DelawareSB 22153rd General Assembly (2024–2026)SenateWALLET

AN ACT TO AMEND TITLE 18 OF THE DELAWARE CODE RELATING TO INSURANCE COVERAGE.

Sponsored By: Bryan Townsend (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

10 provisions identified: 8 benefits, 1 costs, 1 mixed.

Broader treatment coverage for Delaware patients

These rules cover Delaware individual and group plans issued, renewed, or changed after December 31, 2027—not Medicare, Medicaid, or CHIP. Plans must cover all medically necessary mental health and substance use care, including residential, inpatient, intensive outpatient, withdrawal, and emergency services. Coverage includes crisis stabilization, transport, and mobile crisis services; plans must pay covered claims from state-operated or state-authorized mobile crisis programs. A disorder covered in one benefit group must be covered wherever medical or surgical benefits are offered, including required core treatments. Plans may require qualified providers, but supervised team care remains covered; nonclinical placements and supports need not be covered. When plans cover those supports, these rules apply, and the law preserves existing benefits and provider eligibility under Delaware law.

Fewer approval barriers for treatment patients

Beginning January 1, 2028, affected plans cannot require advance approval, pre-admission screening, or referrals for behavioral health diagnosis or medically necessary treatment. Plans cannot conduct concurrent coverage reviews during the first 14 inpatient days, 30 intensive outpatient days, or five inpatient withdrawal-management days. Inpatient facilities must have required accreditation or state approval; facilities must send admission notice and an initial treatment plan within 48 hours, conduct daily clinical reviews, and complete age- and diagnosis-appropriate assessments. Permitted plan reviews must use accepted clinical standards and applicable ASAM, LOCUS, CALOCUS-CASII, or ECSII criteria, authorize the supported level of care, and explain differing placement decisions to patients and providers. For the first 14 inpatient days, nonemergency care can be denied as not medically necessary only when it conflicts with those criteria.

Stronger safeguards against unfair treatment limits

Beginning January 1, 2028, affected plans cannot make non-dollar behavioral health treatment limits stricter than the main limits applied to nearly all medical or surgical benefits in the same group. These limits include provider standards, care management, and definitions of medical necessity; plans cannot design them using biased evidence. Plans must review access data and take and document reasonable action when limits contribute to material differences in access. Those differences are strong evidence of noncompliance. Delaware also adopts federal parity authorities and the rules published September 23, 2024, preserving them despite later federal changes, repeal, or nonenforcement.

Timely care without higher network costs

Beginning January 1, 2028, affected plans must offer nonurgent behavioral health care within 10 business days and urgent care within 24 hours. After a member requests help, plans unable to secure timely, appropriate in-network care must arrange an out-of-network single-case agreement. The agreement sets provider payment, limits member charges to in-network cost sharing, and counts those charges toward in-network deductibles and out-of-pocket limits. Providers must accept that payment in full; this protection does not apply when a member declines an appropriate, timely in-network option. Policies and public websites must explain these rights, with a phone number and dedicated electronic request method; enforcement rests with the Insurance Commissioner, not a new private lawsuit right. The Commissioner can order protection from charges above in-network cost sharing when a plan fails to arrange a required agreement on time.

Easier access to addiction treatment medicines

Beginning January 1, 2028, affected plans with prescription coverage must put at least one form of every FDA-approved addiction medicine on the lowest drug tier. This includes buprenorphine, naltrexone, naloxone, buprenorphine-naloxone, disulfiram, and acamprosate—even medicines previously excluded or outside the formulary. Plans cannot require prior approval for FDA-approved addiction medicines and must approve at least one form of each covered behavioral health medicine on each tier without step therapy. The only allowed trial requirement is an FDA AB-rated equivalent generic with the same active ingredient, dosage form, and strength; prescribed forms reasonably expected to help must be approved. Plans with prescription coverage must also cover methadone administration or dispensing fees at federally defined opioid treatment programs.

Fairer treatment bills for Delaware patients

Beginning January 1, 2028, affected Delaware plans cannot impose greater financial burdens for mental health or substance use care. Copayments, coinsurance, deductibles, benefit limits, and prescription coverage must treat this care as fairly as comparable medical or surgical care. Plans cannot discriminate based on a person's past, current, or predicted mental health or substance use disorder. For covered in-network treatment, patients owe no more than the plan's required copayment, coinsurance, or deductible.

Immediate emergency medicines for Delaware patients

Beginning January 1, 2028, affected plans with prescription coverage must provide immediate access to a medically necessary five-day emergency medication supply. No prior approval is allowed when an emergency medical condition exists and the prescribed behavioral health medicine is covered. This includes opioid withdrawal or stabilization medicines and covered overdose-reversal medicines. Plans cannot add another copayment or coinsurance for another emergency supply of the same medicine within the same 30-day period. Otherwise, cost sharing must follow federal parity rules.

Free fairness reviews for plan members

Beginning January 1, 2028, current or prospective members and providers can request an affected plan's required analysis of behavioral health treatment-limit fairness. Plans must provide it free within 30 days and explain the request process in policies and behavioral health provider contracts. Carriers also report how they choose care-review standards, identify treatment limits, and compare their design and actual operation with medical or surgical limits. The statute sets July 1, 2019, as the first reporting deadline, then July 1 in later years with significant care-management protocol changes. Reports go to the Delaware Health Information Network in conjunction with the Insurance Commissioner; proprietary information can be protected from public disclosure.

Experimental treatments can still be excluded

Beginning January 1, 2028, affected Delaware plans may still exclude experimental or investigational services. Any exclusion must comply with the law's mental health parity requirements. The law does not require coverage of every experimental treatment, so patients can still face uncovered treatment costs.

Steady treatment rules can delay updates

Beginning January 1, 2028, affected plans need not adopt treatment or diagnostic standards released after their plan year starts. This keeps the standards steady during that year, but can delay use of newer standards. The rule covers ASAM, LOCUS, CALOCUS-CASII, ECSII, and the listed diagnostic manuals or classifications. During edition changes, the Insurance Commissioner can designate a version after consulting the state's substance abuse and mental health division.

Sponsors & Cosponsors

Sponsor

Bryan Townsend
Democratic • Senate

Cosponsors

Alonna Berry
Democratic • House
Eric Buckson
Republican • Senate
Frank Burns
Democratic • House
Nnamdi O. Chukwuocha
Democratic • House
Daniel Cruce
Democratic • Senate
Mara Gorman
Democratic • House
Krista Griffith
Democratic • House
Stephanie L. Hansen
Democratic • Senate
Kerri Evelyn Harris
Democratic • House
Debra Heffernan
Democratic • House
Russell Huxtable
Democratic • Senate
Kendra Johnson
Democratic • House
Kamela T Smith
Democratic • House
Larry Lambert
Democratic • House
Michael F. Smith
Republican • House
Melissa Minor-Brown
Democratic • House
Eric Morrison
Democratic • House
Edward S. Osienski
Democratic • House
Brian Pettyjohn
Republican • Senate
Marie Pinkney
Democratic • Senate
Nicole Poore
Democratic • Senate
Ray Seigfried
Democratic • Senate
Claire Snyder-Hall
Democratic • House
David P. Sokola
Democratic • Senate
Laura V. Sturgeon
Democratic • Senate
John "Jack" Walsh
Democratic • Senate

Roll Call Votes

All Roll Calls

Yes: 74 • No: 2

Senate vote • 6/10/2026

Passed (2/3 required)

Yes: 20 • No: 0

House vote • 6/9/2026

Passed (SM required)

Yes: 33 • No: 2

Senate vote • 5/13/2026