Prior Auth/Legislative & Regulatory

HB 381 was signed into law in Delaware in 2016
- Established standards for electronic prior authorization
- Required reporting of specified statistics to DHIN, this component has not been enforced
- 60-day notice for new prior authorization requirements
- Make current requirements accessible on website, written, or electronic form
Several states have enacted robust legislation to enhance patient protections
Prior Authorization is the #1 physician challenge

SB 12 w/ SA 1: Bill Detail
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 to meet needs of urgent, 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.
Extend the period that a pre-authorization is valid from 60 days to 90 days.

The American Medical Association provides a central hub for physicians looking for information on prior authorization reform
The AMA website offers tools such as:
The American Hospital Association incorporate prior authorization reform in several aspects of its 2025 Advocacy Agenda
Prior Authorization is the #1 administrative challenge identified by physicians. MSD has launched a survey to capture Delaware data on the challenges, opportunities, and impacts of prior authorization. It is based on the American Medical Association (AMA) Annual Prior Authorization Survey. Please complete the survey by Monday, March 31, 2025. Want to help the grassroots efforts to improve prior authorization in DE? Click to take the survey at share your experiences today!
Nearly 50 Organizations Advocate for Pre-Authorization Reform: Press Release
Joint Pre-Authorization Reform Letter

Many states have passed more robust legislation in areas related to retrospective denials, reviewer qualification, peer-to-peer consults, and exceptions , than the legislation introduced .
- 24 states and Washington, DC require prior authorization reviewers to meet robust qualifications similar to or exceeding those in Delaware.
- Several states mandate public reporting of prior authorization data, increasing transparency.
- Over 15 states have implemented specific guidelines for response times related to urgent care, enabling quicker decision-making in critical cases.
States with robust legislation include:
- Illinois
- Georgia SB 80 and SB 341
- Arkansas
- Kentucky

Several states have built coalitions of stakeholders to encourage legislators to pass critical prior authorization legislation including Pennsylvania, Colorado, Michigan, and Illinois
Join the Medical Society in "signing-on" to this important bill
The following stakeholders have joined MSD in the fight to improve prior authorization:
- Delaware Healthcare Association
- Delaware Society of Orthopaedic Surgeon
- Delaware Chapter, American Academy of Pediatrics

Advocacy

MSD’s Political Advocacy is a multi-faceted program intended to:

Represent, promote and defend the interests of physicians and their patients in the halls of government;
Educate and advise lawmakers and officials on medical issues that affect our community;
Establish relationships with and evaluate elected officials; and
Provide members the tools they need to stay current on the laws and regulations that affect their practices and to make informed decisions in the ballot booth.

AMA Health Care Advocacy

The MSD Advocacy 101 deck is a great way to learn more about engaging your practice in advocacy. For more information, on MSD’s advocacy initiatives, contact Lisa Gruss at lisa.gruss@medsocdel.org. Advocacy 101 for Physicians.