| SB 9 w/ SA 1 + HA 1 | Signed | Hansen | This Act institutes a State nontidal wetlands program to include additional wetlands that are no longer regulated at the federal level. The State wetlands program will cover both tidal and nontidal wetlands, and in that manner fill in gaps in federal jurisdiction under the Clean Water Act and mitigate the uncertainty surrounding the limits to federal jurisdiction and improve efficiencies in the wetland permitting processes.
Section 1 of the Act makes a number of changes to Chapter 66 of Title 7 of the Delaware Code:
Section 1 adds definitions to § 6603 of Title 7, including for "aquatic habitat functions and services"; "Community Water Access Structure"; "Delaware Wetland Screening Tool," which is a screening tool o be developed in regulations to determine whether an area has the potential to qualify as a wetland; "Exceptional Value Wetlands", which are wetlands that are unique or high functioning, that support flora or fauna that are endangered or threatened, that are located in public water supply Source Water Protection Areas, or located within designated natural areas; "foot bridge"; "linear utility infrastructure projects"; "mitigation"; "normal residential gardening and lawn and landscape maintenance"; "pilings"; "unique wetlands," meaning wetlands that are categorized by the Department of Natural Resources and Environmental Control (DNREC) as Coastal Plain seasonal ponds, inner-dune depression meadows, peatland fens, Piedmont stream valley wetlands, bald cypress swamps, Atlantic white cedar swamps, or black ash seepage swamps; "voluntary wetland habitat restoration project"; and "wetland walkway". In addition, the definition of "wetlands" is revised to include all tidal and nontidal wetlands in the State, and will be further clarified in regulations adopted by DNREC.
Section 1 also amends § 6604 of Title 7 to provide that an applicant for a wetlands permit has the burden of proving whether a proposed activity is within tidal or nontidal wetlands.
In addition, Section 1 amends § 660 of Title 7, concerning activities that are exempt from permit requirements under Chapter 66 of Title 7. Under the Act, the following activities are exempt: farming, provided certain requirements are met, including that farming or an intent to farm has been conducted on the land in the prior 10 years on a rolling basis; silvicultural activities permitted by the Department of Agriculture; conservation practices on lands that are engaged in programs through certain federal or state governmental agencies; hunting, fishing, trapping, and duck blinds; wildlife nesting structures; mosquito control activities authorized by the DNREC; construction of certain drainage ditches, tax ditches, swales, and other drainage features; artificial ponds and borrow pits; construction of directional aids to navigation; placing of boundary stakes; foot bridges; normal residential gardening and lawn and landscape maintenance. In addition, other activities are conditionally exempt: certain activities that would be allowed under a nationwide permit issued by the United States Army Corps of Engineers; nontidal wetlands equal to or less than a contiguous 0.50 acres, provided certain criteria are met; work performed by a state, county, or municipal government or conservation district, or such an entity's designated contractor, on nontidal wetlands in the Delaware Atlantic Coastal Plains Province with a contributing drainage area of less than 800 acres; maintenance, reconstruction, or retrofitting work performed by or with the assistance of any state, county, or municipal government or conservation district in nontidal wetlands; certain work in agricultural drainage ditches; the creation or maintenance of certain ponds constructed in uplands; and wetland walkways, under certain conditions.
Section 1 also amends § 6607 of Title 7, concerning the procedures, regulations, and application fees associated with permit applications. The Act provides that initial regulations promulgated under Chapter 66 will establish the Delaware Wetland Screening Tool. Further, in addition to the regulations the Secretary of DNREC is already directed to adopt, the Secretary is instructed to adopt regulations affording additional protections to Exceptional Value Wetlands; reducing duplication with the permitting requirements of the U.S. Army Corps of Engineers; improving the State's ability to account for impacts from wetlands permitting actions; promulgating mitigation strategies to facilitate no overall net loss in wetland acreage and function and to protect the State's resilience to the impacts of climate change; and establishing general permits for common and environmentally beneficial activities with minimal environmental impact. Section 1 further amends § 6607 concerning the timeline for DNREC issuing a decision regarding a permit application
Section 1 creates a new § 6621, establishing the Wetlands Regulatory Advisory Committee. The Committee is directed to assist DNREC in developing the initial regulations required under Chapter 66 of Title 7 and to evaluate the permitting processes for activities regulated by state and federal agencies. The Committee is to be made up of 23 members, including the County Administrator or County Executive, or the County Administrator's or County Executive's designee; representatives from the Delaware Farm Bureau, the conservation districts, various environmental advocacy groups, an environmental justice organization, the Home Builders Association of Delaware, the Delaware Association of Realtors, the American Council of Engineering Companies of Delaware, the Delmarva Chicken Association, a general business group, a private wetlands consultant certified by the Society of Wetlands Scientists, and members from higher education institutions with specialization in wetlands science, agricultural economics, and with knowledge of forestry or soil conservation. The Committee is directed to review DNREC's implementation of the initial regulations required by Chapter 66 and provide a final report recommending legislative or regulatory improvements.
Section 2 of the Act deletes Chapter 66A of Title 7 of the Delaware Code, "Nontidal Wetland Standards," which had created a Wetlands Advisory Committee to assist the Secretary of the Department of Natural Resources and Environmental Control in developing wetland protection priorities for the State and identifying a comprehensive approach for improving nontidal wetland conservation, restoration, and education to recommend to the General Assembly, and to evaluate the permitting process for activities regulated by state and federal agencies.
Section 3 of the Act provides that activities in private nontidal subaqueous lands authorized under a nationwide permit issued by the U.S. Army Corps of Engineers and in effect in the state are exempt from any requirements under Chapter 72 of Titel 7 of the Delaware Code, if a water quality certification has been received from the Department of Natural Resources and Environmental Control, where necessary.
Section 4 of the Act provides that §§ 6621 and 6622 of Section 1 of the Act, and Section 2 of the Act, are effective upon enactment; Section 3 of the Act is effective 60 days after enactment; and the remaining provisions of the Act are effective upon the adoption of initial regulations by the Department of Natural Resources and Environmental Control. | AN ACT TO AMEND TITLE 7 OF THE DELAWARE CODE RELATING TO THE PROTECTION OF WETLANDS. |
| SB 313 w/ SA 1 | Signed | Mantzavinos | This Act protects Delaware’s nonprofit acute care hospitals from acquisition by entities other than charities or not-for-profit entities during a moratorium period. It also permanently subjects the sale or encumbrance of primary facility real estate of a nonprofit acute care hospital to the Attorney General notice and review requirements of the Conversion Act.
Section 1 makes two primary changes to the definitions in § 2531 of Title 29. First, it clarifies that a "not-for-profit healthcare conversion transaction" includes those undertaken "directly or indirectly through one or more affiliates." This ensures that the Attorney General’s oversight cannot be circumvented by structuring transactions through shell entities or intermediaries. It provides a new, permanent category of conversion transaction: the sale, transfer, conveyance or lease of a hospital's "primary facility real estate" to a for-profit entity. This change ensures that arrangements involving the land and buildings of an acute care hospital are subject to the same notice and review requirements as a change in corporate control. Finally, Section 1 defines for "acute care hospital" and "primary facility real estate.”
Section 2 requires the Attorney General to transmit copies of any Conversion Act notice involving an acute care hospital to the Governor and the Secretary of the Department of Health and Social Services within 10 days of receipt.
Section 3 prohibits any person or entity, other than a charity or not-for-profit entity, from entering into a "change of control transaction" involving acquisition of a nonprofit acute care hospital. It defines a "change of control transaction" as the acquisition of the power to direct the hospital's management, policies, or clinical practices, whether through ownership of voting securities, changes in board composition, or by contract. Any transaction of this nature is void and has no legal effect. The prohibition expressly captures incremental acquisition scenarios, including minority stakes, sub-majority governance rights, board appointment rights, and executive officer appointment rights.
Section 4 amends § 9304 of Title 16 to prohibit any entity or person other than a charity or not-for-profit entity from submitting, and the Health Resources Board from accepting or processing, an application for a Certificate of Public Review for the construction, development, establishment, or acquisition of an acute care hospital. Any such application is void and of no legal effect.
Section 5 provides that Sections 2 through 4 are effective until July 1, 2028, unless terminated sooner or extended by the General Assembly. | AN ACT TO AMEND TITLES 16 AND 29 OF THE DELAWARE CODE RELATING TO THE PROTECTION OF NONPROFIT ACUTE CARE HOSPITALS. |
| SS 2 for SB 1 | Signed | Townsend | This Act amends Titles 16, 18, 29, and 31 of the Delaware Code and Chapter 237, Volume 83 of the Laws of Delaware relating to primary care insurance. Among other things, the Act does the following:
Section 1 of the Act amends § 9903 of Title 16 of the Delaware Code to provide that the Health Care Commission, in coordination with the Primary Care Reform Collaborative, will monitor compliance of primary care providers with value-based care delivery models established under the Office of Value-Based Health Care Delivery (OVBHCD).
Section 2 of the Act amends § 9904A of Title 16 to remove a time frame limitation for the period during which the Health Care Commission is authorized to request written reports by health insurers regarding progress in adopting and implementing value-based payment models. Under the Act, the PCRC may continue to request such reporting going forward.
Section 3 of the Act amends § 329 of Title 18 to provide that administrative penalties for violations of §2503(a)(12), §2503(a)(15), § 3342B, and § 3556A of Title 18 may be equivalent to the amount of the violation, and that penalties imposed for such violations are to be deposited into a Primary Care Fund, which will be used by the Statewide Benefits Office and the Division of Medicaid and Medical Assistance.
Section 4 of the Act amends § 334 of Title 18 to clarify that the OVBHCD has the ability to promulgate regulations necessary to accomplish the stated goals of reducing health-care costs by increasing the availability of high quality, cost-efficient health insurance products that have stable, predictable, and affordable rates.
Section 5 of the Act amends § 2503 of Title 18 to extend current cost containment calculations to rate filing year 2027. Given their relative size and patient populations within Delaware's health care market, Delaware's two smallest hospitals and lone free-standing children's hospital are exempt from that extension. In rate filing year 2028 and thereafter, the Act specifies that costs per service for health benefit plans may not exceed certain Medicare Reference-Based Pricing Targets, which are based on the “Full Medicare rate,” meaning the applicable wage-adjusted base Medicare rate for different services, the Free-Standing Children’s Hospital Medicare outpatient payment rate, or the TEFRA Rate, meaning the target amount under the federal Tax Equity and Fiscal Responsibility Act (TEFRA) Waiver Program applicable to Free-Standing Children's Hospitals, unless certain exemptions apply. Those exemptions are for Delaware's two smallest hospitals and, if making progress with value-based care, for a Delaware hospital in a high-growth, high-Medicare population region. Carriers issuing plans in the commercial market for 2 consecutive years and that cover more than 5,000 members must meet minimum percentages of alternative payment model contracting, as specified.
Section 6 of the Act amends § 3342B of Title 18 concerning primary care coverage offered by individual insurance plans. Under the Act, starting in 2026, carriers must spend at least 11.5% of their total cost of medical care on primary care, at least 5% of which must be via prospective primary care management payments. Carriers must offer value-based care programs and may not deny contracted providers the opportunity to participate in an offered value-based care program. In addition, the Commissioner is required to issue regulations regarding the calculation of total cost of care.
Section 7 of the Act applies the same changes as Section 6 of the Act to § 3556A of Title 18, concerning primary care coverage offered by group insurance plans.
Section 8 of the Act deletes a sunsetting clause contained in Section 14, Chapter 237, Volume 83 of the Laws of Delaware, which would have repealed § 2503(a)(12)a., § 3442B(b)(3), and § 3556A(b)(3) of title 18, effective January 1, 2027.
Section 9 of the Act amends § 5204 of Title 29 to provide that health-insurance coverage for public officers and employees shall be provided by a carrier whose cost per service may not exceed certain Medicare Reference-Based Pricing Targets, which are based on the Full Medicare rate, the Free-Standing Children's Hospital Medicare outpatient payment rate, or the TEFRA Rate, unless certain exemptions apply. Those exemptions are for Delaware's two smallest hospitals and, if making progress with value-based care, for a Delaware hospital in a high-growth, high-Medicare population region. In addition, Section 9 of the Act specifies that coverage shall be provided by a carrier offering value-based care programs equivalent to the commercial market requirements.
Section 10 of the Act amends §5224 of Title 29 concerning primary care coverage of insurance coverage for public officers and employees, to require plans to report data to the OVBHCD on the percentage of primary care spending as a percentage of total medical costs for plan years 2027 and 2028 and to increase spending on primary care by 1% per year thereafter until primary care spending reaches 11.5% of total medical costs.
Section 11 of the Act creates §539 of Title 31, concerning state public assistance, to require entities providing health insurance under § 505(3) to report data on the percentage of primary care spending as a percentage of total medical costs for 2 plan years and, in subsequent years, increase primary care spending by 1% until primary care spending reaches 11.5% of total medical costs.
Section 12 of the Act provides that the Department of Insurance shall promulgate regulations pursuant to the Act within 18 months of enactment, but shall promulgate regulations on or before January 1, 2027 establishing a methodology to determine any appropriate annual inflationary or other applicable adjustments to a hospital's Full Medicare Rate.
Like Senate Substitute No. 1 for Senate Bill No. 1, this Act differs from Senate Bill No. 1 in that it bases the limits for costs per service for health benefit plans on Medicare Reference-Based Pricing Targets, which may differ based on whether the services are outpatient services, inpatient hospital services, or emergency department services, and on whether the services are being provided by a Free-Standing Children's Hospital; under Senate Bill No. 1, the limits for cost-per-service were based on a percentage of Medicare reimbursement for comparable services. In addition, this Act provides more guidance regarding the application of exemptions from those limits.
In addition, Senate Substitute No. 2 for Senate Bill No. 1 differs from Senate Bill No. 1 in that it makes technical edits to definitions and it provides that the Department of Insurance and the State Employee Benefits Office shall lead a process, in consultation with Delaware hospitals, to recommend an appropriate methodology to determine and apply any inflationary or other applicable adjustments to a hospital's Full Medicare Rate not otherwise captured in a hospital's annual Medicare rate update by January 1, 2027. Senate Substitute No. 2 for Senate Bill No. 1 also adds an exemption from the aggregate unit price growth limits in § 2503(a)(12)a.3. of Title 18 for a hospital that is a Free-Standing Children's Hospital, a hospital that qualifies as a Medicare-Dependent Rural Hospital on the grounds that it meets the definition of a Medicare-dependent hospital under 42 C.F.R. § 412.108 for at least 3 of the 5 years immediately preceding the applicable rate filing year, or an Urban Medicaid DSH Hospital. | AN ACT TO AMEND TITLE 16, TITLE 18, TITLE 29, AND TITLE 31 OF THE DELAWARE CODE, AND CHAPTER 237, VOLUME 83 OF THE LAWS OF DELAWARE, RELATING TO PRIMARY CARE SERVICES. |
| SS 1 for SB 13 | Signed | Pinkney | This Act is a Substitute for Senate Bill No. 13. Like Senate Bill No. 13, this Substitute Act amends Title 16 and Title 6 of the Delaware Code relating to hospital charity care and financial assistance and does the following:
(1) Section 1 of the Act amends § 9311 of Title 16 to exempt certain hospitals from the existing charity care requirement and require these hospitals to comply with the new financial assistance requirements under Section 2 of this Act. A hospital that provides exclusively psychiatric services, rehabilitative services, or long-term acute care services remains subject to the charity care requirement.
(2) Section 2 of the Act creates a new Subchapter VII of Chapter 99 of Title 16, §§ 9961 through 9966, establishing minimum financial assistance standards for hospitals and facility-based providers. The subchapter requires full financial assistance for Delaware residents with household income at or below 300% of the federal poverty level, a 75% discount above 300% and at or below 350%, and a 50% discount above 350% and at or below 400%, and requires each hospital to maintain a medical hardship policy providing a 50% minimum discount with an income ceiling of at least 500% of the federal poverty level. Eligibility determinations are valid for at least 1 year, transfer among hospitals and facility-based providers, and suspend collection activity while an application or appeal is pending. Hospitals must provide notice in languages spoken by more than 5% of the hospital's service area, screen patients for financial assistance, report annually to the Diamond State Hospital Cost Review Board (“Board”), and publish a financial assistance policy addressing presumptive eligibility, the application process, Medicaid coordination, and patient refunds. The Board administers the subchapter and conducts compliance reviews, the Division of Health Care Quality may take licensure action on a finding of noncompliance, and the obligations run with the hospital license.
(3) Section 3 of the Act amends § 2505J of Title 6 to prohibit a medical creditor or medical debt collector from taking extraordinary collection action against a patient who qualifies, or whom the creditor has reason to know likely qualifies, for financial assistance.
(4) Section 4 of the Act amends § 2508J of Title 6 to restrict collection communications, litigation, and debt referrals or sales by a medical creditor or medical debt collector that knows or should know that a patient’s financial assistance application or appeal is pending.
(5) Section 5 of the Act amends § 2511J of Title 6 to make noncompliance with the new subchapter, or a patient’s eligibility for financial assistance, a complete defense in a civil action to collect medical debt, and to bar entry of a default judgment in any such action without an affidavit from a responsible officer of the hospital attesting that the patient was offered financial assistance screening.
(6) Section 6 of the Act provides that the minimum financial assistance standards under § 9962(a) and (b) of Title 16 take effect on January 1, 2027, and that all other provisions take effect on the earlier of notice by the Diamond State Hospital Cost Review Board, published in the Register of Regulations, that final implementing regulations have been adopted, or July 1, 2027.
This Substitute Act differs from Senate Bill No. 13 as follows:
(1) Alphabetizes definitions in Section 2 of this Substitute Act and makes other technical corrections throughout this Substitute Act.
(2) Clarifies that hospital services do not include 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.
(3) Makes clear that financial assistance is available to a patient for the patient responsibility portion.
(4) Makes clear that a hospital or facility-based provider may bill a financially qualified patient’s insurance for hospital services.
(5) Requires that a hospital that issues a written eligibility notice include with the notice supporting documentation provided by the patient.
(6) Provides that written notice must be in print or electronic form, as determined by the patient.
(7) Provides that a patient seeking financial assistance or medical hardship must apply for financial assistance.
(8) Specifies that the Diamond State Hospital Cost Review Board must develop regulations related to the requirement that a recipient of financial assistance must be a Delaware resident.
(9) Moves the Division of Health Care Quality’s power to impose civil monetary penalties for the violation of Subchapter VII of Chapter 99 of Title 16 into § 9965 of Title 16 (within Subchapter VII of Chapter 99 of Title 16) rather than adding it to § 1007 of Title 16. As a result, the amendment to § 1007 of Title 16 contained in Section 3 of Senate Bill No. 13 is removed from this Substitute Act. The Division’s power is the same power the Department of Health and Social Services has under Chapter 10 of Title 16. | AN ACT TO AMEND TITLE 6 AND TITLE 16 OF THE DELAWARE CODE RELATING TO HOSPITAL CHARITY CARE AND FINANCIAL ASSISTANCE. |
