CHAPTER 229

FORMERLY

HOUSE BILL NO. 366

AN ACT TO AMEND CHAPTER 91, TITLE 16, OF THE DELAWARE CODE REGARDING REGULATION OF MANAGED CARE ORGANIZATIONS

BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:

WHEREAS, certain Managed Care Organizations are being developed that are different in organizational structure than Health Maintenance Organizations; and

WHEREAS, a great number of Managed Care Organizations currently do not consider themselves Health Maintenance Organizations; and

WHEREAS, it is the intent of the legislature that the State provide the same oversight for all Managed Care Organizations, whether or not they are Health Maintenance Organizations; and

WHEREAS, the Insurance Department has the authority to regulate Managed Care Organizations in several Chapters of Title 18, rather than just Chapter 64; and

WHEREAS, there may be Managed Care Organizations that, in the judgment of the Insurance Commissioner do not engage in the business of insurance and therefore do not need a certificate of authority from the Insurance Department, but would engage in the practice of managed care as defined in this chapter and do need a certificate of authority from Delaware Health and Social Services.

NOW THEREFORE:

BE IT ENACTED by the House of Representatives of the 139th General Assembly of the State of Delaware

Section 1. Amend Title 16, Chapter 91, Delaware Code by striking the phrase "Health Maintenance Organization" as it appears in each instance therein and inserting the phrase "Managed Care Organization" in lieu thereof

Section 2. Amend §9101, Title 16 of the Delaware Code by striking the phrase "the
provisions of Chapter 64 of Title 18, and any chapters specified in §6406 of Title 18." as it appears in said section and inserting the phrase "and the relevant provisions of Title 18." in lieu thereof.

Section 3. Amend (2) §9102, Title 16 of the Delaware Code by striking the phrase
"§9104 of this title and under Chapter 64 of Title 18, or which is operating pending action on an application as provided is subsection (b) of §9103 of this title and subsection (b) of §6403 of Title 18." as it appears in said subsection and inserting the phrase " this title and certificate of authority from the Insurance Department under the relevant provisions of Title 18 or a statement from the Insurance Department that the Insurance Department certificate of authority is not required." in lieu thereof

Section 4. Amend (a) §9103, Chapter 16 of the Delaware Code by striking the phrase "under Chapter 64 of Title 18." as it appears in said subsection and inserting the phrase "a certificate of authority from the Insurance Department under the relevant provisions of Title 18 or a statement from the Insurance Department that the Insurance Department certificate of authority is not required." in lieu thereof

Section 5. Amend (b) §9103, Chapter 16 of the Delaware Code by striking said subsection in its entirety and renumbering subsection (c) §9103 as subsection (b) §9103.

Section 6. Amend (a)(5) §9109, Chapter 16 of the Delaware Code by striking the phrase "pursuant to Chapter 64 of Title 18." as it appears therein, and inserting the phrase "under the relevant provisions of Title 18, or a statement from the Insurance Department that a certificate of authority is not required." in lieu thereof.

Section 7. Amend (d) §9112, Chapter 16 of the Delaware Code by striking said subsection in its entirety.

Section 8. Amend (b) §9115, Chapter 16 of the Delaware Code by striking the phrase "Delaware Health Maintenance Organization Act" or the "Delaware HMO Act" as it appears in said subsection and inserting the phrase "Delaware Managed Care Organization Act" or the "Delaware MCO Act" in lieu thereof.

Approved February 5, 1998