Second Leg of the

152nd General Assembly

May 28, 2024

Busy Year in Legislative Hall for Health Policy

The 152nd General Assembly has been very active in 2024 in health policy legislation, sometimes with good intentions, but not with ideal execution. The Medical Society is monitoring approximately 60 bills (draft and introduced) that directly or indirectly impact physicians and health care of Delawareans. Several Patient Advocacy groups and Specialty Societies have approached us to collaborate and engage on several key bills. MSD is thrilled to see the engagement in the state around physician advocacy, especially during an election year. There are only eight more Legislative Days left in this session!

 

On behalf of the MSD Government Affairs Committee and Executive Board, we thank all the physicians and staff members who have contacted legislators this year, submitted testimony, and came to Legislative Hall. If you would like to learn more about engaging your practice in Advocacy, please view the Advocacy 101 deck. If you are interested in learning more about representing MSD at Legislative Hall, contact Lisa Gruss at lisa.gruss@medsocdel.org.

 

For an overview of bills, please see the most current 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. Both the GAC and Executive Board voted to pursue the original SB 10, 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, 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.

 

As of this publication, the bill has not been released from Committee. 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 DOI to discuss their concerns.

 

MSD encourages all members to write their Senators in support of the bill. Additionally, contact the Senate Banking, Business, Insurance & Technology Committee, asking them to release the bill on its merits.

Primary Care Reform

Primary Care Reform remains a strategic priority for MSD. Our physicians 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, MSD has drafted a bill based on the enhancements and shared it with Senator 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. Senator Townsend has proposed meeting over the Joint Finance Committee two-week break to discuss primary care reform frameworks in order to file a bill in late June to serve as a baseline for discussions.

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 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 has Passed the House and is assigned to the Finance Committee in the Senate. MSD supports this bill and has provided testimony in support.


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 Governor signed the bill on May 16, 2024. MSD supported this bill.

Other Updates


Creation of the Diamond State Hospital Cost Review Board

HB 350 creates the “Diamond State Hospital Cost Review Board.” Stakeholdershave had several conversations and negotiations with the bill sponsors, finally arriving at HS 2 for HB 350 with HA 1 + SA 1. MSD remains “neutral” as recommended by the Government Affairs Committee. Additional organizations have moved from an “opposed” position to “neutral” after the most recent negotiations and amendments to the bill. 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. This bill has passed both Houses and is awaiting Governor signature, who is committed to signing the legislation. MSD is neutral on this bill.


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 last year 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. A draft bill was shared with MSD this month and we anticipate that the bill will be introduced this session. There were no surprises added in the draft language.


Protect Medicaid Act of 2024

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 impacted this bill, like many other health care bills. SS1 was recently introduced for SB 13 and the bill has passed the Senate. MSD has not taken a position on SB 13.


Access to Care

Access to Care is the 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 highlights several bills that follow. 

 

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. This bill has passed the Senate and is reported out of the House Committee. MSD opposes PrEP portion but supports PEP. 


Fertility Treatments

MSD testified in support of HB 374, a bill that provides the same legal protections to physicians and clinicians that provide contraceptive and abortion services to 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, it has passed the House, and is assigned to a Senate Committee. MSD supports HB 374.


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. HB 362 is a bill that requires private insurance plans to cover doula services, similar to Medicaid under HB 80 (151st). MSD supports these bills.


Mobile-Integrated Health and Community Paramedicine

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 is awaiting the Governor’s signature. MSD supports SB 223.


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 WilliamsHS1 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. MSD has provided feedback on the bill.

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. MSD was invited to the Kids Caucus on May 23, 2024, to speak briefly on educational programing for youth and teens. The Caucus meets three to four times during the Legislative Sessions.

 

Lisa Gruss, MSD External Affairs and Development Officer provided a quick overview of the OBVIOUS and APOLLO programs and how these critical programs relate to health care policy. She also staffed a table with resources on these programs and other MSD programs that support the education and advocacy of youth.

 

The Caucus focuses on policy issues and features different speakers. Currently, Senator Evans Gay and Representative Heffernan chair the Kids Caucus. They are seeking speakers for the 2025 session. The Kids Caucus distribution list reaches approximately 600 emails from schools, child advocacy groups, legislators, and staff. Information on highlighted speakers at each Caucus are shared with this distribution list. Please reach out to Lisa Gruss if you have a kids or teens policy topic of interest to share.

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.


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.