The 152nd General Assembly reconvened on January 9, 2024. The second leg started off with many new bills as well as critical ongoing conversations with MSD’s priority legislative topics. The month of February in Legislative Hall is focused on budget hearings. On Thursday, Jan. 25th, Governor Carney presented his Fiscal Year 2025 Recommended Budget, sending the General Assembly a plan to strengthen Delaware's economy, invest in public schools, support families and the workforce, and protect our environment. For an overview of bills, please see the bill chart.

Updates on Priority Legislative Topics

Prior Authorization Reform

MSD, along with the Delaware Healthcare Association (DHA), authored a bill to significantly reform the prior authorization process. SB 10, the "Delaware Pre-Authorization Reform Act of 2023," was introduced on June 8, 2023. In the off session, MSD led a working meeting with Senator Townsend, the bill sponsor, and critical stakeholders to ensure bill was ready to be discussed in committee in the new year. The Association of Health Insurance Plans (AHIP) and the American Medical Association (AMA) have both provided feedback and comments on the bill. While AHIP is relying heavily on existing language of the signed Pennsylvania Prior Authorization Bill, representatives from the AMA believe that the bill is a good start but can be improved to enhance timelines and patient protections. 

Primary Care Reform

Primary Care Reform remains a strategic priority for MSD. Our physicians have continued crucial conversations with Senator Townsend, the bill’s sponsor, in the off-season about concerns in the delays of implementation of SB 120. The Primary Care Reform Collaborative (PCRC) of the Delaware Health Care Commission (DHCC) is drafting a model based on a PMPM amount with a Standard Quality Incentive (SQI) (E&M codes) and prospective Continuous Quality Incentive (CQI) (value-based care transformation) components, with a final proposed model coming in February. MSD held a roundtable of primary care physicians with the bill sponsor in December. The MSD Primary Care Subcommittee has drafted a list of proposed suggestions to enhance primary care reform legislation, which was approved by the MSD Government Affairs Committee and Executive Board.

Educational Transparency

MSD hosted a small work group of Delaware physicians and stakeholders to address Educational Transparency (Title Misappropriation) and what they would like to achieve through legislation in 2024. In Delaware, legislation exists regarding the use of the word “doctor” in the clinical setting; however, with the growth of the digital age and advertising, additional clarity is needed within the legislation to ensure transparency to the patient, as well as their safety. The bill sponsor, Representative Minor-Brown, has agreed to work with MSD regarding legislation to ensure clarity in introduction of non-physician doctors to patients, as well as truthful and transparent advertising. Non-physician degreed doctors would be able to continue to use their earned title. A follow-up meeting was held in January with the bill sponsor, who will work with stakeholders to a draft bill to accommodate language of interested parties.

Physician Workforce

Physician workforce remains a key priority for MSD. MSD is working to build a repository of resources available in Delaware to support workforce initiatives. The Delaware Health Care Commission held a retreat in November 2023 to discuss available data and next steps regarding these issues as it relates not only to physicians, but the entire health care workforce. Delaware Health Force is an effort to create a public-private partnership to gather and aggregate data on this critical topic. This initiative has made available dashboards for public viewing. Please note that this data is driven by the Division of Professional Regulation’s database and other sources to identify licensed health care workers (not necessarily active, practicing).

What is new in 2024?

PrEP and PEP Treatments by Pharmacists

SB 194 is a bill proposed to allow pharmacists to provide HIV pre-exposure prophylaxis (PrEP) and post-exposure (PEP) treatments. This bill was heard in the Senate Health Committee on January 17 with support from many organizations because it expands access to care and addresses health equity. MSD supports the PEP portion, but not the PrEP portion of the bill due to various medical complexities with PrEP treatment. This bill is reported out of the Health & Social Services Committee. We thank Dr. Richard Henderson for providing testimony at the Senate Health Committee hearing.

Medical Marijuana

HB 285 proposes to update the code related to Medical Marijuana. The proposed updates include removing the word “debilitating” and allowing physicians and other clinicians to determine if a patient has a condition appropriate for treatment with medical marijuana. It also allows certain patients to self-certify that they have an appropriate condition. Certain conditions are still listed in the bill. MSD wrote a letter to the House Health Committee addressing our concerns about some specified conditions, such as glaucoma and of lack evidence-based data for use of medical marijuana as treatment. Additionally, they expressed concerns with older populations self-certifying due to a myriad of reasons. This bill has been passed by the House and is awaiting consideration by the Senate Health & Social Services Committee.

Increased Coverage for Speech Therapy

Dr. Laura Moylan testified in support of HB 273, a bill to increase coverage for speech therapy. This act would require insurance coverage for two additional diagnoses – phonological disorder and receptive language disorder. Primary care physicians are a critical component in the identification and primary evaluation of children with speech and language delays. Early referral and therapy can mitigate the development of long-term communication disorders, as well as impact both social and academic development. This bill has been released from the Economic Development/ Banking/ Insurance & Commerce committee. 

Other updates

Alzheimer's Disease, Dementia Education

In late October, 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.” MSD made it clear that legislation regarding regular CME education is not the ideal pathway to improving patient care. MSD is currently scheduling a follow-up meeting with the bill sponsor. If you have any feedback regarding the topics of “diagnosis, treatment, and care” related to CME, please contact Lisa Gruss at [email protected].

Increased Access to Mammograms

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. Although MSD applauds the bill sponsor, Representative Williams, for initiative to make preventive care more accessible to all, the bill lacks details regarding follow-up to abnormal results and liability. We thank Dr. Varipapa and Dr. Henderson for writing a letter on behalf of MSD regarding MSD’s concerns with this bill.

DMOST

Dr. Sarah Matthews and Dr. John Goodill have championed SB 195 – Delaware Medical Orders for Scope of Treatment Act (DMOST). This act will improve the utilization of DMOST forms by enhancing training, maintaining a website, and maintaining an electronic registry. This bill was heard in the Senate Health Committee on January 17. MSD supports this bill.

Did you know?

The Conrad State 30 / J-1 Visa Waiver Program is used to place international medical graduates who have completed their medical education in the United States in underserved areas of the state. Normally, upon completion of their education, these international medical graduates are required to return to their country of nationality for at least two years before returning to the United States. However, under the Conrad State 30/J-1 Visa Waiver Program, this home residency requirement can be waived for up to thirty (30) J-1 physicians annually. The J-1 physicians must agree to practice medicine full-time at a Delaware pre-approved sponsoring site for a minimum of three years. These practice sites must be located in federally designated health professional shortage areas (HPSA) or a medically underserved area (MUA). The program aims to improve access to care for Delawareans in underserved areas of the state. The regulations are located here. For more information on HPSA and MUA, check out - https://bhw.hrsa.gov/workforce-shortage-areas/shortage-designation#hpsas. Use the HPSA Find tool to find data on geographic, population, and facility HPSA through the US.

For more details on specific legislation, or if you have other questions, please contact Mark B. Thompson, MHSA, Executive Director at 302-444-6958, [email protected] or Lincoln Willis, lobbyist at 302-632-9898 or [email protected].

MSD actively monitors all health-related legislation and maintains an active and visible presence in the 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.