Delaware Pre-Authorization Reform Act of 2023

• Shortens pre-authorization response timelines: 48 hours for pharmaceuticals, 4 days for non-electronic service requests, 72 hours for electronic requests, and 24 hours for urgent services.

• Requires electronic pre-authorization capability by January 1, 2024, with responses through the same platform as the request.

• Extends pre-authorization validity from 60 days to 7 months and limits insurers to one pre-authorization per episode of care.

• Establishes qualifications for reviewers making determinations and appeals, including physician licensure and relevant specialty experience, with appeal decisions required within 15 days.

• Prohibits denial of already-delivered services solely due to lack of pre-authorization if services would have been covered with approval, and requires new pre-authorization requirements to have 60 days' notice before implementation.