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) “Disproportionate share hospital payment adjustment” means adjustments in payment for inpatient hospital services furnished by disproportionate share hospitals, as disproportionate share hospitals are described in § 1923 of the Social Security Act, 42 U.S.C. § 1396r-4.

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

(6) “Uniform payment increase” means a payment of an equal dollar amount per unit of service delivered.

(7) “Unit of service” means each day or visit.

84 Del. Laws, c. 476, § 3; 

(a) There is established in the State Treasury and in the accounting system of this State a special fund to be known as the “Hospital Quality and Health Equity Fund” (“Fund”).

(b) All of the following must be deposited into the Fund:

(1) The assessments collected under subchapter II of this chapter.

(2) Interest credited to the Fund under subsection (c) of this section.

(c) The State Treasurer shall invest the Fund consistent with the investment policies established by the Cash Management Policy Board and credit interest to the Fund monthly consistent with the rate established by the Cash Management Policy Board.

84 Del. Laws, c. 476, § 3; 

(a) Except as otherwise provided under this section, moneys deposited into the Fund must be used by the Department exclusively to secure federal matching funds available through this State’s Medicaid Plan and any applicable waivers and, together with the federal matching funds, must be used exclusively by the Department, including any managed care companies under contract to the Division of Medicaid and Medical Assistance, as follows:

(1) Sixty-six percent of the funds must be used to increase payments to hospitals as provided under subsection (b) of this section relating to payments to hospitals.

(2) Thirty-four percent of the funds must be used to make or increase payments for other approved uses of the funds under subsection (c) of this section.

(3) To reimburse any funds advanced from the Department’s Medicaid budget appropriations that were used to make the payments under paragraphs (a)(1) and (2) of this section.

(b) All of the following apply to funds required to be used to increase payments to hospitals under paragraph (a)(1) of this section:

(1) Funds required to be used to increase payments to hospitals under paragraph (a)(1) of this section must be divided into an inpatient and outpatient payment pool of funds in the same proportion that the inpatient services and outpatient services represent in the total amount assessed each fiscal year under the assessment imposed under § 1032 of this title.

(2) The funds annually allocated to the inpatient pool of funds must be used as follows:

a. Ninety percent of the inpatient payment pool of funds must be used to fund a uniform payment increase for each acute care inpatient day provided to an individual enrolled in Medicaid managed care.

b. Six percent of the inpatient payment pool of funds must be used to fund a uniform payment increase for each inpatient rehabilitation day provided by a hospital distinct part unit or freestanding rehabilitation hospital to an individual enrolled in Medicaid managed care.

c. Four percent of the inpatient payment pool of funds must be used to fund a uniform payment increase for each behavioral health day provided by a hospital distinct part unit or freestanding behavioral health hospital to an individual enrolled in Medicaid managed care.

(3) The funds annually allocated to the outpatient pool of funds must be used as follows:

a. Ninety-nine- and one-half percent of the outpatient payment pool of funds must be used to fund a uniform payment increase for each outpatient hospital visit provided to an individual enrolled in Medicaid managed care.

b. One half of 1% of the outpatient payment pool of funds must be used to fund a uniform payment increase for each partial hospitalization program service provided to an individual enrolled in Medicaid managed care.

(c) The approved uses of the funds under paragraph (a)(2) of this section are as follows:

(1) To reimburse the Department for administrative expenses associated with implementing and administering the assessment imposed under § 1032 of this title, including the costs of any staff or consultants engaged by the Department.

(2) To reimburse Medicaid managed care plans for additional administrative expenses incurred that are associated with the implementation of this section and § 1032 of this title, to the extent and in such amounts authorized by the Department.

(3) To develop or enhance funding for Medicaid initiatives, as determined by the Department. Funds may not be used to supplant or replace appropriations for programs in existence on October 1, 2024, except that funds not to exceed 25% may be used to support the general operations of the Medicaid program.

(4) Notwithstanding the requirement that funds be used exclusively to secure federal matching funds, to reimburse the expenses of the Commission.

(d) If the assessment imposed by § 1032 of this title and the payments under paragraphs (a)(1) and (2) of this section are suspended under § 1034 of this title, any moneys remaining in the Fund must be distributed as follows:

(1) If the total of all moneys remaining in the Fund is equal to or less than the Delaware state share of the payments advanced from the Department’s Medicaid budget appropriation to make the payments referred to under paragraphs (a)(1) and (2) of this section and not already reimbursed from the Fund, the Department shall receive the entirety of the moneys remaining in the Fund as reimbursement for the Delaware state share of the payments.

(2) If the total of all moneys remaining in the Fund are greater than the Delaware state share of the payments referred to under paragraphs (a)(1) and (2) of this section and not already reimbursed from the Fund, the remaining moneys must be distributed back to the applicable hospitals generally and proportionately on the same basis as the assessments were collected in the last calendar quarter before the suspension of the assessment imposed by § 1032 of this title and the payments under paragraphs (a)(1) and (2) of this section.

(e) Before receiving payment under this section, a hospital shall attest in writing to the Department that an oral or written, formal or informal agreement or arrangement does not exist to share, redirect, or redistribute Medicaid payments which would result in violation of federal or state law.

84 Del. Laws, c. 476, § 3; 

(a) For each fiscal year beginning with the initial enactment period, the Department shall make an additional payment, either as a direct disbursement from the Fund or through additional or increased Medicaid reimbursements, to the acute care hospital in an amount equal to the average disproportionate share hospital payment adjustment the hospital received for the 3 years before October 1, 2024, less any disproportionate share hospital payment adjustment the hospital remains eligible to receive, if an acute care hospital meets all of the following:

(1) The acute care hospital received a disproportionate share hospital payment adjustment for the year before October 1, 2024.

(2) The acute care hospital continues to meet the requirements to qualify as a disproportionate share hospital under § 1923(d) of the Social Security Act, 42 U.S.C. § 1396r-4(d).

(3) The acute care hospital is determined to be ineligible to receive disproportionate share hospital payment adjustment in an amount equal to the average disproportionate share hospital payment adjustment received by the hospital for the 3 years before October 1, 2024, due to the limit on the amount of payment to a hospital under § 1923(g) of the Social Security Act, 42 U.S.C. § 1396r-4(g).

(b) Before making payments from the Fund under § 1043(a)(1) of this title, the Department shall engage with hospitals to ensure that valid data is used to develop the uniform payment increase under § 1043 of this title. At a minimum, the Department shall do all of the following, as available:

(1) Provide hospitals receiving payments with a thorough written description of the methodology used to identify days and discharges.

(2) Provide hospitals receiving payments with a thorough written description of the methodology used to attribute days and discharges to the hospitals.

(3) Provide hospitals receiving payments with day and discharge counts for the hospitals.

(4) Work with hospitals receiving payments, or designated representatives of the hospitals receiving payments, to attempt to identify the source of any discrepancies between data provided under paragraph (b)(3) of this section and internal hospital data.

84 Del. Laws, c. 476, § 3; 

(a) Establishment; composition. —

The Hospital Quality and Health Equity Assessment Commission is established, consisting of the following members, or a designee of a member serving by virtue of position:

(1) The Secretary of the Department of Health and Social Services.

(2) The Director of the Division of Medicaid and Medical Assistance.

(3) The Director of the Office of Management and Budget.

(4) The Chair of the Senate’s Health and Social Services Committee.

(5) The Chair of the House of Representatives’ Health and Human Development Committee.

(6) One member of the House of Representatives Minority Caucus, appointed by the Speaker of the House of Representatives.

(7) One member of the Senate Minority Caucus, appointed by President Pro Tempore of the Senate.

(8) The Chief Executive Officer of the Delaware Healthcare Association.

(9) The Chair of the Delaware Healthcare Association’s Board of Directors.

(10) Two members of facilities subject to payment of the assessment, 1 of whom must be a member qualified to represent the interests of behavioral or rehabilitation hospitals, appointed by the Governor from a list recommended by the Delaware Healthcare Association.

(b) Term of appointment; compensation; administrative support. — (1) Members of the Commission appointed to the Commission and not serving by virtue of their position serve for a term of 2 years, or until a successor is appointed, and may be reappointed for subsequent terms.

(2) Members of the Commission serve without compensation.

(3) The Department shall provide administrative support for the Commission, and all expenses of the Commission, including fees for consultants, if determined necessary, may be paid from the Fund as authorized in § 1043(c)(4) of this title.

(c) Chair; quorum. —

(1) The Secretary of the Department of Health and Social Services shall serve as Chair of the Commission.

(2) A majority of the members, whether present in person or virtually, constitute a quorum for the transaction of business.

(d) Duties and authority of the Commission. — (1) The Commission shall meet as follows:

a. At least once before the date the first remittance of the assessment imposed under § 1032 of this title is due and, thereafter, at least once a year.

b. At the call of the Chair for the purpose of reviewing implementation of the assessment and taking actions necessary in furtherance of this subchapter and subchapter II of this chapter.

(2) At each Commission meeting under subsection (d)(1)a. of this section, the Division of Medicaid and Medical Assistance shall report to the Commission as to the following:

a. A description of the assessment and its implementation for the ensuing fiscal year.

b. Projections of the Federal Medical Assistance Percentage (FMAP).

c. Projections of each hospital’s estimated assessment.

d. A summary of the Fund balance and expenditures made or budgeted during the current fiscal year and the projected Fund balance and expenditures planned in the ensuing fiscal year.

e. Any draft or submitted preprints, Medicaid Plan amendments, or other submissions made or prepared by the State to CMS to establish or implement the assessment.

f. The status of any discussions or negotiations with CMS related to the assessment and any modifications necessary to assure continued eligibility under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 through 1396w-7.

g. Any matters communicated by CMS relating to potential changes to federal rules or eligibility criteria that may affect implementation of the assessment or the expenditure of moneys from the Fund.

h. The status of updates to tax data to account for new facilities, closed facilities, merged facilities, and triennial base-year updates.

i. The mechanism and process for hospitals to verify any data submitted by the State to CMS.

(e) Modifications. — (1) The Commission shall, in collaboration with the Division of Medicaid and Medical Assistance and the Delaware Health Care Commission, develop and recommend to the General Assembly modifications of subchapter II of this chapter and this subchapter necessary to assure the assessment imposed under § 1032 of this title meets eligibility requirements for federal financial participation under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 through 1396w-7.

(2) The Commission shall meet to develop and approve recommendations to the General Assembly with regard to modifications of subchapter II of this chapter and this subchapter.

(3) The Commission shall submit a report to the General Assembly detailing any recommended modifications of Subchapter II of this chapter or this subchapter approved by the Commission. The report shall include a redline showing any recommended changes. The Commission shall submit the report to all of the following:

a. The President Pro Tempore and Secretary of the Senate, for distribution to all Senators.

b. The Speaker and Chief Clerk of the House of Representatives, for distribution to all Representatives.

c. The Controller General.

d. The Director and Librarian of the Division of Research of Legislative Council.

(f) Proceedings before Commission. — (1) The Commission is a public body, subject to the open meetings requirement of § 10004 of Title 29; provided, however, that the Commission may schedule and conduct private meetings with hospitals when the content of the discussion will include information that is commercial or financial information of a privileged or confidential nature.

(2) Any patient information and financial, utilization, or other data is confidential and not subject to disclosure under Chapter 100 of Title 29.

84 Del. Laws, c. 476, § 3; 

(a) Establishment; composition. —

The Hospital Quality and Health Equity Assessment Commission is established, consisting of the following members, or a designee of a member serving by virtue of position:

(1) The Secretary of the Department of Health and Social Services.

(2) The Director of the Division of Medicaid and Medical Assistance.

(3) The Director of the Office of Management and Budget.

(4) The Chair of the Senate’s Health and Social Services Committee.

(5) The Chair of the House of Representatives’ Health and Human Development Committee.

(6) One member of the House of Representatives Minority Caucus, appointed by the Speaker of the House of Representatives.

(7) One member of the Senate Minority Caucus, appointed by President Pro Tempore of the Senate.

(8) The Chief Executive Officer of the Delaware Healthcare Association.

(9) The Chair of the Delaware Healthcare Association’s Board of Directors.

(10) Two members of facilities subject to payment of the assessment, 1 of whom must be a member qualified to represent the interests of behavioral or rehabilitation hospitals, appointed by the Governor from a list recommended by the Delaware Healthcare Association.

(b) Term of appointment; compensation; administrative support. — (1) Members of the Commission appointed to the Commission and not serving by virtue of their position serve for a term of 2 years, or until a successor is appointed, and may be reappointed for subsequent terms.

(2) Members of the Commission serve without compensation.

(3) The Department shall provide administrative support for the Commission, and all expenses of the Commission, including fees for consultants, if determined necessary, may be paid from the Fund as authorized in § 1043(c)(4) of this title.

(c) Chair; quorum. —

(1) The Secretary of the Department of Health and Social Services shall serve as Chair of the Commission.

(2) A majority of the members, whether present in person or virtually, constitute a quorum for the transaction of business.

(d) Duties and authority of the Commission. — (1) The Commission shall meet as follows:

a. At least once before the date the first remittance of the assessment imposed under § 1032 of this title is due and, thereafter, at least once a year.

b. At the call of the Chair for the purpose of reviewing implementation of the assessment and taking actions necessary in furtherance of this subchapter and subchapter II of this chapter.

(2) At each Commission meeting under subsection (d)(1)a. of this section, the Division of Medicaid and Medical Assistance shall report to the Commission as to the following:

a. A description of the assessment and its implementation for the ensuing fiscal year.

b. Projections of the Federal Medical Assistance Percentage (FMAP).

c. Projections of each hospital’s estimated assessment.

d. A summary of the Fund balance and expenditures made or budgeted during the current fiscal year and the projected Fund balance and expenditures planned in the ensuing fiscal year.

e. Any draft or submitted preprints, Medicaid Plan amendments, or other submissions made or prepared by the State to CMS to establish or implement the assessment.

f. The status of any discussions or negotiations with CMS related to the assessment and any modifications necessary to assure continued eligibility under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 through 1396w-7.

g. Any matters communicated by CMS relating to potential changes to federal rules or eligibility criteria that may affect implementation of the assessment or the expenditure of moneys from the Fund.

h. The status of updates to tax data to account for new facilities, closed facilities, merged facilities, and triennial base-year updates.

i. The mechanism and process for hospitals to verify any data submitted by the State to CMS.

(e) Modifications. — (1) The Commission shall, in collaboration with the Division of Medicaid and Medical Assistance and the Delaware Health Care Commission, develop and recommend to the General Assembly modifications of subchapter II of this chapter and this subchapter necessary to assure the assessment imposed under § 1032 of this title meets eligibility requirements for federal financial participation under Title XIX of the Social Security Act, 42 U.S.C. §§ 1396 through 1396w-7.

(2) The Commission shall meet to develop and approve recommendations to the General Assembly with regard to modifications of subchapter II of this chapter and this subchapter.

(3) The Commission shall submit a report to the General Assembly detailing any recommended modifications of Subchapter II of this chapter or this subchapter approved by the Commission. The report shall include a redline showing any recommended changes. The Commission shall submit the report to all of the following:

a. The President Pro Tempore and Secretary of the Senate, for distribution to all Senators.

b. The Speaker and Chief Clerk of the House of Representatives, for distribution to all Representatives.

c. The Controller General.

d. The Director and Librarian of the Division of Legislative Services.

(f) Proceedings before Commission. — (1) The Commission is a public body, subject to the open meetings requirement of § 10004 of Title 29; provided, however, that the Commission may schedule and conduct private meetings with hospitals when the content of the discussion will include information that is commercial or financial information of a privileged or confidential nature.

(2) Any patient information and financial, utilization, or other data is confidential and not subject to disclosure under Chapter 100 of Title 29.

84 Del. Laws, c. 476, § 3;  84 Del. Laws, c. 255, § 36; 

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

84 Del. Laws, c. 476, § 3;