Healthcare

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.

This resolution requires the Division of Medicaid and Medical Assistance to present a report to the Delaware General Assembly, by January 1, 2026, for the provision of insurance coverage for Community Health Worker services by Medicaid providers, which must include a draft State plan amendment or waiver, as appropriate, to the Governor and all members of the General Assembly, with copies to the Director and the Librarian of the Division of Research of Legislative Council, and the Delaware Public Archives.

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 resolution urges Governor Meyer to submit a waiver request to the United States Department of Agriculture (USDA) seeking to prohibit the use of Supplemental Nutrition Assistance Program (SNAP) benefits for the purchase of candy and sugar-sweetened beverages. The resolution aligns with similar efforts in other states to promote healthier food choices among SNAP recipients and to ensure that taxpayer-funded nutrition programs support the health and well-being of low-income individuals and families. By eliminating “junk foods” from the list of eligible purchases, Delaware can take a meaningful step toward reducing diet-related chronic illnesses and strengthening the nutritional integrity of the SNAP program.

This Act provides a roadmap via an observational study on a small but representative group of diabetic patients to change standard healthcare from current reactive “sick care” to proactive “well care”. This will be accomplished by using a Delaware health system combined with a technology partner to regularly test, measure and manage, and incentivize diabetic patients and their providers to improve the health outcomes for Delawareans and drive down health care costs. The length of the observational study will be 3 years. During that time, data analysis will track results to determine if this Pilot Program shall be renewed and expanded.

The purpose of this Act is to protect medical providers in the State from out-of-state lawsuits and investigations that threaten the practice of medicine in the State. To that end this Act does the following: 1) Clarifies that physicians, physician assistants, and nurses that provide lawful healthcare services in the State do not engage in unprofessional conduct and cannot be disciplined for such services even if such services are illegal or considered to be unprofessional conduct or the unauthorized practice of medicine or nursing in another state. 2) In a civil action or proceeding, prohibits any healthcare provider from disclosing communications and records concerning healthcare services unless the patient authorizes such disclosure, with some exceptions. 3) Provides protections from civil and criminal actions that arise in another state that are based on the provision of health care services that are legal in Delaware. 4) Creates a cause of action for persons against whom a judgment was entered in another state based upon that person allegedly providing, receiving, or helping another person to provide healthcare services that are lawful in Delaware. (This does not apply to an action where no part of the acts that formed the basis for liability occurred in Delaware.) 5) Prohibits an insurer from taking an adverse action against a healthcare provider or organization for performing or providing healthcare services that are lawful in this State. 6) Prohibits any State or local agency, commission, board, or department from assisting a federal law-enforcement agency, another state’s law-enforcement agency, a private citizen, or a quasi-law-enforcement agency in relation to an investigation or inquiry concerning the lawfulness of healthcare services, if such services would be lawful as provided if they occurred entirely in the State.