Healthcare

This Act strengthens procedural protections for pharmacies, pharmacists, and consumers related to regulation of a pharmacy benefits manager by doing all of the following: Adds definitions for the terms “chronic or long-term condition”, “net amount”, “purchaser”, “recoupment”, “similarly situated contracted pharmacy”, and “wholesale invoice audit.” Applies audit notice requirements uniformly and ensures access to an appropriate point of contact. Requires a pharmacy benefits manager to provide a list of records that the auditing entity seeks to audit at least 5 business days before an audit. Limits activities to once every 12 months and sets standards for wholesale invoice audits. Ensures audit costs are borne solely by the pharmacy benefits manager. Clarifies that a pharmacy can appeal the amount of any reimbursement and that a contracted pharmacy’s representative can take actions and receive notices related to appeals on behalf of a pharmacy. Extends pharmacies’ ability to appeal from 10 days to 40 days to account for entities that complete retroactive billing. When an appeal is denied, requires the parties to provide a detailed reason for the denial and specific information about how the pharmacy can appeal the denial to the Department of Insurance. Prohibits retaliation by a pharmacy benefits manager when a pharmacist or pharmacy discloses information to a government agency or during a proceeding if the person who disclosed the information had reasonable cause to believe that the disclosed information is evidence of a violation of a state or federal law. Requires that a pharmacy benefits manager must provide at least 60 days’ notice before amending a contract with a pharmacy or pharmacist. Clarifies that the prohibition against spread pricing applies to all purchasers contracting with pharmacy benefits managers. Changes the reporting requirements for rebates so that pharmacy benefits managers must file the required reports annually instead of quarterly. This change will reduce the amount of incorrect or unclear reporting because rebates are aggregated and reported at the end of the period of time under each contract. Amends national drug acquisition cost compliance to refer to the date of service. Prohibits pharmacy benefit managers from unit-of-use requirements inconsistent with smallest package size availability and manufacturer recommendations. Requires that pharmacy benefit managers may not require pharmacies to dispense therapeutically equivalent or alternative drugs that cost the enrollee more out of pocket than the prescribed drug except for medical reasons. Ensures that enrollee-identifiable or prescriber-identifiable information is not transferred to or shared with affiliated pharmacies for any commercial purpose other than those defined. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

This Act amends Title 16 to establish statewide standards for levels of neonatal care for facilities that operate neonatal nurseries or neonatal intensive care units. The Act requires facilities to comply with nationally recognized standards for levels of neonatal care established by the American Academy of Pediatrics (AAP), ensuring that newborns receive care in facilities equipped to meet the complexity of their medical needs. Under the Act, the Secretary of the Department of Health and Social Services (DHSS) will designate each facility's level of neonatal care based on compliance with the AAP standards, including staffing, equipment, facility capabilities, and patient protocols. The Act further establishes additional requirements for facilities providing Level IV NICU services which care for the most critically ill and medically complex newborns. DHSS must adopt implementing rules by January 30, 2027, and will seek input from the Delaware Perinatal Quality Collaborative and existing NICU providers in developing these rules.

This Act requires a health-care practitioner to offer a patient ultrasound imaging and auscultation of fetal heart tone services before terminating a human pregnancy. The patient is free to choose not to view the ultrasound or listen to the auscultation of fetal heart tone. This Act is known as "The Woman's Right to Know Act.”

This Resolution recognizes the pertinent work of social workers throughout Delaware and the entire country, encourages the creation and expansion of Social Work programs, and recognizes March 2026 as Social Work Month in the State of Delaware.

This Act amends the Childhood Lead Poisoning Prevention Act to update the statutory definition of confirmatory blood lead testing for children under 16 years of age. The Act allows a confirmed elevated blood lead level to be established either through a venous blood lead test or through two capillary blood lead screenings collected within 12 weeks of each other, provided that the applicable lead reference value is met or exceeded. Two positive capillary blood lead screenings yield an effective specificity of approximately 99.75% when properly collected. This change is consistent with the Centers for Disease Control and Prevention surveillance case definition, reduces barriers to case identification and management, and requires conforming regulatory updates.

This Act requires a long-term care facility to refund any deposit or minimum-stay-requirement charges to a resident or a resident’s family if the resident dies prior to or within 60 days of entering the facility, if the individual is unable to enter the facility due to a change in the individual’s medical condition or needs, or if the resident is discharged or transferred from the facility within the first 60 days.

This Act does all of the following: (1) Establishes a regulatory framework for substance use harm reduction programs that provides immunities for program providers and staff. (2) Modifies the definition of drug paraphernalia. (3) Decriminalizes possession of paraphernalia for individuals who use drugs, while retaining prohibitions for paraphernalia used in the manufacturing or distribution of drugs and the selling of certain drug paraphernalia. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

Early access to language is essential to child development. Children identified as Deaf or hard of hearing rely on hearing aids for language development. Language development leads to success in school. Medicaid coverage of hearing aids for children younger than 21 years old applies only to children who qualify for Medicaid. Delaware currently requires private insurers to provide minimum coverage of $1,000 for each hearing aid for individuals younger than 24 years old, covered as a dependent by the policyholder. The cost of hearing aids can vary widely but can cost from $3,000 to $5,000 out-of-pocket. This can be too expensive for families, even with the current $1,000 coverage requirement. The cost of a cochlear implant can range from $30,000 to $100,000, depending on the necessary device, surgery, and rehabilitation. Delaware does not currently require insurers to cover the costs of cochlear implants. This Act is a second substitute for Senate Bill No. 269 and differs from the first substitute Senate Bill No. 269 by changing the cost-sharing limitation to require insurers to cover at least 95%, instead 100%, of the cost of benefits for hearing aid and earmold benefits provided under § 3357(b)(1)a., § 3571A(b)(1)a., and § 5224(b)(1)a. of this Act. Like the first substitute to Senate Bill No. 269, this Act differs from Senate Bill No. 269 in all of the following ways: 1) Includes external sound processors in the definition of a cochlear implant. 2) Clarifies that, for group and blanket health policies and the state employee health plan, the required coverage of hearing-aid related parts and services is limited to individuals younger than 26 years old and covered as a dependent by the policyholder. 3) Names this Act in honor of T. Hollis Jennings who is a testament to the success of state-mandated hearing aid coverage and early intervention. Hollis got hearing aids when she was an infant. Her language developed typically, with no need for speech therapy. She now exceeds grade-level benchmarks in math and ELA. She’s also a phenomenal singer. 4) Makes technical changes to strike through and underline format to make it easier to see changes and to correct grammar. Like Senate Bill No. 269 and the first substitute for Senate Bill No. 269, this Act requires individual health insurance policies under Chapter 33 of Title 18, group and blanket health insurance policies under Chapter 35 of Title 18, and the state employee health plan under Chapter 52 of Title 29 to cover all of the following: 1) At least 1 hearing aid for each ear at least every 3 years, or before the expiration of the 3-year period if a health care professional determines that a new hearing aid is medically necessary. For hearing aids with earmolds, insurers are required to cover at least 1 earmold for each ear at least annually, or sooner if new earmolds are medically necessary. The cost-sharing limitation applies only to coverage of hearing aids. The types of hearing aid covered includes a hearing aid with an earmold, a hearing aid with slim tubing, a receiver-in-ear hearing aid, a bone-anchored hearing aid, and a cochlear implant. 2) Medically necessary hearing aid-related parts, attachments, or accessories. 3) Medically necessary related services related to prescribing, fitting, implanting, or dispensing hearing aids. Coverage must include medically necessary related services provided by a hearing care professional who specializes in providing care to pediatric patients. For individual health insurance policies, the coverage required under this Act applies to all covered individuals, regardless of age, because federal law prohibits states from limiting coverage for an essential health benefit based on an individual’s age unless there is a clinical reason. For group and blanket health insurance policies and the state employee health plan, the required coverage applies only to individuals younger than 26 years old and covered as a dependent by the policyholder. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual and reorganizes paragraphs for clarity. This Act applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2027.

In Delaware, all individual health insurance policies, all group and blanket health insurance policies, the State employee health insurance plan, and Medicaid are required to cover chiropractic and physical therapy treatment for chronic back pain without annual or lifetime numerical limits on physical therapy or chiropractic care visits. To evaluate the effectiveness of this coverage requirement, the Patient Centered Care Subcommittee of the Addiction Action Committee, under the Delaware Department of Health and Social Services, sent a survey to chiropractic therapy and physical therapy providers in Delaware. Although the survey showed that the coverage requirement has improved treatment of chronic pain patients, the survey also showed that the coverage requirement provides supportive chronic pain treatment for only the thoracic region of the spine, which is the middle of the spine from the base of the neck to the bottom of the ribs, and the lumbar region of the spine, which is the lower back. The treatment of chronic pain through chiropractic supportive care, physical therapy, or both, can prevent a patient from requiring opioid pain medications or more expensive treatments, but excluding vital areas of the spine and body from coverage may limit the effectiveness of chiropractic therapy and physical therapy treatment and limits a chronic pain patient’s potential for improvement. This Act encourages treatment of chronic pain patients without opioids by updating the required health insurance coverage to prohibit annual or lifetime numerical visits on physical therapy or chiropractic care visits that are for the purpose of treating the spine and other neuromusculoskeletal structures, including extremities. The updated coverage required under this Act applies to all policies, contracts, or certificates issued, renewed, modified, altered, amended, or reissued after December 31, 2026. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

This Act provides that health care facilities must permit patients who have been issued and possess a valid registry identification card for the medical use of marijuana and have a terminal illness to use medical marijuana on the health care facilities’ premises, subject to certain restrictions. However, a health care facility may prohibit or suspend such use of medical marijuana under some circumstances, such as if the facility's medical professionals determine that use of medical marijuana may have an adverse impact on the medical care and treatment of the patient or is otherwise contraindicated, or if a federal regulatory agency, the United States Department of Justice, or the Centers for Medicare and Medicaid Services initiates an enforcement action against a health care facility based on the use of medical marijuana on the facility's premises or issues a rule or guidance prohibiting the use of medical marijuana at health care facilities. In addition, the Act provides that a person is not subject to civil or criminal liability or professional discipline for complying with the Act, except in cases of gross negligence, recklessness, or intentional misconduct. This Act is modeled on a 2021 California law known as "Ryan's Law."