Bill > SB12

This bill introduces comprehensive reforms to pre-authorization practices in Delaware's health insurance system. The legislation addresses issues highlighted by a 2023 American Medical Association survey showing that pre-authorization requirements significantly delay patient care and negatively impact clinical outcomes. Key provisions include requiring insurers and health plans to: reduce pre-authorization processing times (e.g., 3-5 business days for standard requests, 24 hours for urgent services), establish electronic submission portals by January 1, 2027, ensure that adverse determinations are reviewed by qualified physicians who are not financially incentivized by the review's outcome, provide more transparent appeals processes, and limit pre-authorizations to one per episode of care. The bill also mandates that insurers provide advance notice of changes to pre-authorization requirements, report de-identified statistics on pre-authorization approvals and denials, and ensures that pre-authorization approvals are valid for at least 90 days. These reforms aim to streamline medical care approval processes, reduce administrative burdens on healthcare providers, and improve patient access to timely medical treatments. The act will apply to health insurance policies issued or renewed after December 31, 2026, and is officially known as the "Delaware Pre-Authorization Reform Act of 2025".

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https://legis.delaware.gov/BillDetail?LegislationId=142319