AN ACT TO AMEND TITLES 18 AND 29 OF THE DELAWARE CODE RELATING TO HEALTH CARE.
What changed between versions
The full operative text of the Health Care Professional Access Act is now included, applying to all carriers that require provider credentialing prior to reimbursement and that contract with health care professionals under state-regulated plans in Titles 18, 19, 29, or 31.
A new protection prohibits carriers from denying or terminating credentials based solely on legally protected health care activity, provided the care met the professional standard of care and did not violate Delaware law.
Workers compensation providers certified under Title 19 Chapter 23 are exempted from dual credentialing requirements under this chapter.
Carriers must use the uniform credentialing application (CAQH or Pharmacy Profiles) as the sole application for credentialing and recredentialing, effective January 1, 2028. Carriers may accept another state's application if the professional's primary state is elsewhere.
Carriers may not require recredentialing within 3 years of the most recent successful credentialing (except for disqualifying activity per NCQA standards), must give at least 90 days written notice before recredentialing is required, and may not charge fees for processing applications.
Before denying, suspending, nonrenewing, or terminating credentials, carriers must provide a written explanation with reasons and evidence, offer a hearing before a panel of at least 3 health care professionals (including a clinical peer), and wait at least 60 days after the decision before termination takes effect.
Specific processing deadlines are established: 15 days to confirm a clean application or flag it as incomplete, 30 days after clean application confirmation to approve, deny, or request more time, and 10 calendar days after the process concludes to notify the applicant of the outcome.
Provisional credentialing is required when a carrier misses the decision deadline, or when the professional works in a Health Professional Shortage Area, a Federally-Qualified Health Center, is already credentialed at another Delaware facility with the same carrier, or is credentialed in another state with licensure reciprocity and relocating to Delaware.
Penalties include damages up to $500 per day of delay or $5,000 total per incident of noncompliance, in addition to any other penalties available by law. Complaints are filed with the relevant state regulatory agency.
Co-sponsors were added: Rep. Harris and Reps. Berry, Bolden, Carson, Lambert, and Snyder-Hall join Sen. Pinkney as sponsors.
