Healthcare

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 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 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 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.

This Act expands the scope of prohibited extraordinary collection actions to include a large health-care facility levying on tangible personal property of a patient. It also clarifies that any party taking action to collect medical debt must disclose in court pleadings whether the party is a large health-care facility, and makes technical corrections.

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 Act updates the Respiratory Care Advisory Council to the Board of Medical Licensure and Discipline’s enabling act to allow qualified licensed respiratory therapists to perform all duties associated with extracorporeal life support. Under the current law, respiratory therapists are authorized to assist with such support but may not administer medication during the process. As a result, a therapist is required to wait for another licensed professional to do so, resulting in delays to patient care. This bill eliminates this delay in patient care and allows qualified respiratory therapists to work within the full scope of their training. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

This Act is a Substitute for House Bill No. 449. Like House Bill No. 449, this Substitute Act comprehensively amends Chapter 38 of Title 24 of the Delaware Code, the Dietitian/Nutritionist Licensure Act, to modernize the regulation of dietitians and nutritionists in this State by doing all of the following: (1) Replacing the single “licensed dietitian/nutritionist” license with 2 distinct licensure categories—“licensed dietitian” and “licensed nutritionist”—each with its own defined scope of practice, educational pathway, supervised practice requirements, examination standards, and protected professional titles. Licensed dietitians are authorized to provide medical nutrition therapy for complex and non-complex disease states and medical conditions, including in inpatient and high-acuity settings, while licensed nutritionists are authorized to provide medical nutrition therapy for non-complex conditions in low-acuity outpatient settings. (2) Updating the definitions in Chapter 38 of Title 24 to add defined terms, including “medical nutrition therapy”, “complex”, “non-complex”, “practice of dietetics”, “practice of nutrition”, “nutrition care process”, “therapeutic diet”, “qualified supervisor”, “telehealth”, and “registered dietitian”. (3) Raising the minimum educational requirement for licensed dietitian applicants from a baccalaureate degree to a master’s degree with a program accredited by the Accreditation Council for Education in Nutrition and Dietetics, increases the required supervised practice experience from 900 to 1,000 hours, and modernizes examination requirements by tying them to the Commission on Dietetic Registration. This Substitute Act establishes a parallel licensure pathway for licensed nutritionists based on a master’s or doctoral degree in nutrition with a supervised practice experience of at least 1,000 hours and passage of the certified nutrition specialist examination administered by the Board for Certification of Nutrition Specialists. (4) Amending the composition of the State Board of Dietetics/Nutrition to include 2 licensed dietitian members, 1 licensed dietitian or licensed nutritionist member, 1 Delaware-licensed physician, and 1 public member. It updates the licensure renewal section to require that continuing education hours for licensed dietitians meet the standards of the Commission on Dietetic Registration, and that continuing education hours for licensed nutritionists meet the standards of the Board for Certification of Nutrition Specialists. (5) Revising the licensure required section (§ 3810 of Title 24) to establish protected titles for both licensed dietitians and licensed nutritionists, to clarify who may engage in the practice of medical nutrition therapy, and to update the exemptions from licensure requirements. Exemptions are updated or added for students and trainees in supervised practice programs; persons providing general non-medical nutrition information; out-of-state practitioners providing services via telehealth; persons providing wellness, health coaching, and non-medical weight control services; WIC program employees; and others providing non-discretionary support activities under direct supervision. (6) Adding a new § 3814 of Title 24 authorizing the Board to issue provisional licenses to applicants who have completed education and supervised practice requirements but have not yet passed their licensure examination. (7) Providing that existing Delaware licensed dietitian nutritionists who hold the registered dietitian credential will be grandfathered as licensed dietitians and those who do not hold that credential will be grandfathered as licensed nutritionists, without additional requirements. (8) Making conforming amendments throughout Chapter 38 of Title 24 to replace outdated titles, organizational references, and scope of practice language consistent with the dual licensure structure created by this Act. (9) Making technical corrections to conform Chapter 38 of Title 24 to the standards of the Delaware Legislative Drafting Manual. This Substitute Act differs from House Bill No. 449 by making all of the following changes recommended by the Division of Professional Regulation: (1) Removing antiquated language prohibiting an individual appointed to fill a vacancy from serving on the Board for only 1 additional full term. (2) Providing that the actions that require the affirmative vote of 3 members of the Board are related to disciplinary actions under § 3811(b) of Title 24. (3) Removing a requirement that an applicant for licensure as a nutritionist must complete the required supervised practice experience within 5 years of completing the required educational requirements. (4) Clarifying the documentation required related to the supervised practice experience required for an applicant for licensure as a nutritionist. (5) Removing the requirement that an applicant for licensure as a dietitian or nutritionist complete 75 hours of continuing education for each 5-year period post-examination when the applicant passed the required examination more than 5 years before applying for licensure and has not maintained registration or certification and replacing that requirement with a requirement that the applicant complete continuing education as required by the Board, have actively practiced in dietetics, nutrition, or a substantially related healthcare profession within the last 5 years, completed coursework, supervised practice, or training related to dietetics or nutrition in the last 5 years, or provided other evidence demonstrating current competency. (6) Providing, as part of the grandfather provisions, for a pathway for nutritionists who are practicing at the level of a dietitian to continue practicing at that level. (7) Removing the telehealth provision that was in House Bill No. 449 because Chapter 60 of Title 24 applies to the Board. (8) Reverting to the "reasonably equivalent" standard for reciprocity and ensuring reciprocity is available for certified or licensed dietitians or certified or licensed nutritionists from another state whose standards are not reasonably equivalent if the applicant has held the certification or license in good standing for at least 5 years and the Board determines the applicant qualifies for licensure under Chapter 38 of Title 24. (9) Deferring standards related to qualified supervisors to the Board by regulation. (10) Providing for delayed implementation of this Substitute Act for 18 months or the adoption by the Board of regulations to implement this Substitute Act, whichever comes first. This Substitute Act requires a greater than majority vote for passage because § 11 of Article VIII of the Delaware Constitution requires the affirmative vote of three-fifths of the members elected to each house of the General Assembly to impose or levy a tax or license fee.

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.