DelawareSB 12 w/ SA 1153rd General Assembly (2024–2026)SenateWALLET

AN ACT TO AMEND TITLE 18 AND TITLE 29 OF THE DELAWARE CODE RELATING TO THE DELAWARE PRE AUTHORIZATION ACT OF 2025.

Sponsored By: Bryan Townsend (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 7 benefits, 0 costs, 0 mixed.

Advance notice and protect current approvals

Plans must give you and your provider at least 60 days’ written notice before adding or changing prior authorization rules. If you already have an authorization, new review rules do not apply until the service is re-authorized. Plans must give six months’ notice before changing review criteria, except for safety or recall updates. These protections apply beginning December 31, 2026.

Fewer longer‑lasting prior authorizations

A prior authorization lasts at least 90 days from when your provider gets the approval, if your coverage stays active. Plans cannot require more than one prior authorization for an episode of care; only new or unrelated tests or treatments can need a new one. If one service in a bundled, in‑network package is approved, all other covered in‑network services in that bundle are approved too. These rules start December 31, 2026.

Online prior authorization by 2027

By January 1, 2027, plans must accept and respond to prior authorization requests through the same website, app, or platform used to submit them. A provider portal must show medical policies, peer‑to‑peer steps, contacts, required forms, and what to do if the portal is down. Within 12 months after a portal launches, plans may require providers to use it unless the portal is unavailable, the provider lacks access, or another approved method is allowed. Insurers accept pharmacy electronic prior authorization using the NCPDP SCRIPT standard, required since January 1, 2018.

Qualified reviewers and faster appeals

A denial of a clean request sent by a doctor must be decided by a licensed physician with similar training, and pay cannot depend on the outcome. Appeals of those denials must be reviewed by a different licensed physician who reads all records. For requests from non‑physician providers, a similarly licensed professional must decide or consult a qualified specialist. You have at least 30 days to file an appeal, and the reviewer must decide within 15 days (or 15 days after needed info arrives). Decision letters must explain the findings, list reviewer qualifications, and tie your diagnosis to the criteria. Review teams must be available on weekends and accessible 7:00 AM–7:00 PM on weekdays. These rules start December 31, 2026.

Who these rules cover and when

These protections apply to health insurance policies issued, renewed, or changed in Delaware after December 31, 2026. The State Employee Benefits Committee ensures state group health plans follow these rules starting December 31, 2026. The Department of Health and Social Services includes these requirements in Medicaid‑related contracts when feasible for contracts awarded after that date.

Faster prior authorization decisions

For clean requests sent online, plans must decide and notify your provider within 3 business days; paper or other methods get 5 business days. For urgent care and patient transfers, decisions must come within 24 hours if sent online, or 48 hours otherwise. Plans cannot require prior authorization for medically necessary interfacility transport when they have decided a lower level of care is clinically appropriate. These rules start December 31, 2026.

Public reporting of prior authorizations

Plans that use prior authorization must report de‑identified approval, denial, and appeal data to the Delaware Health Information Network at least twice a year. Reports include reasons for denials and, for appeals, details like specialty, service, indication, and overturn rates. The Department of Health may also request the data. Reporting starts December 31, 2026.

Sponsors & Cosponsors

Sponsor

Bryan Townsend
Democratic • Senate

Cosponsors

William J. Carson
Democratic • House
Mara Gorman
Democratic • House
Krista Griffith
Democratic • House
Kyra L. Hoffner
Democratic • Senate
Russell Huxtable
Democratic • Senate
Melissa Minor-Brown
Democratic • House
Eric Morrison
Democratic • House
Nicole Poore
Democratic • Senate
Bryant L. Richardson
Republican • Senate
Cyndie Romer
Democratic • House
Melanie Ross Levin
Democratic • House
Ray Seigfried
Democratic • Senate
David P. Sokola
Democratic • Senate
John "Jack" Walsh
Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 59 • No: 0

House vote • 6/26/2025

Passed (SM required)

Yes: 39 • No: 0

Senate vote • 5/15/2025