Del. Code Ann. tit. 18 §§ 3301A-3310A – Delaware
Status: Enacted
Requires pharmacy benefit managers who employ “maximum allowable cost,” or MAC pricing for multi-sourced drugs to follow set standards in composing and updating the provide information on MAC and how it is determined to pharmacies …
Del. Code Ann. tit. 18 §§ 333B, 3553B – Delaware
Status: Enacted
Requires health insurance policies to cover any medically appropriate drug approved by the FDA for the treatment of stage 4 metastatic cancer without requiring a patient to first prove that the patient failed to respond …
Del. Code tit. 16, §§ 10301 through 10304: Delaware Health Information Network – Delaware
Status: Enacted Year Enacted: 1995
Statutes create the Delaware Health Information Network and its powers and duties, which includes developing and maintaining a community based health information network to facilitate communication of financial information designed to create efficiencies in health …
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Del. Code tit. 16, §§ 10311 through 10315: The Delaware Health Care Claims Database – Delaware
Status: Enacted Year Enacted: 2016
Creates a centralized health care claims database to enable the state to more effectively understand utilization across the continuum of health care in Delaware and achieve the Triple Aim of the State’s ongoing health-care innovation …
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Del. Code tit. 16, §§ 2001 through 2009: Purpose: Uniform Health Data – Delaware
Status: Enacted Year Enacted: 1989
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 …
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Del. Code tit. 16, §§ 9301 through 9312: Health Planning and Resources Management – Delaware
Status: Enacted Year Enacted: 1978
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 …
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Del. Code tit. 16, §§ 9701 through 9711: Emergency Medical Services Systems – Delaware
Status: Enacted Year Enacted: 1977
Statutes set quality review procedures and standards for emergency care.
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Del. Code tit. 16, §§ 9902 through 9904A: Delaware Health Care Commission – Delaware
Status: Enacted Year Enacted: 1990
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, …
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Del. Code tit. 18, § 102. Definitions: Delaware Insurance Code – Delaware
Status: Enacted Year Enacted: 1968
“Balance billing” means a health-care provider’s demand that a patient pay a greater amount for a given service than the amount the individual’s insurer, managed care organization or health service corporation has paid or will …
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Del. Code tit. 18, § 2318. Care by advanced practice nurses: Unfair Trade Practices Act – Delaware
Status: Enacted Year Enacted: 1990
Statute prevents health insurers from denying benefits for eligible services when they are performed by an advance practice nurse acting within the scope of practice.
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Del. Code tit. 18, § 2730. Collection of overpayments by health insurers and health plans: Insurance Contracts Generally – Delaware
Status: Enacted Year Enacted: 2018
A health insurer or health plan, whenever it engages in overpayment recovery efforts, shall provide written notice to the healthcare provider that identifies the error made in the processing or payment of the claim and …
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Del. Code tit. 18, § 3321A through 3324A: Maximum Allowable Cost Pricing for Prescription Drugs – Delaware
Status: Enacted Year Enacted: 2016
To place a drug on a maximum allowable cost list, a pharmacy benefit manager must ensure that the drug meets the following requirements.
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Del. Code tit. 18, § 333. Arbitration of disputes between insurance carriers and health-care providers: The Insurance Commissioner – Delaware
Status: Enacted Year Enacted: 2007
Provides that every insurance carrier shall be required to submit to arbitration any dispute with a health-care provider regarding reimbursement for an individual claim, procedure or service by that health-care provider for health-care services, upon …
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Del. Code tit. 18, § 3333. Filing of rates: Uniform Health Policy Provisions Law – Delaware
Status: Enacted Year Enacted: 1968
Statute requires insurers issuing health insurance policies to file its premium rates and classification of rates with the Commissioner.
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Del. Code tit. 18, § 3335A through 3337A: Prior Authorization of Emergency Prescriptions and Prescriptions for Chronic or Long-Term Conditions – Delaware
Status: Enacted Year Enacted: 2018
A contract between a pharmacy benefits manager and a pharmacy may not prohibit a pharmacy or pharmacist from doing any of the following.
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Del. Code tit. 18, § 334. Office of Value-Based Health Care Delivery: The Insurance Commissioner – Delaware
Status: Enacted Year Enacted: 2019
Statute establishes the Office of Value-Based Health Care Delivery to reduce health care costs by increasing the availability of high quality, cost efficient health insurance products that have stable, predictable and affordable rates.
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