04/15/2025
(Dover, DE – April 15, 2025) – Close to 50 leading health nonprofits, organizations, and provider offices signed onto a letter of support for the Delaware Pre-Authorization Reform Act of 2025.
The organizations, which represent physicians, hospitals, facilities, home care providers, nurse and nurse practitioner organizations, and patient organizations, urge lawmakers to support Senate Bill 6 sponsored by Senator Bryan Townsend, Senator Nicole Poore, Rep. Krista Griffith and House Speaker Melissa Minor-Brown.
The legislation aims to create a more efficient pre-authorization process that allows for better access to timely health services. Pre-authorization, also known as prior authorization, is a process by which providers are required to request approval from insurance plans for certain healthcare procedures or medications.
More than 90% of physicians surveyed on pre-authorization reported delays in patient care, while 80% voiced concerns that the current process leads to patients abandoning the recommended care due to the hurdles associated with pre-authorization process according to a recent American Medical Association study.
Pre-authorization negatively impacts Delaware’s healthcare workforce by increasing administrative burdens and gets in the way of providing quality care. A more efficient process protects patients, improves outcomes, and reduces healthcare costs.
In the letter, the industry and direct-care experts across the health continuum highlighted the following provisions included in SB 6 that will make a difference:
- Establish quick response times for requests submitted electronically with notification given within 72 hours for non-urgent care and 24 hours for urgent health-care services.
- Adverse determinations should be made by a physician of a same or similar specialty as the treating physician/ practitioner.
- Expanded access for peer-to-peer consults regarding denials must be offered to meet needs of urgent care, hospital, and emergency care physicians and practitioners.
- 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.
- The prior authorization’s duration must be extended from a minimum of 60 days to a minimum of 90 days.
SB 6 is scheduled for a hearing in the Senate Banking, Business, Insurance & Technology Committee on Wednesday at 1 p.m.