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. Both the GAC and Executive Board have voted to pursue the original SB 10, pushing forward for the best reform possible. On Friday, April 19th, the members of the GAC leadership team met to discuss prior authorization, thoroughly reviewing the proposed Delaware bill and comments, as ell as the AMA's State Bill Chart. The team agreed that certain areas must not be conceded as part of bill negotiations, including qualifications of the medical reviewer, peer-to-peer standards, and availability of the medical reviewer beyond standard business hours. Additional discussions included the definition of "electronic" and the reporting requirements of the Department of Insurance.

As next steps, the lobby team will finalize proposed verbiage and coordinate a House Committee hearing date with the bill sponsor. MSD staff is working with the AMA on additional support, including language guidance and expert testimony. Currently, the bill is anticipated to be heard in Committee on May 8th. If you would like to provide testimony on prior authorizations, including compelling patient stories, reach out to Lisa Gruss.

Pictured above from the Prior Authorization Workgroup are, from left, Richard W. Henderson, MD, GAC Chair; Lisa Gruss, External Affairs and Development Officer; Lincoln Willis, lobbyist with The Willis Group; Kim Gomes, Lobbyist with the Byrd/Gomes Group; and MSD President, Robert J. Varipapa, MD.

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. In response to the GAC / Executive Board proposed enhancements for SB 120 shared with Senator Townsend, the Senator has requested a draft bill from MSD. The draft bill is in progress and will be reviewed by the MSD Primary Care Subcommittee first. The goal is to introduce a new bill before the end of the legislative session.

MSD Related Resolutions

The MSD Council adopted resolutions at its Annual Meetings related to current advocacy activity.

Addressing Health Disparities in Food Allergy Prevention (A-2022)

At the Annul Meeting of the Council in November 2022, Sunjay Shah, MD; Randeep Kahlon, MD; and Sangita Modi, MD introduced this resolution that was adopted by the Council as submitted.

RESOLVED, 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 1 early peanut allergen introduction dietary supplement and at least 1 early egg allergen introduction dietary supplement. The cost would be no charge to the insured patients. The bill was voted out of the Appropriations Committee and on the Ready List for the House.

Gun Violence is a Public Health Crisis (A-2023)

This resolution, adopted in November 2023, recognizes gun violence. 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 bill has passed both the House and the Senate, and the Governor has committed to signing this legislation.

Other Updates

Creation of the Diamond State Hospital Cost Review Board

HB 350 creates the “Diamond State Hospital Cost Review Board”. HS1 For HB 350 was reported out of the House Administration and House Appropriations Committees. MSD remains “neutral” as recommended by the Government Affairs Committee. 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 is not ideal. Several organizations have opposed the bill. Based on feedback from various organizations, HS 2 for HB 350 was introduced and substituted in the House on April 23. It passed the House on April 25, along with an additional amendment that changes the composition of the board. There were several hours of debate on this bill, ending with an unusual parliamentary procedure. This legislation remains dynamic, and we will keep you informed.

Alzheimer's Disease, Dementia Education

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 and again on February 26th. As a result of the latter meeting, it was agreed that the new proposed legislation will include a one-time, two-hour CME, due upon re-licensure. MSD is also working on a few areas of compromise, including excluded specialties, attestation language, and education modules from which physicians can select. MSD has shared language with the Senator based on feedback from the AMA. The goal is to introduce a new bill in this session.

Access to Care

Access to Care is core issue to improve health outcomes, not only here in Delaware, but across the US. The AMA recommends 5 ways to improve access to health care. The AMA notes that coverage alone does not guarantee access. The AMA also highlights those increasing efficiencies, such as reducing government and insurance industry burdens, that would ultimately achieve better outcomes. There are currently several bills in the Delaware General Assembly that claim to address “Access to Care.” MSD argues that these bills increase access to testing, but not to care. These bills are highlighted below. 

HIV Pre-Exposure and Post-Exposure Prophylaxis Treatments

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 portion 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 state 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. If you are interested in AMA resources regarding defending scope bills or supporting the increased education of physicians, contact Lisa Gruss at Lisa.Gruss@medsocdel.org or visit AMA’s Scope of Practice Campaign. 

Coverage for Doula Services

In an effort to support maternal and infant health care in the state of Delaware, Representative Minor-Brown introduced HB 345. This act requires Medicaid coverage for additional 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. The bill has passed the House and is reported out of the Senate Health Committee.

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. 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. 

Coverage of Prostate Screening for Men at High Risk

HS 1 for HB 302 (Rep. Bolden) requires all group, blanket, and individual health insurance plans to cover prostate screening for men at high risk. The proposed bill identifies certain high-risk groups. The substitute bill clarifies the ages at which prostate screenings must be covered, consistent with the American Cancer Society guidelines. MSD supports the bill but has suggested different language that would refer to screening guidelines and does not codify specific populations. This bill is reported out of committee.

Did you know?

There are several "caucuses" hosted by legislators focused on different segments of the population, including the Caucus on Aging and the Kids Caucus.

The co-chairs of the Caucus on Aging are Senator Mantzavinos and Representative Johnson.  The Caucus on Aging recently met, and the following panelists contributed to the discussion:

• Dr. David Tam, CEO & President, Beebe Healthcare.
• Shante Hastings, Deputy Secretary, DelDOT.
• Tom Reardon, COO, CHEER.
• Rachel Hersh, Deputy Director, La Red Health Center, Inc.
• Robert Mauch, Deputy Director, Sussex County EMS.
• Brandy Nauman, Director of Community Development & Housing, Sussex County.

The panel discussed an array of topics including:

• Access to health care
• Accessibility in the home and senior safety
• Transportation
• Social isolation

The next meeting of the Caucus on Aging will be held be held at the Tatnall Building (150 MLK Jr. Blvd N, Dover, DE) on May 16th from 10:30 am – 12:00 pm.

For more information on the health caucuses, please reach out to Lisa Gruss. The GAC and lobby team and seeking input for topics to propose for these caucuses.

The Division of Services for Aging and Adults with Physical Disabilities (DSAAPD) also shared they are holding feedback sessions on the Draft 2024-2028 State Plan on Aging this month. To review the draft plan or to find information on upcoming sessions, go to: State Plan Hearings to be Held in April 2024 - Delaware Health and Social Services - State of Delaware.

Contact Us

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

Mark B. Thompson, MHSA, Executive Director

(302) 444-6958

Mark.Thompson@medsocdel.org

Lincoln Willis, lobbyist

(302) 632-9898

Lincoln.Willis@TheWillisGroupLLC.com

Lisa Gruss, External Affairs & Development Officer

(610) 306-6951

Lisa.Gruss@medsocdel.org

MSD actively monitors all health-related legislation and maintains an active and visible presence in Legislative Hall on your behalf.

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