Delaware 153rd General Assembly (2025-2026) Status: Enacted 6 D cosponsors

SB 213 — AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO HOSPITAL BUDGET REVIEW.

Last action — Signed by Governor

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  1. ✓
    Introduced
  2. ✓
    In Committee
  3. ✓
    Passed Senate
  4. ✓
    Passed House
  5. ✓
    To Executive
  6. 6
    Enacted

This bill has been enacted into law. Introduced December 30, 2025. Enacted.

Signed by Governor Matt Meyer (Democratic) on January 30, 2026.

Prognosis

Likely to advance 82% · moderate confidence

Where this bill stands today.

Odds of enactment

High

How often bills like it became law.

  • Enacted

    Current position in the legislative process.

  • 6 sponsors

    6 primary, 0 co-sponsors signed on.

  • Single-party support

    Sponsorship is currently within one party (6 D).

  • Cleared a recorded vote

    Passed 2 recorded votes so far.

Prognosis reads this bill's own signals — stage, sponsorship breadth, committee status, recorded votes and cross-state momentum. Odds come from a model trained on which bills have become law.

Summary

The Hospital Budget Review Act, House Substitute No. 2 to House Bill No. 350 (152nd General Assembly), enacted in 2024, ("HB 350") created the Diamond State Hospital Cost Review Board (“Board”) in an effort to bring greater transparency and accountability to hospital spending in Delaware. HB 350 requires hospitals to submit their budgets to the Board annually, disclose financial and operational information, and comply with the State’s healthcare spending benchmark. HB 350 also authorizes the Board to prospectively approve or modify hospital budgets and imposes penalties for non-compliance. Shortly after HB 350’s enactment, ChristianaCare filed suit in the Court of Chancery, alleging principally that the prospective budget approval and modification authority granted to the Board violates the Delaware Constitution. The litigation raised broader constitutional and policy questions about the balance between State oversight of health care spending and the autonomy of private, nonprofit hospitals. On September 30, 2025, the State and ChristianaCare signed an agreement pausing ChristianaCare’s lawsuit and setting forth the framework for this Act that, if enacted, will fully resolve the case. Under the agreement, the State admitted no fault. This Act incorporates the each of the terms of that agreement. HB 350 has 4 main components. First, hospitals must present detailed budget information annually to the Board. Second, the Board must determine whether the hospital has complied with the State’s healthcare spending benchmark. Third, if the hospital misses the benchmark, it must submit a Performance Improvement Plan (PIP) for approval by the Board. Fourth, if the hospital fails to submit an approved PIP or achieve its objectives, then the Board may prospectively approve or modify the hospital’s budget. This Act addresses constitutional concerns by eliminating the Board’s ability to approve or modify hospital budgets, while preserving the first 3 components of HB 350 with certain modifications and enhancements. First, under this Act, hospitals still must present detailed budget information to the Board each year. However, the Board will evaluate hospitals based on actual expenditure and revenue information for the most recent year, rather than prospectively approving future budgets. As with HB 350, hospitals must report financial information, including costs of operations, revenues, assets, liabilities, and expenditures, scope and volume of service information, and other information deemed relevant by the Board. This Act also requires hospitals to outline changes in year-over-year results and describe the actions it will take in the coming year to meet the benchmark, and further requires the Board to adopt a Uniform Reporting Manual for Budget Submissions to ensure the consistency of information provided by hospitals. Hospitals must provide labor costs by units of service and budget category, salary reporting is narrowed to officers, directors, key employees, and highest-compensated employees, and certain categories, such as payer contract information and three-year capital budgets, are no longer required. Second, HB 350 required the Board to determine annually whether each hospital has met the State’s healthcare spending benchmark. That requirement remains, but this Act expressly requires the Board to issue written findings of fact and determinations as to whether each hospital: (1) has met the benchmark; and, if applicable, (2) has satisfied the elements of the hospital’s Benchmark Compliance Plan (BCP), which replaces the PIP; and (3) is participating in a Meaningful Cost Containment Arrangement (MCCA). Further, the Board may also make policy recommendations to the Delaware Health Care Commission or the General Assembly regarding how to better align hospital budgets with the benchmark, while promoting efficient and economic operations and maintaining the ability of hospitals to meet hospitals’ financial obligations and to provide quality care. Third, beginning in 2027, hospitals that fail to meet the benchmark must submit a BCP for the Board’s approval. As with HB 350, if the BCP does not meet the criteria established by the Board, the Board may require the hospital to amend and resubmit the BCP. If a BCP is required, the Board will examine and determine in writing the following year whether the hospital has satisfied the BCP’s elements. However, if the hospital demonstrates that it is subject to an MCCA, then the hospital is not required to submit to the BCP process for that year. MCCAs are contracts between hospitals and payers (including, in some cases, federal or state governments) that are designed to reduce healthcare costs by holding the hospital financially accountable for controlling healthcare spend for a specific population – including downside risk. However, even if a hospital has an MCCA and therefore is not required to adopt a BCP, it still must present its detailed budget information to the Board every year so that the Board may determine whether it has met the benchmark. A hospital’s adoption of an MCCA does not exempt it from that process, only the requirement that it adopt a BCP—and only for one year. Civil penalties of up to $500,000 for knowingly failing to comply with reporting standards remain in effect.

Bill Text

What changed in the latest version

278 added · 50 removed

Plain-language change summary

The amendment to SB 213 includes the addition of multiple sponsors to the bill, reflecting broader support within the legislature. It modifies the definitions related to hospital budget review by specifying that only certain types of hospitals are subject to these regulations, thus excluding those that provide exclusively psychiatric, rehabilitative, or long-term acute care services. Additionally, it revises language throughout the bill for clarification, such as changing "data" to "financial information" and emphasizing the fiscal year in certain contexts. These changes aim to refine the bill’s language and scope regarding hospital budget compliance requirements.

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Townsend DELAWARE STATE SENATE 153rd GENERAL ASSEMBLY SENATE AMENDMENT NO.
Townsend & Sen.
1 TO SENATE BILL NO.
Sokola & Sen.
213 AMEND Senate Bill No.
Lockman & Rep.
213 by inserting the following after line 4 and before line 5:
Harris & Rep.
“(3) “Hospital” means as defined in § 1001 of this title, except that hospitals that exclusively provide psychiatric services or services, rehabilitative services services, or long-term acute care services are excluded from the application of this subchapter.” FURTHER AMEND Senate Bill No.
Minor-Brown & Rep.
213 on line 52 by inserting “for the most recently completed fiscal year” after “revenues” and before the comma therein.
Osienski DELAWARE STATE SENATE 153rd GENERAL ASSEMBLY SENATE BILL NO.
FURTHER AMEND Senate Bill No.
213 AN ACT TO AMEND TITLE 16 OF THE DELAWARE CODE RELATING TO HOSPITAL BUDGET REVIEW.
213 on line 53 by deleting “data” and inserting in lieu thereof “financial information”.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
FURTHER AMEND Senate Bill No.
Section 1.
213 on line 54 by deleting “previous year.” as it appears therein and inserting in lieu thereof “previous year.
Amend § 9951, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
fiscal year immediately preceding such fiscal year.”.
§ 9951.
FURTHER AMEND Senate Bill No.
Definitions.
213 on line 102 by deleting “a” after “whether” and before “hospital” and inserting in lieu thereof “the”.
As used in this subchapter:
FURTHER AMEND Senate Bill No.
(5) “Manual” means the Uniform Reporting Manual for Budget Submissions to be adopted by regulation by the Board to ensure the consistency of information provided by hospitals under this subchapter.
213 by inserting the following after line 104 and before line 105:
(6) “Meaningful Cost Containment Arrangement” means, with respect to the applicable benchmark compliance plan year, any of the following:
“1.
a.
The application must include a written attestation from the hospital’s chief executive officer of all of the following:
A Medicare or Medicaid Global Budget Arrangement.
A.
b.
That the hospital is not in breach of any material provision of the Meaningful Cost Containment Arrangement.
A Substantial Financial Downside Risk Arrangement.
B.
c.
That the hospital has not received a waiver of any penalties during the term of the Meaningful Cost Containment Arrangement.
Any other qualifying written agreement approved by the Board on application of a hospital under § 9953(d)(7)c.
C.
of this title.
That the penalties and risk provisions of the Meaningful Cost Containment Arrangement have not been modified during the term of the Meaningful Cost Containment Arrangement.
(7) “Medicare or Medicaid Global Budget Arrangement” means a written agreement among Medicare, Medicaid, or other applicable federal or state governmental payer authorities or public programs;
2.
a hospital, health system or affiliate;
If during the applicable benchmark compliance year the hospital breaches any material provision of, receives a waiver of any penalties under, or negotiates new terms of the Meaningful Cost Containment Arrangement, the hospital shall notify the Board.”.
and, as applicable, any necessary third-party payers that is designed to cover the projected costs of hospital-based care for a defined patient population covering at least 50% of the hospital’s historical patient volumes and representing at least 3% of the hospital’s net patient revenue at risk for the applicable benchmark compliance plan year, reflecting a historical baseline calculation adjusted for inflation, demographic shifts, risk adjustment, and other factors for a defined performance period.
(12)a.
“Substantial Financial Downside Risk Arrangement” means, for the applicable benchmark compliance year, 1 or more written agreements between a payer, purchaser, or insurer and a hospital, health system, or affiliate for providing health care services to a defined patient population that provide all of the following:
1.
That total annual costs are not less than 3% of the hospital’s net patient revenue.
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01/19/2026 10:01 AM FURTHER AMEND Senate Bill No.
12/30/2025 11:24 AM 2.
213 on line 120 by inserting the following after “Arrangement” and before “is”:
That a minimum of 10% of the total annual costs for the defined patient population are at risk to the hospital.
“, and for which the hospital’s chief executive officer has provided a written attestation in compliance with § 9953(d)(7)c.1.
3.
of this title,”.
That, for any hospital having an annual operating budget greater than $1,000,000,000, a minimum of 5,000 covered patient lives are subject to the agreement.
FURTHER AMEND Senate Bill No.
b.
213 on line 124 by deleting “or not a performance improvement plan benchmark” and inserting in lieu thereof “or not a performance improvement plan a benchmark”.
The Board may, by regulation, increase the amounts or percentages set forth in paragraphs (12)a.1., a.2., or a.3.
SYNOPSIS This Amendment does all of the following:
of this section.
(1) Exempts long-term acute care hospitals from the budget submission and review procedures adopted in the Hospital Budget Review Act, House Substitute No.
(13) “Total annual costs” means the aggregate yearly healthcare costs of a defined patient population in a Meaningful Cost Containment Arrangement in the applicable benchmark compliance year.
Section 2.
Amend § 9952, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
Show all 228 changed rows (188 more)
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§ 9952.
Diamond State Hospital Cost Review Board.
(f) (1) Four voting members constitutes a quorum of the Board and, except as set forth in paragraph (f)(2) of this section, the Board may take action by affirmative vote of a majority of members present and voting.
(2) The following actions require the affirmative vote of a majority of the voting members of the Board:
a.
Approval of a hospital budget.
b.
Revision of a hospital budget.
c.a.
An enforcement action under § 9957 of this title.
b.
Adoption of a regulation under this subchapter.
c.
Adoption of written findings of fact and determinations under § 9953(d)(7) of this title.
d.
Approval of a performance improvement plan benchmark compliance plan under § 9954 of this title.
(g) The Board shall promulgate rules and regulations necessary for the implementation of this subchapter including a schedule for submission of information required from hospitals under § 9953 of this title.
title and a Manual providing uniform definitions and submission criteria for the budget reporting categories listed in § 9953 of this title.
Section 3.
Amend § 9953, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 9953.
Submission and analysis of hospital financial information.
(a) Hospitals shall annually submit to the Board any of the following information required by the Board under rules, regulations, and guidance promulgated under this subchapter, including the Manual:
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12/30/2025 11:24 AM (1) The hospital’s operating budget for the forthcoming year, including expenditures and revenues, revenues, including the data described in paragraph (a)(2) of this section, redlined to reflect increases and changes from the previous year.
(2) Spending and revenue data from the previous year.
(2)(3) Financial information, including costs of operations, revenues, assets, liabilities, rates, charges, units of service, and wage, salary, and other labor costs for each service line and budget category.
all of the following:
a.
Costs of operations.
b.
Revenues.
c.
Assets.
d.
Liabilities.
e.
Rates and charges in accordance with paragraph (a)(5) of this section.
f.
Labor costs by units of service and budget category.
(3)(4) Scope of services and volume of service information, including inpatient services, outpatient services, and ancillary services by type of service provided.
(4)(5) Utilization information.
(6) New hospital services and programs proposed for the forthcoming year.
(7) Projected 3-year capital budget.
(8)(5) Contract information with public and private payers and purchasers.
Information about payments by payers and purchasers consistent with information subject to public disclosure required by 45 C.F.R.
Part 180.
(6) A narrative regarding the budget reporting categories of this subsection, outlining the changes in the year- over-year results and the actions the hospital has taken and will take in the coming year to adhere to the health care spending benchmark.
(7)(9) Other information the Board determines to be relevant to the budget review process.
Board’s obligations under this section, including information relevant to any determination by the Board under paragraph (d)(7)c.
of this section.
(b) Hospitals shall submit audited financial statements to the Board, within 30 days of such audited financial statements becoming finalized.
This requirement begins with audited financial statements for 2023.
(c) The Board shall conduct reviews of each hospital’s proposed budget based on the information provided pursuant to subsection (a) of this section.
[Repealed.] (d) In connection with budget reviews, the The Board shall do all of the following:
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12/30/2025 11:24 AM 82 (1) Review utilization information.
(2) Consider the expenditure and revenue analysis for the previous year and the proposed expenditure and revenue analysis for the forthcoming year and determine whether the hospital has satisfied the State’s health-care spending policy directives, including the health-care spending benchmark and the annual rate filing cost containment requirements under § 2503 of Title 18.
Analyze and consider the other information submitted by the hospital under subsections (a) and (b) of this section.
(3) Meet with hospitals each hospital to review and discuss their each hospital’s budget proposals for the forthcoming year.
information.
(4) Review the hospital’s investments in workforce development initiatives.
(5) Consider the salaries for the hospital’s executive and clinical leadership and the hospital’s salary spread, including a comparison to salaries in other states in the region.
whose compensation is publicly disclosed in the hospital’s Internal Revenue Service Form 990 filings.
(6) Offer the opportunity for the public to provide comment on hospital budgets and other aspects of hospital costs.
(7) Issue written findings of fact and determinations as to any of the following:
a.
Whether a hospital has satisfied the State’s health-care spending policy directives, including, as applicable, the health-care spending benchmark and the annual rate filing cost containment requirements under § 2503 of Title 18.
b.
Whether a hospital has satisfied the elements of the hospital’s benchmark compliance plan, if applicable.
c.
On the application of a hospital, whether a hospital is participating in a Meaningful Cost Containment Arrangement and therefore is not subject to the benchmark compliance plan process under § 9954 of this title for the applicable benchmark compliance plan year.
(e) A hospital’s violation of the Board’s standards and procedures is subject to enforcement under § 9957 of this title.
(f)(1) The Board may, by a written report, make policy recommendations to the Delaware Health Care Commission, Senate Health & Social Services Committee, and the House Health & Human Development Committee regarding how to better align hospital budgets with the benchmark, while promoting efficient and economic operations and maintaining the ability of hospitals to meet hospitals’ financial obligations and to provide quality care.
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12/30/2025 11:24 AM (2) If the Board submits a report under paragraph (f)(1) of this section, the Board shall provide a copy to the Director and Librarian of the Division of Legislative Services.
Section 4.
Amend § 9954, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 9954.
Performance improvement plans.
Benchmark compliance plans.
(a)(1) Beginning in 2026, 2027, and except as provided in paragraph (a)(2) of this section, if the Board determines that a hospital’s actual annual cost growth has exceeded the spending benchmark, the Board shall send the hospital notice of that finding and may require the hospital to submit a performance improvement plan benchmark compliance plan within 45 days.
(2) A hospital that the Board determines is participating in a Meaningful Cost Containment Arrangement is not subject to this section for the applicable benchmark compliance plan year.
(b) The Board shall promulgate additional regulations and written guidance about the performance improvement planbenchmark compliance plan process, including discretionary factors that the Board may consider in deciding whether or not a performance improvement plan benchmark compliance plan is required, taking into account a hospital’s financial condition, any ongoing strategies or investments that the healthcare entity is implementing to improve patient access and quality, future long-term efficiency, population growth in the hospital service area, and such other factors as the Board may determine to be relevant.
(c) A proposed performance improvement plan benchmark compliance plan submitted by a hospital must identify the causes of the hospital’s cost growth and must include specific strategies, adjustments, and action steps the hospital proposes to implement to improve cost performance.
The proposed performance improvement plan benchmark compliance plan must include specific identifiable and measurable expected outcomes and a timetable for implementation.
The timetable for a performance improvement plan benchmark compliance plan may not exceed 12 months.
(d) If the Board determines that the performance improvement plan benchmark compliance plan is unacceptable or incomplete, the Board shall provide written guidance explaining the criteria that have not been met and may provide an additional time period, up to 30 calendar days, for resubmission.
If the hospital and the Board are unable to agree to a performance improvement plan, the Board may require the hospital to submit to the budget approval process under § 9955 of this title.
The hospital shall address each deficiency noted by the Board in the Board’s written guidance, and resubmit the hospital’s benchmark compliance plan to the Board, no later than 30 days from the date of the hospital’s receipt of the Board’s written guidance.
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12/30/2025 11:24 AM (e) If the Board determines that the performance improvement plan is acceptable, the Board shall notify the hospital of the approval of the plan.
A hospital implementing an approved performance improvement plan may be subject to additional reporting requirements and compliance monitoring, at the discretion of the Board.
[Repealed.] (f) At the conclusion of the timetable established in the performance improvement plan, or at an earlier time determined by the Board, the hospital shall report to the Board regarding the progress or outcome of the performance improvement plan.
If the Board finds that the performance improvement plan has not been successful, the Board may do 1 of the following:
(1) Extend the implementation timetable of the existing performance improvement plan.
(2) Require the hospital to submit a new performance improvement plan.
(3) Require the hospital to participate in the budget approval process under § 9955 of this title.
[Repealed.] (g) When determining whether to approve a performance improvement plan or an amendment thereto under this section the Board shall consider whether the proposal will be effective in achieving the factors set forth under § 9955(c) of this title.
[Repealed.] Section 5.
Amend § 9955, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 9955.
Approval or modification of hospital budget.
[Repealed.] (a) If a hospital has undertaken a performance improvement plan under § 9954 of this title and failed to show sufficient progress or has failed to submit an acceptable performance improvement plan under § 9954 of this title, the hospital may be required to submit the next fiscal year’s budget to the Board for review and approval.
(b) When a hospital budget is submitted for approval under this section, the Board shall approve a hospital’s budget as submitted or engage with the hospital in establishing and approving a modified budget.
A budget must be approved as submitted or as modified by 90 days before the start of the hospital’s fiscal year.
Each hospital shall operate under the original or modified budget as approved.
(c) Individual hospital budgets approved under this section shall:
(1) Adhere as closely to the spending benchmark as is reasonable given the hospital’s financial position and associated economic factors.
(2) Promote efficient and economic operations of the hospital.
(3) Maintain the hospital’s ability to meet its financial obligations and provide quality care.
(d) The Board may not require a hospital budget to be modified if the budget submitted reflects growth equal to or less than the spending benchmark.
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12/30/2025 11:24 AM (e) If the Board and a hospital cannot agree on a modified budget, the Board may impose a modified budget and shall issue a written decision enumerating the reasons why the Board’s modified budget will satisfy the factors under subsection (c) of this section.
(f) The Board may, upon application, adjust a budget established under this section during the fiscal year upon demonstration of need based on exceptional or unforeseen circumstances.
(g) The Board may request, and a hospital shall provide, information determined by the Board to be necessary to determine whether the hospital is operating within a budget established under this section.
(h) When a hospital has successfully met its budget goals for 3 consecutive years, the hospital may no longer be required to participate in the budget approval process under this section.
Section 6.
Amend § 9957, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 9957.
Enforcement.
(a) A hospital that knowingly fails to provide information or adhere to standards, procedures, and deadlines related to the budget review process as required by this subchapter under this subchapter, or a rule or regulation promulgated thereunder under this subchapter, may be assessed a civil penalty of up to $500,000.
(b) In the event that a hospital subject to budget approval under § 9955 of this title fails to maintain its approved budget, the Board may do any of the following:
(1) Factor the amount of net revenues exceeding the budgeted amount of net revenues into the hospital’s budget for the forthcoming year.
(2) Allow the hospital to retain surplus funds if the surplus was achieved while the hospital stayed within its budget.
(3) Allow the hospital to retain surplus funds generated primarily by volume in excess of what was projected for the year in question.
[Repealed.] (c) An order under subsection (a) of this section may be issued only after a hospital has received notice and an opportunity to be heard by the Board.
Section 7.
Amend § 9958, Title 16 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 9958.
Open meetings;
records subject to disclosure.
(c) (1) The Board shall annually convene at least 1 public hearing per hospital subject to this subchapter to allow the hospital to present its annual budget, and performance improvement plan where applicable, financial information DLS :
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12/30/2025 11:24 AM required under § 9953 of this title and any benchmark compliance plan required under § 9954 of this title to the Board and engage in dialogue with the Board regarding questions, concerns, or additional information necessary to determine whether the hospital’s actual and projected annual spend growth is in line with the spending benchmark, other health-care spending directives, and other discretionary factors that the Board may consider as promulgated in regulation.
Section 8.
If any provision of this Act or the application thereof to any person or circumstance is held invalid, the invalidity does not affect other provisions or applications of the Act which can be given effect without the invalid provision or application;
and, to that end, the provisions of this Act are declared to be severable.
SYNOPSIS The Hospital Budget Review Act, House Substitute No.
350 (152nd General Assembly).
350 (152nd General Assembly), enacted in 2024, ("HB 350") created the Diamond State Hospital Cost Review Board (“Board”) in an effort to bring greater transparency and accountability to hospital spending in Delaware.
(2) Makes technical corrections to lines 52 through 54 of this Act to clarify the intent to require hospitals to report expenditures, revenues, and other financial information for the most recently completed fiscal year to the Diamond State Hospital Cost Review Board, redlined against the fiscal year immediately preceding it.
HB 350 requires hospitals to submit their budgets to the Board annually, disclose financial and operational information, and comply with the State’s healthcare spending benchmark.
This is consistent with the structure of this Act and reflects the intent of the parties who negotiated the term sheet reflected in this Act.
HB 350 also authorizes the Board to prospectively approve or modify hospital budgets and imposes penalties for non-compliance.
(3) Requires the hospital’s chief executive officer to attest in writing that the hospital is not in breach of any material provision of, has not received a waiver of any penalties during the term of, and the penalties and risk provisions of the Meaningful Cost Containment Arrangement have not been modified during the term of the Meaningful Cost Containment Arrangement.
Shortly after HB 350’s enactment, ChristianaCare filed suit in the Court of Chancery, alleging principally that the prospective budget approval and modification authority granted to the Board violates the Delaware Constitution.
(4) Requires the hospital to report to the Board any breach, receipt of a waiver of any penalty under, or negotiation of new terms of the Meaningful Cost Containment Arrangement during an applicable benchmark compliance year.
The litigation raised broader constitutional and policy questions about the balance between State oversight of health care spending and the autonomy of private, nonprofit hospitals.
(5) Makes a technical correction to line 124 of this Act to correct grammar in the existing law.
On September 30, 2025, the State and ChristianaCare signed an agreement pausing ChristianaCare’s lawsuit and setting forth the framework for this Act that, if enacted, will fully resolve the case.
Under the agreement, the State admitted no fault.
This Act incorporates the each of the terms of that agreement.
HB 350 has 4 main components.
First, hospitals must present detailed budget information annually to the Board.
Second, the Board must determine whether the hospital has complied with the State’s healthcare spending benchmark.
Third, if the hospital misses the benchmark, it must submit a Performance Improvement Plan (PIP) for approval by the Board.
Fourth, if the hospital fails to submit an approved PIP or achieve its objectives, then the Board may prospectively approve or modify the hospital’s budget.
This Act addresses constitutional concerns by eliminating the Board’s ability to approve or modify hospital budgets, while preserving the first 3 components of HB 350 with certain modifications and enhancements.
First, under this Act, hospitals still must present detailed budget information to the Board each year.
However, the Board will evaluate hospitals based on actual expenditure and revenue information for the most recent year, rather than prospectively approving future budgets.
As with HB 350, hospitals must report financial information, including costs of operations, revenues, assets, liabilities, and expenditures, scope and volume of service information, and other information deemed relevant by the Board.
This Act also requires hospitals to outline changes in year-over-year results and describe the actions it will take in the coming year to meet the benchmark, and further requires the Board to adopt a Uniform Reporting Manual for Budget Submissions to ensure the consistency of information provided by hospitals.
Hospitals must provide labor costs by units of service and budget category, salary reporting is narrowed to officers, directors, key employees, and highest-compensated employees, and certain categories, such as payer contract information and three-year capital budgets, are no longer required.
Second, HB 350 required the Board to determine annually whether each hospital has met the State’s healthcare spending benchmark.
That requirement remains, but this Act expressly requires the Board to issue written findings of fact and determinations as to whether each hospital:
(1) has met the benchmark;
and, if applicable, (2) has satisfied the elements of the hospital’s Benchmark Compliance Plan (BCP), which replaces the PIP;
and (3) is participating in a Meaningful Cost Containment Arrangement (MCCA).
Further, the Board may also make policy recommendations to the Delaware Health Care Commission or the General Assembly regarding how to better align hospital budgets with the benchmark, while promoting efficient and economic operations and maintaining the ability of hospitals to meet hospitals’ financial obligations and to provide quality care.
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12/30/2025 11:24 AM Third, beginning in 2027, hospitals that fail to meet the benchmark must submit a BCP for the Board’s approval.
As with HB 350, if the BCP does not meet the criteria established by the Board, the Board may require the hospital to amend and resubmit the BCP.
If a BCP is required, the Board will examine and determine in writing the following year whether the hospital has satisfied the BCP’s elements.
However, if the hospital demonstrates that it is subject to an MCCA, then the hospital is not required to submit to the BCP process for that year.
MCCAs are contracts between hospitals and payers (including, in some cases, federal or state governments) that are designed to reduce healthcare costs by holding the hospital financially accountable for controlling healthcare spend for a specific population – including downside risk.
However, even if a hospital has an MCCA and therefore is not required to adopt a BCP, it still must present its detailed budget information to the Board every year so that the Board may determine whether it has met the benchmark.
A hospital’s adoption of an MCCA does not exempt it from that process, only the requirement that it adopt a BCP—and only for one year.
Civil penalties of up to $500,000 for knowingly failing to comply with reporting standards remain in effect.
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Action History

  1. Signed by Governor

  2. Passed By House. Votes: 33 YES 7 NO 1 NOT VOTING

  3. Reported Out of Committee (Administration) in House with 2 Favorable, 3 On Its Merits

  4. Assigned to Administration Committee in House

  5. Passed By Senate. Votes: 21 YES

  6. Amendment SA 1 to SB 213 - Passed By Senate. Votes: 21 YES

  7. Amendment SA 1 to SB 213 - Introduced and Placed With Bill

  8. Reported Out of Committee (Executive) in Senate with 2 Favorable, 5 On Its Merits

  9. Introduced and Assigned to Executive Committee in Senate

Sponsors

Sponsorship breakdown

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6 sponsors · 0 co-sponsors · 56 not signed on · 7 voted No

Sponsors (6)

Co-sponsors (0)

None.

Not signed on (56)

56 members have not signed on to this bill.

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"Not signed on" means a member has not sponsored or co-sponsored this bill — it does not imply opposition. Members flagged Voted No have a recorded No vote on this bill.

Whip count is in markup. Polling the chamber and every recorded vote this session. Only the first open is slow. It’s instant for you after this. Calling the roll · Tallying · Engrossing

Votes

SM

Passed 33 Yea · 7 Nay · 2 Other
Party YeaNayPresentNot Voting
Democratic 26001
Republican 7700
Total 33701
% of votes cast 80%17%0%2%
How each member voted (41)
Member Party Vote
Alonna Berry Democratic Yea
Claire Snyder-Hall Democratic Yea
Cyndie Romer Democratic Yea
DeShanna U Neal Democratic Yea
Debra Heffernan Democratic Yea
Edward S. Osienski Democratic Yea
Eric Morrison Democratic Yea
Frank Burns Democratic Yea
Franklin D. Cooke Democratic Yea
Josue O Ortega Democratic Yea
Kamela T Smith Democratic Not Voting
Kendra Johnson Democratic Yea
Kerri Evelyn Harris Democratic Yea
Kimberly Williams Democratic Yea
Krista Griffith Democratic Yea
Larry Lambert Democratic Yea
Madinah Wilson-Anton Democratic Yea
Mara Gorman Democratic Yea
Melanie Ross Levin Democratic Yea
Melissa Minor-Brown Democratic Yea
Nnamdi O. Chukwuocha Democratic Yea
Sean M. Lynn Democratic Yea
Sherae'a Moore Democratic Yea
Sophie Phillips Democratic Yea
Stephanie T. Bolden Democratic Yea
William Bush Democratic Yea
William J. Carson Democratic Yea
Bryan W. Shupe Republican Nay
Charles S Postles Jr. Republican Nay
Daniel B. Short Republican Yea
Jeff Hilovsky Republican Yea
Jeffrey N. Spiegelman Republican Yea
Jesse R. Vanderwende Republican Yea
Kevin S Hensley Republican Yea
Lyndon D. Yearick Republican Nay
Michael F. Smith Republican Yea
Richard G. Collins Republican Nay
Ronald E. Gray Republican Nay
Shannon Morris Republican Nay
Timothy D. Dukes Republican Yea
Valerie Jones Giltner Republican Nay

Official roll call →

SM

Passed 21 Yea · 0 Nay
Party YeaNayPresentNot Voting
Democratic 15000
Republican 6000
Total 21000
% of votes cast 100%0%0%0%
How each member voted (21)
Member Party Vote
Bryan Townsend Democratic Yea
Daniel Cruce Democratic Yea
Darius J. Brown Democratic Yea
David P. Sokola Democratic Yea
John "Jack" Walsh Democratic Yea
Kyra L. Hoffner Democratic Yea
Laura V. Sturgeon Democratic Yea
Marie Pinkney Democratic Yea
Nicole Poore Democratic Yea
Ray Seigfried Democratic Yea
Russell Huxtable Democratic Yea
S. Elizabeth Lockman Democratic Yea
Spiros Mantzavinos Democratic Yea
Stephanie L. Hansen Democratic Yea
Trey Paradee Democratic Yea
Brian Pettyjohn Republican Yea
Bryant L. Richardson Republican Yea
Dave G. Lawson Republican Yea
David L. Wilson Republican Yea
Eric Buckson Republican Yea
Gerald W. Hocker Republican Yea

Official roll call →

Subjects

healthcare labor
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Frequently asked questions

What does SB 213 do?
The Hospital Budget Review Act, House Substitute No. 2 to House Bill No. 350 (152nd General Assembly), enacted in 2024, ("HB 350") created the Diamond State Hospital Cost Review Board (“Board”) in an effort to bring greater transparency and accountability to hospital spending in Delaware. HB 350 requires hospitals to submit their budgets to the Board annually, disclose financial and operational information, and comply with the State’s healthcare spending benchmark. HB 350 also authorizes the Board to prospectively approve or modify hospital budgets and imposes penalties for non-compliance. Shortly after HB 350’s enactment, ChristianaCare filed suit in the Court of Chancery, alleging principally that the prospective budget approval and modification authority granted to the Board violates the Delaware Constitution. The litigation raised broader constitutional and policy questions about the balance between State oversight of health care spending and the autonomy of private, nonprofit hospitals. On September 30, 2025, the State and ChristianaCare signed an agreement pausing ChristianaCare’s lawsuit and setting forth the framework for this Act that, if enacted, will fully resolve the case. Under the agreement, the State admitted no fault. This Act incorporates the each of the terms of that agreement. HB 350 has 4 main components. First, hospitals must present detailed budget information annually to the Board. Second, the Board must determine whether the hospital has complied with the State’s healthcare spending benchmark. Third, if the hospital misses the benchmark, it must submit a Performance Improvement Plan (PIP) for approval by the Board. Fourth, if the hospital fails to submit an approved PIP or achieve its objectives, then the Board may prospectively approve or modify the hospital’s budget. This Act addresses constitutional concerns by eliminating the Board’s ability to approve or modify hospital budgets, while preserving the first 3 components of HB 350 with certain modifications and enhancements. First, under this Act, hospitals still must present detailed budget information to the Board each year. However, the Board will evaluate hospitals based on actual expenditure and revenue information for the most recent year, rather than prospectively approving future budgets. As with HB 350, hospitals must report financial information, including costs of operations, revenues, assets, liabilities, and expenditures, scope and volume of service information, and other information deemed relevant by the Board. This Act also requires hospitals to outline changes in year-over-year results and describe the actions it will take in the coming year to meet the benchmark, and further requires the Board to adopt a Uniform Reporting Manual for Budget Submissions to ensure the consistency of information provided by hospitals. Hospitals must provide labor costs by units of service and budget category, salary reporting is narrowed to officers, directors, key employees, and highest-compensated employees, and certain categories, such as payer contract information and three-year capital budgets, are no longer required. Second, HB 350 required the Board to determine annually whether each hospital has met the State’s healthcare spending benchmark. That requirement remains, but this Act expressly requires the Board to issue written findings of fact and determinations as to whether each hospital: (1) has met the benchmark; and, if applicable, (2) has satisfied the elements of the hospital’s Benchmark Compliance Plan (BCP), which replaces the PIP; and (3) is participating in a Meaningful Cost Containment Arrangement (MCCA). Further, the Board may also make policy recommendations to the Delaware Health Care Commission or the General Assembly regarding how to better align hospital budgets with the benchmark, while promoting efficient and economic operations and maintaining the ability of hospitals to meet hospitals’ financial obligations and to provide quality care. Third, beginning in 2027, hospitals that fail to meet the benchmark must submit a BCP for the Board’s approval. As with HB 350, if the BCP does not meet the criteria established by the Board, the Board may require the hospital to amend and resubmit the BCP. If a BCP is required, the Board will examine and determine in writing the following year whether the hospital has satisfied the BCP’s elements. However, if the hospital demonstrates that it is subject to an MCCA, then the hospital is not required to submit to the BCP process for that year. MCCAs are contracts between hospitals and payers (including, in some cases, federal or state governments) that are designed to reduce healthcare costs by holding the hospital financially accountable for controlling healthcare spend for a specific population – including downside risk. However, even if a hospital has an MCCA and therefore is not required to adopt a BCP, it still must present its detailed budget information to the Board every year so that the Board may determine whether it has met the benchmark. A hospital’s adoption of an MCCA does not exempt it from that process, only the requirement that it adopt a BCP—and only for one year. Civil penalties of up to $500,000 for knowingly failing to comply with reporting standards remain in effect.
Who sponsors SB 213?
SB 213 is sponsored by Edward S. Osienski (Democratic), Trey Paradee (Democratic), Kerri Evelyn Harris (Democratic), Josue O Ortega (Democratic), David P. Sokola (Democratic), and Bryan Townsend (Democratic).
What is the current status of SB 213?
This bill has been enacted into law. Introduced December 30, 2025. Enacted.
Where can I track SB 213?
Track SB 213 free on One Click Politics — get push/email alerts when it moves.

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