Bill > SB6

This bill establishes comprehensive reforms to the pre-authorization process for health insurance in Delaware, addressing significant challenges that physicians and patients face with current pre-authorization practices. The legislation introduces several key provisions, including defining new terms like "Episode of Care" and "Urgent health-care service," and mandating more streamlined and transparent pre-authorization processes. Insurers and health-benefit plans will be required to provide advance notice of pre-authorization changes, reduce processing times for pre-authorization requests (ranging from 2 to 48 hours depending on the service type), and establish electronic provider portals with specific features by January 1, 2027. The bill also requires that adverse determinations be made by qualified physicians who are not financially incentivized by the review's outcome, ensures appeals are reviewed by different physicians, and limits pre-authorizations to one per episode of care. Additionally, insurers must report de-identified pre-authorization statistics to the Delaware Health Information Network and provide more detailed explanations for denials. The legislation aims to reduce administrative burdens on healthcare providers, improve patient access to timely care, and increase transparency in the pre-authorization process, with the reforms set to apply to health insurance policies issued or renewed after December 31, 2026.

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https://legis.delaware.gov/BillDetail?LegislationId=142107