March 16: Watch Live Q & A on Coronavirus Disease

Governor Carney will host a virtual Q&A session with Dr. Kara Odom Walker, Secretary of the Delaware Department of Health and Social Services (DHSS), on Facebook and Livestream to answer questions about the coronavirus.

For the latest Delaware updates, visit de.gov/coronavirus

Submit questions ahead of this Facebook event by email: townhall@delaware.gov


ACA Marketplace Rates to Decrease 19% in Delaware for Plan Year 2020

Dover, DE – Insurance Commissioner Trinidad Navarro officially announced the final approval of the 2019 Affordable Care Act (“ACA”) rates. Highmark Blue Cross Blue Shield of Delaware (“Highmark BCBSD”), the only insurer currently on the Marketplace, originally proposed a rate decrease of 5.8% for its 2019 individual Marketplace business. Commissioner Navarro, ultimately approved a decrease of 19%, after the implementation of a state-run reinsurance program, the first decrease ever since the Marketplace opened in 2013.

The approved decrease was a result of federal approval for the State of Delaware to implement a state-run reinsurance program as established pursuant to the 1332 State Innovation Waiver Application (“Waiver”). Under this program, individual market policies that meet certain minimum criteria, as set forth in the Waiver, will be eligible for reimbursement from a state-administered fund. The fund will be financed through a 1% assessment on the individual, small and large group market premium amounts for all health insurance carriers operating in those markets in Delaware. The assessment will take place annually and may vary depending on the federal government’s actions on the Health Insurance Industry Fee.

“I am happy to announce the first rate decrease in Delaware since the beginning of the Health Insurance Marketplace. In spite of the many efforts in Washington to dismantle the Affordable Care Act, we have been able to work with our state counterparts and stakeholders to give Delaware policyholders much-needed premium relief. I thank Secretary Walker for the work she and her team at DHSS put into seeing the Waiver across the finish line.”

Because this year’s filing may result in lower costs for many consumers, the Department urges consumers to examine their rates and reapply for coverage through the Marketplace.

Presently, approximately 23,000 Delawareans have health insurance through the Affordable Care Act and may be affected by these rates.

Please be advised that the proposed rate decrease will not apply to Delawareans on Medicare, Medicaid, or those with group or individual policies outside of the Marketplace.

 

###

Contact: Vince Ryan

Office: (302) 674-7303

Email: vince.ryan@delaware.gov

                                                          

Delaware Department of Insurance

http://www.insurance.delaware.gov

Dover Office: 302-674-7300

Consumer Services Division: 1-800-282-8611


Delaware Receives Federal Approval to Establish Reinsurance Program for 2020

On June 20, Gov. John Carney signed enabling legislation (House Bill 193) moving Delaware a step closer to a reinsurance program beginning in 2020.

NEW CASTLE (Aug. 20, 2019) – The Department of Health and Social Services (DHSS) received approval today from the Centers for Medicare and Medicaid Services (CMS) for a 1332 State Innovation Waiver under the Affordable Care Act to create a reinsurance program beginning in 2020 as a way to reduce premiums by up to 20 percent in Delaware’s individual health insurance market.

Under Delaware’s reinsurance program, a portion of high-cost health care claims that drive up insurance rates for everyone on the individual market will be reimbursed through an estimated $27 million fund. The fund will use a mix of federal funding and assessments collected by the Delaware Department of Insurance from health insurance carriers. The Delaware Health Care Commission will administer the program.

Coupled with reduced rates already sought on the individual market in Delaware, the state expects a significant reduction in premiums for 2020. CMS authorized Delaware’s reinsurance program through 2024.

“We are grateful to CMS for approving Delaware’s 1332 State Innovation Waiver application that will enable us to establish a reinsurance program in our state,” said DHSS Secretary Dr. Kara Odom Walker, a practicing family physician. “We expect that the reinsurance program will further stabilize the individual health insurance market and make premiums more affordable for Delawareans who need such coverage.”

“The number one complaint/comment we receive from consumers at the Department of Insurance is the high cost of health insurance, especially from those who are not eligible for tax credits,” Insurance Commissioner Trinidad Navarro said. “With this new waiver program, people who earn above 400 percent of the federal poverty level, small business owners, and those who are not covered by their employers will save up to 20 percent on their health insurance premiums in the individual market. My office will continue to work to seek any and all means to help make health insurance more affordable for Delawareans.”

The CMS approval was the final step in a months-long process that included a recommendation from a working group that included DHSS, the Department of Insurance, legislators and other stakeholders, enabling legislation approved by Delaware’s General Assembly in June and signed into law by Gov. John Carney, and public comment periods at the state and federal levels.

Delaware is the 11th state to receive CMS approval for a reinsurance program. A March 2019 analysis by health care consultant Avalere found state-run reinsurance programs reduce premiums by almost 20 percent on average in their first year.

In addition to reducing premiums on the marketplace, the reinsurance program will benefit anyone who buys coverage on the individual market, including people who are not eligible for coverage at their workplace, those who are too young for Medicare or make too much money to be eligible for Medicaid, young people who have aged off their parents’ plans, or those who are self-employed.

In 2019, about 21,000 people enrolled for coverage on Delaware’s Health Insurance Marketplace. Open enrollment for 2020 will begin Nov. 1 and run through Dec. 15. To learn more about the marketplace, go to ChooseHealthDE.com.

-30-

The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.


Health Care Commission Awards More Value-Based Payment Reform Mini-Grants to Delaware Health Care Providers

NEW CASTLE (Dec. 4, 2018) – As part of the State Innovation Model (SIM) initiative, the Delaware Health Care Commission has awarded eight additional value-based payment reform mini-grants to Delaware health care providers in order to facilitate data integration, improve the coordination of patient care or increase readiness to integrate into an Accountable Care Organization (ACO) or operate through an Alternative Payment Method (APM)

DHSS Secretary Dr. Kara Odom Walker

The awards, through the Value-Based Payment Reform Fund, range from $25,000 to $250,000 for work that must be completed by Jan. 31, 2019. The commission received a total of 45 applications from primary care providers, behavioral health providers, hospitals, Accountable Care Organizations (ACOs), Federally Qualified Health Centers (FQHCs) and clinically integrated networks, all of which must be licensed in the State of Delaware. The commission expects to award a few more additional grants for small projects (up to $50,000) and large projects (up to $250,000), based on the scope of the project.

This round of awards went to:

• Nanticoke Hospital ($250,000): To conduct a study on global budgeting and how it could be implemented by Nanticoke and the State of Delaware.

• MedNet ($200,230): To speed up development of a population health management platform through expedited integration of clinical data from the Electronic Medical Records (EMR) platforms represented across the MedNet network.

• Nemours/A.I. duPont Hospital for Children ($200,000): To increase readiness to integrate into an Accountable Care Organization (ACO) or Clinically Integrated Network (CIN) or operate through an Alternative Payment Method (APM), as well as to ensure data integration/infrastructure analytics and improve coordination of patient care.

• Westside Family Healthcare ($179,190): To improve the Federally Qualified Health Center’s ability to thrive into Alternative Payment Methods (APM) by focusing on utilization of Health Information Technology (HIT) to identify and coordinate care of high-risk/cost patients, identify barriers limiting patients from utilizing the appropriate level of care and develop improved data integration with one of its Medicaid Managed Care (MMC) payers to allow use of clinical data for pay-for-value program performance. Part of the work will involve integration of Westside’s Allscripts Electronic Health Records (EHR) system with the Delaware Health Information Network (DHIN).

• Brandywine Counseling and Community Services ($111,716.50): To implement a data integration project that will reorganize its institutional structure to accommodate value-based payments and improve the coordination of patient care, especially for those clients with co-occurring disorders.

• Stoney Batter Family Medicine ($73,000): To upgrade its Allscripts system to facilitate better data-sharing required for participation in value-based programs, conversion to electronic billing and training sessions for employees.

• Delaware Health Net ($34,375): To develop “cost of care” analytics tool to adequately define the cost of a chronic condition population historically when cared that population has been cared for at a health center.

• Stoney Batter Family Medicine ($20,000): To design a training program for care coordinators/providers on how to prevent emergency department and hospital readmissions utilizing hospital-based admission information from DHIN, its ACO practice dashboard for Medicare patients, and its EHR stem to optimize communication.

“We are excited to announce this next round of mini-grant awards in the area of value-based payment reform,” said Department of Health and Social Services (DHSS) Secretary Dr. Kara Odom Walker, a board-certified family physician. “These grants reflect a diversity of ways that providers, hospitals, health centers and health systems are embracing payment reform.”

The first award ($62,168), to Christiana Care Health System’s CareLink Behavioral Health Medical Home Pilot, was announced in November. Applications, which were received during the summer, fell into one of three areas:

• Data integration: Project must enhance the applicant’s data integration, clinical informatics or population-based analytics capabilities. Examples include data exchange infrastructure and analytics projects or support; data warehousing and reporting capacity; and development of data-sharing agreements.
• Improve the coordination of patient care: Project must enhance the applicant’s clinical integration. Examples include conducting data analytics and developing care guidelines for a primary care-based system of complex care management for high-risk population(s); implementing improvements in care transitions such as new business processes or mutual agreements with partner providers; and implementing a practice support call center.
• Increase readiness to integrate into an Accountable Care Organization (ACO) or operate through an Alternative Payment Method (APM): Project must develop, expand or enhance the applicant’s shared governance structures and organizational integration strategies, linking the applicant with ACO leadership and across the continuum of care with providers already contracted with an ACO. An example would be support to model costs of care in preparation for participation in value-based payment arrangements with multiple payers.

-30-

The Department of Health and Social Services is committed to improving the quality of life of Delaware’s citizens by promoting health and well-being, fostering self-sufficiency, and protecting vulnerable populations.