Rep. Kerri Harris

This Act provides civil and criminal remedies for the wrongful disclosure of deep fakes that depict individuals in the nude or engaging in sexual conduct. It provides the same remedies as those available under: (1) the Delaware Uniform Civil Remedies for Unauthorized Disclosure of Intimate Images Act, Chapter 78 of Title 10; and (2) a Violation of Privacy offense under §1335 of Title 11. It further provides that when an adult creates a visual depiction of a minor that is nude or engaging in sexual conduct, the adult would be subject to a felony prosecution, rather than a misdemeanor prosecution.

Like House Bill No. 286, House Substitute No. 1 for House Bill No. 286 prohibits discrimination in life insurance based on genetic characteristics, genetic information, or the result of any genetic test. House Substitute No. 1 for House Bill No. 286 differs from House Bill No. 286 as follows: 1. Provides a definition of “direct-to-consumer genetic testing”. 2. Allows the use of any genetic information that is in an individual's medical record or application for life insurance. 3. Allows a person engaged in the business of life insurance to request that an individual share genetic information from a direct-to-consumer genetic testing or to request that an individual provide written consent for entity to provide that information. 4. Allows an entity that provides direct-to-consumer genetic testing to share information with a person engaged in the business of life insurance but only with the written consent of the individual. 5. Clarifies that a person engaged in the business of life insurance may not do any of the following: a. Require that an individual take a genetic test. b. Require that an individual provide genetic information received from an entity providing direct-to-consumer genetic testing or provide written consent for the entity to provide that information. c. Take into consideration the refusal by an individual to take a genetic test, provide genetic information received from direct-to-consumer genetic testing, or provide written consent to share information from direct-to-consumer genetic testing. Like HB 286, HS 1 for HB 286 also does all of the following: 1. Makes corresponding corrections to § 2317 of Title 18 by revising the heading for clarity and the definition of "insurance" to conform with the terms and definitions used in Title 18. 2. Is known as "The Ericka Byler Act”.

Section 1 of this Act establishes the Legislative Hall Art and History Advisory Commission ("Commission"). The Commission is established to advise and make recommendations to Legislative Council regarding art, monuments, and historical exhibits to be displayed in Legislative Hall or on the grounds of Legislative Hall. Section 2 of this Act ensures that the Commission’s meetings are open to the public.

This Joint Resolution directs the Division of Motor Vehicles to opt into the FMCSA’s federal exemption that allows for first time CDL applicants seeking a school bus only endorsement on their driver’s license. An applicant’s school bus only endorsement would only apply to intrastate operation of a school bus. The Division of Motor Vehicles is directed to implement this policy by May 1, 2024.

Healthcare facility assessments are currently the second largest source of funding for states’ shares of Medicaid costs, behind general funds. Today, 49 states have at least one facility assessment in place, including Delaware, while 34 states and Washington D.C. have 3 or more provider taxes. Delaware is one of only 6 states without a facility assessment on hospitals, causing the state to miss out on critical Medicaid funding that most states are already able to access. This Act is a substitute for Senate Bill No. 13. Like Senate Bill No. 13, this Act creates the Hospital Quality Assessment, which places a 3.58% assessment on Delaware hospitals’ net patient revenues. Funds generated by the Hospital Quality Assessment must be utilized in one of two ways: (1) To increase the inpatient and outpatient payments to hospitals. (2) To develop or enhance funding for Medicaid initiatives, unlocking federal matching dollars. Funds may not be used to supplant or replace appropriations for programs in existence on the effective date of this Act, except for 25% of these funds, which may be used to support the general operations of the Medicaid program. Like Senate Bill No. 13, this Act also creates the Hospital Quality and Health Equity Assessment Commission (“Commission”), which includes state agency and hospital representation. The Commission is required to meet at least annually to monitor the implementation of the assessment. If the Centers for Medicare & Medicaid Services (CMS) determines that either the assessment or the expenditure of money does not satisfy eligibility requirements for federal financial participation or that modifications are necessary to assure continued eligibility for federal financial participation, the Commission shall develop and approve modifications to Subchapters II and III of Chapter 10 of Tile 16 of the Delaware Code and submit the modifications to the General Assembly. This Act differs from Senate Bill No. 13 as follows: (1) By directing the Department of Health and Social Services (“Department”) to administer the Hospital Quality Assessment. (2) By establishing a different method of calculating the assessment for a hospital that begins or ceases hospital operations or does not conduct hospital operations through a calendar year or fiscal year. (3) By prohibiting a hospital subject to the Hospital Quality Assessment from passing on the cost of the assessment to any patient, insurer, self-insured program, or other responsible party. (4) By requiring a hospital subject to the Hospital Quality Assessment to attest in writing to the Department that an oral or written, formal or informal agreement or arrangement does not exist to share, redirect, or redistribute Medicaid payments which would result in violation of federal or state law. (5) By updating the split in percentages of the funds collected from the Hospital Quality Assessment to reflect the wide range of federal match levels for services. The expected amount to be collected by the Assessment does not change as the result of the update. (6) By requiring the Registrar of Regulations to publish in the Register of Regulations a certification by the Commission under § 1034(d) and (e) of Title 16 of the Delaware Code, as contained in this Act. (7) By providing that appointments of members of the Minority Caucus of the House of Representatives and Senate are to be made by the Speaker of the House of Representatives and President Pro Tempore of the Senate, respectively. (8) By making modifications to the requirements for meetings of the Commission. (9) By providing that modifications to Subchapters II and III of Chapter 10 of Tile 16 of the Delaware Code recommended by the Commission take effect as of July 1 of the ensuing fiscal year unless rejected in full by an act of the General Assembly before that ensuing fiscal year. This 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 may be cited as the “Protect Medicaid Act of 2024”.

This Act implements a recommendation from the December 31, 2023, Report of the Retiree Healthcare Benefits Advisory Subcommittee (RHBAS). Under this Act, the State must continue to offer eligible pensioners first employed by the State as a regular officer or employee (first employed) before January 1, 2025, a plan that is comparable to the current Special Medicfill Medicare Supplement plan. However, for eligible pensioners first employed on or after January 1, 2025, the State may offer different Medicare supplement plans that are not high deductible plans. This Act differs from the RHBAS recommendation because it does not limit the plan for eligible pensioners first employed on or after January 1, 2025, to plans that are comparable to the current Medicare supplement Plan G and Plan L. This difference is because under this Act, the State will not be able to offer a different Medicare supplement plan to any eligible pensioners until January 1, 2040, and details about the Medicare supplement plans that will be available at that time is unknown. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual and to align with related legislation.

This resolution directs health care professional licensure boards to review their existing professional licensure application language to revise or remove all intrusive and stigmatizing language around mental health care and treatment and replace it with language that meets the threshold requirements of the Americans with Disabilities Act of 1990 (Pub. L. 101-336. 26 July 1990), by focusing on present functional impairment and the ability to perform the essential requirements of the applicant’s profession with or without a reasonable accommodation. This resolution builds on the progress that the State of Delaware made in removing structural barriers to clinicians seeking mental health and wellbeing treatment through the enactment of Senate Bill 300 in 2022. The resolution also directs each licensure board and the Division of Professional Regulation to submit a report to the General Assembly by February 28, 2025 regarding the boards' review of their applications and certifying that the applications comply with the Americans with Disabilities Act.

This Act adopts the Uniform Health-Care Decisions Act of 2023 (UHCDA 2023) to supersede the Uniform Health-Care Decisions Act of 1993, which Delaware enacted in 1996. The UHCDA 2023 was authored by the Uniform Law Commission (ULC) and was developed in a multiyear collaborative and non-partisan process to modernize and expand on the 1993 version of the act. The UHCDA 2023 maintains processes to address how health-care decisions can be made by or on behalf of individuals who lack capacity, including: (1) Allowing individuals to appoint agents to make health-care decisions for them should they become unable to make those decisions for themselves. (2) Allowing individuals to provide their health-care professionals and agents with instructions about their values and priorities regarding their health care and to indicate medical treatment they do or do not wish to receive. (3) Authorizing certain people to make health-care decisions for individuals incapable of making their own decisions, but who have not appointed agents. (4) Setting forth agent, default surrogate, and health-care professional rights and duties. The UHCDA 2023 reflects substantial changes in how health care is delivered, increases in non-traditional familial relationships and living arrangements, the proliferation of the use of electronic documents, the growing use of separate advance directives exclusively for mental health care, and other recent developments. Some updates to the Act include: (1) Removal of administrative barriers that make the creation of an advance health-care directive more difficult. (2) Addition of provisions to guide determinations of incapacity, which is important because an agent’s or default surrogate’s (surrogate’s) authority to make health-care decisions for a patient typically commences when the patient lacks capacity to make decisions. The Act modernizes the definition of capacity so that it accounts for the functional abilities of an individual and clarifies that the individual may lack capacity to make one decision but retains capacity to make other decisions. (3) Authorizing the use of advance directives exclusively for mental health care. (4) Modernizing default surrogate provisions that allow family members and certain other people close to a patient to make decisions in the event the patient lacks capacity and has not appointed a health-care agent. The new default surrogate provisions update the priority list in the 1993 Act to reflect a broader array of relationships and family structures. They also provide additional options to address disagreements among default surrogates who have equal priority. (5) Clarifying the duties and powers of surrogates. For example, to reduce the likelihood that an individual’s health-care needs will go unmet due to financial barriers, the Act authorizes a surrogate to apply for health insurance for a patient who does not have another fiduciary authorized to do so. (6) Modernizing the optional model form to be readily understandable and accessible to diverse populations. The form gives individuals the opportunity to readily share information about their values and goals for medical care. Thus, it addresses a common concern raised by health-care professionals in the context of advance planning: that instructions included in advance directives often focus exclusively on preferences for particular treatments, and do not provide health-care professionals or surrogates with the type of information about patients’ goals and values that could be used to make value-congruent decisions when novel or unexpected situations arise. The form addresses these concerns by providing options for individuals to indicate goals and values, in addition to specific treatment preferences. This Act also adopts some of the optional provisions suggested by the ULC, including that an agent or surrogate has limited ability to consent to the long-term placement of an individual in a nursing home without express authorization. Specifically, without express authorization, the agent or surrogate may not consent to the placement for more than 100 days over the individual’s contemporaneous objection unless (1) no alternative living arrangement is reasonably feasible or (2) the individual is terminally ill. The ULC suggested 100 days in recognition that the federal Medicare program covers up to 100 days of nursing home care for qualified beneficiaries. This Act does not authorize mercy killing, assisted suicide, or euthanasia. In addition to style changes throughout, this Act makes some modifications to the UHCDA 2023 that are consistent with Act and should not disrupt uniform interpretation. These modifications include: (1) Revising language to conform to Delaware court practices. (2) Providing surrogates with the authority to file insurance or benefit claims on behalf of the individual and to appeal such outcomes, in addition to the UHCDA 2023 allowance for a surrogate to apply for insurance or benefits on behalf of the individual. As under the UHCDA 2023, a surrogate does not have the duty to perform these actions and may only do so if no other fiduciary is authorized to do so. (3) Creating an additional disqualification that disallows a potential surrogate from serving if the individual has a pending Protection From Abuse petition against the potential surrogate, the individual has a Protection From Abuse order against the potential surrogate, or the potential surrogate is the subject of a civil or criminal order prohibiting or limiting contact with the individual. Section 2 of this Act adds a new Chapter 25B to the Delaware Code. Chapter 25B will contain Delaware-specific supplements to the UHCDA 2023. These Delaware-specific additions are being placed within their own chapter to promote uniform interpretation of the UHCDA 2023. Chapter 25B includes § 2502B, which relates to health-care institution authorization to petition for guardianship for an individual to whom the institution is providing care. Section 2502B reinforces the work of the Non-Acute Medical Guardianship Task Force, created by Senate Concurrent Resolution No. 30 by the 150th General Assembly. That task force’s work resulted in the current § 2519 of Title 16, which offers a process and timeline whereby health-care institutions can take steps to help obtain a guardianship for patients who no longer require acute care and can be transferred to another type of health-care setting. While § 2502B retains the ability for a health-care institution to address the discharge of long-term stay patients without an authorized decisionmaker, it modifies the powers in the current § 2519 by doing all of the following: (1) Allowing health-care institutions to petition of the appointment of a guardian in instances beyond where an individual no longer needs acute care. (2) Reiterating that the health-care institution may only petition if they believe there is no less restrictive alternative that will meet the individual’s needs. (3) Streamlining notice requirements and changing who must receive these notices so that a health-care institution does not send a notice if there is a reasonably available surrogate. If there is a reasonably available surrogate and there is a dispute between the surrogate and the health-care institution about the treatment or level of care needed by an individual, then the parties should seek judicial relief under § 2526 of the UHCDA 2023 as opposed to using the guardianship process. The new Chapter 25B also contains a provision to encourage public awareness and use of advance mental health-care directives. Sections 3 through 11 of this Act update the Delaware Code in light of the adoption of the UHCDA 2023 by updating internal citations, updating terms to match the terms used in the UHCDA 2023, and ensuring a consistent list of default surrogate decisionmakers. This Act is effective immediately and is to be implemented 1 year from the date of enactment.

This Act implements a recommendation from the December 31, 2023, Report of the Retiree Healthcare Benefits Advisory Subcommittee. Under this Act, the state group health insurance program must include a pensioner coordination of benefits policy for eligible pensioners who were first employed by the State on or after January 1, 2015, and are eligible for health care coverage through their employer that is not through a plan under Chapter 52 of Title 29. The new pensioner coordination of benefits policy begins July 1, 2027, and must be comparable to the exiting coordination of benefits policy for the spouse of a state group health insurance program participant who is eligible for health care coverage through the spouse's own employer. This Act also codifies the existing spousal coordination of benefits policies for the state group health insurance program. The existing spousal coordination of benefits policies and the pensioner coordination of benefits policy created under this Act apply to all participants in the state group health insurance program, which includes regular officers or employees, eligible pensioners, and individuals eligible under § 5208 and § 5209 of Title 29. In addition, this Act makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.

This Act increases the amount of the annual appropriation to prefund future State employee retiree health insurance as recommended by the Retiree Healthcare Benefits Advisory Subcommittee of the State Employee Benefits Committee. Like other required contributions to the Other Post-Employment Benefits Fund (OPEB) Fund, this appropriation must be included in the review of and plan for proposed expenditures that the Director of the Office of Management and Budget submits to the Governor and in the Governor's Budget Appropriation Bill. This Act also revises existing law to allow the current practice of making the annual payment to the OPEB Fund of 1% of the operating budget appropriations for the prior fiscal year in a Supplementary Appropriation Bill and makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.