While the exact number of nurse vacancies in Delaware fluctuates, healthcare providers agree that the current shortage is unsustainable. Nursing shortages lead to missed nursing care, higher morbidity, and mortality rates. The American Association of Colleges of Nursing (AACN) outlines a number of contributing factors impacting the current national nursing shortage. One is a lack of nursing school faculty - including the preceptors that provide supervision and instruction for clinical practice. Since Delaware’s nursing education programs must require clinical learning experiences provided by these preceptors, nursing students have difficulty completing the required coursework necessary for degree and licensure. Section 1 of this Act provides for an annual appropriation in an amount determined by the General Assembly to the Delaware Nursing Workforce Initiative or similar nonprofit to administer a program to provide funding to hospitals and clinical facilities to implement or continue offering preceptorship programs. Section 2 provides that this Act is effective 6 months after enactment.
This resolution directs the Department of Labor, in collaboration with the Department of Education and the Department of Health and Social Services, to study the creation of a Delaware Healthcare Apprenticeship Degree Program that would place aspiring healthcare professionals in paid clinical positions in healthcare facilities while they complete the training and schooling necessary to become credentialed healthcare professionals. The resolution requires that the study consider how any recommended program may be funded through Delaware’s federal Rural Health Transformation Program award and implemented through or in coordination with the competitive awards made by the Department of Health and Social Services under that program, so that the program complements, rather than duplicates, the State’s ongoing healthcare workforce initiatives. This resolution also directs the Department of Labor to consult with stakeholders to make recommendations for degreed apprenticeship programs beyond healthcare and requires the Department to submit a report of its findings to the Governor, the General Assembly, and the Division of Legislative Services by May 1, 2027.
This Act clarifies that individual, group, and blanket health insurance carriers must provide for and pay for services (including immunizations) that were recommended by the Advisory Committee on Immunization Practices of the Center for Disease Control (CDC) and the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) that were in effect as of January 1, 2025. They must also cover immunizations that were supported by national clinical guidelines or national standards of care in effect on January 1, 2025. To that end, this Act removes provisions that permit carriers to deny coverage for these items or services simply because they are not currently recommended by the Advisory Committee on Immunization Practices of the CDC and the comprehensive guidelines supported by the HRSA. This Act also removes obsolete United States Preventative Task Force provisions related to breast cancer screening from 2009.
This Act modernizes Delaware’s pharmacy practice laws by authorizing pharmacists to practice to the full extent of their education and training. Pharmacists have the expertise necessary to provide patient care beyond what current Delaware law allows, and enabling them to do so is an important step toward expanding access to health care in this State. Under this Act, pharmacists are permitted to independently evaluate patients, identify health conditions, order and prescribe laboratory tests, and prescribe drugs or devices without reliance on statewide protocols, formularies, or specified lists of conditions. Pharmacists may not prescribe controlled substances, with the exception of medications for the treatment of opioid use disorder, which pharmacists may only prescribe under a standing order from the Division of Public Health. In order to enable pharmacists to prescribe medications for the treatment of opioid use disorder under a standing order, this Act also amends the Uniform Controlled Susbstances Act in Chapter 47 of Title 16 to include “pharmacist” in the definition of “practitioner.” To ensure continuity of care, this Act also establishes requirements for documentation of treatment and communication with primary care providers. This Act takes effect immediately, but implementation is delayed by up to 1 year to give the Board of Pharmacy time to implement necessary regulations. This Act does not affect current law regarding the use of statewide protocols, standing orders, or collaborative practice agreements. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.
This Act expands the scope of practice for dental hygienists in this State. Allowing dental hygienists to use the full range of their education and expertise when providing oral health services will help alleviate provider shortages that make it challenging for Delawareans to obtain dental care. In particular, this Act will help fill gaps in access to preventative oral health care. Oral health is inseparable from overall health, and patients are best served when care is delivered through an integrated, team-based model. Dental hygienists play a vital and respected role in prevention, education, and early identification of disease. A collaborative dental team where each provider practices at the top of their education within a structured system of referral, communication, and accountability ensures patients receive timely preventative services along with accurate diagnosis and appropriate treatment. This approach strengthens access while preserving the standard of care and protecting the public. This Act grants dental hygienists the authority to do all of the following, in addition to the services they currently provide: 1. Administer and dispense topical agents under the standing order of a dentist providing general supervision. 2. Prescribe, administer, and dispense fluoride under the standing order of a dentist providing general supervision 3. Apply sealants without the need for a dentist to examine a patient beforehand, provided a dentist will see the patient within 12 months of receiving treatment. 4. Engage in dental hygiene assessment and treatment planning within the scope of the authority of a dental hygienist as defined by the Board of Dentistry and Denal Hygiene based on education and experience. 5. Provide direct access to prophylaxis without the need for a dentist to examine a patient beforehand, provided a dentist will see the patient within 12 months of receiving treatment. 6. Directly supervise dental assistants in a manner to be prescribed by the Board of Dentistry and Dental Hygiene. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.
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 modernizes Delaware law by adding modern medical treatment options biologics or biosimilars to the step therapy exception process. The current law was passed before biosimilars were widely available. Biosimilars are to biologics what generic drugs are to traditional drugs once their exclusivity expires. This revision adds an exclusion to step therapy protocol exceptions for interchangeable biologics and biosimilars.
This Act updates Delaware laws relating to Sexually Transmitted Disease (STD) prevention and control, much of which are outdated and do not reflect current research and medical practice. To that end, this Act does the following: (1) Clarifies that Sexually Transmitted Infections (STIs) are to be treated in the same manner as STDs. (2) Removes the requirement that reportable STDs be reported to DPH within 1 working day. (3) Repeals the provision permitting the Director of DPH to examine a person suspected of being infected with an STD and to order that person to isolate or quarantine. (4) Repeals the provision relating to apprehending, committing, mandating treatment, and quarantine of an infected person. (5) Repeals the provision permitting the Director to bring an action in the Justice of the Peace Court when a person suspected of having an STD presents an imminent danger to public health. (6) Removes the provisions concerning the DOC and DPH isolating or quarantining persons with suspected or known STDs. (7) Provides that health care providers must provide STD and STI testing, but that a pregnant person may refuse testing. Documentation of refusal must be retained in the patient’s medical record along with documentation of test counseling. (8) Repeals the provision permitting a DPH investigator without a medical license to withdraw blood for test purposes. (9) Makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.
This Act protects Delaware’s nonprofit acute care hospitals from acquisition by entities other than charities or not-for-profit entities during a moratorium period. It also permanently subjects the sale or encumbrance of primary facility real estate of a nonprofit acute care hospital to the Attorney General notice and review requirements of the Conversion Act. Section 1 makes two primary changes to the definitions in § 2531 of Title 29. First, it clarifies that a "not-for-profit healthcare conversion transaction" includes those undertaken "directly or indirectly through one or more affiliates." This ensures that the Attorney General’s oversight cannot be circumvented by structuring transactions through shell entities or intermediaries. It provides a new, permanent category of conversion transaction: the sale, transfer, conveyance or lease of a hospital's "primary facility real estate" to a for-profit entity. This change ensures that arrangements involving the land and buildings of an acute care hospital are subject to the same notice and review requirements as a change in corporate control. Finally, Section 1 defines for "acute care hospital" and "primary facility real estate.” Section 2 requires the Attorney General to transmit copies of any Conversion Act notice involving an acute care hospital to the Governor and the Secretary of the Department of Health and Social Services within 10 days of receipt. Section 3 prohibits any person or entity, other than a charity or not-for-profit entity, from entering into a "change of control transaction" involving acquisition of a nonprofit acute care hospital. It defines a "change of control transaction" as the acquisition of the power to direct the hospital's management, policies, or clinical practices, whether through ownership of voting securities, changes in board composition, or by contract. Any transaction of this nature is void and has no legal effect. The prohibition expressly captures incremental acquisition scenarios, including minority stakes, sub-majority governance rights, board appointment rights, and executive officer appointment rights. Section 4 amends § 9304 of Title 16 to prohibit any entity or person other than a charity or not-for-profit entity from submitting, and the Health Resources Board from accepting or processing, an application for a Certificate of Public Review for the construction, development, establishment, or acquisition of an acute care hospital. Any such application is void and of no legal effect. Section 5 provides that Sections 2 through 4 are effective until July 1, 2028, unless terminated sooner or extended by the General Assembly.
This Act amends Titles 16, 18, 29, and 31 of the Delaware Code and Chapter 237, Volume 83 of the Laws of Delaware relating to primary care insurance. Among other things, the Act does the following: Section 1 of the Act amends § 9903 of Title 16 of the Delaware Code to provide that the Health Care Commission, in coordination with the Primary Care Reform Collaborative, will monitor compliance of primary care providers with value-based care delivery models established under the Office of Value-Based Health Care Delivery (OVBHCD). Section 2 of the Act amends § 9904A of Title 16 to remove a time frame limitation for the period during which the Health Care Commission is authorized to request written reports by health insurers regarding progress in adopting and implementing value-based payment models. Under the Act, the PCRC may continue to request such reporting going forward. Section 3 of the Act amends § 329 of Title 18 to provide that administrative penalties for violations of §2503(a)(12), §2503(a)(15), § 3342B, and § 3556A of Title 18 may be equivalent to the amount of the violation, and that penalties imposed for such violations are to be deposited into a Primary Care Fund, which will be used by the Statewide Benefits Office and the Division of Medicaid and Medical Assistance. Section 4 of the Act amends § 334 of Title 18 to clarify that the OVBHCD has the ability to promulgate regulations necessary to accomplish the stated goals of reducing health-care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates. Section 5 of the Act amends § 2503 of Title 18 to extend current cost containment calculations to rate filing year 2027. Given their relative size and patient populations within Delaware's health care market, Delaware's two smallest hospitals and lone free-standing children's hospital are exempt from that extension. In rate filing year 2028 and thereafter, the Act specifies that costs per service for health benefit plans may not exceed certain Medicare Reference-Based Pricing Targets, which are based on the “Full Medicare rate,” meaning the applicable wage-adjusted base Medicare rate for different services, the Free-Standing Children’s Hospital Medicare outpatient payment rate, or the TEFRA Rate, meaning the target amount under the federal Tax Equity and Fiscal Responsibility Act (TEFRA) Waiver Program applicable to Free-Standing Children's Hospitals, unless certain exemptions apply. Those exemptions are for Delaware's two smallest hospitals and, if making progress with value-based care, for a Delaware hospital in a high-growth, high-Medicare population region. Carriers issuing plans in the commercial market for 2 consecutive years and that cover more than 5,000 members must meet minimum percentages of alternative payment model contracting, as specified. Section 6 of the Act amends § 3342B of Title 18 concerning primary care coverage offered by individual insurance plans. Under the Act, starting in 2026, carriers must spend at least 11.5% of their total cost of medical care on primary care, at least 5% of which must be via prospective primary care management payments. Carriers must offer value-based care programs and may not deny contracted providers the opportunity to participate in an offered value-based care program. In addition, the Commissioner is required to issue regulations regarding the calculation of total cost of care. Section 7 of the Act applies the same changes as Section 6 of the Act to § 3556A of Title 18, concerning primary care coverage offered by group insurance plans. Section 8 of the Act deletes a sunsetting clause contained in Section 14, Chapter 237, Volume 83 of the Laws of Delaware, which would have repealed § 2503(a)(12)a., § 3442B(b)(3), and § 3556A(b)(3) of title 18, effective January 1, 2027. Section 9 of the Act amends § 5204 of Title 29 to provide that health-insurance coverage for public officers and employees shall be provided by a carrier whose cost per service may not exceed certain Medicare Reference-Based Pricing Targets, which are based on the Full Medicare rate, the Free-Standing Children's Hospital Medicare outpatient payment rate, or the TEFRA Rate, unless certain exemptions apply. Those exemptions are for Delaware's two smallest hospitals and, if making progress with value-based care, for a Delaware hospital in a high-growth, high-Medicare population region. In addition, Section 9 of the Act specifies that coverage shall be provided by a carrier offering value-based care programs equivalent to the commercial market requirements. Section 10 of the Act amends §5224 of Title 29 concerning primary care coverage of insurance coverage for public officers and employees, to require plans to report data to the OVBHCD on the percentage of primary care spending as a percentage of total medical costs for plan years 2027 and 2028 and to increase spending on primary care by 1% per year thereafter until primary care spending reaches 11.5% of total medical costs. Section 11 of the Act creates §539 of Title 31, concerning state public assistance, to require entities providing health insurance under § 505(3) to report data on the percentage of primary care spending as a percentage of total medical costs for 2 plan years and, in subsequent years, increase primary care spending by 1% until primary care spending reaches 11.5% of total medical costs. Section 12 of the Act provides that the Department of Insurance shall promulgate regulations pursuant to the Act within 18 months of enactment, but shall promulgate regulations on or before January 1, 2027 establishing a methodology to determine any appropriate annual inflationary or other applicable adjustments to a hospital's Full Medicare Rate. Like Senate Substitute No. 1 for Senate Bill No. 1, this Act differs from Senate Bill No. 1 in that it bases the limits for costs per service for health benefit plans on Medicare Reference-Based Pricing Targets, which may differ based on whether the services are outpatient services, inpatient hospital services, or emergency department services, and on whether the services are being provided by a Free-Standing Children's Hospital; under Senate Bill No. 1, the limits for cost-per-service were based on a percentage of Medicare reimbursement for comparable services. In addition, this Act provides more guidance regarding the application of exemptions from those limits. In addition, Senate Substitute No. 2 for Senate Bill No. 1 differs from Senate Bill No. 1 in that it makes technical edits to definitions and it provides that the Department of Insurance and the State Employee Benefits Office shall lead a process, in consultation with Delaware hospitals, to recommend an appropriate methodology to determine and apply any inflationary or other applicable adjustments to a hospital's Full Medicare Rate not otherwise captured in a hospital's annual Medicare rate update by January 1, 2027. Senate Substitute No. 2 for Senate Bill No. 1 also adds an exemption from the aggregate unit price growth limits in § 2503(a)(12)a.3. of Title 18 for a hospital that is a Free-Standing Children's Hospital, a hospital that qualifies as a Medicare-Dependent Rural Hospital on the grounds that it meets the definition of a Medicare-dependent hospital under 42 C.F.R. § 412.108 for at least 3 of the 5 years immediately preceding the applicable rate filing year, or an Urban Medicaid DSH Hospital.
