As used in this subchapter:

(1) “CMS” means the Centers for Medicare and Medicaid Services of the United States Department of Health and Human Services.

(2) “Commission” means the Hospital Quality and Health Equity Assessment Commission established under § 1045 of this title.

(3) “Department” means the Department of Health and Social Services.

(4) a. “Hospital” means a facility classified under § 1001(b) of this title.

b. “Hospital” does not include any of the following:

1. An entity operated by the United States or the agencies or instrumentalities of the United States.

2. An entity operated by this State, the political subdivisions of this State, or the agencies or instrumentalities of this State.

(5) “Hospital Quality and Health Equity Fund” or “Fund” means the fund established under § 1042 of this title.

(6) “Initial enactment period” means the fiscal year of July 1, 2025, through June 30, 2026.

(7) “Net patient revenues” means the hospital’s total patient revenues determined and reported in 1 or more Medicare Cost Reports under 42 C.F.R. § 413.24 and associated with specified services, less total patient revenues not received due to any of the following

a. Bad debt and uncollectable accounts.

b. Contractual adjustments.

c. Charity discounts.

d. Teaching allowances.

e. Policy discounts.

f. Administrative adjustments.

g. Implicit price concessions.

h. Other deductions from revenue.

(8) “Secretary” means the Secretary of the Department of Health and Social Services.

(9) a. “Specified services” means all of the following:

1. Inpatient hospital services, as that term is used in 42 U.S.C. § 1396b(w)(7)(A)(i) and 42 C.F.R. § 433.56(a)(1).

2. Outpatient hospital services, as that term is used in 42 U.S.C. § 1396b(w)(7)(A)(ii) and 42 C.F.R. § 433.56(a)(2).

b. “Specified services” does not include nursing facility services, skilled nursing facility services, or physician services.

(10) “Taxable year” means the period of time for determining the tax due under this subchapter, as follows:

a. For the initial enactment period and the first 2 fiscal years after the initial enactment period, the fiscal year beginning on July 1, 2021, through June 30, 2022.

b. For each subsequent 3-year period after the period under paragraph (10)a. of this section, the 1-year period beginning and ending 3 years after the immediately preceding period of time for determining the tax due under this subchapter, beginning with the period of time of July 1, 2024, through June 30, 2025.

84 Del. Laws, c. 476, § 2; 

(a) (1) Subject to paragraph (a)(2) of this section and § 1034 of this title, beginning with the initial enactment period, a hospital engaged in providing specified services in this State, whether on a for-profit or not-for-profit basis, shall pay to this State an assessment equal to the following percentage of the hospital’s net patient revenues during the taxable year:

a. For the initial enactment period, the percentage is 1.79%.

b. For each subsequent fiscal year after the initial enactment period, the percentage is 3.58%.

(2) Whether inpatient services associated with a patient admission were provided during the taxable year is determined consistent with the requirements of the Medicare Cost Report under 42 C.F.R. § 413.24.

(b) (1) Except as provided under paragraph (b)(3) of this section and subject to § 1034 of this title, the assessment imposed by this section must be paid in 4 equal installments, each consisting of ¼ of the assessment imposed under subsection (a) of this section.

(2) Except as provided under paragraph (b)(3) of this section and subject to § 1034 of this title, the payments under paragraph (b)(1) of this section are due on September 15, December 15, March 15, and June 15, or as otherwise allowed by the Department.

(3) During the initial enactment period, the assessment imposed under subsection (a) of this section must be paid in 2 equal installments each consisting of ½ of the assessment imposed under subsection (a) of this section.

(4) The payments under paragraphs (b)(1) through (3) of this section must be made on forms prescribed by the Department.

(c) (1) For a hospital that did not file a cost report in a taxable year, the first full year in which the hospital first files a cost report is treated as the hospital’s taxable year or, if available, partial data may be annualized.

(2) On and after the first update of the taxable year after a hospital under paragraph (c)(1) of this section has begun filing cost reports, the hospital’s taxable year is the same period as other hospitals.

(d) (1) If a hospital subject to an assessment imposed under subsection (a) of this section merges with another hospital, the combined entity’s net patient revenues equals the sum of the net patient revenues of the pre-merger component entities.

(2) a. If a hospital subject to an assessment imposed under subsection (a) of this section begins or ceases to conduct hospital operations or does not conduct hospital operations throughout a calendar or fiscal year under a valid state license, the Department shall adjust the hospital’s assessment by multiplying the assessment computed under this section by a fraction, the numerator of which is the number of days in the year during which the hospital conducts hospital business, operates a hospital, and maintains licensure, and the denominator of which is 365.

b. The hospital shall pay the required assessment, as computed under paragraph (d)(2)a. of this section, on the date and in pro rata installments as required by the Department for that portion of the state fiscal year during which the hospital operated and maintained state licensure, to the extent not previously paid.

(e) A hospital subject to the assessment imposed under subsection (a) of this section may not pass on the cost of the assessment to any patient, insurer, self-insured program, or other responsible party.

84 Del. Laws, c. 476, § 2; 

(a) Revenues remitted to the State in payment of the assessment imposed under § 1032 of this title must, not later than the last day of the month in which the assessment is collected, be transferred by the Department to the Hospital Quality and Health Equity Fund.

(b) (1) A hospital subject to the assessment imposed under § 1032 of this title may not be guaranteed any repayment or otherwise held harmless of the hospital’s assessment imposed under § 1032 of this title in derogation of 42 C.F.R. § 433.68(f) (related to permissible health care-related taxes).

(2) An expenditure of funds from the Hospital Quality and Health Equity Fund may not be authorized if the expenditure creates an indirect guarantee to hold harmless under 42 C.F.R. § 433.68(f)(3)(i).

84 Del. Laws, c. 476, § 2; 

(a) The Department shall seek a waiver, state plan amendment, preprint approval, or any other authorization from CMS to the extent necessary to implement this subchapter.

(b) Notwithstanding any other law to the contrary, the Department shall administer this subchapter in a manner which meets any and all eligibility requirements necessary for federal financial participation under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 through 1396w-7.

(c) The assessment imposed under § 1032 of this title is suspended, and a hospital does not have an obligation to pay the assessment, when the Commission certifies in a notice to the Registrar of Regulations that any of the following apply:

(1) A federal law or rule change by CMS prohibits the type of assessment imposed under § 1032 of this title or otherwise declares the type of assessment under § 1032 of this title impermissible under Title XIX of theSocial Security Act, 42 U.S.C. §§ 1396 through 1396w-7.

(2) CMS does not permit the State to use the assessment imposed under § 1032 of this title for the State’s share of Medicaid program expenditures without a loss of federal matching funds.

(d) The assessment imposed under § 1032 of this title shall resume, after a suspension initiated under subsection (c) of this section, on the earlier occurrence of 1 of the following:

(1) The Commission certifies in a notice to the Registrar of Regulations of the enactment of an act of the General Assembly modifying this subchapter or subchapter III of this chapter that resolves the condition precipitating the suspension.

(2) The Commission certifies in a notice to the Registrar of Regulations that the condition precipitating the suspension has been resolved.

(e) The Registrar of Regulations shall publish in the next issue of the Register of Regulations a certification under subsection (c) or (d) of this section provided to the Registrar of Regulations.

84 Del. Laws, c. 476, § 2; 

In addition to the penalties authorized under Chapter 5 of Title 30, if a hospital fails to pay the assessment imposed under § 1032 of this title when due, or a hospital fails to timely prepare and submit the form required under § 1032(b) of this title, the Department may do any of the following:

(1) Withhold any Medicaid payments to the hospital, including any payments due to the hospital for Medicaid patients from a managed care company under contract to the Division of Medicaid and Medical Assistance, until the quality assessment amount is paid in full.

(2) Suspend or revoke the hospital’s license.

(3) Develop a plan that requires the hospital to pay any delinquent quality assessment and penalty amounts in installments.

(4) Take any other action authorized by the Department by regulation.

84 Del. Laws, c. 476, § 2; 

The Department may adopt regulations to implement, administer, and enforce this subchapter.

84 Del. Laws, c. 476, § 2;