Delaware Health Care Commission
Del. Code tit. 16, ch. 99
in effectDel. Code tit. 16, § 9902 Delaware Health Care Commission.
(a) (1) There is hereby established the Delaware Health Care Commission, hereinafter in this chapter referred to as the Commission. Said Commission shall consist of 11 members, 5 of whom shall be appointed by the Governor, 1 of whom shall be appointed by the President Pro Tempore of the State Senate and 1 of whom shall be appointed by the Speaker of the House of Representatives. Of the 5 members appointed by the Governor, at least 1 member shall be a resident of each county. The Insurance Commissioner, the Secretary of Finance, the Secretary of Health and Social Services, and the Secretary of Services for Children, Youth and Their Families or their designees shall serve as ex officio members of the Commission.
(2) The Governor shall designate 1 member of the Commission to be Chairperson who shall serve at the pleasure of the Governor. The terms of the remaining 6 appointed members shall be for 4 years except that the initial term of each may be for a lesser period. Any vacancy shall be filled by the Governor for the balance of the unexpired term. A member of the Commission shall be eligible for reappointment. No more than 3 of the Commission members appointed by the Governor shall be of the same political party.
(b) The Commission is constituted an independent public instrumentality and may call upon the Delaware Health Information Network and/or any state agency for any assistance, information or data that may be necessary to carry out the purposes for which it had been established. For administrative and budgetary purposes only, the Commission shall be placed within the Department of Health and Social Services, Office of the Secretary.
(c) The Commission is authorized to reimburse Commission members for mileage associated with Commission responsibilities.
Del. Code tit. 16, § 9903 Duties and authority of the Commission [For application of this section, see 85 Del. Laws, c. 253, § 23].
(a) The Commission may hire staff, contract for consulting services, conduct any technical or actuarial studies which it deems to be necessary to support its work, and publish reports as required in order to accomplish its purposes in accordance with the provisions of this chapter.
(1) The Commission shall, in coordination with the Primary Care Reform Collaborative established under § 9904A of this title, monitor the uptake and compliance of primary care providers with value-based care delivery models, including advising and approving a Delaware Primary Care Model designed to do both of the following:
a. Achieve targets for value-based care through increased participation in alternative payment models that are not paid on a fee for service or per claim basis and include quality and performance improvement requirements.
b. Reward primary care services that are designed to reduce health disparities and address social determinants of health.
(2) The Commission shall develop, and monitor compliance with, alternative payment models that promote value-based care. The Commission may do all of the following:
a. Review and incorporate the Office of Value-Based Health Care Delivery’s, established under § 334 of Title 18, analyses of primary care spending and affordability standards to achieve primary care targets without increasing costs to consumers or the total cost of care.
b. Solicit the following from a health insurer, as defined in § 4004 of Title 18, to the extent permitted under federal law, and from a hospital or acute health-care facility licensed under Chapter 10 of this title:
1. Quality and utilization reporting for providers participating in alternative payment arrangements with performance towards goals, targets, or benchmarks.
2. Demonstration of the practice transformation support for providers and evaluation of progress towards transformative milestones.
c. Adopt regulations to implement this paragraph (a)(2).
(b) As relates to the pilot health access projects, the Commission is expressly authorized to develop such programs in consultation with the appropriate public and private entities; to assign implementation to the appropriate state agency; to monitor and oversee program progress and to ensure that each pilot program is evaluated by an outside, independent evaluator after no more than 2 years of operations.
(c) The Commission shall be responsible for the administration of the Delaware Institute of Medical Education and Research (DIMER), which shall serve as an advisory board to the Commission. The Commission shall have such other duties and authorities with respect to DIMER which are necessary to carry out the intent of the General Assembly as expressed in this chapter.
(d) The Commission shall be responsible for the administration of the Delaware Institute for Dental Education and Research (DIDER), which shall serve as an advisory board to the Commission. The Commission shall have such other duties and authorities with respect to DIDER which are necessary to carry out the intent of the General Assembly as expressed in this chapter.
(e) Other functions which the Commission may undertake include:
(1) Serve as the policy body to advise the Governor and General Assembly on strategies to promoting affordable quality health care to all Delawareans and assuring policies are in place to maintain an optimal health-care environment. Analyze all aspects of the health-care landscape, including, but not limited to, population and health outcomes, service delivery infrastructure, quality, costs, accessibility, utilization, insurance coverage and financing;
(2) Convene, as necessary, public and private stakeholders to identify, analyze and address health policy issues and build consensus around workable solutions. Serve as the coordinating entity between the public and private sectors to implement emerging health initiatives at the federal, state and local levels;
(3) Function in such a way that fosters creative thinking and problem solving across state agency lines and across the public and private sectors;
(4) Ensure that data to support the activities of the Commission are available and accessible;
(5) Monitor cost trends in order to recommend methods to reduce and control health-care costs for public programs and in conjunction with the private sector;
(6) Coordinate efforts with the Health Resources Board and any other entities the Commission identifies as essential to carry out its mission;
(7) Review and recommend changes to state health insurance laws and regulations (in conjunction with the Insurance Commissioner) to promote efficiency, equity and affordability in health insurance premiums;
(8) Coordinate and collaborate with the Delaware Health Information Network [DHIN] to assure that the use of health information technology and health information exchange results in cost effective, quality health care for all Delawareans. Consult with DHIN Board of Directors and staff on implementation of health information technology in Delaware and call upon the DHIN to assist in conducting pilot programs, providing technical support, capabilities and expertise, and/or conducting research necessary to achieve the Commission’s mission;
(9) Oversee efforts to assure that Delaware has an adequate supply and distribution of health-care professionals to provide quality care to all Delawareans in consultation with DIMER, DIDER and other institutions, bodies or agencies as necessary;
(10) Monitor access to health-care programs and make recommendations for changes where necessary; and
(11) Conduct other activities it considers necessary to carry out the intent of the General Assembly as expressed in this chapter.
(f) The Commission must collaborate with the Primary Care Reform Collaborative to develop annual recommendations that will strengthen the primary care system in Delaware. The scope of the recommendations must include all of the following:
(1) Payment reform.
(2) Value-based care.
(3) Workforce and recruitment.
(4) Directing resources to support and expand primary care access.
(5) Increasing integrated care, including for women’s and behavioral health.
(6) Evaluation of system-wide investments into primary care, using claims data obtained from the Delaware Health Care Claims Database.
(g) The Commission shall establish the Delaware Health Insurance Individual Market Stabilization Reinsurance Program & Fund and the Commission shall have all of the following responsibilities.
(1) To provide reinsurance to carriers that offer individual health benefit plans in the State.
(2) Said reinsurance must meet the requirements of a waiver approved under § 1332 of the Affordable Care Act [42 U.S.C. § 18052].
(3) The reinsurance fund must operate under the supervision and control of the Commission, and is funded pursuant to § 8703 of Title 18.
(h) For purposes of funding and administering the reinsurance program outlined in subsection (g) of this section, the fund shall be made up of all of the following:
(1) Any pass-through funds received from the federal government under a waiver approved under § 1332 of the Affordable Care Act [42 U.S.C. § 18052].
(2) Any funds designated by the federal government to provide reinsurance to carriers that offer individual health benefit plans in the State.
(3) Any funds designated by the State pursuant to § 8703 of Title 18 to provide reinsurance to carriers that offer individual health benefit plans in the State.
(i) To carry out its responsibilities in administering the program outlined in subsection (g) of this section and funded pursuant to subsection (h) of this section, the Commission shall promulgate regulations for purposes of all of the following:
(1) Establishing procedures for the handling and accounting of program assets and moneys, as well as for an annual fiscal reporting to the Commission, Insurance Commissioner and General Assembly.
(2) Annually establishing procedures and parameters for reinsuring risks, including all of the following:
a. An attachment point.
b. A coinsurance rate.
c. A coinsurance cap.
(3) Establishing procedures and standards for carriers to submit claims to be reinsured under the program.
(4) Establishing procedures for selecting an administering contractor and setting forth the power and duties of the administering contractor.
(5) Establishing procedures for quarterly reporting or annual reporting, or both, of data under the Affordable Care Act’s § 1332 [42 U.S.C. § 18052] waiver to demonstrate that the waiver remains in compliance with the scope of coverage, affordability, comprehensiveness and deficit requirements.
(6) Establishing procedures for providing each year the actual second-lowest cost Silver Plan premium under the Affordable Care Act’s § 1332 [42 U.S.C. § 18052] waiver and an estimate of the premium as it would have been without the waiver.
(7) Providing for any additional matters necessary for the implementation and administration of the reinsurance program.
(8) Submitting an annual report to the Governor and General Assembly, in consultation with the Department of Health and Social Services and the Department of Insurance.
(j) The Commission shall be responsible for the administration of a Health Care Provider Loan Repayment Program (HCPLRP). The HCPLRP must be administered consistent with all of the following guidelines:
(1) Subject to the appropriation of sufficient funds, the Commission may award education loan repayment grants to qualifying clinicians of up to $50,000 per year for a maximum of 4 years.
(2) Eligible sites may apply to the Commission on behalf of their affiliated, qualifying clinicians for education loan repayment grants from the HCPLRP. Sites eligible to apply for education loan repayment grants on behalf of their qualifying clinicians include all of the following sites located in underserved areas or areas of need:
a. Hospital primary care practices.
b. Private practices.
c. Federally-qualified health centers.
d. Community outpatient facilities.
e. Community mental health facilities.
f. Free medical clinics.
g. School-based health centers.
(3) Health care provider loan repayment grants may only be awarded by the Commission to sites that accept Medicare and Medicaid participants, and may not include concierge practices. To be eligible for a health care provider loan repayment grant, private practice sites and eligible practitioners must participate in the Voluntary Initiative Program administered by the Department of Health and Social Services’ Health Care Connection. Health care provider loan repayment grants to hospital sites must be subject to a dollar-for-dollar match by the applicant hospital.
(4) The award of health care provider loan repayment grants must be limited to the recruitment and retention of new primary care or dental providers in ambulatory and outpatient settings. For purposes of this paragraph (j)(4), a “new primary care or dental provider” means any of the following providers who have completed graduate education within 2 years of the application for a health care provider loan repayment grant being submitted:
a. Physicians practicing family medicine (including osteopathic general practice), internal medicine, pediatrics, obstetrics/ gynecology, geriatrics, and psychiatry.
b. Nurse practitioners, certified nurse midwives, clinical nurse specialists, licensed psychologists, licensed professional counselors of mental health, masters of psychology, licensed clinical social workers, and physician associates practicing adult medicine, family medicine, pediatrics, psychiatry/mental health, geriatrics, women’s health, and optometrists.
c. Dental clinicians possessing a DDS or DMD and practicing general, pediatric, or public health dentistry.
(5) The Commission may grant priority consideration to applications submitted on behalf of primary care and dental clinicians that are DIMER- or DIDER-participating students or participants in Delaware-based residency programs and may annually spend up to $150,000 on marketing and infrastructure to attract clinicians to apply to the HCPLRP.
(6) The Commission shall issue an annual report detailing the number of clinicians applying for and awarded health care provider loan repayment grants, including information regarding the number of applicants and grant recipients by practice area and site location.
(7) The Commission may award health care loan provider repayment grants to no more than 2 optometrists per year.
(k) The Commission shall, in coordination with the Delaware Economic and Financial Advisory Council Health Care Spending Benchmark Subcommittee, be responsible for establishing and monitoring the state health-care spending and quality benchmarks as follows:
(1) As used in this subsection
a. “DEFAC” means the Delaware Economic and Financial Advisory Council.
b. “Insurer” means a private health insurance company that offers any of the following: commercial insurance administration for self-insured employers, Medicare managed care products, Medicaid and CHIP, or Medicaid managed care organization (MCO) products.
c. “Market” means the highest level of categorization of the health insurance market and shall include individual, small group, large group, self-insured, student, and Medicare Advantage markets.
d. “Payer” means a payer, a nongovernment health plan and includes any organization acting as payer that is a subsidiary, affiliate or business owned or controlled by a payer that, during a given calendar year, pays health-care providers for health-care services.
e. “Public programs” means payers that are not insurers and includes Medicare, Medicaid and CHIP, the Veterans Health Administration (VHA), and other similar programs or entities.
f. “Quality benchmark” means the annual performance target for a priority Delaware population-health or quality-of-care concern.
g. “Spending benchmark” means the target annual per capita growth rate for Delaware’s statewide total health-care spending, expressed as the percentage growth from the prior year’s per capita spending.
h. “Subcommittee” means the DEFAC Health Care Spending Benchmark Subcommittee.
(2) The Subcommittee shall be responsible for setting the spending benchmark and shall advise DEFAC, the Governor, the Department of Insurance, State Employee Benefits Committee, the Delaware Division of Medicaid and Medical Assistance, and other relevant state agencies on the spending benchmark.
(3) Subject to paragraph (k)(4) of this section, the spending benchmark shall be the per capita potential gross state product (PGSP) growth rate which shall be calculated as follows:
a. The sum of the following: the expected growth in national labor force productivity; plus, the expected growth in Delaware’s civilian labor force; plus, the expected national inflation;
b. Minus Delaware’s expected population growth.
(4) The methodology used to determine the spending benchmark in paragraph (k)(3) of this section are subject to change if the Subcommittee determines that there is a more effective or precise methodology than paragraph (k)(3) of this section.
(5) The Commission shall annually publish the Delaware Health Care Spending and Quality Benchmarks Implementation Manual on the Commission’s website which shall contain the current definitions and metrics utilized in the spending and quality benchmark calculations.
(6) In calculating any statewide, regional or local health-care cost calculation target or benchmark, the total cost of care calculation, report, study or formulation may utilize data obtained from the Health Care Claims Database maintained by the Delaware Health Information Network.
(7) The Subcommittee shall do all of the following:
a. Review annually all components of the potential gross state product or any other approved methodology, and recommend to DEFAC for its approval whether the forecasted growth rate has changed in such a material way that it warrants a change in the spending benchmark, and if so, how and why the spending benchmark should be modified.
b. Review periodically the methodology of the spending benchmark for possible updates or modifications to the methodology for the performance year starting January 1, 2024, and each year thereafter, and make recommendations to DEFAC by no later than May 31 of each calendar year thereafter, as to whether, and, if so, how and why the spending benchmark methodology and/or the growth rate should change.
c. In the event a recommendation is made that the spending benchmark methodology and/or the growth rate should change, provide the public and interested stakeholders a reasonable opportunity to provide feedback on the proposed changes, and consider any recommendations provided as to the proposed changes.
d. Advise the Governor and DEFAC on current and projected trends in health-care and the health care industry, particularly as they affect the expenditures and revenues of the State, its citizens, and its major industries.
(8) No later than June 30 of each year, DEFAC shall report to the Governor and the Commission regarding any changes to the spending benchmark as approved by DEFAC.
(9) The Commission shall establish and publish the annual spending benchmark on the Commission’s website.
(10) Recognizing the importance of coordination between the Subcommittee and the Commission in the creation of the spending and quality benchmarks, and as part of the Commission’s ongoing efforts to serve as the policy body to advise the Governor and the General Assembly on strategies to promote affordable quality health care to all Delawareans, the Commission shall be responsible for doing all of the following:
a. Setting quality benchmarks for the State and advising the Governor, the Division of Public Health and other relevant state agencies on the quality benchmarks.
b. For each new, 3-year cycle of the quality benchmarks, reviewing the methodology used to establish these benchmarks to determine whether changes should be made to the values used to establish the quality benchmarks to reflect changes in new population health or health-care priority opportunities for improvement, and/or whether the quality benchmarks’ values should be changed to reflect improved health-care performance in the State. If changes are to be made to the values used to establish the quality benchmarks and/or the quality benchmarks, the Commission shall finalize these changes prior to the start of each new, 3-year quality benchmark cycle. For Calendar Year 2025 - 2028 of the quality benchmark cycle, the Commission should finalize any changes on or before December 31, 2024, and then every 3 years thereafter.
c. In the event the Commission determines that the values used to establish the quality benchmarks and/or the quality benchmarks should be changed, the Commission shall make such changes only after providing the public and interested stakeholders a reasonable opportunity to provide feedback on the proposed changes, and considering any recommendations provided as to the proposed changes.
d. Engaging health-care providers and community partners in a regular and ongoing forum, with the State and with each other, to develop strategies to reduce variation in cost and quality and to help the State perform well relative to the spending and quality benchmarks, including reliance on data and, to the extent practicable, evidence-based solutions to address identified opportunities through the variation analysis.
e. Producing timely publications and/or reports with validated data to ensure transparency regarding health-care spending and quality within the State.
(11) Subject to paragraphs (k)(11)d. and (k)(11)e. of this section, payers, insurers, and public programs shall report annually to the Commission by no later than October 1 of each calendar year on performance relative to the spending and quality benchmarks.
a. Spending benchmark data may consist of the prior 2 calendar years.
b. Quality benchmark data shall consist of the previous calendar year.
c. The Commission may use other sources to track variation in costs and quality of high-volume, high-cost and high-value episodes of care (identifying the causes of variation, including mix of services used, unit price variation and provision of low-value care) at both of the following:
1. State health insurance market and individual consumer levels.
2. Medical group and accountable care organization (ACO) levels for entities of a sufficient size, using clinical risk adjustment methodologies.
d. Other payers may be required to report annually to the Commission on performance relative to the spending and quality benchmarks subject to the approval of DEFAC, the Subcommittee, the Governor, and other relevant state agencies.
e. The above annual reporting deadline of October 1 of each calendar year may be modified by the Executive Director of the Commission provided that payers, insurers, and public programs are given written notice of any such modification at least 30 days prior to the annual reporting deadline.
( l ) The Commission is responsible for the administration of the Diamond State Hospital Cost Review Board. The Commission shall have such other duties and authorities with respect to the Diamond State Hospital Cost Review Board as are necessary to carry out the intent of the General Assembly as expressed in this chapter.
Del. Code tit. 16, § 9904 Reporting requirements.
(a) On or before January 15, 1991, the Commission shall report to the Governor and the General Assembly on the status of the recommendations contained in the May 31, 1990, Task Force Report. On or before March 15, 1991, the Commission shall submit to the Governor and the General Assembly its recommendations for legislative action on insurance reform. On or before May 15, 1991, the Commission shall report to the Governor and the General Assembly on the status of specific initiatives in Medicaid, education, outreach and case management, and the pilot model projects.
(b) On or before January 15, 1991, and on or before every January 15 thereafter, the Commission shall report to the Governor and the General Assembly on the status of all of the Task Force recommendations. The comprehensive report shall identify any segments of the population which remain without access to health care and any further recommendations deemed necessary to meet the Commission’s charge.
Del. Code tit. 16, § 9904A Primary Care Reform Collaborative.
(a) The Commission shall convene a Primary Care Reform Collaborative (“Collaborative”) to assist with the development of recommendations to strengthen the primary care system in this State. The Collaborative may collect and accept advice and input from stakeholders, including the Delaware health-care and patient community.
(b) The Collaborative is comprised of the following members, or a designee appointed by the member serving by virtue of position:
(1) The Commission Chairperson. The Commission Chairperson is chair of the Collaborative.
(2) The Chair of the Senate Health & Social Services Committee.
(3) The Chair of the House Health & Human Development Committee.
(4) One member, appointed by the Governor from a list of names provided by the Medical Society of Delaware.
(5) One member, appointed by the Governor from a list of names provided by the Delaware Nurses Association.
(6) One member, appointed by the Governor from a list of names provided by the Delaware Healthcare Association.
(7) Two members representing insurance carriers, appointed by the Governor.
(8) The Secretary, Department of Health and Social Services.
(9) The Director, Division of Medicaid and Medical Assistance.
(10) The Insurance Commissioner, Insurance Department.
(11) The Chair, State Employee Benefits Committee.
(12) One member representing a Federally Qualified Health Center, appointed by the Governor.
(c) The Commission may also require the submission of written reports by any “health insurer,” as defined in § 4004 of Title 18, to the extent permitted under federal law, and any hospital or acute health-care facility licensed under Chapter 10 of this title, regarding all of the following matters:
(1) The hospital’s, acute health-care facility’s, or health insurer’s progress in adopting and implementing value-based payment models during the fiscal year immediately preceding the annual reporting deadline and the overall progress of the reporting entity.
(2) The hospital’s, acute health-care facility’s, or health insurer’s efforts to support primary care access and primary care practitioners in the State, including financial, operational, and other support, in conjunction with the adoption of meaningful value-based payment models.
(d) (1) A quorum of the Collaborative is a majority of its members.
(2) Official action by the Collaborative requires the approval of a quorum of the Collaborative.
(3) The Collaborative may adopt rules necessary for its operation.
Del. Code tit. 16, § 9905 Findings.
(a) The General Assembly finds and declares that the purpose of the Delaware Institute of Medical Education and Research (DIMER), created in 1969 as an alternative to a state sponsored medical school, is sound and should be continued and strengthened. Delaware should continue to provide opportunities for Delaware residents to receive a medical education.
(b) The General Assembly finds and declares that the current arrangement between the State and Sidney Kimmel Medical College of Thomas Jefferson University (SKMC) and the Philadelphia College of Osteopathic Medicine (PCOM), which allows SKMC and PCOM to function as Delaware’s medical schools, produces significant benefits to the State. Through DIMER, SKMC currently admits a minimum of 20 Delaware residents and PCOM admits a minimum of 10 Delaware residents. This program is built upon decades of solid working relationships and should be perpetuated.
(c) The General Assembly finds and declares that a new structure of the DIMER Board will more appropriately reflect DIMER’s abilities to meet its responsibilities as outlined in this legislation.
(d) The General Assembly finds and declares that placing administration of DIMER within the Delaware Health Care Commission will enhance its ability to accomplish its goals and ensure that DIMER’s future functions will be focused on promoting medical education while helping the State to meet its health-care needs.
Del. Code tit. 16, § 9906 Creation of a Board.
(a) There is hereby established the Board of Directors of the Delaware Institute of Medical Education and Research (Board), which shall serve as an advisory board to the Health Care Commission.
(b) The Board shall consist of 19 members as follows:
(1) Eighteen members appointed by the Governor as follows:
a. One member from the Delaware Health Care Commission.
b. Two members from the ChristianaCare Health System.
c. Six representatives from each institution with a graduate medical education program, including ChistianaCare Health System, Bayhealth, Beebe Healthcare, TidalHealth, Nemours Children’s Health, and Saint Francis Hospital.
d. One member from the Delaware Healthcare Association.
e. One member from the Delaware Higher Education Office.
f. Two members from the University of Delaware, 1 of which must be from the College of Health Sciences.
g. One member from Delaware State University.
h. One member from the Medical Society of Delaware.
i. One member from the Delaware Academy of Medicine Delaware Public Health Association.
j. One member from the First State Chapter of the National Medical Association.
k. An at-large member, who is a resident of Sussex County and who represents federally-qualified health centers.
(2) The Director of the Division of Public Health, or the Director’s designee, shall serve as an ex officio member of the Board.
(c) All members, other than the ex officio member, shall be appointed for terms of 3 years. Any member appointed to fill a vacancy shall be appointed only to fill that vacancy for the remainder of the term, but shall be eligible for re-appointment upon expiration of that term.
(d) No member of the Board shall receive compensation for that member’s duties other than normal travel expenses incurred in carrying out the responsibilities as members.
(e) A majority of the total membership of the Board must be present at a Board meeting in order to have quorum and conduct official business. A vacancy on the Board is not counted for quorum.
(f) The Chair of the Board shall be elected by the Board. Candidates for Chair of the Board shall be reviewed by a nominating committee. Membership of the nominating committee and rules for nominating candidates shall be determined by the Board. The Chair shall be subject to a 3-year term with no more than 3 consecutive terms. A Vice Chair shall be established in the same manner and with the same term lengths and limits.
(g) The Board may establish working committees to assist in completing its work; however, it shall maintain a standing “Committee on Rural Health” to assure that the unique health needs of rural Delaware are addressed in DIMER activities.
(h) The Board members shall receive annual training on the importance of diversity in healthcare and how diversity in the medical field reduces healthcare disparities, optimizes care delivery, and increases access to care.
Del. Code tit. 16, § 9907 Purposes of the Board.
The purpose of the Board shall be to initiate, encourage and promote:
(1) The relationship with Sidney Kimmel Medical College of Thomas Jefferson University (SKMC) and the Philadelphia College of Osteopathic Medicine (PCOM) as Delaware’s medical schools, and ensure the annual admission of 20 bona fide Delaware residents into SKMC and 10 bona fide Delaware residents into PCOM.
(2) Expansion of opportunities for Delaware residents to obtain training at a reasonable cost in the health and health-related professions when such residents commit to practice their professions in Delaware.
(3) Incentives for qualified personnel in the health and health-related professions to practice in Delaware.
(4) Continued development of a coordinated program of premedical, medical and graduate education among state public institutions of higher learning, Delaware hospitals, SKMC, and PCOM.
(5) Support of graduate and post-graduate medical and health-care training programs, including emphasis on those programs targeted to meet the State’s health-care needs.
(6) Programs of education and training in the health fields and research in health and health-related fields, both basic and applied, including the vital areas of public health education, community health planning and health-care costs.
Del. Code tit. 16, § 9908 Duties.
(a) The Board shall be responsible for overseeing implementation of policies designed to accomplish the purposes set forth in § 9907 of this title and shall report to the Commission on its progress in an annual report. Its activities and responsibilities shall include:
(1) Developing a recruitment program for medical education in conjunction with local colleges and universities to encourage medical school applications from minorities and residents of rural counties and underserved areas of Delaware, in addition to other students interested in pursuing a medical education.
(2) Developing and maintaining statewide communications, publicity and marketing plans in cooperation with the Delaware Higher Education Office and other interested parties, which will promote awareness of the existence of DIMER and the Sidney Kimmel Medical College of Thomas Jefferson University and the Philadelphia College of Osteopathic Medicine as Delaware’s alternatives to state-sponsored medical schools.
(3) Close monitoring of the relationship between the University of Delaware Medical Scholars Program and all out-of-state admission slots reserved for Delaware residents.
(4) Developing recruitment programs aimed at attracting premedical students interested in community and rural medicine; provided, however, that the Delaware Health Care Commission shall be empowered to expand or replace this activity with other duties if required by the future health care needs of the State.
(5) Support, as appropriate, private sector provider recruitment efforts by consolidating information collection and dissemination efforts, such as statewide recruitment brochures.
(6) Advising the Delaware Higher Education Office, Division of Public Health, and Delaware Health Care Commission as it administers and monitors scholarships, loans and loan repayment programs:
a. Aimed at attracting graduates and residents in disciplines in which there is a shortage as determined by the Delaware Health Care Commission; and
b. Offered to Delaware residents in financial need who wish to pursue a health-related education and to practice health-related professions in Delaware.
The Board may develop working relationships and affiliation agreements with other institutions to facilitate carrying out the purposes of this chapter. Any such agreements shall be approved by the Delaware Health Care Commission, and the State shall be a signatory to any documents setting the terms of the agreements.
(b) In its annual report, the Board shall include progress made on increasing diversity in the DIMER program.
Del. Code tit. 16, § 9909 Delaware Healthy Children Program.
(a) The Delaware Health Care Commission shall develop a program to help Delaware children without access to health insurance to obtain health insurance at affordable cost to their families. The Program shall promote the important objectives of improving the health of uninsured Delaware children and reducing the cost-shifts to policyholders and hospitals caused by uncompensated care. Such program shall be called the Delaware Healthy Children Program (hereinafter in this section, the “Program” or “CHIP”).
(b) The Program shall be administered and implemented by the Department of Health and Social Services [DHSS].
(c) The Program shall operate within the limits of the appropriations made for such purpose in the annual appropriations act. To the extent that private charitable or foundation support is available to implement the Program, such appropriations may be used for a public-private partnership to implement the Program in compliance with of this section.
(d) The Program shall be designed to provide the ability to purchase insurance at a reasonable cost to uninsured Delaware children without access to affordable health insurance through their parents’/guardians’ employers. The Program shall offer a managed care product that may require participants to pay regular premiums and may require participants to pay co-payments, and shall be designed to create incentives for participants to use health services in a prudent and responsible fashion. The Program shall also be designed to minimize the ability of private employers who provide health insurance coverage for their employees to eliminate such coverage, and, to the extent practicable, provide incentives for employers who provide no health insurance coverage for their employees to begin to provide such coverage.
(e) The Program shall offer to children health insurance which emphasizes the prudent and responsible use of preventive services so as to improve the health of participants, promote the early detection of serious health problems such as cancer and to help reduce the need for more expensive care by addressing health problems which can be treated more inexpensively if identified in a timely manner. To this end, the health insurance plan offered by the Program shall offer participants the ability to obtain regular preventative health care in accordance with accepted medical guidelines.
(f) The Program shall be designed to integrate with other state health initiatives to ensure that state resources are used efficiently to extend health insurance access and not to duplicate services available through other state programs, including, but not limited to, the State’s Medicaid program, particularly the primary care managed care plan known as the Diamond State Health Plan, the School-Based Health Center program, and the public-private children’s health access initiative involving the Nemours Foundation. To the extent practicable, the Program shall be administered by the State Medicaid Office and the health insurance plan offered to participants shall be designed to operate in tandem with the Diamond State Health Plan so as to maximize service to participants, contain costs through coordinated purchasing and contracting and minimize administrative costs.
(g) The DHSS is authorized to promulgate rules and regulations and take such other actions as are necessary to implement this section and to secure federal funding to support the Program, including any actions necessary to comply with the Federal Child Health Assistance Act, Title XXI of the federal Social Security Act [42 U.S.C. § 1397aa et seq.]
(h) The Program shall be designed with the intent that program coverage could be extended to low-income uninsured adult Delawareans in the future if sufficient resources are appropriated for such purpose.
(i) The Program shall be designed with the intent that program coverage could be extended to families with incomes above 200% of the Federal poverty level.
(j) (1) The provision of health-care insurance under CHIP shall be extended to eligible children under the age of 19 whose families have personal incomes above 200% of the Federal Poverty Level (FPL), as determined pursuant to 42 U.S.C. § 1397jj(c)(5).
(2) For an eligible child whose family income is greater than 200% of the FPL, the family may purchase a healthcare benefit package, determined by DHSS and subject to any necessary approval under federal law, that provides benefits identical to those provided to an eligible child covered under this section.
(3) To be eligible for coverage under CHIP where family income is greater than 200% of the FPL, a child over 2 years of age must have been uninsured for a continuous period of not less than 3 consecutive months immediately preceding enrollment in CHIP unless:
a. The child’s parent is eligible to receive benefits pursuant to the State’s unemployment compensation laws, as set forth in Title 19;
b. The child’s parent was covered by a health insurance plan, a self-insurance plan or a self-funded plan and involuntarily lost coverage; or
c. A child is transferring from 1 government-subsidized health-care program to another.
(4) DHSS shall have the authority to establish and adjust the levels of co-payments, premiums, and deductibles for children enrolled under this subsection for the purpose of ensuring that the state cost of the plan does not exceed funds specifically appropriated for purposes of this subsection.
(k) The program shall be designed such that program coverage shall include the provision of dental services to children enrolled in the program.
( l ) By September 1 of each calendar year beginning in 2008, DHSS shall develop a form and instructions for school districts to use in communicating to DHSS the information regarding free and reduced price meal eligibility whose submission is required by § 4134 of Title 14. Said form and instructions shall be communicated by October 1 of each calendar year to each school district.
(m) By January 1 of each calendar year beginning in 2009, DHSS shall communicate in writing with the family of each child who may be eligible for the CHIP or Medicaid programs based upon information submitted by the school districts pursuant to § 4134 of Title 14. Said communication shall inform the family that its children may be eligible for free or reduced price health insurance based upon income information received from the school district, and provide information to the family for applying for the CHIP and Medicaid programs. The form provided to families notified pursuant to this subsection shall allow DHSS to calculate how many families have enrolled in the CHIP or Medicaid programs as a result of such notification, and the Department of Insurance shall reimburse DHSS for any administrative costs incurred as a result of such additional enrollments. No funds transferred pursuant to this subsection shall be used to fund insurance benefits for the CHIP or Medicaid programs.
(n) Only persons authorized to carry out initial processing of Medicaid or CHIP applications or make eligibility determinations with respect to Medicaid or CHIP applicants may review information received from the school districts pursuant to § 4134 of Title 14.
(o) Prior to August 1, 2008, DHSS shall enter into written agreements with each of the school districts meeting the requirements of § 4134(e) of Title 14.
(p) “School district” as used in this section shall have the meaning assigned to it in § 4134(g) of Title 14.
(q) DHSS shall cooperate with the school districts and the Insurance Commissioner in developing the written materials required by subsections ( l ) and (o) of this section. DHSS shall cooperate with the Insurance Commissioner in developing the written materials required by subsection (m) of this section.
Del. Code tit. 16, § 9920-9927 §§ 9920-9927. Purpose; creation of Delaware Health Information Network; powers and duties; Immunity from suit; limitation of liability; property rights; regulations; resolution of disputes; privacy; protection of information; no pledge of state credit; no assumption of liability by State [Transferred].
Transferred to §§ 10301 to 10308 of this title by 77 Del. Laws, c. 368, § 16, effective Jan. 1, 2011.
Del. Code tit. 16, § 9940 Findings.
(a) The General Assembly finds and declares that the original purposes for DIDER enacted in 1981 remain sound and should be continued and strengthened.
(b) The General Assembly finds and declares that the arrangement between the State and Temple University Kornberg School of Dentistry and hospital-based residency programs, as provided in Chapter 11 of Title 24, are extremely valuable to the State. The General Assembly further finds that continued support of the Delaware Insitutute for Dental Education and Research to maintain these residencies should be perpetuated.
(c) The General Assembly finds and declares that DIDER can play a pivotal role in implementing many programs that could result in improved access to dental care for Delawareans.
(d) The General Assembly finds and declares that a new structure of the DIDER Board will more appropriately reflect DIDER’s abilities to meet its responsibilities outlined in this legislation.
(e) The General Assembly finds and declares that placing the administration of DIDER within the Delaware Health Care Commission will enhance its ability to accomplish its goals and ensure that DIDER’s future functions will be focused on promoting dental education and helping the State to meet its health-care needs, in concert with DIMER and other state health-care policy activities.
Del. Code tit. 16, § 9941 Creation of a Board.
(a) There is established the Board of Directors of the Delaware Institute for Dental Education and Research (“Board”) which shall serve as an advisory board to the Health Care Commission.
(b) The Board is comprised of 12 members, 9 voting members and 3 nonvoting members.
(1) The 9 voting members are as follows:
a. Eight members, appointed by the Governor, as follows:
1. One member representing the public.
2. One member representing a federally-qualified health center.
3. Three members from the Delaware State Dental Society, appointed in consultation with the Delaware State Dental Society.
4. One member from the State Board of Dentistry and Dental Hygiene, appointed in consultation with the State Board of Dentistry and Dental Hygiene.
5. One dental hygienist, appointed in consultation with the Delaware Dental Hygienist Association.
6. One member from the Christiana Care General Practice Residency Program.
b. The Chair of the Delaware Health Care Commission, or the Chair’s designee, selected in concert with the Delaware Institute for Dental Education and Research, who serves as an ex officio member.
(2) The 3 nonvoting members are as follows:
a. One ex officio member from Delaware State University, Wesley College of Health and Behavioral Sciences
b. One ex officio member from the University of Delaware, Center for Health Profession Studies.
c. The Delaware State Dental Director, or the State Dental Director’s designee, who serves as an ex officio member of the Board.
(c) All members, other than ex officio members, shall be appointed for terms of 3 years. Any member appointed to fill a vacancy shall be appointed only to fill that vacancy for the remainder of the term but shall be eligible for re-appointment upon expiration of that term.
(d) The chair shall be elected by the members from among the board members.
(e) No member of the Board shall receive compensation for that member’s duties other than normal travel expenses incurred in carrying out the responsibilities as members.
(f) A majority of the voting members must be present at a Board meeting in order to have a quorum and conduct official business. A vacancy on the Board is not counted for quorum.
(g) The chair of the board shall be elected by the Board. Candidates for chair of the Board shall be reviewed by a nominating committee. Membership of the nominating committee and rules for nominating candidates shall be determined by the Board. The chair shall be subject to a 3-year term with no more than 3 consecutive terms. A vice chair shall be elected in the same manner and with the same term lengths and limits.
(h) Before becoming a board member, that individual shall receive a training on the importance of diversity in healthcare and how diversity in the dental field reduces healthcare disparities, optimizes care delivery, and increases access to care.
(i) A consultant from Temple University Kornberg School of Dentistry’s admission department or the University of Delaware’s Center for Health Profession Studies Health Professions Evaluation Committee or a similar committee from Delaware State University may be invited to attend relevant meetings as deemed necessary by the chair. Any consultant attending meetings does not vote.
Del. Code tit. 16, § 9942 Purposes of the Board.
The purpose of the Board shall be to support, encourage, and promote all of the following:
(1) Accredited general practice residencies in dentistry at any hospital accredited by the Commission on Dental Accreditation of the American Dental Association in the State that will provide a comprehensive postgraduate training program pursuant to the requirements of Chapter 11 of Title 24.
(2) Expansion of opportunities for Delaware residents to obtain dental hygiene and dental assisting education and training at all levels.
(3) A strengthening of the factors favoring the decision of qualified dental personnel to practice in Delaware, including, but not limited to, tools such as loan repayment programs as approved by the Delaware Health Care Commission and supporting programs such as general and specialty dental residences.
(4) Dental needs of the community at large and particularly those who do not have ready access to dental care.
(5) Expansion of opportunities for Delaware residents to obtain training at a reasonable cost in the dental professions.
(6) Incentives for qualified personnel in the dental professions to practice in Delaware.
(7) Support of general and specialty programs as recognized by the American Dental Association.
Del. Code tit. 16, § 9943 Duties.
The Board shall be responsible for implementation of policies designed to accomplish the purposes set forth in § 9942 of this title, and shall report to the Commission on its progress. Its activities and responsibilities shall include:
(1) Working in conjunction with the State Board of Dentistry and Dental Hygiene, development of programs to encourage and allow dentists to practice in under-served areas of the State, as recognized by the Delaware Health Care Commission, in lieu of hospital-based residency training as a condition of licensure. Such programs may include reciprocity.
(2) Loan repayment programs designed to attract dental personnel to Delaware’s under-served areas, as approved by the Delaware Health Care Commission.
(3) Development of expanded opportunities for dental school graduates to obtain general practice training in Delaware. Examples of such opportunities may include, but not be limited to: satellite sites; partnerships with dental schools; and partnerships with local hospitals.
(4) Developing recruitment programs designed to attract dental personnel to Delaware.
(5) Developing plans for enhanced education opportunities for Delawareans interested in pursuing a dental education such as the current relationship with Temple University, extending them to include other similar institutions based on need.
(6) Developing plans for improving access to dental care, particularly for the underserved populations.
The Board may develop working relationships and affiliation agreements with other institutions to facilitate carrying out the purposes of this chapter. Any such agreements shall be approved by the Delaware Health Care Commission, which shall be a signatory to any documents setting the terms of the agreement.
Del. Code tit. 16, § 9951 Definitions.
As used in this subchapter:
(1) “Board” means the Diamond State Hospital Cost Review Board established by § 9952 of this title.
(2) “Core CPI” means as defined in § 2503 of Title 18.
(3) “Hospital” means as defined in § 1001 of this title, except that hospitals that exclusively provide psychiatric services, rehabilitative services, or long-term acute care services are excluded from the application of this subchapter.
(4) “Insurer” means as defined in § 9903 of this title.
(5) “Manual” means the Uniform Reporting Manual for Budget Submissions to be adopted by regulation by the Board to ensure the consistency of information provided by hospitals under this subchapter.
(6) “Meaningful Cost Containment Arrangement” means, with respect to the applicable benchmark compliance plan year, any of the following:
a. A Medicare or Medicaid Global Budget Arrangement.
b. A Substantial Financial Downside Risk Arrangement.
c. Any other qualifying written agreement approved by the Board on application of a hospital under § 9953(d)(7)c. of this title.
(7) “Medicare or Medicaid Global Budget Arrangement” means a written agreement among Medicare, Medicaid, or other applicable federal or state governmental payer authorities or public programs; a hospital, health system or affiliate; and, as applicable, any necessary third-party payers that is designed to cover the projected costs of hospital-based care for a defined patient population covering at least 50% of the hospital’s historical patient volumes and representing at least 3% of the hospital’s net patient revenue at risk for the applicable benchmark compliance plan year, reflecting a historical baseline calculation adjusted for inflation, demographic shifts, risk adjustment, and other factors for a defined performance period.
(8) “Payer” means as defined in § 9903 of this title.
(9) “Public programs” means as defined in § 9903 of this title.
(10) “Purchaser” means any governmental entity or unit, which offers coverage on a self-insured basis, or any employer that is self-insured within the definitions of the Employee Retirement Income Security Act (ERISA) [29 U.S.C. § 1001 et seq.].
(11) “Spending benchmark” means as defined in § 9903 of this title.
(12) a. “Substantial Financial Downside Risk Arrangement” means, for the applicable benchmark compliance year, 1 or more written agreements between a payer, purchaser, or insurer and a hospital, health system, or affiliate for providing health-care services to a defined patient population that provide all of the following:
1. That total annual costs are not less than 3% of the hospital’s net patient revenue.
2. That a minimum of 10% of the total annual costs for the defined patient population are at risk to the hospital.
3. That, for any hospital having an annual operating budget greater than $1,000,000,000, a minimum of 5,000 covered patient lives are subject to the agreement.
b. The Board may, by regulation, increase the amounts or percentages set forth in paragraphs (12)a.1., a.2., or a.3. of this section.
(13) “Total annual costs” means the aggregate yearly health-care costs of a defined patient population in a Meaningful Cost Containment Arrangement in the applicable benchmark compliance year.
Del. Code tit. 16, § 9952 Diamond State Hospital Cost Review Board.
(a) There is established the Diamond State Hospital Cost Review Board for the purpose of carrying out hospital budget reviews and related functions under this chapter.
(b) (1) The Board consists of 8 members as follows:
a. Seven voting members, including at least 1 member from each county, appointed by the Governor and confirmed by the Senate.
b. The President and CEO of the Delaware Healthcare Association, who shall serve as a nonvoting member.
(2) The members appointed by the Governor shall serve a 4-year term, except that the initial members may be appointed for a term less than 4 years to create staggered terms. A member shall continue to serve on the Board until the member’s successor has been appointed and qualified. A member may serve more than 1 term.
(3) The Governor shall designate a member appointed by the Governor to serve as Chair of the Board, who shall serve as Chair at the pleasure of the Governor.
(c) All members of the Board appointed by the Governor must possess the following qualifications:
(1) Knowledge of health-care policy, health-care delivery, or business, finance, or accounting.
(2) Knowledge, experience, and characteristics that complement those of the remaining members of the Board.
(3) Impartiality and the ability to remain free from undue influence by a personal, business, or professional relationship with any person subject to supervision or regulation by the Board.
(d) The Chair of the Delaware Health Care Commission shall set the date for the initial meeting of the Board and shall set the date of the next meeting if the Chair is vacant.
(e) The members of the Board appointed by the Governor shall each receive a salary as appropriated in the annual Appropriations Act, to be paid in equal monthly payments by the Treasurer of the State.
(f) (1) Four voting members constitutes a quorum of the Board and, except as set forth in paragraph (f)(2) of this section, the Board may take action by affirmative vote of a majority of members present and voting.
(2) The following actions require the affirmative vote of a majority of the voting members of the Board:
a., b. [Repealed.]
c. An enforcement action under § 9957 of this title.
d. Approval of a benchmark compliance plan under § 9954 of this title.
e. Adoption of a regulation under this subchapter.
f. Adoption of written findings of fact and determinations under § 9953(d)(7) of this title.
(g) The Board shall promulgate rules and regulations necessary for the implementation of this subchapter including a schedule for submission of information required from hospitals under § 9953 of this title and a Manual providing uniform definitions and submission criteria for the budget reporting categories listed in § 9953 of this title.
Del. Code tit. 16, § 9953 Submission and analysis of hospital financial information.
(a) Hospitals shall annually submit to the Board any of the following information required by the Board under rules, regulations, and guidance promulgated under this subchapter, including the Manual:
(1) The hospital’s expenditures and revenues for the most recently completed fiscal year, including the financial information described in paragraph (a)(3) of this section, redlined to reflect increases and changes from the fiscal year immediately preceding such fiscal year.
(2) [Repealed.]
(3) Financial information, including all of the following:
a. Costs of operations.
b. Revenues.
c. Assets.
d. Liabilities.
e. Rates and charges in accordance with paragraph (a)(8) of this section.
f. Labor costs by units of service and budget category.
(4) Scope of services and volume of service information, including inpatient services, outpatient services, and ancillary services by type of service provided.
(5) Utilization information.
(6), (7) [Repealed.]
(8) Information about payments by payers and purchasers consistent with information subject to public disclosure required by 45 C.F.R. Part 180.
(9) Other information the Board determines to be relevant to the Board’s obligations under this section, including information relevant to any determination by the Board under paragraph (d)(7)c. of this section.
(10) A narrative regarding the budget reporting categories of this subsection, outlining the changes in the year-over-year results and the actions the hospital has taken and will take in the coming year to adhere to the health-care spending benchmark.
(b) Hospitals shall submit audited financial statements to the Board, within 30 days of such audited financial statements becoming finalized. This requirement begins with audited financial statements for 2023.
(c) [Repealed.]
(d) The Board shall do all of the following:
(1) Review utilization information.
(2) Analyze and consider the other information submitted by the hospital under subsections (a) and (b) of this section.
(3) Meet with each hospital to review and discuss each hospital’s budget information.
(4) Review the hospital’s investments in workforce development initiatives.
(5) Consider the salaries for the hospital’s executive and clinical leadership whose compensation is publicly disclosed in the hospital’s Internal Revenue Service Form 990 filings.
(6) Offer the opportunity for the public to provide comment on hospital budgets and other aspects of hospital costs.
(7) Issue written findings of fact and determinations as to any of the following:
a. Whether a hospital has satisfied the State’s health-care spending policy directives, including, as applicable, the health-care spending benchmark and the annual rate filing cost containment requirements under § 2503 of Title 18.
b. Whether a hospital has satisfied the elements of the hospital’s benchmark compliance plan, if applicable.
c. On the application of a hospital, whether the hospital is participating in a Meaningful Cost Containment Arrangement and therefore is not subject to the benchmark compliance plan process under § 9954 of this title for the applicable benchmark compliance plan year.
1. The application must include a written attestation from the hospital’s chief executive officer of all of the following:
A. That the hospital is not in breach of any material provision of the Meaningful Cost Containment Arrangement.
B. That the hospital has not received a waiver of any penalties during the term of the Meaningful Cost Containment Arrangement.
C. That the penalties and risk provisions of the Meaningful Cost Containment Arrangement have not been modified during the term of the Meaningful Cost Containment Arrangement.
2. If during the applicable benchmark compliance year the hospital breaches any material provision of, receives a waiver of any penalties under, or negotiates new terms of the Meaningful Cost Containment Arrangement, the hospital shall notify the Board.
(e) A hospital’s violation of the Board’s standards and procedures is subject to enforcement under § 9957 of this title.
(f) (1) The Board may, by a written report, make policy recommendations to the Delaware Health Care Commission, Senate Health & Social Services Committee, and the House Health & Human Development Committee regarding how to better align hospital budgets with the benchmark, while promoting efficient and economic operations and maintaining the ability of hospitals to meet hospitals’ financial obligations and to provide quality care.
(2) If the Board submits a report under paragraph (f)(1) of this section, the Board shall provide a copy to the Director and Librarian of the Division of Legislative Services.
Del. Code tit. 16, § 9954 Benchmark compliance plans.
(a) (1) Beginning in 2027, and except as provided in paragraph (a)(2) of this section, if the Board determines that a hospital’s actual annual cost growth has exceeded the spending benchmark, the Board shall send the hospital notice of that finding and may require the hospital to submit a benchmark compliance plan within 45 days.
(2) A hospital that the Board determines is participating in a Meaningful Cost Containment Arrangement, and for which the hospital’s chief executive officer has provided a written attestation in compliance with § 9953(d)(7)c.1. of this title, is not subject to this section for the applicable benchmark compliance plan year.
(b) The Board shall promulgate additional regulations and written guidance about the benchmark compliance plan process, including discretionary factors that the Board may consider in deciding whether a benchmark compliance plan is required, taking into account a hospital’s financial condition, any ongoing strategies or investments that the health-care entity is implementing to improve patient access and quality, future long-term efficiency, population growth in the hospital service area, and such other factors as the Board may determine to be relevant.
(c) A benchmark compliance plan submitted by a hospital must identify the causes of the hospital’s cost growth and must include specific strategies, adjustments, and action steps the hospital proposes to implement to improve cost performance. The benchmark compliance plan must include specific identifiable and measurable expected outcomes and a timetable for implementation. The timetable for a benchmark compliance plan may not exceed 12 months.
(d) If the Board determines that the benchmark compliance plan is incomplete, the Board shall provide written guidance explaining the criteria that have not been met and may provide an additional time period, up to 30 days, for resubmission. The hospital shall address each deficiency noted by the Board in the Board’s written guidance, and resubmit the hospital’s benchmark compliance plan to the Board, no later than 30 days from the date of the hospital’s receipt of the Board’s written guidance.
(e)-(g) [Repealed.]
Del. Code tit. 16, § 9955 Approval or modification of hospital budget [Repealed].
Del. Code tit. 16, § 9956 Appeal from a final decision of the Board.
(a) A hospital affected by any final decision of the Board may appeal from such order to the Superior Court within 30 days from the date upon which such decision is served. The appeal shall be filed with the prothonotary of the Superior Court and the summons in the appeal shall be served upon the Chair of the Board and the Secretary of the Department of Health and Social Services, either personally or by certified mail.
(b) The appeal shall be based upon the record created before the Board.
(c) The scope of review before the Court shall be that the Board’s findings shall be upheld if they are supported by sufficient evidence, free of error of law, and not arbitrary or capricious. When factual issues are reviewed the Court shall take due account of the presumption of official regularity and the specialized competence of the Board.
Del. Code tit. 16, § 9957 Enforcement.
(a) A hospital that knowingly fails to provide information or adhere to standards, procedures, and deadlines under this subchapter, or a rule or regulation promulgated under this subchapter, may be assessed a civil penalty of up to $500,000.
(b) [Repealed.]
(c) An order under subsection (a) of this section may be issued only after a hospital has received notice and an opportunity to be heard by the Board.
Del. Code tit. 16, § 9958 Open meetings; records subject to disclosure.
(a) The Board is a public body, subject to the open meetings requirement of § 10004 of Title 29; provided, however, that the Board may schedule and conduct private meetings with hospitals when the content of the discussion will include information that is commercial or financial information of a privileged or confidential nature.
(b) (1) Except as provided under paragraph (b)(2) of this section, records submitted by hospitals to the Board are not public records for purposes of the Freedom of Information Act [Chapter 100 of Title 29].
(2) The following are public records and shall be posted on the Board’s or the Commission’s website:
a. Original and modified budgets.
b. Spending and revenue data.
c. Utilization information.
(c) (1) The Board shall annually convene at least 1 public hearing per hospital subject to this subchapter to allow the hospital to present financial information required under § 9953 of this title and any benchmark compliance plan required under § 9954 of this title to the Board and engage in dialogue with the Board regarding questions, concerns, or additional information necessary to determine whether the hospital’s actual and projected annual spend growth is in line with the spending benchmark, other health-care spending directives, and other discretionary factors that the Board may consider as promulgated in regulation.
(2) The Board may schedule more than 1 hospital for the same public hearing required under paragraph (c)(1) of this section, but each hospital must be allowed at least 1 hour for its presentation.
Del. Code tit. 16, § 9959 Temporary pricing measures for calendar year 2025 and 2026 [Expires Jan. 1, 2027, pursuant to 84 Del. Laws, c. 270, § 5].
(a) Except as provided in subsection (c) of this section, for calendar years 2025 and 2026, a hospital may not charge any payer, purchaser, insurer, or public program an amount that exceeds the greater of 2% or Core CPI plus 1% over rates from the previous year.
(b) A hospital may not charge or collect from a patient or any other individual or entity any amount that exceeds the amount permitted to be billed under subsection (a) of this section for any service.
(c) This section does not apply to a hospital that serves less than 5% Medicare eligible patients per year or a hospital that derives 45% or more of its revenue from Medicaid or uninsured patients.
Del. Code tit. 16, § 9961 Definitions [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].
For the purposes of this subchapter:
(1) “Board” means the Diamond State Hospital Cost Review Board established by § 9952 of this title.
(2) “Department” means the Department of Health and Social Services.
(3) “Division” means the Division of Health Care Quality.
(4) “Facility-based provider” means a health-care professional licensed under Title 24 who furnishes hospital services.
(5) “Financial assistance” means free or discounted care for medically necessary hospital services provided to a financially qualified patient, resulting in a full or partial write-off of the patient’s responsibilities for the services.
(6) “Financially qualified patient” means a patient who meets all of the following:
a. Has household income at or below the applicable percentage of the federal poverty level established under this subchapter.
b. Is a resident of this State.
(7) a. “Hospital” means as defined in § 1001 of this title.
b. “Hospital” does not include a hospital that provides exclusively psychiatric services, rehabilitative services, or long-term acute care.
(8) a. “Hospital services” means medically necessary services provided to a patient in connection with the patient’s hospital visit, including services provided during or as part of an inpatient admission, emergency department visit, observation stay, or hospital outpatient procedure or visit.
b. “Hospital services” include services provided at the hospital, at any off-campus location operated under the hospital’s license or Medicare provider agreement, and at a freestanding emergency department affiliated with the hospital, regardless of the identity of the entity billing for the service.
c. “Hospital services” do not include any of the following:
1. Services provided after the patient refuses, or the holder of the medical power of attorney, the legal guardian, or the patient’s family refuse for the patient, to be discharged from the hospital when recommended by the hospital.
2. Services provided by a facility-based provider at a location that is not the hospital, an off-campus location operated under the hospital’s license or Medicare provider agreement, or a freestanding emergency department affiliated with the hospital.
d. The Board may by regulation specify categories of services that are or are not hospital services consistent with this paragraph (8).
(9) “Medical hardship” means out-of-pocket hospital expenses incurred for a hospital visit, including health plan deductibles and out-of-pocket hospital expenses, which equal or exceed 10% of the patient’s annual household income.
(10) “Medically necessary” or “medical necessity” means the provision of health-care services or products that a prudent physician would provide to a patient for the purpose of diagnosing or treating an illness, injury, disease, or the symptoms of an illness, injury, or disease in a manner that is all of the following:
a. In accordance with generally accepted standards of medical practice.
b. Consistent with the symptoms or treatment of the condition.
c. Not solely for anyone’s convenience.
d. Not including investigational or experimental health-care services.
(11) “Patient responsibility” means the amount owed by a patient for medically necessary hospital services after payment or adjustment by any insurer, health plan, Medicare, Medicaid, or other third-party payer, including copayments, coinsurance, deductibles, and any other amounts owed by the patient.
Del. Code tit. 16, § 9962 Minimum financial assistance standards [Effective Jan. 1, 2027, until fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].
(a) (1) A hospital and a facility-based provider shall, at a minimum, provide financial assistance for the patient responsibility arising from medically necessary hospital services to financially qualified patients as follows:
a. Full financial assistance for medically necessary hospital services for financially qualified patients with household income at or below 300% of the federal poverty level.
b. Discounted financial assistance for medically necessary hospital services for financially qualified patients with household income greater than 300% and at or below 350% of the federal poverty level, in an amount that reduces the patient’s responsibility by no less than 75%.
c. Discounted financial assistance for medically necessary hospital services for financially qualified patients with household income greater than 350% and at or below 400% of the federal poverty level, in an amount that reduces the patient’s responsibility by no less than 50%.
(2) Notwithstanding any other provision of this subchapter, a hospital may choose to grant eligibility for the hospital’s financial assistance policies to patients with household incomes greater than 400% of the federal poverty level.
(b) (1) A hospital shall have a medical hardship policy that allows patients with incomes above the thresholds established in subsection (a) of this section, but who are experiencing medical hardship, to qualify for discounted financial assistance.
(2) The hospital may establish a household income ceiling on eligibility under the hospital’s medical hardship policy, but the ceiling may not be lower than 500% of the federal poverty level.
(3) Under the hospital’s medical hardship policy, the hospital shall discount the patient’s responsibility for medically necessary hospital services by no less than 50%.
(4) A patient previously denied financial assistance under subsection (a) of this section shall provide additional documentation supporting the medical hardship.
(5) A medical hardship determination is valid for 1 year from the date of the determination and applies to all hospital services furnished during the determination period.
(6) A facility-based provider shall honor a hospital’s medical hardship determination on the same terms as an eligibility determination under subsection (f) of this section.
Del. Code tit. 16, § 9963 Duties of the Board [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].
(a) The Board may adopt regulations to administer, enforce, or implement this subchapter.
(b) The Board shall establish by regulation, with input from the Delaware Healthcare Association, all of the following:
(1) Categories of information and documentation that hospitals may request from patients when determining eligibility for financial assistance. The categories may not exceed what is reasonably necessary to verify income and household size. A hospital may not request information or documentation outside the categories established under this subsection.
(2) Categories of presumptive eligibility for financial assistance, which may include enrollment in or eligibility for income-based public benefits, residency in publicly subsidized housing, current or recent receipt of services in homeless services systems, or other indicators of household income reasonably available to the hospital.
(3) Methodologies for identifying presumptively eligible patients, including standards governing the use of historical data, predictive modeling, and any other approaches the Board permits hospitals to use. The Board may require, permit, or restrict the use of specific methodologies.
(4) That a recipient of financial assistance must be a Delaware resident.
(c) The Board shall prescribe all of the following:
(1) A standard financial assistance application consistent with the categories established under subsection (b) of this section, which hospitals shall use when determining eligibility for financial assistance.
a. A hospital may request Board approval to use a modified application in lieu of the standard application.
b. The Board shall approve a modified application that reduces applicant burden.
c. The Board may not approve a modified application that requires information or documentation beyond the categories established under subsection (b) of this section.
(2) A standardized list of acceptable forms of income verification consistent with the categories established under subsection (b) of this section.
(3) A list of income-based public assistance programs established by the Board under § 9964(1) of this title and associated forms of verification.
(d) The Board shall maintain a website and shall publicly post on the website all of the following:
(1) The financial assistance policies and reports submitted by a hospital under § 9962(j) of this title within 30 days of receipt.
(2) Information on financial assistance rights, hospital financial assistance policies required under § 9964 of this title, and items prescribed by the Board under § 9962(b) of this title.
(3) The documents the Board is required to prescribe under subsection (b) of this section.
(e) The Board may initiate reviews for hospital compliance with this subchapter on the occurrence of any of the following:
(1) A credible complaint alleging noncompliance.
(2) Outlier patterns in reporting under this section, including unusually high denial or closure rates, unusually long determination times, or unusually low presumptive eligibility usage.
(3) Evidence of lack of written communication about financial assistance eligibility during billing or collection activity taken during a pending determination.
(4) Any other risk indicators as the Board may establish by regulation.
Del. Code tit. 16, § 9964 Hospital financial assistance policies [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].
In accordance with federal and state guidelines, a hospital shall publish the hospital’s financial assistance policy and application on the hospital’s website. In addition to other information required under this subchapter, a hospital shall include all of the following in the hospital’s financial assistance policy:
(1) Presumptive eligibility program. —
The criteria the hospital uses to presumptively determine an individual’s eligibility for financial assistance, which at a minimum must do all of the following:
a. Apply categories of presumptive eligibility established by regulation of the Board. The hospital may apply other categories that are no more restrictive in scope than those established by the Board.
b. Use methodologies for identifying presumptively eligibility patients consistent with regulations of the Board, which may include historical data from individuals approved through the hospital’s full application process, predictive modeling using publicly available data, or other methodologies the Board permits.
c. Not impose documentation or verification requirements beyond those required by the Board.
d. Publish information on the presumptive program and the basis for presumptive eligibility.
e. A statement that a presumptive financial assistance determination is valid for no less than 180 days.
(2) Patient application rights following presumptive determination. —
A patient may not be required to submit a full application for financial assistance if the patient qualifies for presumptive eligibility. A patient may choose to apply for financial assistance to extend the approval time period to 1 year.
(3) Application process. —
Requirements for hospitals screening a patient for financial assistance, which must include all of the following:
a. Allowances for a patient to apply for financial assistance, which must include all of the following:
1. The patient was screened for presumptive eligibility and was found not to be eligible.
2. Patients may apply for financial assistance at any time during the collections process, including after the patient account has been sold, referred to, or assigned to another entity. If the patient is determined eligible after the patient’s account has been sold, referred, or assigned to another entity, the hospital shall notify the entity that the debt is invalid.
3. A patient previously denied financial assistance may apply again for financial assistance if financial circumstances have changed or the patient incurred additional medical expenses.
b. The availability of staff assistance for a patient completing an application for financial assistance.
c. The ability for a patient to submit the patient’s financial assistant application in a variety of methods including electronically, by mail, or in person.
d. A determination and written notification to the patient on eligibility for financial assistance within 21 days of the completed application submission, including notification, if denied, of the opportunity to appeal.
e. An appeals process for a patient deemed ineligible for financial assistance in accordance with the process prescribed by the Board. A patient must have the ability to provide additional documentation supporting the patient’s appeal.
f. Practices the hospitals may not employ when administering the financial assistance process, including all of the following:
1. Requiring documentation or verification not included on the standardized list created by the Board.
2. Requiring documentation not reasonably available to the patient or not necessary to determine eligibility for financial assistance.
3. Deeming applications incomplete without providing written notice of the missing information and a reasonable opportunity to complete the form. The written notice must be in print or electronic form, as determined by the patient.
4. Closing or denying an application due to missed internal deadlines where the hospital possesses sufficient information to determine eligibility.
5. Engaging in any other practice, policy, or pattern of conduct that has the purpose or effect of delaying, deterring, or discouraging access to financial assistance.
(4) Requirements for Medicaid coordination when screening. —
When reliable information reasonably available to the hospital indicates that a patient is reasonably likely to be eligible for Medicaid coverage for the date of service, the hospital may initiate the Medicaid coordination process concurrently with financial assistance screening.
a. A hospital may not deny or delay financial assistance on the basis that a patient may be eligible for Medicaid or other public coverage unless the hospital has screened the patient for such coverage using information reasonably available to the hospital, has made reasonable efforts to assist the patient with enrollment in Medicaid or other public coverage, and has documented the results of that screening in the patient’s medical record.
b. Hospitals shall only document whether the patient appears to be eligible for Medicaid or other public coverage and not the reasons for eligibility or ineligibility.
c. A patient who is not eligible for Medicaid or other public coverage as a matter of federal or state law may not be required to undergo screening for Medicaid or other public coverage as a condition of financial assistance eligibility.
d. Nothing in this subchapter prohibits a hospital from assisting a patient with enrollment in Medicaid or other coverage, if the hospital’s assistance does not delay the application of financial assistance.
(5) Requirements if hospitals choose to permit provisional financial assistance pending determination of Medicaid or other public coverage, including all of the following:
a. That a hospital may not treat financial assistance as provisional for more than 180 days after the date of the eligibility determination unless the patient has a pending coverage application and the hospital documents that status in the patient’s medical record.
b. That any reconciliation must occur no later than 30 days after the hospital receives notice of coverage approval or denial, and the hospital must provide the patient a written reconciliation notice describing any adjustments.
c. That a patient may not be billed or sent to collections for any amount covered by financial assistance while reconciliation is pending, and any overpayment must be refunded within 30 days of reconciliation.
(6) Procedures for the refund of hospital service costs to a patient if the hospital failed to screen the patient for presumptive eligibility for financial assistance as required or previously determined, incorrectly, that the patient did not qualify for financial assistance based on information provided by the patient at the time of the incorrect determination.
a. The hospital shall refund any amounts paid, and waive any amounts owed, by the patient that are covered by the patient’s financial assistance eligibility, including reasonable costs incurred in securing financial assistance.
b. If the hospital sold the debt to a collection agency or authorized a collection agency to collect debts on behalf of the hospital, the hospital shall notify the collection agency that the debt is invalid.
Del. Code tit. 16, § 9965 Licensure and penalties [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].
(a) On finding that a hospital is not in compliance with the financial assistance requirements under this subchapter, the Board shall notify the Division of Health Care Quality.
(b) The Division of Health Care Quality may impose civil monetary penalties for the violation of this subchapter.
Del. Code tit. 16, § 9966 Successor liability [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].
The obligations imposed by this subchapter run with the hospital license and apply to any successor owner or operator of a hospital licensed under Chapter 10 of this title .
Source: DE Code (Official Site)URL: https://delcode.delaware.gov/title16/c099/sc01/index.htmlFetched: 10/4/2026