Atracare & The Medical Society of Delaware

Fighting for Prior Authorization Reform

At Atracare, we see the frustration firsthand: patients waiting days, sometimes weeks, for their insurance companies to approve procedures, tests, or prescriptions that have already been recommended by their doctors. These delays, driven by the prior authorization process, create unnecessary stress for patients and prevent timely access to care. Fortunately, efforts are underway to change that here in Delaware.

The Medical Society of Delaware (MSD), in partnership with healthcare providers across the state, is leading the fight to reform prior authorization rules through new legislation: Senate Bill 12 with Senate Amendment 1 (SB 12 w/ SA 1).

Why Prior Authorization Reform is Needed

Prior authorization remains the single largest administrative burden facing physicians today. While prior reforms have been attempted — such as Delaware’s HB 381 signed into law in 2016 — enforcement has been limited and many gaps remain. Currently:

• Prior authorization rules continue to delay care.
• Insurance companies often take days or weeks to respond to requests.
• Denials are sometimes reviewed by individuals who aren’t even practicing in the same specialty as the treating physician.
• Even with electronic submission processes in place, timelines for responses are not always honored.

Many other states have taken stronger action, adopting robust legislation that better protects patients, increases transparency, and holds insurers accountable.

What SB 12 w/ SA 1 Proposes to Change

SB 12 w/ SA 1 introduces several important changes that would directly benefit both patients and physicians in Delaware:

• Require quick response times for prior authorization requests:
  • Non-urgent requests: insurers must respond within 72 hours.
  • Urgent care requests: insurers must respond within 24 hours.
• Ensure that adverse determinations (denials) are made by physicians practicing in the same or similar specialty as the treating provider.
• Expand access to peer-to-peer consultations for denied claims, especially for urgent, hospital, and emergency care situations.
• Mandate that, by January 1, 2027, insurers must fully support electronic prior authorization platforms for both submitting and responding to requests.
• Extend the validity period of approved prior authorizations from 60 days to 90 days, reducing the need for repeated authorizations on the same care plan.

The Broader National Push for Reform

Delaware is not alone in tackling this issue. Several states, including Illinois, Georgia, Arkansas, Kentucky, Michigan, Pennsylvania, and Colorado, have passed comprehensive prior authorization reforms in recent years. Many of these laws include:

• Robust reviewer qualifications
• Public reporting of authorization data for transparency
• Fast-tracked response times for urgent care needs

How You Can Help Support the Reform

Patients, providers, and the broader community all have a role to play in advancing this legislation. Here’s how you can help:

• Contact your Delaware State Senator and Representative to voice your support for SB 12 w/ SA 1. You can find your legislators at the Delaware General Assembly’s website.
• Reach out to the bill sponsors and Health Committee chairs to encourage progress:
  • Senator Bryan Townsend (Senate Majority Leader)
  • Senator Nicole Poore
  • Representative Krista Griffith
  • Representative Melissa Minor-Brown (Speaker of the House)
  • Senator Pinkney
  • Representative Chukwuocha
• Share your personal stories as a patient or healthcare provider on how prior authorization delays have affected care.
• Encourage your professional organizations or healthcare groups to join the coalition advocating for reform alongside the Medical Society of Delaware.

Atracare’s Commitment to Patient-First Healthcare

At Atracare, we fully support the Medical Society of Delaware’s leadership on this issue. Prior authorization reform means fewer administrative hurdles and faster access to care for our patients — whether it’s a needed medication, diagnostic testing, or critical procedures.

By streamlining this process, we can focus more on what matters most: delivering high-quality healthcare when our patients need it, without unnecessary delays.

Atracare continues to serve the Delaware Beaches community with:

• Primary Care
• Pediatrics
• Urgent Care
• Mental Health Services
• Lactation Consulting
• And more

For more information on prior authorization reform, visit The Medical Society of Delaware

Information from this article has been sourced from The Medical Society of Delaware >

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 [email protected]. Advocacy 101 for Physicians.