This Amendment clarifies that a health-care provider may determine that a covered health-care service delivered on an expedited basis is an “urgent health-care service.” In addition, this Amendment provides that any compensation paid to a health-care provider or consulting healthcare provider for review of a clean pre-authorization request submitted by a health-care provider other than a physician, or of an appeal from an adverse determination of such a request, may not be contingent upon the outcome of the review.

Plain English Breakdown

The official status shows the bill passed the Senate on May 15, 2025, but no effective date or final enrollment confirmation for the entire state government process is listed.

Amendment to Senate Bill No. 12 on Urgent Care and Review Payments

This amendment allows any health-care provider, not just physicians, to decide if a fast-tracked service is urgent and bans paying reviewers based on whether they approve or deny requests.

What This Bill Does

• Changes the law so that 'treating physician' becomes 'treating health-care provider'.
• Allows any treating health-care provider to determine if an expedited service counts as an urgent health-care service.
• Updates references from a 'physician's scope' to a 'health-care provider's scope'.
• Requires that payment for reviewing clean pre-authorization requests cannot depend on the result of the review.
• Prohibits paying consulting providers based on whether they approve or deny an appeal.

Who It Names or Affects

• Treating health-care providers who deliver services
• Consulting health-care providers who review pre-authorization requests

Terms To Know

Expedited basis

A fast process for delivering a covered health-care service.

Clean pre-authorization request

An application submitted by a non-physician provider that is reviewed before approval or denial.

Contingent upon outcome

Payment depends on whether the reviewer says yes or no to a request.

Limits and Unknowns

• The text does not state when this law will officially take effect.
• The source material does not define which specific types of providers count as 'health-care providers' beyond physicians.
• The amendment only applies to reviews of clean requests and appeals, not other types of decisions.

Official Summary Text

This Amendment clarifies that a health-care provider may determine that a covered health-care service delivered on an expedited basis is an “urgent health-care service.”
In addition, this Amendment provides that any compensation paid to a health-care provider or consulting healthcare provider for review of a clean pre-authorization request submitted by a health-care provider other than a physician, or of an appeal from an adverse determination of such a request, may not be contingent upon the outcome of the review.

Current Bill Text

Legislation Document

SPONSOR:

Sen. Townsend

DELAWARE STATE SENATE

153rd GENERAL ASSEMBLY

SENATE AMENDMENT NO. 1

TO

SENATE BILL NO. 12

AMEND Senate Bill No. 12 on line 27 by deleting “

treating physician

” as it appears therein and inserting in lieu thereof “

treating health-care provider

”.

FURTHER AMEND Senate Bill No. 12 on line 27 by deleting “

physician’s scope

” as it appears therein and inserting in lieu thereof “

health-care provider’s scope

”.

FURTHER AMEND Senate Bill No. 12 on line 85 by inserting “

Any compensation paid to the health-care provider or consulting health-care provider may not be contingent upon the outcome of the review of the clean pre-authorization request or appeal from an adverse determination.

” after “

health-care provider.

” therein.

FURTHER AMEND Senate Bill No. 12 on line 200 by deleting “

treating physician

” as it appears therein and inserting in lieu thereof “

treating health-care provider

”.

FURTHER AMEND Senate Bill No. 12 on line 200 by deleting “

physician’s scope

” as it appears therein and inserting in lieu thereof “

health-care provider’s scope

”.

FURTHER AMEND Senate Bill No. 12 on line 257 by inserting “

Any compensation paid to the health-care provider or consulting health-care provider may not be contingent upon the outcome of the review of the clean pre-authorization request or appeal from an adverse determination.

” after “

health-care provider.

” therein.

SYNOPSIS

This Amendment clarifies that a health-care provider may determine that a covered health-care service delivered on an expedited basis is an “urgent health-care service.”

In addition, this Amendment provides that any compensation paid to a health-care provider or consulting healthcare provider for review of a clean pre-authorization request submitted by a health-care provider other than a physician, or of an appeal from an adverse determination of such a request, may not be contingent upon the outcome of the review.

Author: Senator Townsend