July 1, 2020
Leg Two of the 150th General Assembly Concludes
Shortly after midnight this morning, the House and Senate adjourned the 2020 legislative session. In what can only be referred to as an unprecedented session, both chambers conducted their work remotely. There was agreement reached to limit the number of bills to be considered due to the COVID-19 pandemic. SB 200 regarding primary care data sharing was signed into law before the outbreak came to Delaware but most health care bills were stopped in their tracks in March. HS 1 for HB 348, regarding telemedicine, passed and awaits the Governor's signature. It was one of several bills that temporarily codified provisions in the Governor's Emergency Order and Modifications thereto.

Finally, two important legislators are not running for re-election. Senator Harris McDowell enjoyed a 44 year tenure and a laudable Senate career. Representative Quinn Johnson announced his retirement on Monday and was an important leader on many legislative matters. Both served as Co-Chairs of the Joint Finance Committee and will be missed.

Here is a wrap up of some of the bills MSD worked on:

Mental Health Primary Care ( HB 307) - This bill is an attempt to require coverage of an annual behavioral health well check. 
This bill is fairly complex and while supported, leaves a lot of unanswered questions. 
It would be expected that this bill will be re-introduced in 2021. 

Urgent Care & MedSpa ( SB 171) - This Act establishes a new subchapter of Title 16 regulating urgent care facilities. It requires such facilities, existing and new, to obtain a license from DHSS, which requires the urgent care facility to either be accredited by an approved accrediting body or be seeking such accreditation. If the urgent care facility is seeking accreditation, it can operate on a provisional license for nine months. If accreditation is not obtained, the urgent care facility can apply once for a renewal of a provisional license. Operating without a license or accreditation will subject urgent care facilities to fines. The Act grants DHSS the power to promulgate various regulations to enforce the Act. DHSS can also make and enforce orders to protect the public health and share information with the Division of Professional Regulation. The Act requires each urgent care facility in the State to enroll in the Delaware Health Information Network ("DHIN") and to notify a patient's primary care provider through the DHIN to facilitate the coordination of care. This bill was introduced at the end of 2019. 
The sponsor will have to re-introduce the bill in 2021 if it is to move forward.

Smart Justice ( HB 144) - This act further defines assault in the second degree to include other health care treatment providers and employees and hospital security personnel who are injured while performing their work-related duties. 
This bill passed the house and then stalled in the Senate due to COVID. It would be expected the sponsor will re-introduce the bill in 2021.

Childhood Lead Advisory Committee ( HB 166) - At this time, blood lead level screening and testing rates are well below what the Division of Public Health would expect them to be based upon the risk factors that determine when screening or testing is necessary. This bill simplifies the requirements and the process for health care providers and eliminates confusion that may be causing the low compliance rate for screening or testing, and defines terms used in the Act. This bill mandates screening, defined as capillary blood test, at 12 and 24 months of age. The bill clarifies insurance coverage for the costs of compliance with the Act. The Division of Public Health is also directed to report on elevated blood lead levels to the General Assembly annually and to develop regulations to implement and enforce the Act within 12 months of being enacted. 
The bill was introduced and assigned to a committee. The sponsor will have to re-introduce the bill in 2021 if it is to move forward. 

Prison Nurseries ( HB 258) - This bill looks to create prison nurseries so that women inmates that give birth during incarceration have the option of raising their infant in prison up to 18 months. Goal is to allow a mother and child to bond during this critical time while helping to lower recidivism rates of those women inmates and further taking the burden off the foster care system and reducing the damage done between mother and child relationship as a result of imprisonment. 
This bill was introduced at the end of 2019 and has not moved. The sponsor will have to re-introduce the bill in 2021 if it is to move forward. 

Pharmaceutical Costs ( HB 287) - HS 1 for HB 287: This bill creates the Pharmaceuticals Purchasing Study Group created by HCR 35. First, this Act creates the Interagency Pharmaceutical Purchasing Collaborative ("Collaborative") to leverage the total volume of State pharmaceutical purchases to negotiate lower prices. The Collaborative must conduct a data analysis of current pharmaceutical purchasing prices paid by State agencies to create a data analytic profile. 

After building the data analytic profile, the Collaborative must build a market database by assessing the value, as determined by cost and patient outcome, of individual drugs and calculating the volume of individual drug purchases by all State agencies. 

The Collaborative must use the market database to identify opportunities to leverage the total volume of State pharmaceutical purchases to negotiate lower prices which may include a group purchasing agreement or a consortium with other states. 

Second, this Act requires that State agency contracts to purchase pharmaceuticals must contain specific transparency provisions. These transparency provisions will allow the State to monitor and control the cost of pharmaceutical purchases. 

Finally, this Act clearly provides that information received or generated by the Collaborative or under contract transparency provisions is not public information under the Freedom of Information Act. However, the Collaborative must provide an annual report that summarizes the Collaborative's work. 

House Substitute No. 1 for House Bill No. 287 differs from House Bill No. 287 as follows: 

1. In § 6317A(e)(2)a. of Title 29, requires the Interagency Pharmaceutical Purchasing Collaborative to assess the value of individual drugs using evidence-based cost and patient outcomes instead of by the simple cost and patient outcomes. 

2. Changes "pharmacy benefit manager" to "wholesaler" in § 6937(a)(1) of Title 29, because the acquisition cost is negotiated between a wholesaler and manufacturer not between a pharmacy benefit manager and manufacturer. 

3. Requires the Secretary of the Department of Health and Social Services to provide and purchase the data analytics required under § 6317A(e)(1) of Title 29 by March 31, 2021.

The substitute was adopted 3/12/20 but was then not worked because of COVID. The sponsor will have to re-introduce the bill in 2021 if it is to move forward.

Surprise Billing ( HB 286) - The national conversation on what to do about surprise billing has reached a boiling point. While stakeholders and policymakers agree that patients should not be put through a stressful surprise billing situation, there is disagreement across the country on exactly how to address the issue. In Delaware, the proposal is to expand the existing emergency procedures process that uses the Department of Insurance-led arbitration for out-of-network services delivered to patients at in-network hospitals. 
This bill came out of the House Health Committee in January and didn't move because of COVID-19.

Maternal Health Disparities ( SCR 66) - National data is stark regarding disparities in maternal mortality and morbidity. Delaware is ahead of the curve on addressing the problem by establishing evaluative bodies such as the Perinatal Quality Collaborative. However, in concert with the Delaware chapter of ACOG, the Society is encouraging the state to extend Medicaid coverage post-partum from six weeks to a year. 
This passed both the House and Senate in January. A report was due by April 1, 2020 but was delayed due to COVID-19.

Primary Care ( SB 200)- Legislation is being passed to smooth the path of actionable data between the Primary Care Collaborative and the Delaware Health Information Network (DHIN). With a better grasp on where the spend is in Delaware, coinciding with initial rounds of information from the state's Benchmark initiative, this data should underpin important next steps for structural change in care delivery. 
It was signed by the Governor 2/10/20.

Medical Marijuana Cultivation ( HB 243) -A curve-ball alternative approach to using a dispensary, HB 243 would allow for the cultivation of marijuana by persons holding a medical marijuana card or their caregivers. The Society remains neutral on medical marijuana provided the program remains evidence-based, and opposed to marijuana legalization, but has concerns about the enforceability and safety of home cultivation.
This was introduced at the end of the 2019 Session and was tabled in the House at the beginning of January.

Physician Assisted Suicide ( HB 140) - This continues to be a hot topic in Delaware with public debate churning a difficult issue. The Society reaffirmed its opposition at the most recent Delegate Meeting at the close of 2019 and the Ethics Committee meets regularly on the topic. Dueling Op-Eds were published in the News Journal, with the Society's Dr. Goodill penning the physician case for opposition. The Society expects to host a Hot Topic on the issue in the coming months.
Introduced 5/2/19 in the House, it has not made it through committee. We will see this again.

Physician Assistants ( HB169) - The Society has stood firm to ensure that the physician remains ultimately responsible to the patient for medicine delivered in the team setting. Working with the Division of Professional Regulation, a consensus amendment is being addressed to ensure bulwarks against the corporate practice of medicine and erosion of physician responsibility to their patients.
This bill was worked in the House Sunset committee on 1/22/20 with the agreement of a consensus amendment. COVID stopped the process. We expect to see this bill next year.

DHSS Restructure ( SCR 65)- The Society continues to track the ongoing analysis and recommendation for the future of the Department of Health and Social Services. Legislators have suggested dividing the Department and a task force is meeting to do a comprehensive review of the state's largest agency. 
SCR 65 was passed in June 2019 and required a report by March 31, 2020.  HB 345 was passed at the end of June 2020.  HB 345 continues certain task forces that were forced to stop working because of COVID.  We expect this task force to continue it's work in the Fall.

Genetic Discrimination ( SB 144) - Florida has now crafted legislation similar to the model that MSD and the AMA assisted in creating in Delaware. It is clear that national traction is coming to the difficult issue of patient rights and expectations of privacy as it pertains to their genetic information.
This bill was introduced at the end of the 2019 session and has been assigned to a committee but has not moved since.

Temporary Extension of Emergency Declaration Regarding Telemedicine ( HS1 for HB 348 with HA 1) - This bill extends the Governor's Emergency Declaration regarding telemedicine until July 1, 2021. It is expected that a new bill will be run in 2021 which permanently adopts some of these provisions and makes some changes to them based upon experience over the next 6 to 12 months. The Society will monitor and suggest changes in 2021.
This bill has passed both chambers and awaits the Governor's signature. 

If you have questions, please contact Mark B. Thompson, MHSA, Executive Director at 302-444-6958, Mark.Thompson@medsocdel.org or Lincoln Willis, lobbyist at 302-632-9898 or  Lincoln.Willis@TheWillisGroupLLC.com.  
MSD actively monitors all health related legislation and maintains an active and visible presence in Legislative Hall on your behalf. 

The Medical Society of Delaware Legislative e-update is a benefit to our members, providing information on legislative activity of interest in the 150th General Assembly in Dover.