16 Del. C. § 9961: Definitions [Effective upon fulfillment of contingency in 85 Del. Laws, c. 349, § 6(b)].

For the purposes of this subchapter:

(1) “Board” means the Diamond State Hospital Cost Review Board established by § 9952 of this title.

(2) “Department” means the Department of Health and Social Services.

(3) “Division” means the Division of Health Care Quality.

(4) “Facility-based provider” means a health-care professional licensed under Title 24 who furnishes hospital services.

(5) “Financial assistance” means free or discounted care for medically necessary hospital services provided to a financially qualified patient, resulting in a full or partial write-off of the patient’s responsibilities for the services.

(6) “Financially qualified patient” means a patient who meets all of the following:

a. Has household income at or below the applicable percentage of the federal poverty level established under this subchapter.

b. Is a resident of this State.

(7) a. “Hospital” means as defined in § 1001 of this title.

b. “Hospital” does not include a hospital that provides exclusively psychiatric services, rehabilitative services, or long-term acute care.

(8) a. “Hospital services” means medically necessary services provided to a patient in connection with the patient’s hospital visit, including services provided during or as part of an inpatient admission, emergency department visit, observation stay, or hospital outpatient procedure or visit.

b. “Hospital services” include services provided at the hospital, at any off-campus location operated under the hospital’s license or Medicare provider agreement, and at a freestanding emergency department affiliated with the hospital, regardless of the identity of the entity billing for the service.

c. “Hospital services” do not include any of the following:

1. Services provided after the patient refuses, or the holder of the medical power of attorney, the legal guardian, or the patient’s family refuse for the patient, to be discharged from the hospital when recommended by the hospital.

2. Services provided by a facility-based provider at a location that is not the hospital, an off-campus location operated under the hospital’s license or Medicare provider agreement, or a freestanding emergency department affiliated with the hospital.

d. The Board may by regulation specify categories of services that are or are not hospital services consistent with this paragraph (8).

(9) “Medical hardship” means out-of-pocket hospital expenses incurred for a hospital visit, including health plan deductibles and out-of-pocket hospital expenses, which equal or exceed 10% of the patient’s annual household income.

(10) “Medically necessary” or “medical necessity” means the provision of health-care services or products that a prudent physician would provide to a patient for the purpose of diagnosing or treating an illness, injury, disease, or the symptoms of an illness, injury, or disease in a manner that is all of the following:

a. In accordance with generally accepted standards of medical practice.

b. Consistent with the symptoms or treatment of the condition.

c. Not solely for anyone’s convenience.

d. Not including investigational or experimental health-care services.

(11) “Patient responsibility” means the amount owed by a patient for medically necessary hospital services after payment or adjustment by any insurer, health plan, Medicare, Medicaid, or other third-party payer, including copayments, coinsurance, deductibles, and any other amounts owed by the patient.