SB 272 — AN ACT TO AMEND TITLES 18 AND 29 OF THE DELAWARE CODE RELATING TO HEALTH INSURANCE, AND TITLE 31 OF THE DELAWARE CODE RELATING TO PHARMACIST CARE.

Poore DELAWARE& STATERep. SENATE 152nd GENERAL ASSEMBLY SENATE AMENDMENT NO.

1Minor-Brown TOSens. SENATE BILL NO.

272Brown, AMENDBuckson, SenateGay, BillHansen, No.Hocker, Hoffner, Huxtable, Lawson, Lockman, Mantzavinos, S.

272McBride, onParadee, linePettyjohn, 7Pinkney, byRichardson, deletingSokola, theSturgeon, wordTownsend, “issued”Walsh, whereWilson; it first appears and by substituting in lieu thereof the word “delivered”.

FURTHERReps. AMEND Senate Bill No.

272Baumbach, byChukwuocha, deletingDorsey linesWalker, 13S. through 25 and substituting in lieu thereof the following:

“(a)Moore, ForMorrison, purposesSpiegelman, ofK. this section, “carrier” means any entity that provides health insurance in this State.

“Carrier”Williams includesDELAWARE anySTATE insuranceSENATE company,152nd managedGENERAL careASSEMBLY organization,SENATE healthBILL serviceNO. corporation, health maintenance organization, and any other entity providing a plan of health insurance or health benefits subject to state insurance regulation.

“Carrier”272 alsoAN includesACT anyTO third-partyAMEND administratorTITLES or18 otherAND entity29 thatOF adjusts,THE administers,DELAWARE orCODE settlesRELATING claimsTO inHEALTH connectionINSURANCE, withAND healthTITLE benefit31 plans.OF THE DELAWARE CODE RELATING TO PHARMACIST CARE.

(b)BE ForIT anyENACTED individualBY insuranceTHE policy,GENERAL contract,ASSEMBLY orOF certificateTHE thatSTATE isOF delivered,DELAWARE: issued for delivery, renewed, extended, or modified in this State after [the effective date of this Act], a carrier must provide reimbursement to a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service or procedure is all of the following:

Section 1.

Amend Chapter 23, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§ 2321.

Provider types, generally.

Pharmacists.

(a) No health insurer, health service corporation, managed care organization, or health maintenance organization may deny benefits for eligible services based on the type of provider performing the service as long as the provider is acting within the provider’s scope of practice.

(b) No contract of insurance issued or issued for delivery in this State by a health insurer, health service corporation, managed care organization, or health maintenance organization may exclude pharmacists as providers of services covered in the contract.

Section 2.

Amend Chapter 33, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

§3370G.

Pharmacist services reimbursement.

(a) For any individual insurance policy, contract, or certificate that is delivered, issued for delivery, renewed, extended, or modified in this State after [the effective date of this Act], an insurer or third-party administrator for an insurer must provide reimbursement to a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service or procedure is all of the following:

(c) Whenever a service is performed by a licensed pharmacist and reimbursed by a carrier, the licensed pharmacist must be granted such rights of participation, plan admission, and registration as may be granted by the carrier to any health care service provider or practitioner, including a physician, advance practice registered nurse, or physician assistant performing such a service.” FURTHER AMEND Senate Bill No.

272 by deleting lines 29 through 41 and substituting in lieu thereof the following:

FJMAVP :

CBK Page 1 of 24 Released:

05/07/202404/22/2024 04:1312:31 PM “(a)(b) ForWhenever purposesa service is performed by a licensed pharmacist and reimbursed by a professional health services plan corporation, the licensed pharmacist must be granted such rights of thisparticipation, section,plan “carrier”admission, meansand anyregistration entityas thatmay providesbe granted by the professional health insuranceservices inplan thiscorporation State.to a physician or osteopath performing such a service.

“Carrier”(c) includesWhen anypayment insuranceis company,made managedfor health care organization,services healthperformed serviceby corporation,a healthlicensed maintenancepharmacist, organization,no andpayment anyor otherreimbursement entitymay providingbe apaid planto ofa healthphysician insurance or healthosteopath benefitsfor subjectthe toservices stateperformed insuranceby regulation.the licensed pharmacist.

“Carrier”Section also3. includes any third-party administrator or other entity that adjusts, administers, or settles claims in connection with health benefit plans.

(b)Amend ForChapter all35, groupTitle and18 blanket insurance policies, contracts, or certificates that are delivered, issued for delivery, renewed, extended, or modified in this State after [the effective date of thisthe Act],Delaware aCode carrierby mustmaking providedeletions reimbursementas toshown aby pharmaciststrike forthrough aand serviceinsertions oras procedureshown atby aunderline rateas notfollows: less than that provided to other nonphysician practitioners if the service or procedure is all of the following:

§ 3571AA.

Pharmacist Services Reimbursement.

(a) For all group and blanket insurance policies, contracts, or certificates that are delivered, issued for delivery, renewed, extended, or modified in this State after [the effective date of this Act], an insurer or third-party administrator for an insurer must provide reimbursement to a pharmacist for a service or procedure at a rate not less than that provided to other nonphysician practitioners if the service or procedure is all of the following:

(c)(b) Whenever a service is performed by a licensed pharmacist and reimbursed by a carrier,professional health services plan corporation, the licensed pharmacist must be granted such rights of participation, plan admission, and registration as may be granted by the carrierprofessional to any health careservices serviceplan providercorporation orto practitioner, including a physician,physician advance practice registered nurse, or physicianosteopath assistant performing such a service.”service. FURTHER AMEND Senate Bill No.

272(c) onWhen linespayment 52is andmade 53for health care services performed by deletinga “alicensed pharmacist, no payment or reimbursement may be paid to a physician or osteopath”osteopath andfor substitutingthe inservices lieuperformed thereof:by the licensed pharmacist.

“anySection health4. care service provider or practitioner, including a physician, advance practice registered nurse, or physician assistant”.

FURTHERAmend AMENDChapter Senate52, BillTitle No.29 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:

272§ by5218. deleting lines 54 and 55 in their entirety.

FURTHERPharmacist AMENDServices SenateReimbursement. Bill No.

272(a) onThe lineplan 80must byprovide deletingreimbursement “Sectionto 4”a andpharmacist substitutingfor ina lieuservice thereofor 32procedure “Sectionat 5”.a rate not less than that provided to other nonphysician practitioners if the service or procedure is all of the following: