DE SB6

Shortens timelines for insurers to respond to pre-authorization requests: 5 business days for non-electronic submissions, 3 business days for electronic submissions, and 24 hours for urgent care requests submitted electronically

Extends the validity period of pre-authorizations from 60 days to 90 days and limits insurers to requiring only 1 pre-authorization per episode of care for a specific medical condition

Requires insurers to provide 6 months notice before changing utilization review criteria for health-care services, with changes applying only upon re-authorization rather than to existing authorizations

Mandates that adverse determinations and appeals be reviewed by physicians with appropriate specialty training, with compensation not contingent on review outcomes, and requires appeals decisions within 15 days

Requires insurers to establish electronic provider portals by January 1, 2027, for submitting pre-authorization requests, with the law applying to policies issued or renewed after December 31, 2026