Rep. Cyndie Romer

This Act is the product of the work of stakeholders who, with the encouragement of Senate Concurrent Resolution No. 50 (152nd General Assembly), met to examine how to integrate mobile-integrated healthcare and community paramedicine into existing regulatory structures in this State. Mobile-integrated healthcare and community paramedicine are innovative patient-centered models for the delivery of health care services that utilize mobile resources to deliver care and services to patients in an out-of-hospital environment in coordination with healthcare facilities or other healthcare providers. As part of mobile-integrated healthcare and community paramedicine programs, emergency medical services provider agencies across the country of all sizes and types are partnering with hospitals, primary care physicians, nurses, and mental health and social services providers on innovative programs that both navigate patients to the right level of care as well as achieve goals of improved care and lower costs. Clinical research studies comparing patients in traditional hospitals with patients who received hospital-level care at home through mobile-integrated healthcare and community paramedicine programs have found that those who received in-home care experienced fewer readmissions, lower mortality rates, reduced falls, and higher patient satisfaction rates. Based on temporary federal law enacted to relieve strain on healthcare systems caused by the COVID-19 pandemic, hospitals in this State developed relationships with emergency medical services provider agencies to implement mobile-integrated healthcare and community paramedicine programs. However, this temporary federal authorization will end on December 31, 2024. Many states have acted ahead of the expiration of this federal authorization to incorporate mobile-integrated healthcare and community paramedicine programs into existing regulatory structures. This Act integrates mobile-integrated healthcare and community paramedicine programs into existing regulatory structures in this State by authorizing the establishment of mobile-integrated healthcare and community paramedicine programs in this State through the Office of Emergency Medical Services (“Office”) in the Department of Health and Social Service’s Division of Public Health (“Division”). Specifically, this Act does the following: (1) Authorizes an organization licensed as or actively seeking licensure as an emergency medical services provider agency to apply to the Office to establish a mobile-integrated healthcare or community paramedicine program. (2) Requires the Office to review applications to establish mobile-integrated healthcare or community paramedicine programs and make recommendations to the Director of the Division, who is required to approve applications that meet the requirements established by this Act and regulations adopted by the Office. (3) The Office is required to establish standards, approved by the Board of Medical Licensure and Discipline, for the establishment and operation of mobile-integrated healthcare or community paramedicine programs This Act takes effect immediately for purposes of the Office of Emergency Medical Services preparing to implement this Act, but is not implemented until the date of publication in the Register of Regulations of a notice by the Director of the Office of Emergency Medical Services that the Office is prepared to implement this Act. The changes to the definition section, § 9802 of Title 16 of the Delaware Code, in Sections 2 and 3 of this Act are identical. These changes had to be made twice as § 9802 of Title 16 currently has 2 versions, one effective until July 17, 2028, and one effect as of July 17, 2028. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual and, in Section 5 of this Act, to correct an internal reference in § 6701B of Title 18 of the Delaware Code affected by changes in Sections 2 and 3 of this Act.

This Act modernizes and expands the concept of maternal mental health by replacing the definition of maternal depression with the more encompassing definition of perinatal mood and anxiety disorder. This Act contemplates treatment for any caregiver who may be affected by perinatal mood and anxiety disorder. This Act avoids use of gender-based pronouns as recommended by the Legislative Drafting Manual.

This Act updates House Bill 455 from the 151st General Assembly by providing the same legal protections afforded providers of contraceptive and abortion services to providers of fertility treatment. In summary, this Act does the following: (1) Clarifies that medical professionals who provide fertility treatment care cannot be disciplined for such services even if such services are illegal or considered to be unprofessional conduct or the unauthorized practice of medicine in another state, so long as such services are lawful in this State; (2) Prohibits health care providers from disclosing communications and records concerning fertility treatment without the patient’s authorization in any civil action or proceeding, with some exceptions; (3) Protects health care providers from out-of-state civil actions relating to fertility treatment that is legal in Delaware, including the issuance of a summons or the enforcement of subpoenas relating to such cases; (4) Creates a cause of action for recouperation of out-of-state judgments relating to fertility treatment that is lawful in Delaware; and (5) Prohibits insurance companies from taking any adverse action against health care professionals who provide fertility treatment and services.

This Act permits a terminally ill individual who is an adult resident of Delaware to request and self-administer medication to end the individual's life in a humane and dignified manner if both the individual's attending physician or attending advanced practice registered nurse (APRN) and a consulting physician or consulting APRN agree on the individual's diagnosis and prognosis and believe the individual has decision-making capacity, is making an informed decision, and is acting voluntarily. This Act uses terms and definitions that are consistent with other Delaware laws in Title 16, specifically Chapter 25 (regarding advance health-care directives) and Chapter 25A (regarding Delaware Medical Orders for Scope of Treatment). This Act provides the following procedural safeguards: 1. No one may request medication to end life on behalf of another individual. 2. An individual cannot qualify for medication to end life under this chapter solely because of the individual's age or disability. A mental illness or mental health condition is not a qualifying condition under this Act and a mental illness or mental health condition may be the reason that an individual does not have decision-making capacity and is thus, ineligible for medication to end their life in a humane and dignified manner. 3. Both the individual's attending physician or attending APRN and a consulting physician or consulting APRN must confirm that the individual has a terminal illness and a prognosis of 6 months or less to live, has decision-making capacity, is making an informed decision, and is acting voluntarily. 4. The individual's attending physician or attending APRN must also provide specific disclosures to the individual to ensure that the individual is making an informed decision, including the presentation of all end of life options which include comfort care, palliative care, hospice care, and pain control. 5. The individual must be evaluated by a psychiatrist or a psychologist if either the attending or consulting physicians or APRNs are concerned that the individual lacks decision-making capacity. 6. The individual must complete a witnessed form requesting medication to end life and there are limitations on who can witness the signing of the form. 7. The attending physician or attending APRN must offer the individual the opportunity to rescind the request for medication to end life before writing a prescription for the medication. 8. Two waiting periods must pass before the attending physician or attending APRN may prescribe the medication to end life. 9. The attending physician or attending APRN must provide the qualified patient with instructions about the proper safe-keeping and disposal of unused medication to end life in a humane and dignified manner under applicable state or federal guidelines. The United States Food and Drug Administration guidelines include using a medication collection site or a medication disposal pouch, that deactivates and renders drugs ineffective. 10. An insurer or health-care provider may not deny or alter health-care benefits otherwise available to an individual based upon the availability of medication to end life or otherwise coerce or require a request for medication to end life as a condition of receiving care. 11. A health-care institution may prohibit a physician or APRN from prescribing medication under this Act on the health-care institution's premises and a physician or APRN may to refuse to prescribe medication under this Act. 12. A request or prescription for or the dispensing of medication under this Act does not constitute elder abuse, suicide, assisted-suicide, homicide, or euthanasia. 13. People acting in good faith and in accordance with generally accepted health-care standards under this Act have immunity, but those acting with negligence, recklessness, or intentional misconduct do not have criminal or civil immunity. 14. The Department of Health and Social Services (DHSS) must develop rules and regulations to collect information regarding compliance with this Act and require health-care providers to file a report when medication to end life in a humane and dignified manner is prescribed or dispensed. DHSS may review samples of records maintained under this Act. The information DHSS collects must include the information necessary to assess a physician's or APRN's compliance with their responsibilities under this Act and DHSS has explicit authority to share information with the Division of Professional Regulation if DHSS suspects that a health-care provider failed to comply with the requirements under this Act. 15. DHSS must complete an annual statistical report of information collected under this Act, similar to public reports available in other states such as New Jersey where this end of life option is available. This report has the following purposes: • To assist the DHSS in its oversight responsibilities for this Act. • To assist the public in learning how well this new law is operating. 16. The Department of State may also promulgate regulations or develop forms and protocols necessary under this Act. 17. Allows the Office of Controlled Substances to provide reports of data in the prescription monitoring program to DHSS to assess compliance with this Act. This Act takes effect when final regulations required under this Act have been promulgated or July 1, 2024, whichever occurs earlier. This Act is known as "The Ron Silverio/Heather Block End of Life Options Law" in memory of Ron Silverio and Heather Block, who were passionate advocates that passed away without this option becoming available to them.

For claims for line of duty death benefits for covered persons, which include police officers, firefighters, auxiliary and volunteer ambulance and rescue company members, paramedics, and others, submitted on July 1, 2023, and thereafter, this Act increases the benefits for the beneficiary or beneficiaries from $200,000 to $375,000, payable in annual installments, with the maximum amount paid in any 1 calendar year being $50,000.

This substitute for House Bill 383 does the following: Like House Bill 383, Section 1 of this Act prohibits discrimination against 340B drug distribution by manufacturers, third-party logistics providers, and wholesale distributors. Violations are deemed an unlawful practice enforceable by the Consumer Protection Unit of the Department of Justice. The Department of Justice has authority to promulgate regulations to implement the provisions of this Act. This Section differs from House Bill 383 by removing repackagers from the list of entities prohibited from engaging in 340B drug discrimination, authorizing the Board of Pharmacy to promulgate regulations and take disciplinary action against both licensees and holders of permits issued by the Board, and requiring covered entities, manufacturers, third-party-logistics providers, and wholesale distributors to publish annual reports on their websites and provide copies of the reports to the Board of Pharmacy, Speaker of the House, Senate President Pro Tempore, Office of the Governor, and members of the House and Senate Health Committees and Joint Finance Committee. Section 2 of this Act prohibits discrimination by pharmacy benefits managers against 340B covered entities. Violations are deemed unfair practices in the insurance business. Contracts purporting to include provisions in violation of this Act are deemed void and unenforceable. This Section differs from House Bill 383 by making technical changes to correct internal references and changing references to “health carriers” to reference “purchasers” instead. Section 3 of this Act contains severability language in the event that any provision or the application of the Act to a person or circumstance is deemed to be invalid. Section 4 of this Act contains non-preemption language to ensure that the Act can be read and interpreted to not conflict with other State or federal law.

Section 1 amends Title 31 to require all health benefit plans delivered or issued for Medicaid to cover services related to the termination of pregnancy. Coverage provided under this section is not subject to any deductible, coinsurance, copayment, or any other cost-sharing requirement and must cover the full scope of services permissible under the law. It also moves the definition of “carrier” out of individual provisions and into the general definition section for the chapter. Section 2 adds a definition of “religious employer” to Title 18. Sections 3 and 4 amend Title 18 to require both individual and group health carriers to cover services related to the termination of pregnancy with identical cost-sharing prohibitions. Certain types of limited coverage plans are exempt from the requirement, and HDHP and catastrophic plans are exempt from the cost-sharing prohibitions if such requirements would cause them to lose their status and treatment under federal law. A religious employer may obtain an exclusion from the carrier if the requirements conflict with the organization’s bona fide religious beliefs and practices. Section 5 amends Title 29 to require coverage for services related to the termination of pregnancy under the state employee health plan. Coverage shall not be subject to any deductible, coinsurance, copayment, or any other cost-sharing requirement and shall apply to the full scope of services permissible under the law. The changes to Medicaid and the state employee health plan are effective January 1 of the year following enactment. The changes to insurance requirements for private group, blanket, and individual coverage are effective for policies issued, renewed, or altered after December 31, 2025. This substitute differs from the original bill as follows: (1) It makes several technical corrections; (2) It limits the permissible applications of referral, prior authorization, and in-network requirements to ensure full and timely access to covered services; (3) It requires federal funds to be used for Medicaid services wherever the use of federal funds is allowed and specifies State funds will otherwise be used for covered services; (4) It adds a definition of religious employer and requires a religious employer to cover services when the life or health of the covered individual is at risk; (5) It changes the effective and application dates of the coverage requirements; (6) It caps the benefit at $750 per year per covered individual for Medicaid; and for private insurance it allows the benefit to be limited to $750 per covered individual per year. The bill also makes a technical change by moving the definition of “carrier” out of individual sections of Chapter 5 of Title 29 and into the general definitions section for that chapter.

The Delaware Energy Solutions Act of 2024 authorizes processes necessary to help meet the net zero goals of the Climate Change Solutions Act of 2023. The bill facilitates a transition to carbon-free energy sources by (i) preparing for offshore wind to be a significant element of Delaware’s energy future, if cost is competitive with other potential sources, and (ii) increasing options for interconnecting renewable energy resources to the transmission grid. The bill authorizes the State Energy Office (SEO), with the approval of the Public Service Commission (PSC), to issue solicitations to procure offshore wind. A solicitation can be for a project that serves only Delaware, or in coordination with other states, and authorizes procurement of at least 800 megawatts but not more than 1,200 megawatts of power to Delaware, in a single or multiple solicitations. Solicitations proceed through the following steps: The SEO drafts a solicitation for wind energy if it believes market conditions would result in a bid of no more than 110 percent of the “Delaware Benchmark Price,” defined as the average price that Delmarva Power has paid for power and renewable energy compliance over the prior three years. The Renewable Energy Task Force, an existing public body, must be consulted on the structure and factors of the proposed solicitation. The PSC evaluates the proposed solicitation and determines in a public process, with public comment, if issuing the solicitation would be in the public interest. If so, PSC issues a Preliminary Order allowing the solicitation to proceed. Municipal utilities and rural electric cooperatives are provided an option to participate in the potential project. Third-party “Qualified Purchasers,” such as those that currently purchase electricity for Delaware industries and utilities, could also participate. After preliminary PSC approval, SEO issues the solicitation. Pricing is the key factor, and the returned bids will also include information about avoided greenhouse gas emissions as well as environmental, economic, health and electric grid benefits to Delaware. The SEO cannot proceed to negotiate a contract unless a bid comes back with a price at or below 110 percent of the Delaware Benchmark Price. If contract negotiations occur, SEO confers with PSC staff in finalizing the terms of the contract. PSC reviews the proposed purchase contract to verify that the bid meets all statutory and solicitation requirements, including the examination of the bid price to ensure it is no more than 110 percent of the Delaware Benchmark Price, and is competitive with other new renewable or carbon-free energy projects in the region. If PSC approval is granted, Delmarva Power and any public utility that elected to participate would amend their rates to pass on the costs or savings of the project to their customers. In addition to allowing offshore wind procurement, the bill enhances the PSC’s current Certificate of Public Convenience and Necessity (CPCN) process by giving the Commission authority to issue a CPCN in connection with renewable energy interconnection facilities, such as the transmission lines from an offshore wind project to a nearby substation, or the lines connecting a utility scale solar project (over 30 MW) to a nearby substation. The bill outlines the factors PSC should consider when granting a CPCN for renewable energy interconnection facilities. Additionally, the bill provides separate authority to the Delaware Department of Transportation to permit such facilities in a State-owned Right of Way under Title 17, once a CPCN is issued by the PSC.

This Joint Resolution designates August 31, 2024, as "International Overdose Awareness Day" in the State of Delaware and requires that in observance, the State flag be flown at half-staff at State facilities. By recognizing International Overdose Awareness Day, this Joint Resolution affirms the importance of overdose awareness, remembers those who have died from overdose, and acknowledges the grief suffered from losing a loved one to overdose.

This Act creates the Delaware Grocery Initiative. The Delaware Grocery Initiative is a healthy foods initiative that seeks to provide financial assistance to eligible food resources as designated by the bill. The Act defines food deserts and eligibility requirements for the initiative. The Act authorizes the Division of Small Business to implement the grant and financial support system. This substitute bill does the following: 1. Adds the following terms in the definition section of the Act: Council, food resource, Healthy Foods Retail Initiative, Program, and specialty grocer. 2. Modifies the definition of food desert. 3. Removes terms of grocery store, rural tract, and urban tract in lieu of the new definitions of food resource and food desert. 4. Designates the Division of Small Business, instead of the Office of State Planning, as theagency authorized to implement the Delaware Grocery Initiative and authorizes the Division of Small Business to adopt rules. 5. Replaces the grocery and food desert study with a food access strategy. 6. Subject to appropriation, creates a food access strategy to address food insecurity and requires submission of a report to the General Assembly and the Governor by June 1, 2025.