DelawareSS 1 for SB 334153rd General Assembly (2024–2026)SenateWALLET

AN ACT TO AMEND TITLES 18 AND 29 OF THE DELAWARE CODE RELATING TO HEALTH CARE.

Sponsored By: Marie Pinkney (Democratic)

Signed by Governor

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Bill Overview

Analyzed Economic Effects

7 provisions identified: 4 benefits, 0 costs, 3 mixed.

Providers can seek damages for delays

Beginning January 1, 2028, providers can report credentialing violations to the state agency overseeing the carrier's relevant activity. The agency can refer complaints to another agency when appropriate. A provider complainant may receive damages up to $500 per day of delayed carrier action, capped at $5,000 per incident. Awards are not automatic and are in addition to other legally authorized penalties.

Providers gain review and hearing protections

Beginning January 1, 2028, providers can review credentialing information and its source when disclosure is allowed. Carriers must flag information that fails their standards or substantially differs from the provider's submission. Providers can submit corrections or added information for carrier confirmation and request formal reconsideration. Before ending or not renewing credentials, carriers must give written reasons, supporting evidence, and 30 days to request a hearing. A requested hearing must occur within 30 days before at least 3 health professionals, including a same-discipline clinical peer in the same or a similar specialty. Panel pay cannot depend on the outcome; the panel can restore credentials, restore them with conditions, or uphold the action. Termination or nonrenewal generally must wait at least 60 days after notice, and at least 60 days after receipt of a panel decision upholding it. These procedures exclude specified imminent patient-harm, final government fraud, and final government discipline cases that impair practice. Carriers may act over conduct that could disqualify providers under credentialing standards, but cannot act solely because providers gave or helped with legally protected care that met professional standards and Delaware law.

Workers' compensation providers avoid extra credentialing

Beginning January 1, 2028, Delaware-certified workers' compensation providers do not need additional credentialing under this law to receive payment. This exemption applies only to providers certified under Delaware's workers' compensation law and services covered by that law. Existing workers' compensation certification rules remain in place.

Health plans must follow provider review rules

Beginning January 1, 2028, covered health plans must follow written rules for checking providers' qualifications before contracting with them. A committee of health professionals must review information and decide denials or terminations. Plans must share their policies on request, keep records for at least 3 years, and protect confidential information. These rules cover Delaware state employee plans and Medicaid managed care plans as federal law allows. Plans can still apply additional contracting criteria beyond credentialing standards.

Providers face fewer repeat application demands

Beginning January 1, 2028, carriers generally cannot require another full credential review within 3 years of successful credentialing. Earlier review is allowed for conduct that could disqualify a provider under National Committee for Quality Assurance standards. Required review cycles also cannot exceed 3 years unless those standards allow it. Carriers must give at least 90 days' written notice electronically, plus certified mail or legally valid proof of mailing. When providers change jobs or locations, add a location, or join a new facility, carriers can request only needed updates—not a new application.

Providers get free applications and deadlines

Beginning January 1, 2028, covered carriers and application services must use one uniform provider application, and carriers cannot charge processing fees. Carriers must accept online submissions; providers practicing outside Delaware can choose their primary or home state's required application instead. Carriers have 15 days to confirm completeness or list all corrections; missed deadlines make the application count as complete. Applicants have 30 days to supply requested corrections, or carriers may treat the application as withdrawn. After confirming completeness, carriers have 30 days to approve, deny, or explain a delay with an estimated review time and temporary-credential information. They must send the outcome within 10 calendar days after review ends.

Temporary provider approval comes with payment limits

Beginning January 1, 2028, carriers must give qualifying providers temporary credentials from confirmation of a complete uniform application through approval or denial. Providers qualify when carriers miss decision deadlines, when providers mainly work in designated shortage areas or federally qualified health centers, or when they already hold that carrier's credentials at another Delaware location. Providers also qualify with that carrier's credentials in a reciprocal-licensing state when moving to Delaware or providing multistate care including Delaware. Temporary credentials are barred for applications reporting malpractice settlements in the prior 5 calendar years or licensing-board discipline. If final approval is denied, carriers may recover reimbursements paid in the 120 days before denial. If credentials are ultimately granted, carriers must pay for services dating back to submission of a complete application. Providers must wait for notice of the credential effective date before submitting claims; claims submitted before approval may receive out-of-network treatment.

Sponsors & Cosponsors

Sponsor

Marie Pinkney
Democratic • Senate

Cosponsors

Alonna Berry
Democratic • House
Stephanie T. Bolden
Democratic • House
William J. Carson
Democratic • House
Kerri Evelyn Harris
Democratic • House
Larry Lambert
Democratic • House
Claire Snyder-Hall
Democratic • House

Roll Call Votes

All Roll Calls

Yes: 61 • No: 0

House vote • 6/23/2026

Passed (SM required)

Yes: 41 • No: 0

Senate vote • 6/11/2026