In the current legislative session, Delaware has introduced legislation regulating health insurers’ ability to recover overpayments from health providers.
Delaware’s current regular legislative session runs from 1/10/2017 – 6/30/2017. Legislation from the 2017 session will carry over through 2018.
Recent Legislative Developments
|2017||HB172||This Bill limits a health insurer’s right to overpayment recovery to two years from the date of the original payment. The time limit does not apply where there is fraud or other intentional misconduct, when overpayment recovery is initiated by a self-insured plan, or where required by a federal or state plan. The bill also requires 30 days’ notice to healthcare providers regarding an attempt to recover overpayment as well as requiring insurers to have policies and procedures allowing challenge to the alleged overpayment. This bill affects all lines of health insurance including both individual and group policies.
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We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- Code Ann. tit. 16, §§ 2001-2009 establishes a state organized health information database based on hospital and nursing home billing data for health care purchasers, health care insurers, health care providers and the general public to review. The database includes charge levels, age-specific utilization patterns, morbidity patterns, patient origin and trends in health care charges.
- Code Ann. tit. 16, §§ 9901-9903 establishes the Delaware Health Care Commission as an independent state body that is charged with advising the Governor and General Assembly on healthcare policy. Its role is to “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,” and to “[m]onitor cost trends in order to recommend methods to reduce and control health-care costs for public programs and in conjunction with the private sector.”
- Code Ann. tit. 16, §§ 2501-2534 requires that health insurers must file and obtain prior approval from the state department of insurance to implement premium rates, which are the costs of insurance broken down to a per-unit cost. Rates shall not be excessive, inadequate or unfairly discriminatory.
- Code Ann. tit 16 §§ 2301-2318, the “Unfair Trade Practices Act,” prohibits unfair methods of competition and unfair or deceptive acts or practices in the business of insurance, including unreasonable restraints of trade and monopolization.
- Code Ann. tit. 16, §§ 9301-9312 requires a health care facility must obtain a “Certificate of Public Review” (analogous to a Certificate of Need) prior the acquisition of major medical equipment or the construction or expansion of a facility. In the interest of controlling healthcare costs, the review is based on whether there is a public need for the proposed project, whether there are less costly alternatives to the proposed action, and on how the action would impact the cost and quality of healthcare.
- Luke’s Health Care Sys. v. FTC, No. 14-35173 (9th Cir. March 7, 2014): Delaware joined 15 other states in filing amicus brief, explaining that the acceleration of health care costs due to the growth of large health care provider systems has become a matter of grave concern for the States.