HB 381 Summary

• Establishes pre-authorization transparency requirements for health insurers, health benefit plans, and utilization review entities operating in Delaware, effective January 1, 2017.

• Requires insurers to make pre-authorization requirements and clinical criteria readily accessible on websites in clear, understandable language, with 60 days' notice before implementing new or amended requirements.

• Sets processing deadlines: 2 business days for pharmaceutical pre-authorizations and 5-8 business days for health care service pre-authorizations depending on submission method (electronic or standard).

• Mandates pre-authorizations remain valid for one year for pharmaceuticals and minimum 60 days for health care services, prohibits retroactive revocation based on medical necessity, and requires reporting of approval/denial statistics to the Delaware Health Information Network at least twice annually.

• Makes all health care services automatically deemed preauthorized if utilization review entities fail to meet statutory deadlines and prohibits waiver of these requirements through contract terms.