Overview
Delaware has a long legislative history in healthcare price transparency initiatives. Delaware legislators have authorized the Delaware Health Information Network to develop a centralized health care claims database since 2016. The Delaware Health Care Claims Database collects healthcare claims, enrollment, and provider data from Medicare, Medicaid, and the seven largest commercial health insurers in the state. To protect consumers against surprise billing, Delaware prohibits balance billing for medically necessary services through non-network providers that are not available in-network. Another law requires out-of-network facilities rendering nonemergency services to provide disclosure of any out-of-network charges not covered by the insurance.
To control the state’s rising healthcare costs, Delaware passed legislation that gave the Delaware Health and Social Services (DHSS) authority to establish a benchmark that would link the growth rate of health-care spending to the state’s rate of economic growth. Governor John Carney (D) also issued an executive order in 2018 that formed an advisory group to help set the benchmark. In 2021, the legislature passed a sweeping healthcare bill that would place rate caps on hospital price growth to boost investment in primary care, compel certain payers to tie their business to alternative payment models by 2023, and create shared accountability for both the cost and quality of care.
In the provider market, the state has statutes that voids covenant not to compete provisions of an employment, partnership or corporate agreement between and/or among physicians. Delaware also conducts a Certificate of Public Review (analogous to a Certificate of Need) prior to the acquisition of nonprofit healthcare facilities. In the interest of controlling healthcare costs, the review is based on whether there is a public need for the proposed action, whether there are less costly alternatives to the proposed action, and on how the action would impact the cost and quality of healthcare.
Delaware also has robust laws that promote the use of telehealth services. The state mandates both coverage and payment parity, requiring health plans to cover telehealth services for members and pay providers on at least the same basis as in-person services. Since the coronavirus pandemic, the state further amended telemedicine laws to allow patients to access telemedicine services without an in-person visit.
See below for an overview of existing Delaware state mandates. Click on citation tab for detailed information of specific statutes (click link to download statute text).
State Action
Latest Legislative Session: 1/10/2023 - 1/9/2024 (2023-2024 term). *Current session bill updates are ongoing. Check back weekly for updates.
HB 105 – Delaware
Introduced: 2019 Status: Enacted
Step therapy protocols are a mechanism by which health insurance companies require patients to try one or more prescriptions drugs before coverage is provided for the actual drug prescribed by the patients health care provider. …
HB 146 – Delaware
Introduced: 2019 Status: Enacted
This bill makes three changes to health insurers and their relationships to providers. First, it limits the number of records that can be requested by a payer from a provider for post claim adjudication audits …
HB 150 – Delaware
Introduced: 2023 Status: In Process
This Act directs the Department of Health and Social Services to develop and operate a limited medical assistance program for children in Delaware who are not otherwise covered, including children who are not documented. A …
HB 160 – Delaware
Introduced: 2021 Status: Enacted
An Act to amend Titles 18 and 24 of the Delaware code relating to preserving telehealth and adopting the interstate medical licensure compact.
HB 169 – Delaware
Introduced: 2019 Status: Inactive / Dead
This bill changes the relationship between physicians and physician assistants from supervisory to collaborative, in recognition of the evolving role of physician assistants and reflecting the education, training, and experience required for licensing, which emphasizes …
Del. Code tit. 18, §§ 7201 through 7205: Small Employer Health Insurance – Delaware
Introduced: Status: Enacted
Statutes regulate rate setting and out of pocket costs for health benefit plans offered through small employer health insurances. Statutes include provisions that health benefit plans covering small employers must comply with, including a prohibition …
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Del. Code tit. 18, §§ 7301 through 7303: Pharmacy Access Act – Delaware
Introduced: Status: Enacted
The General Assembly finds that pharmaceutical services and prescription drugs are an essential service to the people of this State and that the broadest possible access to such services should be mandated and therefore finds …
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Del. Code tit. 18, §§ 7601 through 7614: Discount Medical Plans – Delaware
Introduced: Status: Enacted
A discount medical plan organization shall have a written provider agreement with all providers offering medical or ancillary services to its members. The written provider agreement may be entered into directly with the provider or …
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Del. Code tit. 18, §§ 8501 through 8511: Corporate Governance Annual Disclosure Act – Delaware
Introduced: Status: Enacted
Requires insurers to submit to the Commissioner a Corporate Governance Annual Disclosure (CGAD). Provides for the confidential treatment of the corporate governance annual disclosure and related information that will contain confidential and sensitive information related …
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Del. Code tit. 18, §§ 8701 through 8703: The Delaware Health Insurance Individual Market Stabilization Reinsurance Program – Delaware
Introduced: Status: Enacted
Statutes purpose is to establish a funding mechanism for the Delaware Health Insurance Individual Market Stabilization and Reinsurance Program. Statutes state that following a successful approval of Delaware’s § 1332 waiver application, any carrier subject to …
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Federal Trade Commission v. Shire ViroPharma Inc. – Delaware
District Court: District of Delaware Status: Decided
On February 7, 2017, the FTC filed a complaint against Shire ViroPharma, alleging that the pharmaceutical company engaged in unfair method of competition and violated …
Federal Trade Commission and State of Idaho v. St. Luke’s Health System, Ltd and Saltzer Medical Group, P.A. – California, Connecticut, Delaware, Idaho, Illinois, Iowa, Kentucky, Maine, Maryland, Mississippi, Montana, Nevada, New Mexico, Oregon, Pennsylvania, Tennessee, Washington
District Court: District of Idaho Status: Decided
In March 2013, the FTC and the Idaho Attorney General filed a joint complaint challenging the merger betweenSt. Luke’s Health System, Idaho’s largest health system, …
In re: Suboxone Antitrust Litigation (State of Wisconsin, et al. v. Indivior Inc, et al.) – Alabama, Alaska, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Illinois, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Mexico, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Utah, Virginia, Washington, West Virginia, Wisconsin
District Court: E.D. Pennsylvania Status: Pending
In September 2016, 35 state attorneys general and the District of Columbia brought a multi-district case against pharmaceutical manufacturer Indivior, MonoSol RX et al., alleging …
In Re: Generic Pharmaceuticals Pricing Antitrust Litigation – Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Hawaii, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin
District Court: Eastern District of Pennsylvania Status: Pending
Plaintiffs are attorney generals from 48 states, Puerto Rico, and the District of Columbia, as well as classes of private plaintiffs that filed an antitrust …
Additional Resources
STATE BUDGET
Delaware operates on an annual budget cycle. The governor submits a proposed budget by February 1 to the state legislature, and a budget is passed by June 30. The fiscal year begins on July 1 and ends on June 30 the following year.
REGULATION & ENFORCEMENT
- Delaware was one of 16 states to file an amicus brief supporting the FTC’s winning position in the Ninth Circuit appeal of St. Luke’s Health Care Sys. v. FTC, No. 14-35173 (March 7, 2014), decided February 10, 2015. The States’ brief stated that the acceleration of health care costs due to the growth of large health care provider systems had become a matter of grave concern for the states.
KEY RESOURCES
- Delaware State Legislature
- Delaware Office of the Attorney General
- Delaware Office of Management and Budget