Several physicians, staff members, and lobbyists describe the second leg of the 152nd Delaware General Assembly as one of the most active for health care bills. We saw everything from broad cost containment measures to insurance mandates to scope of practice. A few themes started to trickle through in legislation this session. The intention, although often admirable, left much to be desired on implementation and execution in some cases. Other bills brought favorable changes to physicians and improved health care to Delawareans. Some of these themes include:

• Monitoring health care costs
• Access to care
• Scope of practice
• Fiscal responsibility
• Insurance mandates

The year 2024 also marks an election year. Governor, Lt. Governor, and Insurance Commissioner seats are all up for grabs. Five legislators have announced their retirement or are entering different races: Rep. Sherry Dorsey-Walker (D), Rep. Sean Matthews (D), Rep. Paul Baumbach (D), Rep. Pete Schwartzkopf (D), and Rep. Mike Ramone (R). Several Senators have entered other races, but their Delaware Senate seats are not up in 2024.

Every year in Legislative Hall is different. Every year brings on new lessons for the Government Affairs Committee, the Executive Board, and the Medical Society of Delaware as whole. It is evident to physicians that all of these themes interplay and also impact the physician and health care workforce. It has never been more important for our membership to have their voices heard.

For an overview of bills, please refer to the bill chart.

Big Wins for Health Care in 2024!

The Medical Society of Delaware collaborated with the Delaware Department of Health and Social Services (DHSS) and the Department of Motor Vehicles (DMV) to update the archaic legislation around physicians’ mandated reporting of CNS related incidents to the DMV. Spearheaded by MSD President Dr. Varipapa, the goal was to remove language related to mandated reporting. The result was HB 314, an Act to Amend Titles 21 and 24 of the Delaware Code Relating to driver's licenses. Delaware is now aligned with the majority of states in the US, leaving only five states with the mandated reporting requirement. Through these collaborative discussions, review of other state bills and statutes, and legislative support, this bill is now ready for the Governor's action. MSD supports this bill and provided testimony in support.

In November 2022, Sunjay Shah MD, Randeep Kahlon MD, and Sangita Modi MD introduced a resolution to the MSD Council on “Addressing Health Disparities in Food Allergy Prevention." The Council adopted the resolution with the directive that the Medical Society of Delaware supports efforts by the Delaware State Legislature to provide education to families on food allergy prevention and create access to infant-safe peanut and well-cooked egg protein for all infants. HB 274 amends the Delaware code relating to insurance coverage of allergen introduction in dietary supplements for infants. This act would require all health insurance plans subject to requirements under Delaware law, including Medicaid, to provide coverage to infants under the age of 1 of at least one early peanut allergen introduction dietary supplement and at least one early egg allergen introduction dietary supplement. The cost would be no charge to the insured patients. The bill is now ready for Governor action. MSD supports this bill and provided testimony in support.

In November 2023, MSD adopted a resolution on gun safety. SS 1 for SB 2 w/ HA 2, HA 6, HA 10, HA 11 is a bill that updates the code related to deadly weapons. This act has multiple components including creating an application process, requiring an application to complete a firearms training course within five years of application, adding limits on transfers and sales, among other new requirements for records and training. The voucher program for low-income residents was removed due to the fiscal note. The Governor signed the bill on May 16, 2024. MSD supports this bill.

MSD Priority Issues

One essential learning for MSD is about planning for fiscal notes. Several of our key priority issues involve fiscal notes. Several factors are impacting the microscope on health care costs including HB 350, fiscal budgets, pharmacy spend, and others.   

SB 10 Prior Authorization Update

MSD, along with the Delaware Health care Association (DHA), authored a bill to significantly reform the prior authorization process. SB 10, the “The Delaware Pre-Authorization Reform Act of 2023” was introduced on June 8, 2023. Both the GAC and Executive Board voted to pursue the original SB 10 bill, after several months of conversations and negotiations with stakeholders, pushing forward for the best reform possible. SB 10 was heard in the Senate Banking, Business, Insurance, & Technology Committee on May 15, 2024. MSD appreciates the physicians and staff who testified or sent stories for testimony and those who contacted their Senators. DHA and the American Medical Association (AMA) also provided robust testimony in support of SB 10. There was significant opposition from Highmark and the America’s Health Insurance Plans (AHIP is a political advocacy and trade association of health insurance companies), despite there being more robust legislation in several states including Kentucky, Arkansas, Illinois, and Georgia. The Department of Insurance (DOI) voiced support of prior authorization reform but opposed SB 10 as written, encouraging the stakeholders to look to the Pennsylvania prior authorization bill. The AMA has consistently indicated concerns about the Pennsylvania legislation.

Neither MSD nor DHA were made aware of a fiscal note, attached to the bill, until the May 15th Committee hearing. The fiscal note seemed to be viewed unfavorably in the Committee due to the onerous amount of $14.7 million. Given the current focus of the General Assembly to either contain or reduce overall health care related costs, this became a focus of the discussion. However, there was no evidence presented to explain how that amount was determined.

This bill has not been released from the Committee due to the fiscal note. MSD is collaborating with the bill Sponsor, Senator Townsend, on next steps. MSD is also in conversations with DHA and AMA to identify data sources locally and nationally related to the fiscal note. Negotiations with stakeholders continue. MSD is planning a meeting with the DOI to discuss their concerns.

Although MSD is disappointed that this bill did not pass in this legislative session, it is optimistic about next session based on lessons learned. MSD continues to collaborate with the AMA on this issue. The AMA maintains prior authorization reform as a key legislative topic and recently released data from a physician survey. Stay tuned for more information and continue to share your prior authorization experiences with Lisa.Gruss@medsocdel.org.

Primary Care Reform Update

Primary care reform remains a strategic priority for MSD. Our physicians have continued crucial conversations with Senator Townsend, the bill’s sponsor, about concerns in the delays of implementation of SB 120. In response, the MSD Government Affairs Committee (GAC) / Executive Board proposed enhancements for SB 120. MSD has drafted a bill based on the enhancements and shared it with Sen. Townsend. This bill would potentially require a large fiscal note due to the state-funded items. There is additional scrutiny regarding bills with large fiscal notes being introduced at this time. MSD met with Senator Townsend to discuss a framework for a new bill, including pulling together collateral to meet with legislators regarding prior authorization and its impact. MSD staff and lobbyist will be meeting in the next few weeks in the off-session to plan a strategy that will be shared with the GAC.

Educational Transparency/ Title Misappropriation

Several states have passed bills on title misappropriation, including Indiana, Georgia, Tennessee, as well as Washington DC. These bills provide transparency regarding whom can call themselves doctor and elaborate on provisions on truth in advertising, allowing for patient protections and safety. The Medical Society of Delaware has been advocating for similar legislation in Delaware despite pushback from nursing groups. These groups advocate for the use of their “doctor” title if it has been appropriately earned. HB 447 was introduced by the bill sponsor, Rep. Minor-Brown, late in the session with no conversation with MSD and other key stakeholders. The bill removes several key elements of our draft bill introduced in the spring. Due to pressure from Committee members, the bill was removed from the House Sunset Committee Hearing. MSD physicians, staff, and lobbyists will continue to work on this bill during the off session.

Other Updates

MSD met with Senator Mantzavinos, the bill sponsor for SB 283 (151st) and its sister bill, SB 185, related to continuing education for the “diagnosis, treatment, and care of patients with Alzheimer’s disease or other dementias” in late October 2023 and again on February 26, 2024. Sen. Mantzavinos introduced a new bill, SB 319 (152nd), which was a result of the collaborative discussions and compromises between MSD and the bill sponsor. SB 319 mandates a one-time, 2-hour CME for physicians (some exemptions exist) upon license renewal. This begins with the 2027 license renewal. SB 319 is ready for Governor action. MSD supports this bill.

SB 194 proposes to increase the scope of practice for pharmacists, allowing them to initiate, dispense and administer HIV PrEP and PEP. PrEP is a medically complex process and MSD/GAC provided verbal and written testimony against this part of the bill for several reasons. MSD met with the bill sponsor, pharmacists, and additional stakeholders regarding concerns with pharmacists increasing scope in this area. Several states allow for pharmacists to administer PrEP and MSD has engaged the AMA in this discussion, receiving feedback from other medical societies on their experience. MSD contract lobbyists and physicians met with Senator McBride regarding concerns with this bill. The AMA does not support increased scope legislation. The discussion resulted in SA1 to SB 194, which addresses the timing of pharmacist training, approved tests, and follow-up with a primary care physician.  Although the amendment addresses some of the members' concerns, MSD remains opposed to the PrEP portion of the bill. SA1 to SB 194 is a bill that covers several issues including scope of practice and access to care. While MSD understands that the intent of the bill is to address access to care, there are several concerns, including follow-up and liability. This bill is ready for Governor action. MSD opposes PrEP part but supports PEP.

HB 350 creates the Diamond State Hospital Cost Review Board. Stakeholders have had several conversations and negotiations with the bill sponsors, finally arriving at HS 2 for HB 350 with HA 1 + SA 1. The GAC, Executive Board, and Council agree with the premise of the bill that hospital and health care costs need to be controlled, but the manner in which the bill proposes the oversight and monitoring was not ideal. This bill caused a lot of contentious conversation, as well as distraction for several weeks, if not months this session. Until the details of this bill could be ironed out, many other pieces of health care legislation were delayed. The Governor signed this bill on 6/13/2024. MSD is neutral on this bill.

Senator McBride introduced SB 13, the “Protect Medicaid Act of 2024” earlier this year. This Act creates the Hospital Quality Assessment, placing a 3.58% assessment on Delaware hospitals’ net patient revenues. The bill defines how the funds can be used, including for Medicaid initiatives. Delaware is one of only six states without a facility assessment on hospitals. HB 350 had affected this bill, like many other health care bills. SS 1 was added for SB 13 and the bill passed the Senate. An amendment was added on June 27th and the bill was passed the House and Senate on June 30th. SB 13 is now ready for Governor action. MSD has not taken a position on SB 13.

This General Assembly demonstrated interest in providing protections to physicians and patients with certain legislation. MSD testified in support of HB 374, a bill that provides the same legal protections to physicians and clinicians who provide contraceptive and abortion services as those that provide fertility treatments. The bill sponsor, Representative Johnson, provided personal testimony as to why this bill is important to her. Despite some debate in the House Committee where it was first introduced, the bill has passed both Houses and is ready for Governor action. MSD Supports HB 374.

In efforts to support maternal and infant health care in the state of Delaware, Representative Minor-Brown introduced HB 345. This act requires Medicaid coverage for added postpartum visits with a doula upon recommendation of a licensed clinician. Both ACOG and MSD support this important bill as it helps to address the maternal-fetal morbidity and mortality in the state. However, it does not address the OB/GYN shortage facing Delaware. HB 362 is a bill that requires private insurance plans to cover doula services, similar to Medicaid under HB 80 (151st). HB 362 is ready for Governor action and HB 345 was signed by the Governor on 6/30/2024. MSD Supports these bills.

After the bill failed to pass its first chamber hearing, the Delaware Senate was able to narrowly pass HB 140 relating to End of Life Options (also known as medical aid in dying). This bill was contentious for not only the legislators, but for those submitting public comment. HB 140 is ready for Governor action, but it is not clear if the Governor plans to sign or veto the bill. MSD maintained a position of engaged neutrality on this bill.

SB 223 is an innovative bill to address keeping patients out of the ER that could benefit from other services. This allows for mobile-integrated health and community paramedicine to deliver health care services to patients in out-of-hospital settings with the coordination of physicians and a coordinated health team. This bill reduces stresses on health care systems and also helps the care team address social determinants of health that may be leading to overuse of emergency care. This innovative bill, addressing access to care as well as equity, is ready for Governor action. MSD supports SB 223. 

HB 253 is a bill that would update the Delaware Code relating to mammograms. This Act’s goal is to increase access to mammograms for women 40 years of age and older. In collaborating with other stakeholders on this bill, including the American College of Radiology (ACR), MSD proposed new language to the bill sponsor, Representative Williams. HS1 for HB 253 w/ HA 1 adds additional language on how to address abnormal results/ dense breast findings if the patient does not have a referring physician. The bill also addresses that if the facility does not accept self-referred patients, it must provide the patients with written notice and a referral for the patient. This bill is an access to care bill, but MSD notes that it is access to testing and not a true access to care bill. This bill is ready for Governor Action. MSD has provided feedback on the bill, supporting access to care, but has concerns with the implementation, follow-up, and liability.

In addition to HB 253, several bills have been passed to address women’s health care, as well as cancer in this session. MSD often defers to our colleagues at ACOG for guidance and their position on women’s health policy, in addition to HB 345 and HB 362 mentioned above. Here are some other examples:

SS1 SB 212 – Bureau of Health Equity (Ready for Governor Action). ACOG and MSD support.

HS 2 for HB 110 – Termination of Pregnancy (Ready for Governor Action). ACOG supports/MSD no position.

SB 232- Insurance coverage for contraceptives (Ready for Governor Action). ACOG and MSD support.

SB 300 Kyle - CPC marketing (Ready for Governor Action). ACOG and MSD support.

SB 301 Kyle - contraceptive and abortion on college campuses (Ready for Governor Action). ACOG supports/ MSD no position.

Lastly, mandated cancer coverage by insurance was brought up in a few bills, including HB 15, HB 16, and HB 302. HB 15 w/ HA 1 and HB 16 w/ HA 1, sponsored by Speaker Valerie Longhurst, requires health insurance policies to cover annual ovarian cancer screening tests for women at risk for ovarian cancer. HS 1 for HB 302 requires all group, blanket, and individual health insurance policies to cover prostate screening for men at risk of prostate cancer. Although both of these bills aim at improving access and equity, MSD had concerns with codifying risk. Each of these bills are at a different stage at the time of this publication:

• HB 15 – Signed
• HB 16 – Ready for Governor Action
• HB 302 – Ready for Governor Action

Did You Know?

DELPAC will be sponsoring a Primary Election Candidates’ Night featuring candidates for Governor, Lt. Governor, and Insurance Commissioner on August 13, 2024, at the Smyrna Opera House. Members may register now. Please contact Lisa Gruss with questions.

Also, save the date for October 7, 2024, for DELPAC’s General Election Candidates’ Night to be held at the Smyrna Opera House.  

Contact MSD

For more details on specific legislation or if you have questions, please contact:

Mark B. Thompson, MHSA, Executive Director at 302-444-6958, Mark.Thompson@medsocdel.org

Lisa Gruss, External Affairs & Develop Officer at 610-306-6951, Lisa.Gruss@medsocdel.org

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-Updates are a benefit to our members, providing information on legislative activity of interest in the 152nd General Assembly in Dover.