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 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. MSD has provided feedback on the bill.
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