This Joint Resolution directs the Department of Health & Social Services to explore and consider additional solutions for tackling the State's high cost of health care and to submit a report to the General Assembly by January 1, 2027, that explores the feasibility of additional strategies to lower health care costs. The report will explore updating the current Medicaid outlier methodology, ways to ensure further cost savings for 2027, and the feasibility of a statewide adoption of a global budget or 2-sided risk models, and will evaluate options for a public option or other publicly sponsored coverage strategy.
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 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.
The Department of Health and Social Services (DHSS), through the Division of Services for Aging and Adults with Physical Disabilities (DSAAPD), operates the Delaware Hospital for the Chronically Ill (DHCI), a Long-Term Care (LTC) facility in Smyrna, Delaware. DHCI is a facility of last resort for Delawareans that require a skilled nursing facility level of care and have no viable options for private nursing facility care. The Delaware Hospital for the Chronically Ill’s name no longer reflects the dignity of all residents who live there. The existing statute uses outdated and offensive language, often referring to residents as “inmates.” It does not align with current policies and procedures around operation and maintenance of DHCI or the skilled care, screening, and admission of its residents, nor does it recognize DHCI’s role as a skilled nursing facility that maintains a five-star rating from the Centers for Medicare and Medicaid Services (CMS). This bill provides a technical update to reflect DHCI’s current practices, policies and procedures as a LTC facility of last resort. It strikes outdated language and aligns the statute with current DHCI, state, CMS practices and requirements. Finally, this bill renames the Delaware Hospital for the Chronically Ill to the Eleanor Cain Center. It will be named in honor of Eleanor Lee Cain, who served as the DSAAPD director from 1973 to 2001 and was a champion for older adults.
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."
This Senate Joint Resolution directs the Department of Health and Social Services to submit a state plan amendment increasing eligibility for Medicaid Long Term Services and Supports to 300% of SSI, which is consistent with the eligibility limit in all other states and the District of Columbia.
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 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.
