Healthcare

This Senate Joint Resolution directs the Division of Medicaid & Medical Assistance (DMMA) to explore amending our Delaware Medicaid State Plan to allow for the adoption of the Children’s Health Insurance Program (CHIP) From-Conception-to-End-of-Pregnancy (FCEP) option and the creation of a Health Services Initiative (HSI) that will allow our State to use federal funding to partially cover prenatal and postpartum care for individuals otherwise ineligible for free or low-cost health-care coverage due to immigration status. This Joint Resolution also requires DMMA to provide a report to the General Assembly as to its findings no later than January 1, 2026.

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.

Excess skin and subcutaneous tissue can create a risk of rashes or infections, make walking and movement difficult, and make everyday chores difficult. An example of treatment that removes excess skin and subcutaneous tissue is a panniculectomy. A panniculectomy is an operative procedure that contours, or changes the shape and form, of the abdomen by removing significant excess skin and subcutaneous tissue. Removal of excess skin and subcutaneous tissue can improve a patient’s health and quality of life. This Act requires individual health insurance plans delivered under Chapter 33 of Title 18 and group and blanket health insurance plans delivered under Chapter 35 of Title 18 to cover medically necessary removal of excess skin and subcutaneous tissue, including panniculectomies. This Act also requires the State employee health insurance plan and State Medicaid plans to cover medically necessary removal of excess skin and subcutaneous tissue, including panniculectomies. Medically necessary means as defined in § 3371(8) for individual health insurance plans and as defined in § 3581(8) for group and blanket health insurance plans, State employee health insurance plans, and State Medicaid plans. This Act applies to all policies, contracts, or certicates issued, renewed, modified, alterered, amended, or resissued after December 31, 2026.

This Act updates the terminology used to describe or citations used to reference those who make financial or health-care decisions on behalf of a principal or individual, including when that principal or individual lacks capacity. This Act takes effect on September 30, 2025, to coincide with when the Delaware Uniform Health-Care Decisions Act of 2023 (DUHCDA 2023) takes effect. Section 1 of this Act amends § 3982 of Title 12 by: (1) Removing the phrase “durable power of attorney for health-care decisions” and instead citing to the definition of “advance health-care directive” under DUHCDA 2023. A durable power of attorney for health-care decisions, or other similar variations on that phrase, are synonyms for a power of attorney for health care. A power of attorney for health care is included in the definition of advance health-care directive under DUHCDA 2023. For shorthand, elsewhere in this Synopsis this change will be referred to as “citing to the DUHCDA 2023 to remove synonyms.” (2) Changing "surrogate" to "default surrogate" to align with the new definitions of "surrogate" and "default surrogate" under DUHCDA 2023. For shorthand, elsewhere in this Synopsis this change will be referred to as “aligning the term ‘surrogate’ with the DUHCDA 2023”. (3) Added reference to an agent under a durable power of attorney to § 3983(4)a. since it is in § 3983(4)b. and those paragraphs should mirror each other, as paragraph (4)a. handles a situation when there is no decision maker willing or able to serve and paragraph (4)b. addresses a situation where a decision maker is determined unsuitable. Section 2 of this Act amends § 3983 of Title 12 by aligning the term ‘surrogate’ with the DUHCDA 2023. Section 3 of this Act amends § 1121 of Title 16 by: (1) Completing the list of internal citations. (2) Repealing § 1121(b)(40) because § 1122 defines the decision makers to whom third-party decision making passes when an individual lacks capacity to make decisions. Additionally, § 1121 is where resident rights are listed, not the rights of third parties. Section 4 of this Act revises § 1122 of Title 16 by: (1) Revising the description of legal standards for when decision making authority passes to a third party under the processes listed, including deleting that a standard is when a resident is "unable to communicate with others" and adding a reference to federal law since a representative payee under § 205(j) of the Social Security Act is included in the list. (2) Citing to the DUHCDA 2023 to remove synonyms. (3) Aligning the term ‘surrogate’ with the DUHCDA 2023. Section 5 of this Act amends § 1145 of Title 16 by: (1) Citing to the DUHCDA 2023 to remove synonyms. (2) Aligning the term ‘surrogate’ with the DUHCDA 2023. Section 6 of this Act amends § 2503A of Title 16 by: (1) Citing to the DUHCDA 2023 to remove synonyms. (2) Aligning the term ‘surrogate’ with the DUHCDA 2023. Section 7 of this Act amends § 5530 of Title 16 by: (1) Citing to the DUHCDA 2023 to remove synonyms. (2) Repealing subsection (e) because it refers to a list of individuals that was removed by SB 309 (GA 152) in favor of citing directly to DUHCDA 2023. Section 8 of this Act amends § 5531 of Title 16 by citing to the DUHCDA 2023 to remove synonyms. Section 9 of this Act amends § 2718 of Title 21 by: (1) Correcting the word “advanced” to “advance” in “advance care directive”. (2) Listing the advance planning documents referenced in the citation to § 9706(h) of Title 16. Section 9706(h) allows the promulgation of regulations related to EMS provider compliance with identified advance planning documents. It is not the section that establishes or defines the advance planning documents. Section 10 of this Act amends § 3912 of Title 31 by changing the term “power of attorney” to “agent” because an agent is the actor whereas the power of attorney is the document or grant of authority to act as agent. Section 11 of this Act is an effective date. This Act takes effect on September 30, 2025. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

This is a Substitute for Senate Joint Resolution No. 7. Like Senate Joint Resolution No. 7, this Substitute directs the State Employees Benefits Committee (SEBC) to utilize specific strategies and policies when interacting and contracting with Pharmacy Benefit Managers (PBM) in order to achieve lower cost pharmaceutical drug benefit plans for the State. This Substitute differs from Senate Joint Resolution No. 7 by clarifying that the SEBC has a duty to consider all of the following strategies and policies when negotiating for pharmaceuticals: 1. Drug cost transparency. 2. Formation of an independent Pharmacy and Therapeutics Committee. 3. Any other supply chain tactics such as a reverse auction or transparency committee. 4. Compacts with other states to negotiate directly with drug manufacturers. 5. Paying no higher price for all drugs negotiated by Medicare. 6. Requiring PBMs disclose administrative expenses for all pharmaceutical drugs. 7. Requiring PBMs bid based on lowest pricing sources, not average wholesale price. 8. Requiring the SEBC be provided all agreements between PBMs and pharmaceutical companies when those agreements are for drugs contracted for on behalf of the SEBC. 9. Performing audits when the SEBC believes it should be entitled to information to achieve transparency or clarity. This Substitute differs from Senate Joint Resolution No. 7 by directing the SEBC to prepare a report by August 1, 2026, to summarize any difficulties in implementing any of these policies and to submit the report to the Governor; the President Pro Tempore of the Senate and Speaker of the House of Representatives, for distribution to all members of the General Assembly; the Director and the Librarian of the Division of Legislative Services; and the Public Archives.

This Senate Concurrent Resolution directs the Department of Health and Social Services to conduct a review of public assistance programs to identify benefit cliffs and consider these outcomes with perspective of asset-limited, income-constrained employed (ALICE) individuals. The Resolution also direct the Department of Health and Social Services to prepare a report that details its findings and recommendations by January 9, 2026.

This Legislation is the Delaware Pre-Authorization Reform Act of 2025. Section 1 of the Act applies to health Insurance Contracts regulated under Chapter 33 of Title 18. Section 1 provides that changes in utilization review terms for a health-care service, such as the clinical criteria used to conduct utilization reviews for a health-care service, will apply only upon re-authorization of the health-care service. Covered persons must be notified at least 6 months before any changes to utilization review terms, except in certain circumstances such as changes in clinical guideline status In addition, Section 1 sets qualifications for who may make determinations with regard to requests for pre- authorization of health-care services and appeals of adverse determinations; a timeline and required contents for the notification of an outcome of appeal of an adverse determination or a notification that additional information is necessary to make the determination of appeal; and requirements for any utilization review entity used to perform utilization review by an insurer, health-benefit plan, or health-service corporation. Section 1 also shortens the timelines for the determination of pre-authorization requests and notification to the health-care provider of the determination. For requests for pre-authorization of non-urgent health-care services not submitted electronically, the utilization review entity must notify the health-care provider within 5 business days of receipt of the request; for requests submitted electronically, notification must be given within 3 business days of receipt. For requests for pre-authorization for urgent health-care services submitted electronically, notification must be given within 24 hours of receipt. By January 1, 2027, insurers, health-benefit plans, health-service corporations, and utilization review entities must accept and respond to electronic pre-authorization requests through the same platform as the electronic request was submitted. In addition, Section 1 extends the time period that a pre-authorization is valid for from 60 days to 90 days. Finally, Section 1 provides that no more than 1 pre-authorization may be required for a single episode of care, and that if pre-authorization is granted as to a health-care service that is part of a group of services for which a bundled payment is charged, pre-authorization for the other health-care services included in the group is deemed to be approved as well. Section 2 of the Act applies to Group and Blanket Health Insurance under Chapter 35 of Title 18 and makes the same changes to pre-authorization standards and procedures that Section 1 of the Act makes to Health Insurance Contracts regulated under Chapter 33 of Title 18. Section 3 of the Act provides that the State Employee Benefits Committee established under § 9602 of the Title 29 of the Delaware Code must ensure that carriers administering plans for group health insurance comply with the requirements and provisions for pre-authorization set forth in Chapter 33, Subchapter II and Chapter 35, Subchapter V of Title 18. Section 4 of the Act provides that the Act will apply to health insurance policies, contracts, or certificates issued, modified, or renewed after December 31, 2026. Section 5 of the Act provides that the Department of Health and Social Services must, to the extent feasible, assure that contracts awarded to carriers providing health insurance relating to Medicaid assistance comply with the requirements and provisions for pre-authorization set forth in Chapter 33, Subchapter II and Chapter 35, Subchapter V of Title 18. Section 6 provides that this Act is known as the "Delaware Pre-Authorization Reform Act of 2025."

This Act supports critical health care workforce research and planning efforts by giving the Division of Public Health and the Delaware Health Care Commission the ability to obtain comprehensive workforce-related data from the Division of Professional Regulation. It requires the Division of Public Health’s Office of Healthcare Provider Resources to collaborate with the Delaware Health Care Commission and the Division of Professional Regulation to determine what data should be collected from health care providers during the licensing and renewal process to assist the Division of Public Health with workforce research and planning. This Act also directs the Division of Professional Regulation to collect health care workforce-related data during the licensing or renewal processes. The data collected will be for purpose of health care workforce research and planning and will not include personal information such as personal financial information. The health care provider licensing process provides a rich opportunity for this State to obtain information it needs to ensure that its health care workforce is equipped to meet the needs of Delaware residents. Collecting data with the goal of informing health care workforce research and planning is a common practice nationwide, with at least 28 states collecting health care workforce data as part of the licensing process. Such data will fill crucial gaps in the Division of Public Health’s ability to understand health care workforce needs and develop policies and programs aimed at meeting them. As is currently the case, health care workforce data collected by the Division of Professional Regulation may only be used for official state business. This Act provides that official state business includes the following purposes specific to health care workforce research and planning: 1. Identifying and tracking data related to Health Professional Shortage Areas (HPSAs), Maternity Care Target Areas (MCTAs), and Medically Underserved Areas and Populations (MUA/Ps), and other initiatives identified by the United States Department of Health and Human Services. 2. Health care workforce research and planning. 3. Understanding issues related to supply, demand, distribution, and use of health care workers. 4. Informing health care workforce policy. This Act also makes technical corrections to conform existing law with the standards of the Delaware Legislative Drafting Manual.

This House Concurrent Resolution recognizes the significant contributions of nurses as frontline healthcare workers, recognizes the importance of basic protections and rights for this profession, and resolves that the rights of nurses are upheld and promoted throughout the state.

This resolution addresses the issue of workplace violence in healthcare, encourages preventive measures, promotes collaboration and support for healthcare workers, and proclaims the month of April 2025 as “Healthcare Workplace Violence Prevention & Awareness Month” in the State of Delaware.