Healthcare

This Act expands the scope of prohibited extraordinary collection actions to include a large health-care facility levying on tangible personal property of a patient. It also clarifies that any party taking action to collect medical debt must disclose in court pleadings whether the party is a large health-care facility, and makes technical corrections.

This Act requires that individual, group, State employee, and public assistance insurance plans provide coverage for biomarker testing, when the test is supported by medical and scientific evidence. The Act applies to all such policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027. This Act is a substitute for and differs from Senate Bill No. 120 in that this Act clarifies that it does not prevent a provision restricting coverage to services by a licensed, certified, or carrier-approved provider or facility, restrict the use of utilization management, or require coverage of biomarker testing for screening purposes or coverage of investigatory and experimental biomarker tests. In addition, the Act differs from Senate Bill No. 120 in that it applies to policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027, rather than December 31, 2026.

This Act updates the Respiratory Care Advisory Council to the Board of Medical Licensure and Discipline’s enabling act to allow qualified licensed respiratory therapists to perform all duties associated with extracorporeal life support. Under the current law, respiratory therapists are authorized to assist with such support but may not administer medication during the process. As a result, a therapist is required to wait for another licensed professional to do so, resulting in delays to patient care. This bill eliminates this delay in patient care and allows qualified respiratory therapists to work within the full scope of their training. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

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.