151st General Assembly Wraps For 2021 -
Almost!
July 8, 2021
The first leg of the 151st General Assembly closed shortly after midnight June 30th. Unlike last year, this was a busy session. The pandemic curtailed a lot of activity in 2020, but things returned to a brisk pace as the legislature (and all of us) learned to operate in a virtual world. Committee meetings were held via Zoom. The legislature met virtually until June where the month began with only legislators and staff present in Legislative Hall. Eventually, a limited number of visitors were allowed into the galleries. The Governor signed the Operating Budget, Bond Bill, Grants in Aid, and a supplemental budget on the afternoon of June 30th. Each chamber met in-person to work a limited number of bills on the 30th and then returned to their homes and conducted their midnight formalities via Zoom. 
 
The State of Emergency remained in place but the Governor announced an end date of July 13th as vaccination rates pass 70%, new cases hover around 20 per day, and hospitalizations also hover in the 20 per day range as well. 
 
Finally, the legislature is expected to go into special session in the fall to finalize redistricting with a deadline of November 7th
 
Here is a wrap up of some of the bills MSD worked on: 
 
Primary Care Reform (SS 1 for SB 120) – After three years of work by the Primary Care Reform Collaborative, Senator Townsend and Representative Bentz introduced this Primary Care Reform bill. While the Collaborative did not propose the bill, the legislation was heavily informed by their efforts. 
 
The bill seeks to strengthen the primary care system in the State by doing the following: (1) Directing the Health Care Commission to monitor compliance with value-based care delivery models and develop, and monitor compliance with, alternative payment methods that promote value-based care. (2) Requiring rate filings limit aggregate unit price growth for inpatient, outpatient, and other medical services, to certain percentage increases. (3) Requiring an insurance carrier to spend a certain percentage of its total cost on primary care. (4) Requiring the Office of Value-Based Health Care Delivery to establish mandatory minimums for payment innovations, including alternative payment models, and evaluate annually whether primary care spending is increasing in compliance with the established mandatory minimums for payment innovations. (5) In Sections 2 and 3 of this Act, revising the appointment process for members of the Primary Care Reform Collaborative who are not members by virtue of position to comply with the requirements of the Delaware Constitution. 
The bill passed both chambers and awaits the Governor’s signature. MSD and the Primary Care Subcommittee worked on and supported this legislation
  
APRN Interstate Compact (HB 21) – This bill makes Delaware the second state to adopt the Advanced Practice Registered Nurse Compact. It allows for APRN licensure portability and gives the interstate commission of APRN Compact Administrators the ability to adopt rules relating to its operation when seven states have enacted the compact. 
 
While the bill literally states that state licensure law is not overridden, MSD believes and testified to the fact that it actually does overturn existing state law that was agreed to and modified over the last six years.  
The bill awaits the Governor’s signature. MSD opposed this bill as it would effectively take the currently required 4,000 hours of APRN practice under a collaborative agreement before independent practice down to 2,080 hours. MSD believes in license portability but believes patient safety dictates more experience is required before independent practice is appropriate. 
 
APRN Compact “Companion” Bill (HB 141) – Billed as a “companion” bill to HB 21, the bill seeks to align the Delaware Board of Nursing statute with the APRN Compact. The Act removes the requirement for a collaborative agreement for licensure purposes although employers and health care organizations may still require one. The Act amends the definitions of “APRN” and “full practice authority” so that they are consistent with national standards. The Act also removes the definition of “independent practice” since, nationally, “independent practice” means having “full practice authority." This Act grants full practice authority in conjunction with licensure and removes the current requirements for obtaining independent practice. The Act changes the composition of the APRN Committee to include nine APRNs and clarifies the Committee’s purpose, which is to make recommendations to the Delaware Board of Nursing regarding APRN practices, the Compact, and licensure.
The bill awaits the Governor’s signature. MSD opposed this bill for the same reasons as HB 21. Further, MSD argued that the bill goes well beyond making the changes necessary under the Compact and is premature as the Compact still needs to be ratified by five other states. The earliest that five other states could conceivably adopt the compact is in 2022. 
 
Telehealth and Adopting the Interstate Medical Licensure Compact (HB 160) – This bill continues and enhances Delawareans’ access to telehealth and telemedicine services and, through the adoption of the Interstate Medical Licensure Compact, ensures that telehealth services can be provided through qualified medical practitioners in a streamlined and efficient pathway to licensure that meets the health care delivery system needs of the 21st Century. With respect to telemedicine and telehealth, this Act consolidates the existing law relating to telehealth within a single new chapter applicable to all health care providers authorized to practice telemedicine and participate in telehealth and makes permanent the telehealth flexibilities put in place for the Covid-19 pandemic. The Act carries through many of the changes embodied in the Covid-19 telehealth legislation passed by the 150th General Assembly in 2020 (HS 1 for HB 348 with HA1, signed 7/17/20), which would otherwise have expired on July 1, 2021. 
Signed by the Governor. MSD supported the legislation
 
Physicians Assistants (HB 33 w/HA 1 and SA 1) - 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 the team-based practice model. The bill retains a 1:4 ratio of physician assistants to physicians unless a regulation of the Board increases or decreases the number. This limit of 1:4 does not apply to physicians and physician assistants who practice in the same physical office or facility building, such as an emergency department. This bill adds two physician assistants members recommended by the Regulatory Council for Physician Assistants to the Board of Medical Licensure and Discipline in lieu of two public members. The bill authorizes physician assistants to participate as uncompensated volunteers in public or community events. MSD worked to ensure that the physician remains ultimately responsible to the patient for medicine delivered in a team setting. 
Passed both Chambers. MSD worked with the PAs on amendments to similar legislation, HB 169, last year. Those changes were incorporated into the new bill. 
 
Lead Poisoning Testing (HB 222 w/ HA 1) – This bill mandates testing for lead poisoning. Specifically, it: (1) Defines “screening” and “testing” for clarity. (2) Mandates screening, defined as a capillary blood test, at or around 12 and 24 months of age. (3) Clarifies insurance coverage for the costs of compliance with the Act. And, (4) Directs the Division of Public Health to report on elevated blood lead levels to the General Assembly annually and to develop regulations to implement and enforce the Act within 12 months of being enacted. 
Signed by the Governor. MSD continues to oppose mandatory testing. 
 
Physician-Assisted Suicide (HB 140) – The bill was introduced on June 30th but saw no activity. This continues to be a hot topic in Delaware with public debate churning a difficult issue. MSD reaffirmed its opposition after multiple discussions of the Government Affairs Committee and Executive Board. Last year, dueling Op-Eds were published in the News Journal.
Introduced on the final day of the legislative session. It will remain an active bill in 2022. 
 
Health Care Provider Loan Repayment Program (HB 48 w/ HA 1) - This Act establishes a Health Care Provider Loan Repayment Program for new primary care providers to be administered by the Delaware Health Care Commission. Under the loan repayment program, the Health Care Commission may award education loan repayment grants to new primary care providers of up to $50,000 per year for a maximum of four years. Priority consideration may be given to DIMER-participating students and participants in Delaware-based residency programs. Sites eligible to apply for grants on behalf of their new primary care providers must be located in underserved areas or areas of need and must accept Medicare and Medicaid participants. Grants to hospital sites must be matched on a dollar-for-dollar basis by the applicant hospital and the disbursement of grants from the program is contingent upon an initial, one-time contribution to the Health Care Provider Loan Repayment Program, in an amount Fiscal Year 21 appropriation of State funds up to a maximum of $1 million, from Delaware health insurers. This Act also provides that the Delaware Healthcare Commission may award Health Care Provider Repayment grants on a prorated annual basis.
Passed both Chambers and awaits Governor’s Signature. MSD supports.
 
Definition of Hospitals (HB 161 s/ HA 1) – This bill adds surgical hospitals—specialized hospitals providing surgical services at a level of care higher than freestanding surgery centers but whose patients do not require all of the services provided by “General” acute care hospitals. 
Awaits Governor’s signature.
 
Pharmacist Distribution of Contraceptives (SB 105) - This Act allows pharmacists to administer or dispense contraceptives under a standing order from the Division of Public Health. At least 11 states, the District of Columbia, and the U.S. Virgin Islands allow pharmacists to dispense contraceptives without a prescription from another health care practitioner. This practice is supported by the American College of Obstetricians and Gynecologists. 
Awaits Governor’s signature. 
 
Repealing Certain Provisions Relating to Abortion (HB 31) – This bill codifies existing case law by repealing certain provisions relating to abortion including provisions that treat abortion differently than other medical procedures, and provisions that criminalize women and the sale of medical devices and medicines. 
Awaits Governor’s signature. DE Chapter of the American College of Obstetricians and Gynecologists supports
 
Medical Marijuana Recommendations (SB 60 w/ SA 1) – As amended, this bill allows APRNs and PAs to recommend medical marijuana for adult patients. It also adds pediatric psychiatrists and developmental pediatricians to the list of specialists authorized to recommend medical marijuana for pediatric patients. 
Signed by the Governor. 
 
Lead Poisoning Prevention (HB 63) – This bill requires the Department of Health and Social Services to provide support staff for the Childhood Lead Advisory Committee. 
Signed by the Governor.
 
Medication Diversion (SB 84) - This Act elevates medication diversion out of the definition of abuse for the sake of clarity and is not intended to change existing reporting obligations for facilities under Subchapter III of Chapter 11 of Title 16 of the Delaware Code (“Subchapter III”). This Act ensures reporting requirements are triggered for facilities and hospitals covered by Subchapter III if medication diversion occurs in the facilities or hospitals. Reporting is essential to the Department of Justice’s ability to prosecute and recommend treatment, when appropriate, for the person committing medication diversion. 
Signed by the Governor.
 
Epinephrine Autoinjectors (SB 55) - This Act creates emergency access to epinephrine that allows an institution of higher education to acquire and stock a supply of epinephrine autoinjectors if an employee or agent has completed a training program. This Act allows the individual who has completed the training program to provide an epinephrine autoinjector to someone experiencing anaphylaxis for immediate self-administration or administer an epinephrine autoinjector to someone experiencing anaphylaxis. Before an individual administers an epinephrine autoinjector under this Act, the individual must notify EMS immediately, and after administration, must report the administration to the prescribing health care provider. 
Awaits Governor’s signature.
 
Electronic Submission of Death Certificates (SB 69) – This bill removes the sunset provision passed in HB 354 last year and makes permanent the ability to electronically file death certificates. 
Signed by the Governor. 
 
Covid-19 Vaccination Restrictions (SB 58) - This Act removes the State’s authority to forcibly isolate, quarantine, vaccinate, or treat individuals against their will for COVID-19 during a state of emergency relating to COVID-19. 
Assigned to committee in February. No action is anticipated. 

Excessive and Unconscionable Prices for Prescription Drugs
(HB 62) – This bill prohibits manufacturers from raising the price of prescription drugs outside of certain market conditions that might justify a price hike. It is specifically limited to the prices charged to consumers in the State of Delaware for generic and off-patent drugs. It authorizes the Attorney General to investigate price increases identified by State agencies above a certain threshold. Manufacturers or distributors may be fined up to $10,000 per day for sales that violate the Act. Each sale of a drug excessively and unconscionably priced constitutes a separate violation. A manufacturer or distributor is prohibited from withdrawing a generic or off-patent drug for sale in this state to avoid application of the Act.
Passed House. Awaits consideration in the Senate.
 
If you have questions, please contact Mark B. Thompson, MHSA, Executive Director at 302-444-6958, Mark.Thompson@medsocdel.org, or Lincoln Willis, lobbyist at 302-632-9898 or Lincoln.Willis@TheWillisGroupLLC.com.
 
MSD actively monitors all health-related legislation and maintains an active and visible presence in Legislative Hall on your behalf. 

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