Rep. Ed Osienski

Over 80% of pharmaceuticals in the United States are purchased through pharmacy benefits manager ("PBM") networks. PBMs serve as intermediaries between health plans, pharmaceutical manufacturers, and pharmacies or pharmacists, and PBMs establish networks for patients to receive reimbursement for drugs. Given the scope of PBMs in the healthcare delivery system, this Act is designed to provide enhanced oversight and transparency as it relates to PBMs. Specifically, this Act does the following: (1) If a PBM denies an appeal for reimbursement subject to maximum allowable cost pricing, requires the PBM to provide the national drug code number of wholesalers in Delaware that have the drug in stock below maximum allowable cost. (2) Authorizes a pharmacy or pharmacist to decline to dispense a prescription drug or provide a pharmacy service to a patient if the amount reimbursed by a PBM is less than the pharmacy acquisition cost. If a pharmacy or pharmacist declines to provide a drug or service, the pharmacy or pharmacist must inform the patient that the pharmacy or pharmacist did this because of the costs of providing the drug or service and provide the patient with a list of pharmacies in the area that may provide the drug or service. (3) Requires PBMs to provide a reasonably adequate and accessible pharmacy benefits manager network. (4) Increases transparency by requiring PBMs to provide reports to the Insurance Commissioner on network adequacy and the amount of rebates received by PBMs to provide reports to the Insurance Commissioner on network adequacy and the amount of rebates received by PBMs and distributed to insurers or patients. (5) Prohibits PBMs from engaging in certain conduct, such as spread pricing, false advertising, and reimbursing a pharmacist or pharmacy in an amount less than the PBM reimburses itself or an affiliate for the same drug or service. If a PBM engages in prohibited conduct, the Insurance Commissioner is authorized to deny, suspend, or revoke the PBM's registration under § 3355A of Title 18 or impose penalties or take other enforcement action under § 3359A of Title 18. (6) Clarifies that the Insurance Commissioner is authorized to deny an application for registration filed by a PBM. (7) Increases the registration and renewal fee to be paid by a PBM to better reflect the cost of the registration and renewal process and better align with the fee assessed by other states that require PBMs to register. (8) Transfers § 3359A of Title 18 (regarding penalties and enforcement) to a separate subchapter focused on prohibited practices, penalties, and enforcement. In addition, this Act makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual. Finally, this Act requires a greater than majority vote for passage because § 10 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 increase the effective rate of any tax levied or license fee imposed.

This Act is designed to increase the opportunity for Delaware children to undergo developmental screening with a research-based screening tool at an early age in order to identify children who may be eligible for Early Intervention or special education services. It requires any applicant for a license or renewal of a license to operate a child care facility on or after July 1, 2023 to commit that each child between the age of birth and 5 years old (who has not yet entered kindergarten) enrolled by the child care provider will undergo developmental and social emotional screening. The screening mechanism to be used is the screening system approved by the Department of Education and will be administered by the parent or guardian of the child seeking to be enrolled in the child care facility. This Act permits an operator of a child care facility at a YMCA to be appointed to the Provider Advisory Board, changes references from “day care” to “child care” in the existing law and makes other changes consistent with the Legislative Drafting Manual.

This Act mandates that the Department of Natural Resources and Environmental Control and the Division of Public Health establish maximum contaminant levels for specific contaminants found in drinking water in this state. Such contaminants include PFOA and PFOS, which are man-made chemicals. In certain studies, these chemicals were found to be associated with increased risks of chronic diseases. The Environmental Protection Agency, thus far, has not established a maximum contaminant levels, but have issued health advisories. The establishment of maximum contaminant levels is essential in order to protect the health and safety of all Delawareans from contaminants in drinking water.

The Victims’ Compensation Assistance Program (“Agency” or “VCAP”) administers the Victims’ Compensation Fund and provides financial assistance to eligible victims of crimes to help cover the costs of a variety of services that help victims and their families begin to rebuild their lives, including lost wages, medical expenses, payment for mental health counseling, and funeral expenses. By awarding financial compensation for losses that victims sustain as a result of crime, VCAP can help alleviate the financial burden and distress that crime leaves behind. In FY 2019, VCAP paid $2,091,787.94 to and on behalf of victims of crime. VCAP is solvent and the Victims’ Compensation Fund balance as of June 30, 2020 was $4,155,111.82. This Act seeks to improve the efficiency and effectiveness of VCAP in the following ways: (1) Lifts the statutory employment cap that limited the number of employees VCAP could employ. This update will enable the Department of Justice to augment VCAP staff by utilizing grant or federal funding. (2) Codifies benefits and more clearly enumerates available benefits and increases the funeral and burial benefit to $5,000/$2,500, respectively. (3) Makes several changes to conform to the current practice, including removing the claims payment process description in § 9005(8) and § 9009, updating the claims application process in § 9009, and removing the reporting requirements in § 9017. (4) Amends § 9009(10) to give the Agency specific authority to close inactive claims. (5) Updates the list of Advisory Council members to reflect the dissolution of the Sexual Assault Network of Delaware, which became the Delaware Alliance Against Sexual Violence. (6) Expands the population of victims able to be served, including changes to ensure victims of human trafficking are eligible for compensation. (7) Extends the deadlines to request reconsideration and file an appeal with the Appeals Board and reorganizes appeals process provisions by placing them all in the same section. (8) Changes "offense date" to "sentencing date" in § 9014(c). (9) Updates the chapter so that each program is referred to by a consistent name. (10) Adds defined terms “Executive Director” and “claimant” to the definitions section and further clarifies to which category of victims parts of the Code apply. (11) Removes the term “incompetent” in favor of adopting a phrase that uses people first language. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

Like House Bill No. 166, House Substitute No. 1 for House Bill No. 166 establishes the Elevate Delaware program. Elevate Delaware will provide payments for tuition and auxiliary expenses, up to $10,000, for individuals to attend an approved non-credit certificate program. The Workforce Development Board will create a list of non- credit certificate programs eligible for the Elevate Delaware program and establish priorities based upon the skill requirements of employers in Delaware. It also allows the Department of Labor to provide payments to participants in Elevate Delaware to cover auxiliary expenses necessary to meet basic living expenses or purchase supplies necessary for the non-certificate program or employment upon completion of the program. House Substitute No. 1 for House Bill No. 166 differs from House Bill No. 166 as follows: 1. Instead of basing eligibility upon graduation from a Delaware high school, individuals are eligible for Elevate Delaware if they are employed by an employer with under 51 employees and are subject to Delaware income tax. This change helps small employers expand by investing in workforce development and helps Delaware residents increase their earning capacity. Currently, over 83% of Delaware employers have under 51 employees. 2. States that the intent of Elevate Delaware is to preserve jobs in Delaware and for Delaware residents and that the Department of Labor may recoup payments made on behalf of individuals if either the individual or an employer acts in bad faith under the requirements of Elevate Delaware. 3. Requires that if an individual is not a resident of Delaware, the individual’s employer must intend to retain the individual as an employee for at least 1 year following completion of the eligible program and the individual must intend to work in Delaware for at least 1 year following completion of the eligible program. 4. Tuition payments are made directly to an eligible program. 5. Allows Elevate Delaware payments to be made for supplies an individual needs for the training program or employment upon completion of the program. 6. Requires the Workforce Development Board to approve non-credit certificate programs throughout the State, based upon the population of each county. 7. Takes effect for program that begin after December 31, 2021 instead of within 1 year from enactment of this Act. 8. Removes the requirement that the Joint Legislative Oversight and Sunset Committee review this Act because this review can occur without a specific requirement in this Act.

The purpose of this act is to open up The Delaware Student Excellence Equals Degree Act (SEED Act) to adult Delaware residents, who are not recent high school graduates. Currently, about 56% of Delawareans age 25-64 lack a post-secondary degree. This expansion of the SEED grant program will encourage adult learners to return to school to enhance their knowledge and skills and increase their job opportunities. Adult individuals with a high school diploma or less education were significantly impacted by Covid-19-related job loss. This legislation can help to mitigate the effects of the pandemic on those adults. Tennessee has instituted a similar program called the Tennessee Reconnect Act.

This Act is a substitute for Senate Bill No. 120. Like Senate Bill No. 120, this Substitute continues recent efforts to strengthen the primary care system in this State by doing the following: (1) Directing the Health Care Commission to monitor compliance with value-based care delivery models and develop, and monitor compliance with, alternative payment methods that promote value-based care. (2) Requiring rate filings limit aggregate unit price growth for inpatient, outpatient, and other medical services, to certain percentage increases. (3) Requiring an insurance carrier to spend a certain percentage of its total cost on primary care. (4) Requiring the Office of Value-Based Health Care Delivery to establish mandatory minimums for payment innovations, including alternative payment models, and evaluate annually whether primary care spending is increasing in compliance with the established mandatory minimums for payment innovations. (5) In Sections 2 and 3 of this Act, revising the appointment process for members of the Primary Care Reform Collaborative who are not members by virtue of position to comply with the requirements of the Delaware Constitution. These revisions are largely similar to those proposed in Senate Substitute No. 1 to Senate Bill No. 59 (151st General Assembly) (“the Substitute”). As such, Section 2 is designed to take effect if the Substitute does not pass both chambers or passes but is not enacted; Section 3 is designed to take effect if the Substitute passes both chambers and is enacted. (6) Making technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual This Substitute differs from Senate Bill No. 120 as it does all of the following: (1) Adds a “whereas clause” stating that the Department of Insurance does not regulate Medicaid or employer-based plans provided under the Employee Retirement Income Security Act, or their rates. (2) Provides that rate filings for health benefit plans may not include aggregate unit price growth for nonprofessional services that exceed the greater of 2% or Core CPI plus 1% in 2024, 2025, and 2026. (3) Makes a technical correction to properly alphabetize definitions in Section 4 of the Act (relating to § 2503 of Title 18). (4) Removes “mental health and substance abuse disorder” from the definition of an “inpatient hospital”. (5) Adds a definition of “professional services” and makes clear that “nonprofessional services”, which are subject to the aggregate unit price growth limits of § 2503(a)(12)a. of Title 18, do not include professional services. (6) Amends the definition of “other medical services” to make clear the term includes the facility component of vision exams, dental services, and other services when those services are billed separately from the professional component. (7) Changes the date for mandatory minimums for payment innovations to support a robust system of primary care to January 1, 2026. (8) Make clear that the Office of Value-Based Health Care Delivery is to annually evaluate whether primary care spending is increasing in compliance with the requirements of, and regulations adopted under, all of Title 18. (9) Requires the Office of Value-Based Health Care Delivery to collect data and develop reports to monitor and evaluate the percentage of spending in primary care that is delegated to hospitals and related networks for care coordination through alternative payment models. (10) Removes the sunset date on provisions requiring individual, group, and State employee insurance plans to reimburse primary care physicians, certified nurse practitioners, physician assistants, and other front-line practitioners for chronic care management and primary care at no less than the physician Medicare rate. (11) Sunsets Sections 5 and 6 of this Act and § 2503(a)(12)a. of Title 18 as contained in Section 4 of this Act on January 1, 2027.

This Act creates a new Utilities Coordination Council, as recommended by the Utilities Coordination Working Group established by SCR No. 48 from the 150th General Assembly. The purpose of the Council is to review and recommend best practices for efficient utility relocations on transportation projects on Delaware's highways. Additionally, the Council will be responsible for implementation, accountability, and the resolution of any specific utility delays.

This bill removes the training minimum wage and youth minimum wage, which takes effect 90 days after enactment.

This Senate Joint Resolution requires the Department of Natural Resources and Environmental Control to engage authoritative federal agencies to identify the administrative structure, legal structure, and resource needs to establish a State nontidal wetlands permitting program effectively shifting the permitting program from the federal to the State level. This Senate Joint Resolution also requires that a report containing the results of this review be completed and made public within 1 year.