Bill > SB10

This bill, the Delaware Pre-Authorization Reform Act of 2023, aims to reform laws relating to insurance pre-authorization practices in order to keep Delaware residents healthy and ensure patients can access necessary medical care in a timely manner. Key provisions include: - Defining "episode of care" and "urgent health-care service" to provide clarity on the types of services covered. - Requiring insurers to provide advance notice of changes to pre-authorization requirements and prohibiting those changes from applying to pre-authorizations already granted. - Mandating detailed reporting of pre-authorization data, including denials and appeals, and making this information publicly available. - Specifying qualifications and review requirements for clinicians making adverse pre-authorization determinations and reviewing appeals. - Establishing timelines for insurers to respond to pre-authorization requests, including expedited timelines for urgent services and patient transfers. - Limiting insurers to requiring only one pre-authorization per episode of care, with exceptions for additional tests or procedures. - Prohibiting insurers from retroactively denying coverage for pre-authorized services. - Requiring the Department of Insurance to create a uniform pre-authorization form. Overall, the bill aims to increase transparency, timeliness, and fairness in the pre-authorization process for patients and providers in Delaware.