Read the full stored bill text
Legislation Document
SPONSOR:
Rep. Gorman & Rep. Kamela Smith & Sen. Cruce
Reps. Osienski, Berry, Burns, Morrison, K. Johnson, Snyder-Hall, Harris; Sens. Sokola, Hansen, Huxtable, Seigfried, Pinkney, Lockman
HOUSE OF REPRESENTATIVES
153rd GENERAL ASSEMBLY
HOUSE BILL NO. 338
AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO HEALTH CARRIER COVERAGE OF IMMUNIZATIONS AND PREVENTIVE SERVICES.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF DELAWARE:
Section 1. Amend § 3363, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3363. Recommended
immunizations.
immunizations and preventive services.
(b) A health carrier shall provide coverage for the following items and services. A health carrier shall not impose any costs, such as a copayment, coinsurance or deductible with respect to the following items and services:
(1) Except as otherwise provided in this section, evidence-based items or services that
have in effect
had
a rating of “A” or “B” in the recommendations of the United States Preventive Services Task Force
that were in effect on January 1, 2025
with respect to the individual
involved;
involved.
(2) Immunizations for routine use in children, adolescents and adults that
have in effect a recommendation from
were recommended by
the Advisory Committee on Immunization Practices of the Centers for Disease Control and
Prevention
Prevention in effect on January 1, 2025,
or other immunizations that were supported by national clinical guidelines or national standards of care in effect on January 1, 2025,
with respect to the individual involved. For purposes of this paragraph, a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention is considered in effect after it has been adopted by the Director of the Centers for Disease Control and Prevention, and a recommendation is considered to be for routine use if it is listed on the Immunization Schedules of the Centers for Disease Control and
Prevention;
Prevention.
(3) With respect to infants, children and adolescents, evidence-informed preventive care, and screenings provided for in comprehensive guidelines supported by the Health Resources and Services
Administration; and
Administration in effect on January 1, 2025.
(4) With respect to women, to the extent not described in paragraph (b)(1) of this section, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services
Administration.
Administration in effect on January 1, 2025.
(c)
A health carrier is not required to provide coverage for any items or services specified in any recommendation or guideline described in subsection (b) of this section after the recommendation or guideline is no longer described in subsection (b) of this section.
[Repealed.]
(e)
For purposes of subsection (b) of this section and for purpose of any other provision of law, the United States Preventive Services Task Force recommendations regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current.
[Repealed.]
(f)
A health carrier shall at least annually at the beginning of each new plan year or policy year, whichever is applicable, revise the preventive services covered under its health benefit plans pursuant to this section consistent with the recommendations of the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the guidelines with respect to infants, children, adolescents and women evidence-based preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration in effect at the time.
[Repealed.]
(m) Nothing in this section prohibits a health carrier from providing coverage for items and services in addition to those recommended by the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, or provided by guidelines supported by the Health Resources and Services
Administration, or from denying coverage for items and services that are not recommended by that task force or that advisory committee, or under those guidelines.
Administration.
A health carrier may impose cost-sharing requirements for a treatment not described in this section even if the treatment results from an item or service described herein.
Section 2. Amend § 3558, Title 18 of the Delaware Code by making deletions as shown by strike through and insertions as shown by underline as follows:
§ 3558. Immunizations and preventive services.
(a) This section applies to any health carrier providing coverage under an individual or group health benefit plan.
(1) This section does not apply to grandfathered plan coverage.
(2) For purposes of this section, “grandfathered plan coverage” means coverage provided by a health carrier in which an individual was enrolled on March 23, 2010, for as long as it maintains that status in accordance with federal regulations.
(3) This section shall not apply to accident-only, specified diseases, hospital, indemnity, disability income or other fixed indemnity policies.
(b) A health carrier shall provide coverage for the following items and services. A health carrier shall not impose any costs, such as a copayment, coinsurance or deductible with respect to the following items and services:
(1) Except as otherwise provided in this section, evidence-based items or services that
have in effect
had
a rating of A or B in the recommendations of the United States Preventive Services Task Force
that were in effect on January 1, 2025
with respect to the individual
involved;
involved.
(2) Immunizations for routine use in children, adolescents and adults that
have in effect a recommendation from
were recommended by
the Advisory Committee on Immunization Practices of the Centers for Disease Control and
Prevention
Prevention in effect on January 1, 2025, or other immunizations that were supported by national clinical guidelines or national standards of care in effect on January 1, 2025,
with respect to the individual involved. For purposes of this paragraph, a recommendation from the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention is considered in effect after it has been adopted by the Director of the Centers for Disease Control and Prevention, and a recommendation is considered to be for routine use if it is listed on the Immunization Schedules of the Centers for Disease Control and
Prevention;
Prevention.
(3) With respect to infants, children and adolescents, evidence-informed preventive care, and screenings provided for in comprehensive guidelines supported by the Health Resources and Services
Administration; and
Administration in effect on January 1, 2025.
(4) With respect to women, to the extent not described in paragraph (b)(1) of this section, evidence-informed preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services
Administration.
Administration in effect on January 1, 2025.
(c)
A health carrier is not required to provide coverage for any items or services specified in any recommendation or guideline described in subsection (b) of this section after the recommendation or guideline is no longer described in subsection (b) of this section.
[
Repealed.
]
(e)
For purposes of subsection (b) of this section and for purpose of any other provision of law, the United States Preventive Services Task Force recommendations regarding breast cancer screening, mammography and prevention issued in or around November 2009 are not considered to be current.
[
Repealed.
]
(f)
A health carrier shall at least annually at the beginning of each new plan year or policy year, whichever is applicable, revise the preventive services covered under its health benefit plans pursuant to this section consistent with the recommendations of the United States Preventive Services Task Force, the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the guidelines with respect to infants, children, adolescents and women evidence-based preventive care and screenings provided for in comprehensive guidelines supported by the Health Resources and Services Administration in effect at the time.
[
Repealed.
]
(m) Nothing in this section prohibits a health carrier from providing coverage for items and services in addition to those recommended by the United States Preventive Services Task Force or the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, or provided by guidelines supported by the Health Resources and Services
Administration, or from denying coverage for items and services that are not recommended by that task force or that advisory committee, or under those guidelines.
Administration.
A health carrier may impose cost-sharing requirements for a treatment not described in this section even if the treatment results from an item or service described herein.
SYNOPSIS
This Act clarifies that individual, group, and blanket health insurance carriers must provide for and pay for services (including immunizations) that were recommended by the Advisory Committee on Immunization Practices of the Center for Disease Control (CDC) and the comprehensive guidelines supported by the Health Resources and Services Administration (HRSA) that were in effect as of January 1, 2025. They must also cover immunizations that were supported by national clinical guidelines or national standards of care in effect on January 1, 2025.
To that end, this Act removes provisions that permit carriers to deny coverage for these items or services simply because they are not currently recommended by the Advisory Committee on Immunization Practices of the CDC and the comprehensive guidelines supported by the HRSA. This Act also removes obsolete United States Preventative Task Force provisions related to breast cancer screening from 2009.