Delaware § 539 - Primary care coverage.

§ 539. Primary care coverage.

(a) To the extent consistent with federal law:

(1) The entities providing health insurance under § 505(3) of this title shall report data for 2 plan years on the percentage of primary care spend as a percentage of total medical costs, each by July 1 of the following year.

(2) In the third year, the entities providing health insurance under § 505(3) of this title shall increase primary care spending by 1% from the higher of the 2 prior plan years.

(3) In fourth, fifth, and additional plan years as necessary, the entities providing health insurance under § 505(3) of this title shall increase primary care spending by 1% until primary care spending reaches 11.5% of total medical costs.

(4) The entities providing health insurance under § 505(3) of this title shall spend at least 11.5% of total cost of medical care on primary care thereafter.

(5) The methodology for compliance with this section shall be determined by the Division, to the extent feasible, consistent with regulations set forth by the Office of Value-Based Health Care Delivery under § 334 of Title 18.

(b) The Division of Medicaid and Medical Assistance may exclude certain high-cost claims in calculating total cost of medical care for purposes of this section.

(c) The entities providing health insurance under § 505(3) of this title shall offer value-based care programs as determined by contract with the Division.

85 Del. Laws, c. 348, § 11;