Del. Code Ann. tit. 31, § 539
Primary care coverage
85 Del. Laws, c. 348, § 11;
(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.