This Legislation is the Delaware Pre-Authorization Reform Act of 2025. Section 1 of the Act applies to health Insurance Contracts regulated under Chapter 33 of Title 18. Section 1 provides that changes in utilization review terms for a health-care service, such as the clinical criteria used to conduct utilization reviews for a health-care service, will apply only upon re-authorization of the health-care service. Covered persons must be notified at least 6 months before any changes to utilization review terms, except in certain circumstances such as changes in clinical guideline status In addition, Section 1 sets qualifications for who may make determinations with regard to requests for pre- authorization of health-care services and appeals of adverse determinations; a timeline and required contents for the notification of an outcome of appeal of an adverse determination or a notification that additional information is necessary to make the determination of appeal; and requirements for any utilization review entity used to perform utilization review by an insurer, health-benefit plan, or health-service corporation. Section 1 also shortens the timelines for the determination of pre-authorization requests and notification to the health-care provider of the determination. For requests for pre-authorization of non-urgent health-care services not submitted electronically, the utilization review entity must notify the health-care provider within 5 business days of receipt of the request; for requests submitted electronically, notification must be given within 3 business days of receipt. For requests for pre-authorization for urgent health-care services submitted electronically, notification must be given within 24 hours of receipt. By January 1, 2027, insurers, health-benefit plans, health-service corporations, and utilization review entities must accept and respond to electronic pre-authorization requests through the same platform as the electronic request was submitted. In addition, Section 1 extends the time period that a pre-authorization is valid for from 60 days to 90 days. Finally, Section 1 provides that no more than 1 pre-authorization may be required for a single episode of care, and that if pre-authorization is granted as to a health-care service that is part of a group of services for which a bundled payment is charged, pre-authorization for the other health-care services included in the group is deemed to be approved as well. Section 2 of the Act applies to Group and Blanket Health Insurance under Chapter 35 of Title 18 and makes the same changes to pre-authorization standards and procedures that Section 1 of the Act makes to Health Insurance Contracts regulated under Chapter 33 of Title 18. Section 3 of the Act provides that the State Employee Benefits Committee established under § 9602 of the Title 29 of the Delaware Code must ensure that carriers administering plans for group health insurance comply with the requirements and provisions for pre-authorization set forth in Chapter 33, Subchapter II and Chapter 35, Subchapter V of Title 18. Section 4 of the Act provides that the Act will apply to health insurance policies, contracts, or certificates issued, modified, or renewed after December 31, 2026. Section 5 of the Act provides that the Department of Health and Social Services must, to the extent feasible, assure that contracts awarded to carriers providing health insurance relating to Medicaid assistance comply with the requirements and provisions for pre-authorization set forth in Chapter 33, Subchapter II and Chapter 35, Subchapter V of Title 18. Section 6 provides that this Act is known as the "Delaware Pre-Authorization Reform Act of 2025."
Sponsored bills
Maddy summarySB 147 adopts the Dentist and Dental Hygienist Compact within Delaware. This compact is an agreement among participating states designed to streamline the licensing process for dental professionals. It allows dentists and dental hygienists who hold a valid license in one member state to practice in other member states without needing to obtain a separate license in each jurisdiction. The bill aims to facilitate the practice of qualified dental professionals across state lines.
This Concurrent Resolution commends the 2025 Delaware Educational Support Professional of the Year, Melissa Wilson, and all of the District/Charter Network Educational Support Professionals of the Year.
This resolution designates May 2025 as “Haitian Heritage Month” and May 18, 2025, as "Haitian Flag Day" in the State of Delaware and encourages all Delawareans to honor Haitian and Haitian American culture.
This resolution recognizes and commends the Theta Zeta Zeta Chapter of Zeta Phi Beta Sorority, Incorporated, for its years of exemplary service to the Dover community, with a focus on educational equity, health advocacy, civic engagement, and empowering women and children. The chapter’s work reflects the sorority’s historic legacy of scholarship, service, sisterhood, and finer womanhood.
This resolution designates May 15, 2025, as "Global Accessibility Awareness Day" in the State of Delaware, affirms the importance of making the internet and technology accessible to all, and encourages expanded efforts to keep Delaware residents properly informed about the need for equitable digital access and inclusion.
This Concurrent Resolution celebrates Homeschool Awareness Month in May 2025 and aims to demonstrate how homeschooling can be a better option than regular schooling for many children.
This Concurrent Resolution recognizes the escalating HIV crisis in Delaware and the drastic reduction in federal HIV prevention funding. The Resolution encourages healthcare providers, advocacy organizations, and community leaders to collaborate in exploring avenues to reduce HIV infections and ensuring equitable access to preventative care statewide.
This resolution acknowledges the critical and immediate need for funding for community-based mental health services. It recognizes the expertise and importance of Community Mental Health providers and its workforce to Delawareans with mental illness to our state on the occasion of May 14, 2025, as “Community Mental Health Workforce” Advocacy Day, co-sponsored by the Ability Network of Delaware.
This Act prohibits discrimination based on weight, height, or body size in transportation, public accommodation, housing, commerce and trade, employment, jury selection, education, and public administration. This Act also makes technical corrections to conform existing law to the standards of the Delaware Legislative Drafting Manual.