It is declared to be the legislative intent that the purpose of this chapter is to promote the welfare and happiness of all of the people of this State by providing public assistance to all of its eligible needy, unemployable and distressed, that assistance shall be administered promptly and humanely with due regard for the preservation of family life and without discrimination on account of race, religion or political affiliation and that assistance shall be administered in such a way and manner as to encourage self-respect, self-dependency and the desire to be a good citizen and useful to society. It is further declared to be the legislative intent that public assistance be administered, to the extent practicable, in such a way that: private sector work is more economically attractive than public assistance; public assistance recipients exercise personal responsibility in exchange for government assistance; public assistance is transitional, not a way of life, for recipients; both parents are held responsible for supporting and parenting their children; recipients are not encouraged to have additional children while receiving public assistance; and the formation and maintenance of two-parent families is encouraged and teenage pregnancy is discouraged.

31 Del. C. 1953, §  501;  50 Del. Laws, c. 278, §  5;  58 Del. Laws, c. 341, §  3;  70 Del. Laws, c. 65, §  2; 

As used in this chapter:

(1) “Applicant” means any person or family who applies for assistance or welfare services or on whose behalf such application is made under the terms of this chapter.

(2) “Assistance” means assistance to or on behalf of eligible needy persons or eligible families to enable them to improve their standard of living, including money payments, child care, job training, education, other support services, medical or surgical care, dental care, nursing, burial, board and care in a private institution, adult foster care, rest residential facility for adults, public medical institution as a patient, or such other aid as may be deemed necessary.

(3) “Dental care” means payment of all or part of the costs on behalf of an eligible recipient for preventive and restorative treatment which the Department of Health and Social Services authorizes by regulation.

(4) “Employable” refers to any person who:

a. Is between the ages of 18 and 54; and who

b. Is determined by the Department of Health and Social Services (pursuant to published regulations developed in consultation with the Department of Labor) to be physically and mentally able to work.

(5) “Medical advisory committee” means a committee appointed by the Secretary of the Department of Health and Social Services, composed of representatives from the field of medicine, osteopathy, dentistry, nursing, pharmacy, hospital services and such other fields concerned with health as the Secretary of the Department of Health and Social Services may deem appropriate, to provide to the board advice, recommendations and assistance in the formulation and administration of programs of medical and health care.

(6) “Medical assistance” means medical or dental care furnished on behalf of recipients who are eligible for assistance in any of the categories in § 505 of this title.

(7) “Medical care” means payment of all or part of the costs on behalf of eligible recipients; provided, that such payments are within the limitations of the funds appropriated by the General Assembly and the United States Congress for this purpose, for:

a. Inpatient hospital services;

b. Outpatient hospital services;

c. Other laboratory and X-ray services;

d. Nursing services;

e. Physician’s services, whether furnished in the office, the patient’s house, a hospital, a skilled nursing home or elsewhere;

f. Drugs and medicine; or

g. Such other health services and supplies as specified by the Department on recommendation by the Medical Advisory Committee.

Such payments shall be made only to persons, institutions and entities which meet the standards as established by the Department of Health and Social Services and which promote safe and adequate treatment of individuals in the interest of public health and safety.

(8) “Recipient” means any person or family to whom or for whom assistance is paid under this chapter.

(9) “Standard of need” means the subsistence level for a decent standard of living established by regulations of the Department of Health and Social Services.

(10) “Underemployment” and “unemployment” means as defined under regulations of the Department of Health and Social Services in consultation with the Department of Labor.

(11) “Unemployable” means not employable.

31 Del. C. 1953, §  502;  50 Del. Laws, c. 278, §  5;  53 Del. Laws, c. 409, §  1;  54 Del. Laws, c. 359, §  1;  55 Del. Laws, c. 367, §§  1, 2;  56 Del. Laws, c. 332, §§  1-4;  57 Del. Laws, c. 591, §  34;  58 Del. Laws, c. 135, §  1;  58 Del. Laws, c. 341, §  4;  58 Del. Laws, c. 511, §§  65, 66;  70 Del. Laws, c. 65, §§  3-10;  82 Del. Laws, c. 187, § 1;  82 Del. Laws, c. 290, § 1;  82 Del. Laws, c. 290, § 5; 

As used in this chapter:

(1) “Applicant” means any person or family who applies for assistance or welfare services or on whose behalf such application is made under the terms of this chapter.

(2) “Assistance” means assistance to or on behalf of eligible needy persons or eligible families to enable them to improve their standard of living, including money payments, child care, job training, education, other support services, medical or surgical care, dental care, nursing, burial, board and care in a private institution, adult foster care, rest residential facility for adults, public medical institution as a patient, or such other aid as may be deemed necessary.

(3) “Carrier” means any entity that provides health insurance under § 505(3) of this title.

(4) “Dental care” means payment of all or part of the costs on behalf of an eligible recipient for preventive and restorative treatment which the Department of Health and Social Services authorizes by regulation.

(5) “Employable” refers to any person who:

a. Is between the ages of 18 and 54; and who

b. Is determined by the Department of Health and Social Services (pursuant to published regulations developed in consultation with the Department of Labor) to be physically and mentally able to work.

(6) “Medical advisory committee” means a committee appointed by the Secretary of the Department of Health and Social Services, composed of representatives from the field of medicine, osteopathy, dentistry, nursing, pharmacy, hospital services and such other fields concerned with health as the Secretary of the Department of Health and Social Services may deem appropriate, to provide to the board advice, recommendations and assistance in the formulation and administration of programs of medical and health care.

(7) “Medical assistance” means medical or dental care furnished on behalf of recipients who are eligible for assistance in any of the categories in § 505 of this title.

(8) “Medical care” means payment of all or part of the costs on behalf of eligible recipients; provided, that such payments are within the limitations of the funds appropriated by the General Assembly and the United States Congress for this purpose, for any of the following:

a. Inpatient hospital services.

b. Outpatient hospital services.

c. Other laboratory and X-ray services.

d. Nursing services.

e. Physician’s services, whether furnished in the office, the patient’s house, a hospital, a skilled nursing home or elsewhere.

f. Pharmacist’s services, whether furnished in the office, the patient’s house, a hospital, a skilled nursing facility, an assisted living facility, a pharmacy, a federally-qualified health center, a rural health clinic, or elsewhere.

g. Drugs and medicine.

h. Such other health services and supplies as specified by the Department on recommendation by the Medical Advisory Committee.

Such payments may be made only to persons, institutions, and entities which meet the standards as established by the Department of Health and Social Services and which promote safe and adequate treatment of individuals in the interest of public health and safety.

(9) “Recipient” means any person or family to whom or for whom assistance is paid under this chapter.

(10) “Standard of need” means the subsistence level for a decent standard of living established by regulations of the Department of Health and Social Services.

(11) “Underemployment” and “unemployment” means as defined under regulations of the Department of Health and Social Services in consultation with the Department of Labor.

(12) “Unemployable” means not employable.

31 Del. C. 1953, §  502;  50 Del. Laws, c. 278, §  5;  53 Del. Laws, c. 409, §  1;  54 Del. Laws, c. 359, §  1;  55 Del. Laws, c. 367, §§  1, 2;  56 Del. Laws, c. 332, §§  1-4;  57 Del. Laws, c. 591, §  34;  58 Del. Laws, c. 135, §  1;  58 Del. Laws, c. 341, §  4;  58 Del. Laws, c. 511, §§  65, 66;  70 Del. Laws, c. 65, §§  3-10;  82 Del. Laws, c. 187, § 1;  82 Del. Laws, c. 290, § 1;  82 Del. Laws, c. 290, § 5;  84 Del. Laws, c. 421, § 5; 

(a) Anti-fraud. — Assistance shall not be granted under this chapter to any person or family otherwise eligible for assistance under the categories described in § 505 of this title, having conveyed or transferred real or personal property of a value of $500 or more without fair consideration within 2 years preceding the date of application for assistance or subsequently while receiving assistance, or to any person who is an inmate of any public institution (except as a patient in a medical institution).

(b) Medicaid. — (1) Medical assistance may be granted to medically and financially eligible persons in accordance with Titles IV-A, IV-E, XVI, and XIX of the Social Security Act (42 U.S.C. §§ 601 et seq., 1381 et seq., and 1396 et seq.), federally approved waivers of these sections of the act, and rules and regulations established by the Department of Health and Social Services. Eligibility for and payment of medical assistance must be determined under policies and regulations established by the Department of Health and Social Services. Eligibility standards, recipient copay, and provider reimbursement must be set in accordance with state and federal mandates, state and federal funding levels, approved waivers, and rules and regulations established by the Department. The amount of assistance in each case of medical care must not duplicate any other coverage or payment made or available for the costs of such health services and supplies. To the extent permitted by federal requirements, no annual or lifetime numerical limitations may be placed on physical therapy or chiropractic care visits that are for the purpose of treating back pain.

(2) a. Except as otherwise provided in paragraph (b)(2)b. of this section, the amount of assistance provided to an adult recipient for dental care must not exceed $1,000 per year.

b. The Department may establish a review process through which extra benefit dollars, not exceeding an additional $1,500 per adult recipient, may be authorized on an emergency basis for dental care treatments.

c. All payments for dental care treatments are subject to a $3.00 copay for adult recipients.

(3) The Department, Division of Medicaid and Medical Assistance shall seek approval from the Centers for Medicare and Medicaid Services, within the United States Department of Health and Human Services to extend Medicaid postpartum coverage to 12 months through the state plan amendment option created by the American Rescue Plan Act of 2021 [42 U.S.C. § 1396a(e)(16)].

(c) General assistance. — Eligibility for and the amount of general assistance granted to recipients shall be determined in accordance with rules and regulations made by the Department with due regard to the resources, income, necessary expenditures of the recipient, the limit of funds appropriated therefor and the legislative intent expressed in § 501 of this title.

(d) Temporary Assistance for Needy Families. — Eligibility for and the amount of assistance granted to families under Temporary Assistance for Needy Families shall be determined in accordance with rules and regulations made by the Department with due regard to the resources, income and necessary expenditures of Delaware families the limit of funds appropriated therefor, and the legislative intent expressed in § 501 of this title.

In order to receive assistance under this subsection, the parent, guardian or persons standing in loco parentis to a dependent child must have instituted suit for nonsupport in the Family Court or must cooperate with the Department of Health and Social Services for the purpose of instituting proceedings for nonsupport in Family Court on the behalf of such parent, guardian or person standing in loco parentis.

(e) Child care assistance. — Persons seeking employment who are in need of child care services in order to obtain employment, to retain employment, or to obtain training leading to employment are eligible to apply for child care assistance under the Child Care Subsidy Program. Such persons seeking employment are eligible to apply for child care assistance for a period not to exceed 90 consecutive days over the course of 1 year. Eligibility for and the amount of assistance granted to persons under Delaware’s Child Care Subsidy Program shall be determined in accordance with the rules and regulations made by the Department of Health and Social Services, Division of Social Services and Chapter 3 of this title.

(f) Form of payment. — Such monetary assistance, as shall be granted under this chapter, shall be paid to such needy person in the form of any method meeting the requirements of good accounting control and federal regulations and having the approval of the Secretary of the Finance Department. However, when monetary assistance is paid personally to a recipient, the recipient must have an identification card bearing the recipient's picture. The identification card shall be provided by the State through its appropriate agency upon the request of any recipient at a cost not to exceed $ 2.00, except that any recipient who is 65 years of age or older, or has blindness or a disability shall not be required to pay any fee for an identification card.

During the month of January, the Department shall send a notice to recipients paid by the Department under this subsection in the form of:

(1) Any notice available from the Internal Revenue Service concerning the EIC, including but not limited to the notice of a possible federal tax refund due to the earned income credit; or

(2) A notice developed by the Department which shall include the maximum earned income credit and the maximum earnings to which such tax credit shall apply, as determined by the federal government.

37 Del. Laws, c. 85, §  7;  Code 1935, §  1610;  41 Del. Laws, c. 124, §  2;  45 Del. Laws, c. 96, §  2;  46 Del. Laws, c. 79;  48 Del. Laws, c. 182, §  2;  31 Del. C. 1953, §  503;  50 Del. Laws, c. 278, §  5;  50 Del. Laws, c. 477, §§  1, 2;  53 Del. Laws, c. 409, §  2;  53 Del. Laws, c. 431, §§  1-4;  54 Del. Laws, c. 54;  54 Del. Laws, c. 257, §§  1-3;  54 Del. Laws, c. 359, §  2;  55 Del. Laws, c. 312;  55 Del. Laws, c. 353;  55 Del. Laws, c. 367, §§  3-6;  56 Del. Laws, c. 330, §§  1, 2;  56 Del. Laws, c. 452;  57 Del. Laws, c. 72;  57 Del. Laws, c. 236;  57 Del. Laws, c. 248;  57 Del. Laws, c. 250, §  1;  57 Del. Laws, c. 251;  57 Del. Laws, c. 345;  57 Del. Laws, c. 391;  57 Del. Laws, c. 491, §§  1, 2;  57 Del. Laws, c. 629, §  1;  58 Del. Laws, c. 122;  58 Del. Laws, c. 165;  58 Del. Laws, c. 306, §  5e;  58 Del. Laws, c. 341, §  1;  59 Del. Laws, c. 164, §  1;  59 Del. Laws, c. 394, §  1;  62 Del. Laws, c. 130;  64 Del. Laws, c. 148, §  1;  65 Del. Laws, c. 87, §  127;  65 Del. Laws, c. 107, §  1;  65 Del. Laws, c. 348, §  145;  66 Del. Laws, c. 85, §  178;  66 Del. Laws, c. 303, §  205;  67 Del. Laws, c. 47, §  158;  67 Del. Laws, c. 281, §  123;  69 Del. Laws, c. 443, §  3;  70 Del. Laws, c. 65, §§  11-14;  78 Del. Laws, c. 179, §  325;  81 Del. Laws, c. 217, § 1;  81 Del. Laws, c. 367, § 2;  81 Del. Laws, c. 430, §§   5, 7;  82 Del. Laws, c. 187, § 2;  82 Del. Laws, c. 290, § 2;  82 Del. Laws, c. 290, § 6;  83 Del. Laws, c. 363, § 1; 

(a) Any law of the State to the contrary notwithstanding, the application and/or receipt of public assistance under § 503(d) of this title shall act as an automatic and immediate assignment of all rights of support for the applicant and/or recipient and any dependent child. Such assignment shall have the full force and effect of law to the State and shall be collectible by the Division of Child Support Services. All money collected pursuant to such assignment shall be deposited directly to the credit of the Division of Child Support Services Account for distribution in accordance with § 457 of the Social Services Amendments of 1974 (42 U.S.C. § 657).

(b) Whenever it appears to the Family Court or the Department of Health and Social Services that a child support obligor of any dependent child or children cannot comply with a support order, the Court or the Department may act to improve the earning capacities of a child support obligor by cooperating with the appropriate state agencies to provide the necessary training, job upgrading, or both.

31 Del. C. 1953, §  503A;  57 Del. Laws, c. 250, §  1;  60 Del. Laws, c. 280, §  1;  70 Del. Laws, c. 65, §  15;  80 Del. Laws, c. 234, § 31;  81 Del. Laws, c. 78, § 14; 

Assistance may be granted, in accordance with rules and regulations established by the Department of Health and Social Services under § 503 of this title, in the following categories:

(1) Temporary Assistance for Needy Families. —

Assistance with respect to needy families with children. Temporary Assistance for Needy Families means aid granted to a family, as that term is defined pursuant to Department of Health and Social Service Regulations, with respect to a child or children under the age of 18 who has or have been deprived of parental support or care by reason of death, continued absence from the home, physical or mental incapacity, unemployment, or underemployment.

If found feasible by and in accordance with regulations prescribed by the Department, the term Temporary Assistance for Needy Families shall also include aid granted with respect to children who are removed from their home and placed in foster care as a result of a judicial determination initiated during the month in or for which such a family was receiving such aid or initiated during the month in or for which such a family would have received the aid if application for aid had been made, or if such children, who within 6 months prior to the month court proceedings were initiated, had been living with a specified relative and would have been eligible for assistance in or for such month except for failure to meet the “living with” requirements, that continuation in the parent’s or relative’s home would be contrary to the child’s welfare.

(2) General assistance. —

Assistance granted to eligible needy persons residing in Delaware who are unemployable.

(3) Medicaid assistance. —

Assistance granted in the form of medical care, including dental care, to individuals eligible in accordance with Title IV-A, XVI, XIX of the Social Security Act [42 U.S.C. §§ 601 et seq., 1381 et seq., and 1396 et seq.], federally approved waivers, and rules and regulations established by the Department of Health and Social Services.

(4) Child care assistance. —

Assistance granted to eligible persons who need child care but are unable to pay for all or part of the cost of care.

37 Del. Laws, c. 85, §  6;  Code 1935, §  1609;  41 Del. Laws, c. 124, §  1;  31 Del. C. 1953, §§  501, 504;  50 Del. Laws, c. 278, §  5;  52 Del. Laws, c. 259;  53 Del. Laws, c. 431, §§  5-8;  54 Del. Laws, c. 359, §  3;  55 Del. Laws, c. 299, §  2;  55 Del. Laws, c. 367, §  7;  57 Del. Laws, c. 248;  57 Del. Laws, c. 249;  58 Del. Laws, c. 341, §  2;  59 Del. Laws, c. 228, §  1;  59 Del. Laws, c. 433, §  1;  61 Del. Laws, c. 443, §  1;  63 Del. Laws, c. 185, §  1;  66 Del. Laws, c. 85, §  181;  66 Del. Laws, c. 166, §  1;  70 Del. Laws, c. 65, §§  16, 17;  80 Del. Laws, c. 28, § 5;  81 Del. Laws, c. 28, § 4;  81 Del. Laws, c. 28, § 5;  81 Del. Laws, c. 217, § 2;  81 Del. Laws, c. 367, § 2;  81 Del. Laws, c. 367, § 2;  82 Del. Laws, c. 187, § 3;  82 Del. Laws, c. 290, § 3;  82 Del. Laws, c. 290, § 7; 

No person shall receive assistance for the same period under more than 1 of the categories of assistance listed in § 505(1-3) of this title, including assistance to the needy blind, if the payment of such assistance would be inconsistent with any requirement for federal aid with respect thereto as set forth in rules and regulations of the Department and the Delaware Commission for the Blind [repealed].

31 Del. C. 1953, §  505;  50 Del. Laws, c. 278, §  5;  54 Del. Laws, c. 359, §  4;  55 Del. Laws, c. 299, §  1;  83 Del. Laws, c. 455, § 5; 

Any person in need of public assistance while physically present in Delaware, but who lacks residence in this State as defined in this chapter, may be granted assistance subject to the immediate initiation, pursuant to rules and regulations of the Department, of all lawful steps to determine residence elsewhere. Assistance to any such person shall be terminated when any one of the following events first occurs:

(1) Such person moves to some other jurisdiction;

(2) Such person receives public assistance of any kind from some other jurisdiction;

(3) Such person ceases to be a needy person; or

(4) Such person is found to have residence elsewhere.

37 Del. Laws, c. 85, §§  6, 11;  Code 1935, §§  1609, 1614;  41 Del. Laws, c. 124, §  1;  45 Del. Laws, c. 96, §§  1, 3;  46 Del. Laws, c. 314;  31 Del. C. 1953, §  506;  50 Del. Laws, c. 278, §  5;  70 Del. Laws, c. 186, §  1; 

(a) Application for assistance shall be made to the appropriate county office of the Department. The application shall be in writing in the manner and form and giving such information as shall be required by the Department. An opportunity to file an application shall be given any person desiring to do so. The Department shall act on all applications and furnish aid to eligible persons with reasonable promptness.

(b) The information supplied by an applicant in an application for assistance shall be sworn to as being true and correct to the best of the applicant’s knowledge, and any employee of the Department accepting such application is hereby given the authority to administer an oath to the applicant in the manner prescribed in Chapter 53 of Title 10, that the information given is true and correct to the best of the knowledge of the applicant.

37 Del. Laws, c. 85, §  8;  Code 1935, §  1611;  31 Del. C. 1953, §  507;  50 Del. Laws, c. 278, §  5;  54 Del. Laws, c. 285;  70 Del. Laws, c. 186, §  1; 

All assistance grants made under this chapter shall be reconsidered as frequently as may be required by the rules of the Department to assure continued eligibility. After such further investigation, as the Department may deem necessary, the amount and manner of giving assistance may be changed or the assistance payments shall be terminated if it is found that the recipient’s circumstances have altered sufficiently to warrant such action. Assistance payments may at any time be cancelled or revoked or suspended for a temporary period pending further determination if the recipient’s eligibility is not clearly established.

37 Del. Laws, c. 85, §  13;  Code 1935, §  511;  31 Del. C. 1953, §  508;  50 Del. Laws, c. 278, §  5;  58 Del. Laws, c. 135, §  2;  64 Del. Laws, c. 148, §  2; 

If at any time during the period assistance payments are being made to any person, such person becomes possessed of any property, real or personal, or of any income in excess of the amount of such property and income last declared by such person to the Department, such person shall notify the Department promptly concerning the receipt and possession of such property or income and the Department shall, in accordance with rules established by it, reconsider the eligibility of such person to receive such assistance or the amount of assistance to which entitled, according to the circumstances. Any excess paid to any person by reason of such person’s failure to report as required by this section shall be recoverable in a civil action against such person or against such person’s estate.

37 Del. Laws, c. 85, §  12;  Code 1935, §  1615;  31 Del. C. 1953, §  509;  50 Del. Laws, c. 278, §  5;  70 Del. Laws, c. 186, §  1; 

(a) Nothing contained in this chapter shall be construed to relieve any person from the liability of maintaining and supporting the person’s parent or parents or child or spouse, as provided by the laws of this State. However, the provisions of § 501(a) of Title 13 shall not be considered by the Department in determining eligibility for assistance of any applicant or recipient of such assistance, but the Department shall encourage persons to seek and relatives to provide support that will eliminate or reduce the need for public assistance.

(b) Notwithstanding the provisions of this section or any other provision of law, the financial responsibility of an individual for any applicant or recipient of medical care shall be disregarded unless such applicant is such individual’s spouse or child who is under the age of 18 years or who is blind or permanently and totally disabled.

31 Del. C. 1953, §  510;  50 Del. Laws, c. 278, §  5;  53 Del. Laws, c. 155;  54 Del. Laws, c. 80;  55 Del. Laws, c. 367, §  8;  59 Del. Laws, c. 48, §  7;  70 Del. Laws, c. 186, §  1; 

The Department shall administer this chapter and in connection therewith shall:

(1) Establish rules and regulations to carry out the provisions of this chapter consistent with the intent as expressed in § 501 of this title, including, but not limited to, rules, regulations and standards as to eligibility for assistance, the nature, duration and extent of such assistance as well as sanctions for noncompliance with such rules, regulations and standards for eligibility for assistance;

(2) Cooperate with the federal Department of Health and Human Services or with any successor department or agency thereof, in any reasonable manner not contrary to law, as may be required to qualify for federal aid with respect to functions and programs coming within the purview of this chapter, shall make such reports to the Department of Health and Human Services in such form and containing such information as that Department may from time to time require, shall comply with such provisions as said agency may from time to time find necessary to assure the correctness and verification of such reports, and shall apply to the Department of Health and Human Services and other relevant federal departments for waivers of federal rules and regulations deemed to impede the achievement of the legislative intent expressed in § 501 of this title.

(3) Make periodic surveys of cost-of-living factors in relation to the needs of recipients of assistance and welfare services, in order that the standards for such assistance and welfare services remain reasonably sufficient and at the same time provide recipients with incentive to seek and maintain private sector work.

(4) Enter into agreements or understandings with appropriate public agencies in other states whereby any or all of the benefits of this chapter may be extended to Delaware residents living in other states or to residents of other states living in Delaware on a reciprocal basis. In this connection the Department may establish policies which waive or alter the residence requirements of § 505 of this title;

(5) Promulgate such rules and regulations as may be necessary to assure that its information concerning applicants and recipients is used or disclosed solely for purposes directly connected with the administration of assistance;

(6) Cooperate with the federal government in carrying out the purposes of any federal acts concerning public welfare and in other matters of mutual concern pertaining to public welfare, including the adoption of such methods of administration as are necessary for the efficient operation of the plan for such public assistance and welfare services; and

(7) Guarantee that assistance provided as medical care, including dental care, when paid to providers of such medical care is on a prompt basis, usually not later than 30 days from the report of services by a physician, pharmacist, or other professional health care provider, or 20 days from the report of services by a hospital or skilled nursing facility; provided, however, that should financial advances from the Department of Finance be necessary to carry out this chapter, they must be permitted upon the concurrence of the Secretary of the Department of Finance and the Secretary of the Department of Health and Social Services.

(8) Supplementary Security Income Program (Title XVI Social Security Act). — a. The Secretary of the Department of Health and Social Services, in carrying out the purposes of this title, may enter into agreements on behalf of the State with the Secretary of Health and Human Services or with other appropriate federal officials, under the Supplementary Security Income Program established by Title XVI of the Social Security Act [42 U.S.C. § 1381 et seq.], as amended, or under any other federal welfare or public assistance programs hereafter established, which are not contrary to or in conflict with the purposes of this title.

b. Notwithstanding any other provision of law, the Secretary of the Department of Health and Social Services is empowered to transfer funds, within the limits of appropriation by the General Assembly, to the Secretary of Health and Human Services or to other appropriate federal official, pursuant to any agreement referred to in paragraph a. of this subdivision or pursuant to any other federal welfare or public assistance programs hereafter established, which are not contrary to or in conflict with the purposes of this title.

(9), (10) [Repealed.]

31 Del. C. 1953, §  511;  50 Del. Laws, c. 278, §  5;  60 Del. Laws, c. 86, §  1;  70 Del. Laws, c. 65, §§  16, 18, 30;  81 Del. Laws, c. 367, § 2;  82 Del. Laws, c. 187, § 4;  82 Del. Laws, c. 290, § 4;  82 Del. Laws, c. 290, § 8; 

Assistance granted under this chapter shall not be transferable or assignable, at law or in equity, and none of the money paid or payable under this chapter shall be subject to execution, levy, attachment, garnishment or other legal process or to the operation of any bankruptcy or insolvency law, with the exception that the State shall seek recoupment for overpayments. Such recoupment may not exceed an amount which will result in the assistance unit’s retaining from its combined aid, income and liquid resources, less than 90% of the amount payable under the State Plan to a family of the same composition with no other income. Recoupment must be made in accordance with applicable federal laws and regulations. The Department shall publish regulations establishing the recoupment rate at any time when there is a change.

37 Del. Laws, c. 85, §  19;  Code 1935, §  1622;  31 Del. C. 1953, §  512;  50 Del. Laws, c. 278, §  5;  62 Del. Laws, c. 373, §  1;  63 Del. Laws, c. 413, §  1;  66 Del. Laws, c. 286, §  1; 

Repealed by 70 Del. Laws, c. 65, § 19, effective June 19, 1995.

Every allowance of assistance under the provisions of this part shall be deemed to have been allowed under and shall be held subject to the provisions of any amending or repealing act that may be passed, and no person receiving assistance under this part shall have any claim for compensation by reason of the allowance for assistance being affected in any way by any such amending or repealing act.

Taxes and assessments for public purposes by the State or any political subdivision thereof, whether county, hundred, city or town, shall be assessed and levied upon the property of aged persons to whom assistance has been allowed under this chapter in the same manner as such taxes and assessments are levied and assessed by law upon the properties of other owners. The time for payment of any taxes or assessments so levied and assessed shall be deferred until such time as the property of such aged person is transferred from the name of such aged person or until such aged person dies, in which event the face amount of the taxes and assessments so levied or assessed, without penalties or interest, shall be payable within 90 days from the date of such transfer or death. After the expiration of such 90-day period there shall be due, with respect to any such property, the same amount or amounts for taxes or assessments as would have been due after the expiration of 90 days from the date the taxes or assessments became due and payable had the property not been owned by an aged person, to whom assistance had been allowed under this chapter. In the event of the sale of any such property under any form of execution process (including sales in any form of insolvency proceeding), such taxes and assessments shall be due and payable as of the date of the offering of such property for sale under such execution process.

37 Del. Laws, c. 85, §  20;  Code 1935, §  1623;  42 Del. Laws, c. 114;  31 Del. C 1953,, §  515;  50 Del. Laws, c. 278, §  5; 

Repealed by 65 Del. Laws, c. 345, § 1, effective June 30, 1986.

Notwithstanding any other provision of law, the Levy Court or County Council of any county shall not provide for the hospital treatment and medical care of any individual receiving assistance in any of the categories listed in § 505(1)-(3) of this title or receiving assistance as aid to the blind pursuant to this title.

31 Del. C. 1953, §  517;  53 Del. Laws, c. 432;  54 Del. Laws, c. 359, §  5;  55 Del. Laws, c. 85, §  39A;  55 Del. Laws, c. 367, §  11; 

The Department of Health and Social Services may issue and implement rules and regulations establishing sanctions for families receiving Temporary Assistance for Needy Families who fail to comply with work, education, training, work eligibility, parenting or personal responsibility requirements established by the Department pursuant to § 512(1) of this title. Such sanctions may, among other things, reduce assistance to such a family and may include, for a family who has failed to comply with job placement, education, training or work eligibility requirements under the Temporary Assistance for Needy Families program. The Department shall afford recipients due process as provided under applicable rules and regulations prior to the implementation of any such sanctions.

31 Del. C. 1953, §  518;  57 Del. Laws, c. 247;  70 Del. Laws, c. 65, §  20;  81 Del. Laws, c. 367, § 2; 

Notwithstanding any other provision of law, the Department of Public Welfare may make payment of assistance grants under the Temporary Assistance for Needy Families program on behalf of certain eligible cases or families directly to the Employment Security Commission, Department of Labor, of this State, with the understanding that such assistance payments so made shall be used to compensate the eligible case or family for employment services rendered through placement of the employable adult or person 16 years of age or older and not in school with a public or private nonprofit agency for the purpose of performing specific duties.

The Employment Security Commission shall maintain accounting controls of such assistance payments made by the Department of Public Welfare and shall refund to the Department of Public Welfare any and all such assistance payments received which may not have been used for the intended purpose, such refunding to be effected within 90 days after such payment is issued.

31 Del. C. 1953, §  519;  57 Del. Laws, c. 252;  81 Del. Laws, c. 367, § 2; 

Any applicant for or recipient of public assistance benefits under this chapter or Chapter 6 of this title against whom an administrative hearing decision has been decided may appeal such decision to the Superior Court if the decision would result in financial harm to the appellant. The appeal shall be filed within 30 days of the day of the final administrative decision. The appeal shall be on the record without a trial de novo. The Court shall decide all relevant questions and all other matters involved, and shall sustain any factual findings of the administrative hearing decision that are supported by substantial evidence on the record as a whole. The Court may remand the matter for further factual findings or other proceedings consistent with the Court’s order. The notice of appeal and all other matters regulating the appeal shall be in the form and according to the procedure as shall be provided by the rules of the Superior Court.

64 Del. Laws, c. 482, §  1;  83 Del. Laws, c. 134, § 1; 

Funds appropriated to the Department of Health and Social Services, Division of Social Services, for “Emergency and Disaster Assistance” and used for special emergency needs of any welfare-receiving household (except those households specifically excluded by the regulations) shall not exceed a total of $1,200 for emergency shelter certified by the Department, $450 for mortgage or rent assistance, and $200 for other costs relating to self-sufficiency of the household for any 1 such household in the fiscal year ending June 30. Notwithstanding any other provision of law, the Director of the Office of Management and Budget is empowered to transfer, advance or allocate emergency funds, within the limits of the funds appropriated, to the Department of Health and Social Services for the purpose of administration of emergency assistance. Such transfer, advance or allocation shall not be apportioned by county and shall be allocated in the following manner:

(1) Twenty percent of the total emergency fund appropriation shall be allocated promptly in the first quarter of the state fiscal year;

(2) Twenty-five percent of the total emergency fund appropriation shall be allocated promptly in the second quarter of the state fiscal year;

(3) Thirty percent of the total emergency fund appropriation shall be allocated promptly in the third quarter of the state fiscal year; and

(4) Twenty-five percent of the total emergency fund appropriation shall be allocated promptly in the fourth quarter of the state fiscal year.

65 Del. Laws, c. 87, §  147;  65 Del. Laws, c. 348, §  158;  66 Del. Laws, c. 85, §  179;  69 Del. Laws, c. 57, §§  1, 2;  70 Del. Laws, c. 65, §  21;  71 Del. Laws, c. 284, §  1;  75 Del. Laws, c. 88, §  21(14); 

(a) Subrogation is defined as the doctrine of law which enables insurers to recover payments from any third party who is responsible for an injury. In any claim for benefits by a recipient who receives medical care under this title, where the recipient has a cause of action against any other person, the Department of Health and Social Services shall be subrogated against (substituted for) the recipient to the extent of any payment made by the Department of Health and Social Services on behalf of the recipient receiving medical care, resulting from the occurrence which constituted the basis for the action against the other person.

(b) After the deduction of applicable attorney fees and litigation costs, any funds received by an individual who has received medical care under this title, the individual’s attorney or the individual’s guardian or personal representative, by means of judgment, award or settlement of the cause of action, shall be held for the benefit of the Department of Health and Social Services to the extent indicated in subsection (a) of this section.

(c) If, after being notified in writing of a subrogation claim and possible liability under this section, a recipient receiving medical care under this title, recipient’s attorney or recipient’s guardian or personal representative disposes of funds that are required to be held for the benefit of the Department under this section without the written approval of the Department, that recipient shall be liable to the Department for any amount that, as a result of the disposition of the funds, is not recoverable by the Department.

(d) The Department may compromise, settle and release a subrogated claim if the Department determines that collection would result in substantial hardship on the recipient receiving medical care or, in a wrongful death action, on the surviving dependents of the deceased.

65 Del. Laws, c. 124, §  1;  70 Del. Laws, c. 65, §  22;  70 Del. Laws, c. 186, §  1; 

(a) Persons who qualify for assistance under § 505(1) of this title shall be eligible to participate in secondary education, post-secondary education up to the baccalaureate level, adult basic education or vocational training as an approved work activity provided each of the following requirements are met:

(1) The person does not hold a baccalaureate degree.

(2) The secondary, postsecondary education up to the baccalaureate level or vocational education is pursued through an accredited or approved school program.

(3) The person is enrolled with enough credit hours to have full-time student status and is in good standing as it relates to attendance and achievement as defined by the program the person is attending.

(4) If the person attending school would otherwise be subject to a work requirement in order to receive assistance under § 505(1) of this title, the combination of credit hours and work hours shall equal at least 20 hours per week while the program is in session. This work requirement may be met through work-study, internships or externships, or through work as a research assistant. If possible, during scheduled breaks, the work requirement will be the same as for other program participants, with work experience related to the field of study. However, if the student is enrolled full-time for the next semester and work activity placement cannot be arranged for the duration of the break in classes, it may be excused.

(b) Loans, scholarships, grants and work-study received by the recipient to pay for tuition and materials are excluded in the determination of eligibility for assistance under § 505(1) of this title or the amount of assistance received by the recipient.

(c) The Department of Health and Social Services shall advise all persons of this section at application interviews and, at a minimum, at each recertification appointment.

(d) Persons attending education and training programs under this section shall receive support services, such as assistance with transportation and child care, while they attend the educational or vocational training program on the same basis as support services are provided other persons who are receiving assistance under § 505(1) of this title.

(e) If program completion will occur within 1 semester or quarter after the time limit expires, an extension may be granted for that semester or quarter.

(f) Persons sanctioned while attending educational or vocational programs shall be afforded the same due process as provided other persons under §§ 518 and 520 of this title.

72 Del. Laws, c. 119, §  1; 

Pursuant to the option granted the State by 21 U.S.C. § 862a(d)(1), an individual convicted under federal or state law of any offense which is classified as a felony by the law of the jurisdiction involved and which has as an element the possession, use, or distribution of a controlled substance shall be exempt from the prohibition contained in 21 U.S.C. § 862a(a) against eligibility for assistance under 42 U.S.C. § 601 et seq. if the individual is otherwise eligible for assistance under the Temporary Assistance for Needy Families (TANF) funded program.

81 Del. Laws, c. 47, § 1; 

(a) Definitions. — For the purposes of this section, the following words and phrases shall have the following meanings:

(1) “ASAM criteria” means the comprehensive set of guidelines for placement, continued stay, and transfer or discharge of patients with addiction established by the American Society of Addiction Medicine (“ASAM”) for use in determining medically necessary treatment.

(2) “Carrier” means any entity that provides health insurance under § 505(3) of this title.

(3) “Drug and alcohol dependencies” means substance abuse disorder or the chronic, habitual, regular, or recurrent use of alcohol, inhalants, or controlled substances as identified in Chapter 47 of Title 16.

(4) “Health benefit plan” means any assistance provided to an individual under § 505(3) of this title.

(5) “Serious mental illness” means any of the following biologically based mental illnesses: schizophrenia, bipolar disorder, obsessive-compulsive disorder, major depressive disorder, panic disorder, anorexia nervosa, bulimia nervosa, schizo affective disorder, and delusional disorder. The diagnostic criteria set out in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders shall be utilized to determine whether a beneficiary of a health benefit plan is suffering from a serious mental illness.

(b) Coverage of serious mental illness and drug and alcohol dependencies. — a. Carriers shall provide coverage for serious mental illnesses and drug and alcohol dependencies in all health benefit plans delivered or issued for delivery under § 505(3) of this title. Coverage for serious mental illnesses and drug and alcohol dependencies must provide:

1. Inpatient coverage for the diagnosis and treatment of drug and alcohol dependencies.

2. Unlimited medically necessary treatment for drug and alcohol dependencies as required by the Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a) and determined by the use of the full set of ASAM criteria, in all of the following:

A. Treatment provided in residential setting.

B. Intensive outpatient programs.

C. Inpatient withdrawal management.

b. Subject to subsections (a) and (c) through (e) of this section, no carrier may issue for delivery, or deliver, in this State any health benefit plan containing terms that place a greater financial burden on an insured for covered services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency than for covered services provided in the diagnosis and treatment of any other illness or disease covered by the health benefit plan. By way of example, such terms include deductibles, copays, monetary limits, coinsurance factors, limits in the numbers of visits, limits in the length of inpatient stays, durational limits or limits in the coverage of prescription medicines.

(2) a. A health benefit plan under § 505(3) that provides coverage for prescription drugs must provide coverage for the treatment of serious mental illnesses and drug and alcohol dependencies that includes immediate access, without prior authorization, to a 72-hour emergency supply of prescribed medications covered under the health benefit plan for the medically necessary treatment of serious mental illnesses and drug and alcohol dependencies where an emergency medical condition exists, including a prescribed drug or medication associated with the management of opioid withdrawal or stabilization, except where otherwise prohibited by law.

b. Coverage of an emergency supply of prescribed medications must include medication for opioid overdose reversal otherwise covered under the health benefit plan prescribed to a covered person.

c. Coverage provided under this paragraph (b)(2) of this section may be subject to copayments, coinsurance, and annual deductibles that are consistent with those imposed on other benefits within the health benefit plan; provided, however, a health benefit plan must not impose an additional copayment or coinsurance on a covered person who received an emergency supply of the same medication in the same 30-day period in which the emergency supply of medication was dispensed.

d. This paragraph (b)(2) does not preclude the imposition of a copayment or coinsurance on the initial emergency supply of medication in an amount that is less than the copayment or coinsurance otherwise applicable to a 30-day supply of such medication, provided that the total sum of copayments or coinsurance for an entire 30-day supply of the medication does not exceed the copayment or coinsurance otherwise applicable to a 30-day supply of such medication.

(c) Eligibility for coverage. — (1) Subject to the limitations set forth in subsection (d) of this section, a health benefit plan may condition coverage of services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency on the following further requirements that the service or services:

a. Must be rendered by a mental health professional licensed or certified by the State Board of Licensing including, but not limited to, psychologists, psychiatrists, social workers, and other such mental health professionals, or a drug and alcohol counselor who has been certified by the Delaware Certified Alcohol and Drug Counselors Certification Board, or in a mental health facility licensed by the State or in a treatment facility approved by the Department of Health and Social Services or the Bureau of Alcoholism and Drug Abuse as set forth in Chapter 22 of Title 16 or substantially similar licensing entities in other states.

b. Must be medically necessary.

c. Must be covered services subject to any administrative requirements of the health benefit plan.

(2) A health benefit plan may further condition coverage of services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency in the same manner and to the same extent as coverage for all other illnesses and diseases is conditioned. Such conditions may include, by way of example, and not by way of limitation, precertification and referral requirements.

(d) Benefit management. — (1) A carrier may, directly or by contract with another qualified entity, manage the benefit prescribed by subsection (b) of this section in order to limit coverage of services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency to those services that are deemed medically necessary as follows:

a. The management of benefits for serious mental illnesses and drug and alcohol dependencies may be by methods used for the management of benefits provided for other medical conditions, or may be by management methods unique to mental health benefits. Such may include, by way of example and not limitation, preadmission screening, prior authorization of services, utilization review, and the development and monitoring of treatment plans.

b. A carrier may not impose precertification, prior authorization, preadmission screening, or referral requirements for the diagnosis and medically necessary treatment, including in-patient treatment, of drug and alcohol dependencies.

c. The benefit prescribed by paragraph (b)(1) of this section may not be subject to concurrent utilization review during the first 14 days of any inpatient admission to a facility approved by a nationally recognized healthcare accrediting organization or the Division of Substance Abuse and Mental Health, 30 days of intensive outpatient program treatment, or 5 days of inpatient withdrawal management, provided that the facility notifies the carrier of both the admission and the initial treatment plan within 48 hours of the admission. The facility shall perform daily clinical review of the patient, including the periodic consultation with the carrier to ensure that the facility is using the evidence-based and peer reviewed clinical review tool utilized by the carrier which is designated by the American Society of Addiction Medicine (“ASAM”) or, if applicable, any state-specific ASAM criteria, and appropriate to the age of the patient, to ensure that the inpatient treatment is medically necessary for the patient.

d. Any utilization review of treatment provided under paragraph (b)(1) of this section may include a review of all services provided during such inpatient treatment, including all services provided during the first 14 days of such inpatient treatment, 30 days of intensive outpatient program treatment, or 5 days of inpatient withdrawal management; provided, however, the carrier may only deny coverage for any portion of the initial 14-day inpatient treatment on the basis that such treatment was not medically necessary if such inpatient treatment was contrary to the evidence-based and peer reviewed clinical review tool utilized by the carrier which is designated by ASAM or, if applicable, any state-specific ASAM criteria.

e. A covered person does not have any financial obligation to the facility for any treatment under paragraph (b)(1) of this section other than any copayment, coinsurance, or deductible otherwise required under the health benefit plan.

(2) This section shall not be interpreted to require a carrier to employ the same benefit management procedures for serious mental illnesses and drug and alcohol dependencies that are employed for the management of other illnesses or diseases covered by the health benefit plan or to require parity or equivalence in the rate, or dollar value of, claims denied.

(e) Out of network services. — Where a health benefit plan provides benefits for the diagnosis and treatment of serious mental illnesses and drug and alcohol dependencies within a network of providers and where a beneficiary of the health benefit plan obtains services consisting of diagnosis and treatment of a serious mental illness and drug and alcohol dependency outside of the network of providers, this section shall not apply. The health benefit plan may contain terms and conditions applicable to out of network services without reference to this section.

(f) Reporting requirements. — Each carrier must submit a report to the Department on or before July 1, 2019, and any year thereafter during which the carrier makes significant changes to how it designs and applies its medical management protocols; the report must contain the following information:

(1) A description of the process used to develop or select the medical necessity criteria for mental illness and drug and alcohol dependencies benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits.

(2) As requested by the Department, identification of select nonquantitative treatment limitations (NQTLs) that are applied to mental illness and drug and alcohol dependencies benefits and medical and surgical benefits within each classification of benefits; there may be no separate NQTLs that apply to mental illness and drug and alcohol dependencies benefits that do not also apply to medical and surgical benefits within any classification of benefits.

(3) The results of an analysis that demonstrates that for the medical necessity criteria described in paragraph (f)(1) of this section and for each NQTL identified in paragraph (f)(2) of this section, as written and in operation, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to mental illness and drug and alcohol dependencies benefits within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to medical and surgical benefits within the corresponding classification of benefits; at a minimum, the results of the analysis shall:

a. Identify the factors used to determine that an NQTL will apply to a benefit, including factors that were considered but rejected.

b. Identify and define the specific evidentiary standards used to define the factors and any other evidence relied upon in designing each NQTL.

c. Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each NQTL, as written, for mental illness and drug and alcohol dependencies benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each NQTL, as written, for medical and surgical benefits.

d. Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to apply each NQTL, in operation, for mental illness and drug and alcohol dependencies benefits are comparable to, and applied no more stringently than, the processes or strategies used to apply each NQTL, in operation, for medical and surgical benefits.

e. Disclose the specific findings and conclusions reached by the carrier that the results of the analyses above indicate that the carrier is in compliance with this section and the Mental Health Parity and Addiction Equity Act of 2008 [P.L. 104-204] and its implementing regulations, which includes 42 C.F.R. Part 438, Subpart K, and any other related federal regulations found in the Code of Federal Regulations.

(4) Any information submitted to the Department of Health and Social Services by a carrier that is considered proprietary by the carrier shall not be made public record.

(5) The Department of Health and Social Services shall retain the authority to enforce the provisions of this section. The provisions of this section shall not give rise to a private cause of action.

81 Del. Laws, c. 190, § 7;  81 Del. Laws, c. 406, § 3; 

(a) Definitions. — For the purposes of this section, the following words and phrases shall have the following meanings:

(1) “ASAM criteria” means the comprehensive set of guidelines for placement, continued stay, and transfer or discharge of patients with addiction established by the American Society of Addiction Medicine (“ASAM”) for use in determining medically necessary treatment.

(2) “Drug and alcohol dependencies” means substance abuse disorder or the chronic, habitual, regular, or recurrent use of alcohol, inhalants, or controlled substances as identified in Chapter 47 of Title 16.

(3) “Health benefit plan” means any assistance provided to an individual under § 505(3) of this title.

(4) “Serious mental illness” means any of the following biologically based mental illnesses: schizophrenia, bipolar disorder, obsessive-compulsive disorder, major depressive disorder, panic disorder, anorexia nervosa, bulimia nervosa, schizo affective disorder, and delusional disorder. The diagnostic criteria set out in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders shall be utilized to determine whether a beneficiary of a health benefit plan is suffering from a serious mental illness.

(b) Coverage of serious mental illness and drug and alcohol dependencies. — a. Carriers shall provide coverage for serious mental illnesses and drug and alcohol dependencies in all health benefit plans delivered or issued for delivery under § 505(3) of this title. Coverage for serious mental illnesses and drug and alcohol dependencies must provide:

1. Inpatient coverage for the diagnosis and treatment of drug and alcohol dependencies.

2. Unlimited medically necessary treatment for drug and alcohol dependencies as required by the Mental Health Parity and Addiction Equity Act of 2008 (29 U.S.C. § 1185a) and determined by the use of the full set of ASAM criteria, in all of the following:

A. Treatment provided in residential setting.

B. Intensive outpatient programs.

C. Inpatient withdrawal management.

b. Subject to subsections (a) and (c) through (e) of this section, no carrier may issue for delivery, or deliver, in this State any health benefit plan containing terms that place a greater financial burden on an insured for covered services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency than for covered services provided in the diagnosis and treatment of any other illness or disease covered by the health benefit plan. By way of example, such terms include deductibles, copays, monetary limits, coinsurance factors, limits in the numbers of visits, limits in the length of inpatient stays, durational limits or limits in the coverage of prescription medicines.

(2) a. A health benefit plan under § 505(3) that provides coverage for prescription drugs must provide coverage for the treatment of serious mental illnesses and drug and alcohol dependencies that includes immediate access, without prior authorization, to a 72-hour emergency supply of prescribed medications covered under the health benefit plan for the medically necessary treatment of serious mental illnesses and drug and alcohol dependencies where an emergency medical condition exists, including a prescribed drug or medication associated with the management of opioid withdrawal or stabilization, except where otherwise prohibited by law.

b. Coverage of an emergency supply of prescribed medications must include medication for opioid overdose reversal otherwise covered under the health benefit plan prescribed to a covered person.

c. Coverage provided under this paragraph (b)(2) of this section may be subject to copayments, coinsurance, and annual deductibles that are consistent with those imposed on other benefits within the health benefit plan; provided, however, a health benefit plan must not impose an additional copayment or coinsurance on a covered person who received an emergency supply of the same medication in the same 30-day period in which the emergency supply of medication was dispensed.

d. This paragraph (b)(2) does not preclude the imposition of a copayment or coinsurance on the initial emergency supply of medication in an amount that is less than the copayment or coinsurance otherwise applicable to a 30-day supply of such medication, provided that the total sum of copayments or coinsurance for an entire 30-day supply of the medication does not exceed the copayment or coinsurance otherwise applicable to a 30-day supply of such medication.

(c) Eligibility for coverage. — (1) Subject to the limitations set forth in subsection (d) of this section, a health benefit plan may condition coverage of services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency on the following further requirements that the service or services:

a. Must be rendered by a mental health professional licensed or certified by the State Board of Licensing including, but not limited to, psychologists, psychiatrists, social workers, and other such mental health professionals, or a drug and alcohol counselor who has been certified by the Delaware Certified Alcohol and Drug Counselors Certification Board, or in a mental health facility licensed by the State or in a treatment facility approved by the Department of Health and Social Services or the Bureau of Alcoholism and Drug Abuse as set forth in Chapter 22 of Title 16 or substantially similar licensing entities in other states.

b. Must be medically necessary.

c. Must be covered services subject to any administrative requirements of the health benefit plan.

(2) A health benefit plan may further condition coverage of services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency in the same manner and to the same extent as coverage for all other illnesses and diseases is conditioned. Such conditions may include, by way of example, and not by way of limitation, precertification and referral requirements.

(d) Benefit management. — (1) A carrier may, directly or by contract with another qualified entity, manage the benefit prescribed by subsection (b) of this section in order to limit coverage of services provided in the diagnosis and treatment of a serious mental illness and drug and alcohol dependency to those services that are deemed medically necessary as follows:

a. The management of benefits for serious mental illnesses and drug and alcohol dependencies may be by methods used for the management of benefits provided for other medical conditions, or may be by management methods unique to mental health benefits. Such may include, by way of example and not limitation, preadmission screening, prior authorization of services, utilization review, and the development and monitoring of treatment plans.

b. A carrier may not impose precertification, prior authorization, preadmission screening, or referral requirements for the diagnosis and medically necessary treatment, including in-patient treatment, of drug and alcohol dependencies.

c. The benefit prescribed by paragraph (b)(1) of this section may not be subject to concurrent utilization review during the first 14 days of any inpatient admission to a facility approved by a nationally recognized healthcare accrediting organization or the Division of Substance Abuse and Mental Health, 30 days of intensive outpatient program treatment, or 5 days of inpatient withdrawal management, provided that the facility notifies the carrier of both the admission and the initial treatment plan within 48 hours of the admission. The facility shall perform daily clinical review of the patient, including the periodic consultation with the carrier to ensure that the facility is using the evidence-based and peer reviewed clinical review tool utilized by the carrier which is designated by the American Society of Addiction Medicine (“ASAM”) or, if applicable, any state-specific ASAM criteria, and appropriate to the age of the patient, to ensure that the inpatient treatment is medically necessary for the patient.

d. Any utilization review of treatment provided under paragraph (b)(1) of this section may include a review of all services provided during such inpatient treatment, including all services provided during the first 14 days of such inpatient treatment, 30 days of intensive outpatient program treatment, or 5 days of inpatient withdrawal management; provided, however, the carrier may only deny coverage for any portion of the initial 14-day inpatient treatment on the basis that such treatment was not medically necessary if such inpatient treatment was contrary to the evidence-based and peer reviewed clinical review tool utilized by the carrier which is designated by ASAM or, if applicable, any state-specific ASAM criteria.

e. A covered person does not have any financial obligation to the facility for any treatment under paragraph (b)(1) of this section other than any copayment, coinsurance, or deductible otherwise required under the health benefit plan.

(2) This section shall not be interpreted to require a carrier to employ the same benefit management procedures for serious mental illnesses and drug and alcohol dependencies that are employed for the management of other illnesses or diseases covered by the health benefit plan or to require parity or equivalence in the rate, or dollar value of, claims denied.

(e) Out of network services. — Where a health benefit plan provides benefits for the diagnosis and treatment of serious mental illnesses and drug and alcohol dependencies within a network of providers and where a beneficiary of the health benefit plan obtains services consisting of diagnosis and treatment of a serious mental illness and drug and alcohol dependency outside of the network of providers, this section shall not apply. The health benefit plan may contain terms and conditions applicable to out of network services without reference to this section.

(f) Reporting requirements. — Each carrier must submit a report to the Department on or before July 1, 2019, and any year thereafter during which the carrier makes significant changes to how it designs and applies its medical management protocols; the report must contain the following information:

(1) A description of the process used to develop or select the medical necessity criteria for mental illness and drug and alcohol dependencies benefits and the process used to develop or select the medical necessity criteria for medical and surgical benefits.

(2) As requested by the Department, identification of select nonquantitative treatment limitations (NQTLs) that are applied to mental illness and drug and alcohol dependencies benefits and medical and surgical benefits within each classification of benefits; there may be no separate NQTLs that apply to mental illness and drug and alcohol dependencies benefits that do not also apply to medical and surgical benefits within any classification of benefits.

(3) The results of an analysis that demonstrates that for the medical necessity criteria described in paragraph (f)(1) of this section and for each NQTL identified in paragraph (f)(2) of this section, as written and in operation, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to mental illness and drug and alcohol dependencies benefits within each classification of benefits are comparable to, and are applied no more stringently than, the processes, strategies, evidentiary standards, or other factors used in applying the medical necessity criteria and each NQTL to medical and surgical benefits within the corresponding classification of benefits; at a minimum, the results of the analysis shall:

a. Identify the factors used to determine that an NQTL will apply to a benefit, including factors that were considered but rejected.

b. Identify and define the specific evidentiary standards used to define the factors and any other evidence relied upon in designing each NQTL.

c. Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to design each NQTL, as written, for mental illness and drug and alcohol dependencies benefits are comparable to, and are applied no more stringently than, the processes and strategies used to design each NQTL, as written, for medical and surgical benefits.

d. Provide the comparative analyses, including the results of the analyses, performed to determine that the processes and strategies used to apply each NQTL, in operation, for mental illness and drug and alcohol dependencies benefits are comparable to, and applied no more stringently than, the processes or strategies used to apply each NQTL, in operation, for medical and surgical benefits.

e. Disclose the specific findings and conclusions reached by the carrier that the results of the analyses above indicate that the carrier is in compliance with this section and the Mental Health Parity and Addiction Equity Act of 2008 [P.L. 104-204] and its implementing regulations, which includes 42 C.F.R. Part 438, Subpart K, and any other related federal regulations found in the Code of Federal Regulations.

(4) Any information submitted to the Department of Health and Social Services by a carrier that is considered proprietary by the carrier shall not be made public record.

(5) The Department of Health and Social Services shall retain the authority to enforce the provisions of this section. The provisions of this section shall not give rise to a private cause of action.

81 Del. Laws, c. 190, § 7;  81 Del. Laws, c. 406, § 3;  84 Del. Laws, c. 402, § 1; 

(a) For purposes of this section:

(1) “FDA” means the Food and Drug Administration.

(2) “Therapeutic equivalent” means a contraceptive drug, device, or product that meets all of the following:

a. Approved as safe and effective.

b. Pharmaceutically equivalent to another contraceptive drug, device or product in that it contains an identical amount of the same active drug ingredient in the same dosage form and route of administration and meets compendial or other applicable standards of strength, quality, purity, and identity.

c. Assigned, by the FDA, the same therapeutic equivalence code as another contraceptive drug, device, or product.

(b) Carriers shall provide coverage for contraceptive methods in all health benefit plans delivered or issued for delivery under § 505(3) of this title. Coverage for contraceptive methods must include all of the following:

(1) All FDA-approved contraceptive drugs, devices, and other products as follows:

a. If the FDA has approved 1 or more therapeutic equivalents of a contraceptive drug, device, or product, a carrier is not required to include all such therapeutically equivalent versions in its formulary as long as at least 1 is included and covered without cost-sharing and in accordance with this section.

b. If there is a therapeutic equivalent of a drug, device, or other product for an FDA-approved contraceptive method, the carrier may provide coverage for more than 1 drug, device, or other product and may impose cost-sharing requirements as long as at least 1 drug, device, or other product for that method is available without cost-sharing. If, however, an individual’s attending provider recommends a particular FDA-approved contraceptive based on a medical determination with respect to that individual, regardless of whether the contraceptive has a therapeutic equivalent, the carrier shall provide coverage for the prescribed contraceptive drug, device, or product without cost-sharing.

c. The carrier is not required to provide coverage for male condoms.

(2) FDA-approved emergency contraception available over-the-counter, whether with a prescription or dispensed consistent with the requirements of Chapter 25 of Title 24.

(3) A prescription for contraceptives intended to last for no more than a 12-month period which may be dispensed all at once or over the course of the 12-month period, regardless of whether the covered individual was enrolled in a plan or policy under § 505(3) of this title at the time the prescription contraceptive was first dispensed.

(4) Voluntary female sterilization procedures.

(5) Patient education and counseling on contraception.

(6) Follow-up services related to the drugs, devices, products, and procedures covered under this subsection, including management of side effects, counseling for continued adherence, and device insertion and removal.

(7) Immediate postpartum insertion of long-acting reversible contraception.

(c) A carrier may not impose any deductible, coinsurance, copayment, or any other cost-sharing requirement for coverage provided under this section, except under paragraph (b)(1) of this section or as otherwise required under federal law. A carrier may not impose unreasonable restrictions or delays in the coverage under this section, except that reasonable medical management techniques may be applied to coverage within a method category, as defined by the FDA, but not across types of methods.

(d) This section does not preclude coverage for contraceptive drugs, devices, products, and procedures as prescribed by a provider for reasons other than contraceptive purposes, including decreasing the risk of ovarian cancer, eliminating symptoms of menopause, or providing contraception that is necessary to preserve the life or health of the covered individual.

(e) Carriers are not required under this section to cover experimental or investigational treatments.

81 Del. Laws, c. 323, § 4;  70 Del. Laws, c. 186, § 1; 

Carriers shall provide coverage for treatment of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections and pediatric acute onset neuropsychiatric syndrome, including the use of intravenous immunoglobulin therapy in all health benefit plans delivered or issued for delivery under § 505(3) of this title.

81 Del. Laws, c. 400, § 4; 

(a) For purposes of this section, “epinephrine autoinjector” means a single-use device used for the automatic injection of a premeasured dose of epinephrine into the human body.

(b) Carriers shall provide coverage for medically-necessary epinephrine autoinjectors.

83 Del. Laws, c. 42, § 4;  84 Del. Laws, c. 36, § 4; 

(a) For purposes of this section, “insulin pump” means a small, portable medical device that is approved by the U.S. Food and Drug Administration to provide continuous subcutaneous insulin infusion.

(b) Carriers shall provide coverage for a medically-necessary insulin pump at no cost in all health benefit plans delivered or issued for delivery under § 505(3) of this title.

83 Del. Laws, c. 241, § 4; 

(a) As used in this section:

(1) “Carrier” means any entity that provides health insurance under § 505(3) of this title.

(2) “Doula services” means services provided by a trained doula and designed to provide physical, emotional, and educational support to pregnant and birthing persons before, during, and after childbirth. “Doula services” include the following:

a. Support and assistance during labor and childbirth.

b. Prenatal and postpartum support and education.

c. Breastfeeding assistance and lactation support.

d. Parenting education.

e. Support for a birthing person following loss of pregnancy.

(b) Beginning January 1, 2024, all carriers shall provide coverage of doula services that includes all of the following:

(1) Three prenatal visits, of up to 90 minutes.

(2) Three postpartum visits, of up to 90 minutes.

(3) Attendance through labor and birth.

(c) Coverage must be provided for additional postpartum doula visits with a recommendation by a practitioner or clinician licensed under Title 24 acting within their scope of practice.

(d) The Division of Medicaid and Medical Assistance shall establish, in collaboration with stakeholders, a process for doulas to be certified and to enroll as participating providers, as well as a reimbursement rate for doula services that supports a livable annual income for full-time practicing doulas.

83 Del. Laws, c. 366, § 1;  84 Del. Laws, c. 159, § 1;  84 Del. Laws, c. 291, § 1; 

(a) As used in this section:

(1) “Behavioral health well check” means a predeductible annual visit with a licensed mental health clinician with at minimum a masters level degree. The well check must include but is not limited to a review of medical history, evaluation of adverse childhood experiences, use of a group of developmentally-appropriate mental health screening tools, and may include anticipatory behavioral health guidance congruent with stage of life using the diagnosis of “annual behavioral health well check.”

(2) “Carrier” means any entity that provides health insurance under § 505(3) of this title.

(b) All carriers shall provide coverage of an annual behavioral health well check, which, except as provided in subsection (d) of this section, shall be reimbursed at rates comparable to rates for the provision of other medical care, provided that reimbursement may be adjusted for payment of claims that are billed by a nonphysician clinician so long as the methodology to determine such adjustments is comparable to and applied no more stringently than the methodology for adjustments made for reimbursement of claims billed by nonphysician clinicians for other medical care, in accordance with 42 CFR § 438.910(d)(1).

(c) (1) The Division of Medicaid and Medical Assistance shall develop and implement procedural codes for purposes of billing for a behavioral health well check that are comparable to the rates under the following CPT codes:

a. 99381.

b. 99382.

c. 99383.

d. 99384.

e. 99385.

f. 99386.

g. 99387.

h. 99391.

i. 99392.

j. 99393.

k. 99394.

l. 99395.

m. 99396.

n. 99397.

(2), (3) [Repealed.]

(d) An annual behavioral health well check may be reimbursed through a value-based arrangement, a capitated arrangement, a bundled payment arrangement, or any other alternative payment arrangement that is not a traditional fee-for-service arrangement, provided that a carrier must have documentation demonstrating that within such payment arrangement the annual behavioral health well check is valued commensurate to the value established under subsection (b) of this section.

(e) An annual behavioral health well check may be incorporated into and reimbursed within any type of integrated primary care service delivery method including, but not limited to, the psychiatric collaborative care model, the primary care behavioral health model or behavioral health consultant model, any model that involves co-location of mental health professionals within general medical settings, or any other integrated care model that focuses on the delivery of primary care.

(f) Nothing in this section prevents the operation of policy provisions such as copayments, coinsurance, allowable charge limitations, coordination of benefits, or provisions restricting coverage to services rendered by licensed, certified, or carrier-approved providers or facilities.

83 Del. Laws, c. 388, § 3;  84 Del. Laws, c. 501, § 1; 

(a) As used in this section, “behavioral health well check” means a predeductible annual visit with a licensed mental health clinician with at minimum a masters level degree. The well check must include but is not limited to a review of medical history, evaluation of adverse childhood experiences, use of a group of developmentally-appropriate mental health screening tools, and may include anticipatory behavioral health guidance congruent with stage of life using the diagnosis of “annual behavioral health well check.”

(b) All carriers shall provide coverage of an annual behavioral health well check, which, except as provided in subsection (d) of this section, shall be reimbursed at rates comparable to rates for the provision of other medical care, provided that reimbursement may be adjusted for payment of claims that are billed by a nonphysician clinician so long as the methodology to determine such adjustments is comparable to and applied no more stringently than the methodology for adjustments made for reimbursement of claims billed by nonphysician clinicians for other medical care, in accordance with 42 CFR § 438.910(d)(1).

(c) (1) The Division of Medicaid and Medical Assistance shall develop and implement procedural codes for purposes of billing for a behavioral health well check that are comparable to the rates under the following CPT codes:

a. 99381.

b. 99382.

c. 99383.

d. 99384.

e. 99385.

f. 99386.

g. 99387.

h. 99391.

i. 99392.

j. 99393.

k. 99394.

l. 99395.

m. 99396.

n. 99397.

(2), (3) [Repealed.]

(d) An annual behavioral health well check may be reimbursed through a value-based arrangement, a capitated arrangement, a bundled payment arrangement, or any other alternative payment arrangement that is not a traditional fee-for-service arrangement, provided that a carrier must have documentation demonstrating that within such payment arrangement the annual behavioral health well check is valued commensurate to the value established under subsection (b) of this section.

(e) An annual behavioral health well check may be incorporated into and reimbursed within any type of integrated primary care service delivery method including, but not limited to, the psychiatric collaborative care model, the primary care behavioral health model or behavioral health consultant model, any model that involves co-location of mental health professionals within general medical settings, or any other integrated care model that focuses on the delivery of primary care.

(f) Nothing in this section prevents the operation of policy provisions such as copayments, coinsurance, allowable charge limitations, coordination of benefits, or provisions restricting coverage to services rendered by licensed, certified, or carrier-approved providers or facilities.

83 Del. Laws, c. 388, § 3;  84 Del. Laws, c. 501, § 1;  84 Del. Laws, c. 402, § 1; 

(a) As used in this section:

(1) “Breast magnetic resonance imaging” or “breast MRI” means a diagnostic tool, including standard and abbreviated breast MRI, that uses radio waves and magnets to produce detailed images of structures within the breast. A breast MRI may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.

(2) “Breast ultrasound” means a noninvasive diagnostic tool that uses high-frequency sound waves and their echoes to produce detailed images of structures within the breast. A breast ultrasound may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.

(3) “Carrier” means any entity that provides health insurance under § 505(3) of this title.

(4) “Cost-sharing requirement” means a deductible, coinsurance, or copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out-of-pocket expense.

(5) “Diagnostic breast examination” means a medically-necessary and clinically-appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following:

a. To evaluate an abnormality seen or suspected from a screening examination for breast cancer.

b. To evaluate an abnormality detected by another means of examination.

(6) “Mammogram” means a diagnostic or screening mammography exam using a low-dose X-ray to produce an image of the breast.

(7) “Supplemental breast screening examination” means a medically-necessary and clinically-appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following:

a. To screen for breast cancer when there is no abnormality seen or suspected in the breast.

b. Based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer.

(b) All carriers shall provide coverage for diagnostic breast examinations and supplemental breast screening examinations. The terms of such coverage, including cost-sharing requirements, shall be no less favorable than the cost-sharing requirements applicable to screening mammography for breast cancer.

84 Del. Laws, c. 121, § 4; 

(a) As used in this section:

(1) “Breast magnetic resonance imaging” or “breast MRI” means a diagnostic tool, including standard and abbreviated breast MRI, that uses radio waves and magnets to produce detailed images of structures within the breast. A breast MRI may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.

(2) “Breast ultrasound” means a noninvasive diagnostic tool that uses high-frequency sound waves and their echoes to produce detailed images of structures within the breast. A breast ultrasound may be used as a screening tool when clinically indicated, including after indeterminant results from a mammogram that requires additional evaluation and for those at high risk for breast cancer.

(3) “Cost-sharing requirement” means a deductible, coinsurance, or copayment and any maximum limitation on the application of such a deductible, coinsurance, copayment, or similar out-of-pocket expense.

(4) “Diagnostic breast examination” means a medically-necessary and clinically-appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following:

a. To evaluate an abnormality seen or suspected from a screening examination for breast cancer.

b. To evaluate an abnormality detected by another means of examination.

(5) “Mammogram” means a diagnostic or screening mammography exam using a low-dose X-ray to produce an image of the breast.

(6) “Supplemental breast screening examination” means a medically-necessary and clinically-appropriate examination of the breast, including such examination using breast MRI, breast ultrasound, or mammogram, that is used for either of the following:

a. To screen for breast cancer when there is no abnormality seen or suspected in the breast.

b. Based on personal or family medical history or additional factors that may increase the individual’s risk of breast cancer.

(b) All carriers shall provide coverage for diagnostic breast examinations and supplemental breast screening examinations. The terms of such coverage, including cost-sharing requirements, shall be no less favorable than the cost-sharing requirements applicable to screening mammography for breast cancer.

84 Del. Laws, c. 121, § 4;  84 Del. Laws, c. 402, § 1; 

(a) By January 1, 2025, the Department of Health and Social Services shall apply to the Centers for Medicare and Medicaid Services for a state plan amendment that authorizes the State to provide for reimbursement for all medically-necessary behavioral health services provided in a school setting to all individuals enrolled in the program or the Delaware Children’s Health Insurance Program, regardless of whether the services are provided under an Individualized Educational Program or Individualized Family Service Plan.

(b) After the state plan amendment is approved, eligible services provided in a school setting by any school Medicaid allowable licensed or credentialed mental health provider shall be reimbursable.

(c) Local education agencies must use the funds reimbursed for school-based behavioral health services to support school-based behavioral health programs and services.

(d) Local education agencies must reinvest the funds reimbursed to support school-based behavioral health programs and services.

(e) Upon obtaining federal approval, the Department of Health and Social Services shall update its regulations and provider manuals to reflect the changes to the program and provide comprehensive and advanced training to local education agencies.

(f) The Department of Health and Social Services shall notify the Chief Clerk of the House and the Secretary of the Senate of the occurrence of the following:

(1) The submission of the state plan amendment to the Centers for Medicare and Medicaid Services.

(2) Receipt of approval for the state plan amendment.

(3) The submission of a cost allocation plan amendment following the approval of the state plan amendment.

(4) Receipt of approval of the cost allocation plan amendment.

84 Del. Laws, c. 349, § 1; 

(a) For purposes of this section:

(1) “Dietary supplement” means as defined in the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. § 321.

(2) “Early egg allergen introduction dietary supplement” means a dietary supplement that is prescribed to an infant by a health-care practitioner and contains sufficient infant-safe, well-cooked egg protein to reduce the risk of food allergies.

(3) “Early peanut allergen introduction dietary supplement” means a dietary supplement that is prescribed to an infant by a health-care practitioner and contains sufficient infant-safe peanut protein to reduce the risk of food allergies.

(4) “Health-care practitioner” means an individual licensed and authorized to write medical orders for an individual under Title 24.

(5) “Infant” means a child who has not attained the age of 1 year.

(b) Carriers shall provide coverage at no cost in all health benefit plans delivered or issued for delivery under § 505(3) of this title for at least 1 of each of the following:

(1) An early egg allergen introduction dietary supplement.

(2) An early peanut allergen introduction dietary supplement.

84 Del. Laws, c. 376, § 4; 

(a) Carriers shall cover services related to the termination of pregnancy up to a maximum of $750 per covered individual per year in all health benefit plans delivered or issued for delivery under § 505(3) of this title.

(b) Coverage provided under this section may not be subject to any deductible, coinsurance, copayment, or any other cost-sharing requirement up to the $750 maximum.

(c) A carrier must provide coverage for the full scope of services permissible under the law.

(d) Coverage provided under this section may not require a referral or prior authorization as a condition of coverage.

(e) If a policy or contract limits an insured’s access to a network of participating providers for other health-care services, then it may limit access for services related to termination of pregnancy, but the policy or contract must include in all its provider networks a sufficient number of providers of termination of pregnancy services to accommodate the direct access needs of their enrollees.

(f) Coverage provided under this section must be funded by Delaware state resources if services are not eligible for federal funds. If federal funds are permitted to be used for services under this section, then federal funds must be used.

84 Del. Laws, c. 402, § 1; 

(a) “Carrier” means any entity that provides health insurance under § 505(3) of this title.

(b) Carriers shall provide coverage for an annual mammogram for the purpose of early detection for a woman 40 years of age or older, with or without referral from the woman’s health-care provider.

84 Del. Laws, c. 483, § 4; 

(a) For purposes of this section:

(1) “At risk for ovarian cancer” means any of the following:

a. Having a family history of any of the following:

1. One or more first- or second-degree relatives with ovarian cancer.

2. Clusters of women relatives with breast cancer.

3. Nonpolyposis colorectal cancer.

4. Breast cancer in a male relative.

b. Testing positive for any of the following genetic mutations:

1. Brca1 or brca2.

2. Lynch Syndrome.

c. Having a personal history of any of the following:

1. Ovarian cancer.

2. Endometriosis.

3. Unexplained infertility.

4. Uterine fibroids.

5. Polycystic ovarian syndrome.

(2) “Carrier” means any entity that provides health insurance under § 505(3) of this title.

(3) “Monitoring tests” and “screening tests” mean tests and examinations for ovarian cancer using any of the following methods that are recommended by a patient’s physician:

a. Tumor marker tests supported by national clinical guidelines, national standards of care, or peer reviewed medical literature.

b. Transvaginal ultrasound.

c. Pelvic examination.

d. Other screening tests supported by national clinical guidelines, national standards of care, or peer reviewed medical literature.

(b) Carriers shall provide coverage for all the following:

(1) Monitoring tests for ovarian cancer after a woman is treated for ovarian cancer.

(2) Annual screening tests for women at risk for ovarian cancer.

(c) Coverage required by subsection (b) of this section must be at no cost in all health benefits plans delivered or issued for delivery by carriers.

84 Del. Laws, c. 488, § 2;