DE| The Delaware Department of Insurance‘s Bulletin No. 163 announces the implementation of the Delaware Pre-Authorization Act of 2025 (Senate Bill 12), establishing uniform standards and procedures for the pre-authorization of healthcare services by health insurers, benefit plans, and utilization review entities operating in Delaware, effective for policies issued, renewed, or amended after December 31, 2026. The Act aims to reduce administrative burden, improve access to care, and enhance transparency in utilization review practices, introducing statutory definitions, specific notice and review requirements, and mandated timelines for response and appeals. Additionally, it requires the adoption of electronic provider portals by January 1, 2027 for pre-authorization requests, with detailed compliance features and enforcement timelines.
Key Points:
- Uniform pre-authorization standards apply to all Delaware health insurance policies issued, renewed, or amended after December 31, 2026.
- Insurers must comply with rigorous notice, review, and appeal procedures, including physician and non-physician reviewer requirements and strict response deadlines.
- All regulated entities must implement electronic provider portals with specific compliance features for pre-authorization requests by January 1, 2027.