SB 32 — AN ACT TO AMEND TITLE 6 OF THE DELAWARE CODE RELATING PATIENT BROKERING.

(1) Offering or paying a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engaging in any form of split-fee arrangement, to induce the referral of a patient or patronage to or from a health-care provider or health-care facility.

(2) Soliciting or receiving a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engaging in any form of split-fee arrangement, in return for referring a patient or patronage to or from a health-care provider or health-care facility.

(3) Soliciting or receiving a commission, benefit, bonus, rebate, kickback, or bribe, directly or indirectly, in cash or in kind, or engaging in any form of a split-fee arrangement, in return for the acceptance or acknowledgement of treatment from a health-care provider or health-care facility.

(4) Aid, abet, advise, or otherwise participate in the conduct prohibited under this section.

§ 2503E.

Application.

This section does not apply to any of the following:

(1) Any discount, payment, waiver of payment, or payment practice not prohibited by 42 U.S.C.

§ 1320a- 7b(b).

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DIG :

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03/13/2019 10:28 AM (2) Any payment, compensation, or financial arrangement within a group practice, if the payment, compensation, or arrangement is not to or from a person who is not a member of the group practice.

(3) Payments to a health-care provider or health-care facility for professional consultation services.

(4) Commissions, fees, or other remuneration lawfully paid to insurance agents as provided under Title 18.

(5) Payments by a carrier who reimburses, provides, offers to provide, or administers health, mental health, or substance abuse goods or services under a health benefit plan.

(6) Payments to or by a health-care provider or health-care facility, or a health-care provider network entity, that has contracted with a carrier, a health-care purchasing group, Medicare, or Medicaid to provide health, metal health, or substance abuse goods or services under a health benefit plan when such payments are for goods or services under the plan.

(7) Payments by a health-care provider or health-care facility to a health, mental health, or substance abuse information service that provides information upon request and without charge to consumers about providers of health- care goods or services to enable consumers to select appropriate providers or facilities, provided that the information service meets all of the following criteria:

a.

Does not attempt through its standard questions for solicitation of consumer criteria or through any other means to steer or lead a consumer to select or consider selection of a particular health-care provider or health-care facility.

DoesThis notparagraph provide(1) orof representthis itselfsection asincludes providinga diagnosticpatient, orclaim, counseling services or assessmentsbenefit ofunder illnessa orFederal injuryhealth andcare doesprogram, notas makedefined anyunder promises§ of1128B(f) curethe orSocial guaranteesSecurity ofAct, treatment.42 U.S.C.

c.§ 1320a-7b(f), or a health benefit plan.”.

DoesFURTHER notAMEND provideSenate orBill arrangeNo. for transportation of a consumer to or from the location of a health-care provider or health-care facility.

d.32 between lines 85 and 86 by inserting the following:

Charges“(11) andPayments collectsto fees from a health-care provider or health-care facility participatingunder inthe itsrequirements servicesof thata arecontract set in advance, are consistent with the fairState marketto valueprovide forassistance thoseto informationindividuals services,with andmental arehealth notconditions basedor onsubstance theuse potentialdisorders valuein ofidentifying aand patientobtaining orresources patients to apay health-carefor providertreatment, orincluding health-careclinical facilityand orrelated ofservices thefor goodsan orindividual serviceswith provideda bymental thehealth health-carecondition provider or health-caresubstance facility.use disorder.”.

(8)FURTHER AnAMEND individualSenate employedBill byNo. the assisted living facility, or with whom the facility contracts to provide marketing services for the facility, if the individual clearly indicates that they work with or for the facility.

(9)32 Paymentson byline an87 assistedby livinginserting facility“(a)” tobefore a“The” referraltherein. service that provides information, consultation, or referrals to consumers to assist them in finding appropriate care or housing options for seniors or disabled adults if the referred consumers are not Medicaid recipients.

LCFURTHER :AMEND Senate Bill No.

DIG32 :between lines 88 and 89 by inserting the following:

CM“(b) PageA 3violation of 4this Released:chapter shall be deemed an unlawful practice under § 2513 of this title and a violation of Subchapter II of Chapter 25 of this title.

03/13/2019(c) 10:28Nothing AMin 83this (10)chapter Amodifies residentrequirements ofunder anmental assistedhealth livingparity facilitylaws, whoincluding refers§ a3343, friend,§ family3571T, member, or other§ individual3578 withof whomTitle the18 residentor has a personal relationship to the assistedfederal livingMental facility,Health inParity whichand caseAddiction theEquity assistedAct livingof facility2008 may(29 provideU.S.C. a monetary reward to the resident for making such referral.

§ 2504E.1185a).”.

Enforcement.SYNOPSIS This Amendment makes the following changes to Senate Bill No.

The32: Attorney General has the same authority to enforce and carry out this chapter as under Chapter 25 of Title 29 and by §§ 2511 through 2527 and 2531 through 2536 of this title.

§1. 2505E.

Penalties.Identifies additional kinds of payments that are not prohibited.

(a)2. A person who violates this chapter is subject to a civil penalty, in addition to all costs, of not more than $10,000 per violation.

(b)Uses Ifenforcement thelanguage violationthat is againstconsistent an elder person or person with aother disability,chapters ain personTitle who6. violates this chapter is subject to an additional civil penalty of not more than $10,000 per violation under § 2581 of this title.

(c)3. Each day that a wilful violation continues is considered a separate violation.

(d)Clarifies Forthat the purpose of this chapter,Act adoes wilfulnot violationmodify occursany whenrequirements theunder personState committing the violation knew or shouldfederal havemental knownhealth thatparity thelaws. person’s conduct was prohibited under this chapter.

§2506E.

Remedies and penalties not exclusive.

The remedies and penalties under this chapter are not exclusive and are in addition to any other procedures, rights, or remedies which exist with respect to any other provisions of law including Subchapter II and Subchapter III of Chapter 25 of this title, actions brought by private parties, or state or federal criminal prosecutions.

SYNOPSIS This Act prohibits the practice known as patient brokering, which is the practice where patient brokers are paid a fee to place insured people in treatment centers so that the treatment centers receive thousands of dollars in insurance claim payments for each patient.

Increasingly, patient brokers fraudulently enroll patients in low-deductible health plans with out- of-network treatment benefits.

Patient brokers target individuals with substance use disorders, who are told that they are receiving their treatment through a scholarship.

Not only does this perpetrate fraud against insurers, when insurance plans are terminated for nonpayment of the premium, individuals are discharged from the treatment program with no services or housing and often in a state that is far from home.

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