant for licensure as a nutritionist must complete the required supervised practice experience within 5 years of completing the required educational requirements. (4) Clarifying the documentation required related to the supervised practice experience required for an applicant for licensure as a nutritionist. (5) Removing the requirement that an applicant for licensure as a dietitian or nutritionist complete 75 hours of continuing education for each 5-year period post-examination when the applicant passed the required examination more than 5 years before applying for licensure and has not maintained registration or certification and replacing that requirement with a requirement that the applicant complete continuing education as required by the Board, have actively practiced in dietetics, nutrition, or a substantially related healthcare profession within the last 5 years, completed coursework, supervised practice, or training related to dietetics or nutrition in the last 5 years, or provided other evidence demonstrating current competency. (6) Providing, as part of the grandfather provisions, for a pathway for nutritionists who are practicing at the level of a dietitian to continue practicing at that level. (7) Removing the telehealth provision that was in House Bill No. 449 because Chapter 60 of Title 24 applies to the Board. (8) Reverting to the "reasonably equivalent" standard for reciprocity and ensuring reciprocity is available for certified or licensed dietitians or certified or licensed nutritionists from another state whose standards are not reasonably equivalent if the applicant has held the certification or license in good standing for at least 5 years and the Board determines the applicant qualifies for licensure under Chapter 38 of Title 24. (9) Deferring standards related to qualified supervisors to the Board by regulation. (10) Providing for delayed implementation of this Substitute Act for 18 months or the adoption by the Board of regulations to implement this Substitute Act, whichever comes first. This Substitute Act requires a greater than majority vote for passage because § 11 of Article VIII of the Delaware Constitution requires the affirmative vote of three-fifths of the members elected to each house of the General Assembly to impose or levy a tax or license fee.
This Act prohibits individual, group, state employee, and Medicaid health plans from differentiating in the reimbursement rate of a health service based on whether the service was provided by a certified registered nurse anesthetist or by a physician.
This Act makes a technical correction to the optional special powers form in the Uniform Health Care Decisions Act in Title 16. Currently, the existing language in the form implies any number of days can be written in to the advance directive when designating a maximum length of time for a mental health care related admission. However, under § 2518(e) of Title 16, an agent or default surrogate may not consent to voluntary admission of an individual to a facility for mental health treatment for longer than 72 hours. This Act removes the open-ended language in the form, so that a voluntary admission to a mental health facility by an agent may not exceed 72 hours.
This Act is a substitute for House Bill No. 322 which permits employees of, or security personnel working for, a health-care institution, as defined under Chapter 25C of Title 16, or a medical or dental practice licensed under Title 24, for the purpose of summoning a law-enforcement officer, take any person presenting a security or safety risk at such premises into custody and detain the person in a reasonable manner on the premises for a reasonable time. This House Substitute to House Bill No. 322 differs from the initial bill as it clarifies the definition of health-care institution, medical practice, and dental practice.
This Act is a substitute for Senate Bill No. 319 and makes all of the following changes: 1. Changes the definition of “hormone replacement therapy” to clarify that hormone replacement therapy must be approved by the United States Food and Drug and Administration. 2. Removes pellet medication from the definition of “hormone replacement therapy” because it is not currently approved by the United States Food and Drug and Administration for treating menopause or perimenopause. 3. Makes technical corrections. Like Senate Bill No. 319, this substitute requires individual health insurance plans, group and blanket health insurance plans, the state employee health plan, and state Medicaid insurance to cover medically necessary diagnostic services and treatment for menopause, perimenopause, and symptoms of menopause or perimenopause, including all of the following: 1. Consultation and diagnostic testing. 2. Hormonal therapies, including hormone replacement therapy and bioidentical hormone treatments, that are approved by the United States Food and Drug Administration. 3. Non-hormonal treatments, including selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, neurokinin B antagonists, and other medications to manage menopause symptoms. 4. All drugs, devices, and combination products approved by the United States Food and Drug Administration for the treatment of menopause and perimenopause symptoms. 5. Therapy to treat menopause induced by a hysterectomy. 6. Behavioral health care services. 7. Pelvic floor physical therapy. 8. Bone health treatments due to hormonal changes related to menopause and perimenopause, including screenings and medications. 9. Preventative services for early detection and treatment of health conditions related to menopause and perimenopause, including osteoporosis and cancer. 10. Counseling and education regarding menopause management. Additionally, an insurer or carrier must provide clear and accessible information about covered diagnostic services and treatment for menopause, perimenopause, and menopause and perimenopause symptoms to each covered individual or Medicaid recipient. Menopause and perimenopause diagnostic and treatment benefits or assistance must be provided to the same extent as benefits or assistance for other medical conditions, but coverage for medically necessary hormone replacement therapy provided under this Act may not be any of the following, except as otherwise provided by federal Medicaid law: 1. Denied or limited, if the use of the hormone replacement therapy is supported by national clinical guidelines, national standards of care, or peer-reviewed medical literature for the treatment of menopause, perimenopause, or menopause and perimenopause symptoms. 2. Subject to prior authorization or step therapy requirements. The Act provides a religious exemption for group and blanket health policies. If the coverage requirement conflicts with a religious employer’s bona fide religious beliefs or practices, the religious employer may request a coverage exclusion for the coverage required under Section 2 of this Act and an insurer shall grant the exclusion. A religious employer who is granted an exclusion must give its employees reasonable and timely notice of the exclusion. This Act applies to all policies, contracts, or certificates that are issued, renewed, modified, altered, amended, or reissued after December 31, 2027.
This Act is a substitute for HB 200 and differs from HB 200 by requiring health insurance coverage only for pre-exposure prophylaxis (“PrEP”) medication and post-exposure prophylaxis (“PEP”) medication. This Act also makes technical corrections including updating section numbers and updating the applicability date so insurance companies can file rates that include the cost of the coverage required under this Act. This Act requires individual health insurance plans, group and blanket health insurance plans, the state employee health plan, and state Medicaid insurance to cover medically necessary PrEP medication for the prevention of human immunodeficiency virus (“HIV”) infection before possible HIV exposure and medically necessary PEP medication for the prevention of HIV infection after possible HIV exposure. The coverage must include must be provided without any of the following: 1. Cost-sharing requirements, including deductibles, coinsurance, copayments, and out-of-pocket expenses. 2. Prior authorization or step therapy requirements. 3. Unreasonable delay in coverage determination. This Act applies to all policies, contracts, or certificates that are renewed, modified, altered, amended, or reissued after December 31, 2027.
This Act creates a new Delaware Nursing Advancement Fund (Fund) for purposes of funding a nonprofit that will maintain information and conduct studies about the nursing workforce, advance the profession of nursing, monitor trends in the nursing applicant pool, facilitate partnerships, educate the public about opportunities and careers in nursing, and distribute information about the nursing workforce. Money for the Fund will come from a $10 fee on initial and renewal applications to the Board of Nursing, as well as any disciplinary fines. The Division of Professional Regulation will make a grant award to a nonprofit to accomplish the purposes of the Fund. This Act requires a three-fourths majority vote for passage because of the requirements of Section 4, Article VIII of the Delaware Constitution.
Sections 1 and 2 of this Act identify DHIN as the State’s sanctioned provider of Health Data Utility (HDU) services. The HDU concept arises and builds off of services provided by Health Information Exchanges (HIEs) such as DHIN. Including this language will align with DHIN’s development and assist the State in responding to federal and other grant funding opportunities that require or prefer collaboration with a sanctioned HDU. Section 2 of this Act is a clarifying provision that states DHIN’s ability to contract with organizations in furtherance of its mission in business arrangements that facilitate DHIN’s underlying mission, notwithstanding that those organizations may provide services (such as direct provision of treatment to patients) that DHIN does not directly provide under this chapter. It also makes a technical change to align the list of stakeholders identified with lists that appear elsewhere in the statute. Section 3 of this Act aligns DHIN’s use cases more clearly with the requirements of federal law that relate to using health data for analytic and research purposes, including the Health Insurance Portability and Accountability Act of 1996 (HIPAA) and the Federal Policy for Protection of Human Subjects (the Common Rule) and makes a technical correction to a description of DHIN processes. This change will also ensure consistency between permitted uses of claims data for research purposes and permitted uses of clinical data. Sections 4 and 5 clarify DHIN’s ability to incorporate clinically relevant information into a patient’s longitudinal record, excluding pricing information, for access as permitted by the laws and regulations governing DHIN’s HIE services. This clarification ensures patients will have access to the clinical information included in claims data for their own uses. Section 5 makes a technical correction to recognize that DHIN’s enabling legislation and applicable federal law do not permit DHIN to “report” data to the public that would be suitable for the public health improvement research and activities purposes designed to be encouraged by that section, and clarifies that the identified agencies will have access to the standardized claims data sets curated by DHIN from the Delaware Health Care Claims Database as otherwise permitted under this statute at no cost.
This Act requires that a hospital create a discharge plan if a pregnant patient who is experiencing signs or symptoms consistent with labor is discharged before delivery. This requirement to create a discharge plan applies to patients discharged from either in-patient treatment or observation status and must contain all of the following: 1. Aftercare instructions and guidelines and that these instructions and guidelines were explained to the patient, patient’s agent, or patient’s lay caregiver. 2. An assessment of travel distance and time between the primary residence of the patient and the hospital. 3. Verification of reliable transportation between the primary residence of the patient and the hospital. 4. Identification of a back-up hospital or facility at which the patient may obtain labor and delivery services. This Act is modeled on the Women Expansion of Learning and Labor Safety or WELLS Act, H.R. 7830, which was introduced in Congress on March 5, 2026. The WELLS Act is named after Mercedes Wells, a Black woman who was forced to give birth on the side of the road minutes after being discharged from a hospital while in active labor. Under existing law, Chapter 30J of Title 16 provides discharge planning requirements when a patient is being discharged home after admission to a hospital. The requirements under this Act are in addition to, but can be combined with, these existing discharge planning requirements if the patient being discharged is pregnant and experiencing signs or symptoms consistent with labor. This Act also renames and reorganizes Chapter 30J of Title 16 by making existing law Subchapter I and creating a new Subchapter II with the requirements under this Act. As such, this Act makes corresponding changes to existing law to change references to Chapter 30J to the new subchapter.
Enacted in 2015, Chapter 25A of Title 16, the Delaware Medical Orders for Scope of Treatment Act created a voluntary process and a document that can used by patients with serious illness or frailty to provide direction to emergency care personnel regarding the patient's preferences in regard to scope of care and treatment. This Act changes the name "Delaware Medical Orders for Scope of Treatment (DMOST)" under Chapter 25A of Title 16 to "Delaware Portable Orders for Life-Sustaining Treatment (POLST)" to align with the national effort to create a uniform form. This Act contains a savings provision so that the name change under this Act does not affect the validity or effect of DMOST forms. This Act also revises Chapter 25A of Title 16 as follows: • Repeals requirements that conflict with the national model law regarding a patient’s ability to limit the future authority of the patient’s authorized representative to modify the orders in the patient’s POLST form. • Allows any health-care practitioner authorized under Chapter 25A of Title 16 to complete a POLST form to find that a patient lacks sufficient decision-making capacity to execute a POLST form. Under existing law, all practitioners who are licensed and authorized to write medical orders under Title 24 may complete POLST forms but only physicians can determine that a patient lacks sufficient decision-making capacity to execute a POLST form. This change is consistent with the capacity provisions under Chapter 25 of Title 16, the recently enacted Uniform Health-Care Decisions Act. • Requires that a health-care practitioner document their finding that a patient lacks decision-making capacity in the patient’s medical record. • Clarifies the existing requirement that a patient’s authorized representative may not execute a POLST form for a patient unless the patient’s lack of decision-making capacity is documented in the patient’s medical record. Makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual, including corresponding name changes to other Code sections that reference the DMOST form. In § 2718(c)(5) of Title 21, the name for an advance health-care directive under Chapter 25 of Title 16 is also corrected.
