Prior Authorization Reform

MSD continues to support enhanced prior authorization reforms. SB 12 w/SA 1, the "Delaware Pre-Authorization Reform Act," was signed by Governor Matt Meyer last year, with implementation required after December 31, 2026.

MSD remains steadfast that additional reforms are needed to align with the most advanced states that have prior authorization reform. In conversations with the Delaware Department of Insurance (DOI), they have shared the following response to our recommendations to legislators and partners:

1. On the recommendation of gold carding options for practices that have consistently met standards for performance and quality metrics for certain prior authorization requirements, DOI will inquire with carriers as to their current status of gold carding programs.
2. On the recommendation of enhanced compliance mechanisms for insurance companies including automatic approval if/when a plan fails to comply within the time limits (the current system allows for delays in treatment, some of which worsens outcomes and may increase costs overall), DOI indicated there is shared automatic approval if plans fail to comply within timelines that is already law, stating that, "Any failure by a utilization review entity to comply with the deadlines and other requirements specified in this subchapter will result in any health care services subject to review to be automatically deemed preauthorized."
3. On the recommendation of requiring disclosure of use of Artificial Intelligence (AI) in making determinations, if not already the case, DOI noted that AI adverse determinations are already prohibited for clean submissions by virtue of the provider parity requirements. They can only return a submission for incompleteness, etc. This only applies to the plans the state can regulate.

Educational Transparency/Title Misappropriation

MSD was awarded a Scope of Practice Partnership (SOPP) grant from the American Medical Association (AMA) to partner with a public relations/marketing vendor (Seven Letter) to perform a public survey and awareness campaign regarding educational transparency/title misappropriation in Delaware. The qualitative voter focus group was completed in 2025 and quantitative survey and analysis was completed in January 2026. MSD has drafted a Title Transparency bill and is currently seeking stakeholder feedback.

Scope of practice expansion is a key factor in the Rural Health Transformation Plan (RHTP), and MSD maintains that it is essential for patients to have transparency in who they are seeing for their health care.

Rural Health Buzz:

Rural Health Transformation Plan (RHTP)

The federal government awarded Delaware $157 million in late December as part of a national program aimed at bolstering rural health care across all 50 states. The initial award represents the first round of funding. In November, Governor Meyer announced Delaware's 15 initiatives submitted to the federal government. These initiatives include a medical school in the state, expansion of mobile health, investment in preventive services, library support, and more.

Physician Assistant Scope of Practice

In order to move the RHTP forward, several policy initiatives will need to be implemented. The Governor's office has engaged MSD on conversations regarding expanding scope of practice. MSD has met with the Governor's office several times regarding the Physician Assistant Scope of Practice draft bill. MSD has leveraged the policies and resources of the American Medical Association (AMA) to guide the conversations and feedback to the Office of the Governor. Five recommendations were made by the GAC Select Subcommittee:

• Limit physician assistant independent practice to primary care and mental health care.
• Limit physician assistant independent practice to rural areas or health care shortage areas (as defined by the federal government's Health Resources and Services Administration (HRSA).
• Require 8,000 post graduate clinical hours in the specific medical field in which the physician assistant sees patients in his/her practice.
• Should a physician assistant switch from one medical specialty to another (for example, from primary care to mental health care), there must be another 8,000 hours of clinical training in the new medical specialty and include a collaborative agreement.
• Increase the number of physicians on the Physician Assistant Regulatory Council, including at least one physician being in primary care or mental health care and who collaborates with a physician assistant.

MSD has not received an updated bill but understands that the Office of the Governor will be using 6,000 hours for clinical training, instead of the 8,000 hours as recommended by MSD.

Pharmacy Scope of Practice

The GAC Select Subcommittee met on Wednesday, March 4th to discuss the Pharmacy Scope of Practice bill. The Select Subcommittee voice several concerns with the language, including, "independent practice authority," "performing limited physical assessments," and "providing treatment that is based on national, evidence-based published guidance."

The Select Subcommittee approved a motion stating MSD's ideological opposition but willing to offer improvements in the sake of patient safety.

What is MSD Monitoring in the General Assembly?

HB 191- This Act clarifies that a nonhuman entity, including an agent powered by AI, may not be licensed as a professional nurse, APRN, practical nurse, physician, or physician assistant. It further clarifies that a nonhuman entity may not use any of the foregoing professional titles.

What does this mean? The Act requires transparency from AI and chatbot tools that they cannot "pose" as a health care professional.

Sponsor: Representative M. Minor-Brown

MSD Position: Supports

Status: Passed the House

HB 224 - The Act authorizes licensed Physician Assistants (PAs) in Delaware to pronounce death and to complete a medical certification of death. The Act also removes registered nurses from the list of practitioners who may complete a medical certification of death, as it conflicts with the scope of practice set out in Title 24.

What does this mean? Driven by delays during COVID-19 and scope of practice expansions, this allows PAs to pronounce death and complete a death certificate.

Sponsor: Representative K. Johnson

MSD Position: Neutral

Status: Reported out of Senate Health Committee

HB 305 - This bill replaces HS 1 for HB 163 and provides a roadmap via an observational study on a small but representative group of diabetic patients to change standard health care from current reactive "sick care" to proactive "well care." HB 305 is different from HB 163 in that it does not require a fiscal note because this Pilot Program will be federally funded through the Rural Health Transformation Program. A Request for Proposal (RFP) recently dropped through the Delaware Bid Portal to support this effort.

Sponsor: Representative Jeff Hilovsky

MSD Position: Supports

Status: Reported out of House Health Committee

ACTION: Please reach out to your Representatives asking them to support HB 305.

Refer to the MSD bill chart for an update on bills introduced in the Legislative session. Several bills were introduced in the March 5, 2026, House and Senate Prefiles.

Automobile Insurance Reform Task Force - This Task Force, born out of SCR 111, has been meeting for several months and chaired by Senator Mantzavinos. On March 5, the Task Force met to vote on the outstanding recommendations, including the recommendation to evaluate a medical fee schedule. The physicians on the Task Force have worked tirelessly over the past six months to ensure that, when this vote comes up, it will fail and be viewed unfavorably. This vote was successfully defeated on March 5 at the meeting. MSD has supported a number of consensus recommendations, which include supporting the Department of Motor Vehicles' live time verification efforts. This initiative will ensure insurance verification during any accidents or traffic incidents, allowing for the identification of uninsured motorists in real time.

Upcoming Events

Pubs and Politics

MSD’s Pubs and Politics series is a fantastic way to engage with your colleagues and legislators in an informal way. Below are the dates for this year's Pubs & Politics event series.

Tuesday, March 24 – McGlynns, Dover (Registration open!)

Tuesday, June 2 – Club at Baywood, Millsboro (SAVE THE DATE)

Tuesday, December 8 - Augustine Tavern, Port Penn (SAVE THE DATE)

Contact Us

For more details on specific legislation or if you have other questions, please contact:

Lisa Gruss

External Affairs & Development Officer

610-306-6951

Lisa.Gruss@medsocdel.org

Mark B. Thompson, MHSA

Executive Director

302-444-6958

Mark.Thompson@medsocdel.org

Lincoln Willis

Lobbyist

302-632-9898

Lincoln.Willis@TheWillisGroupLLC.com

MSD actively monitors all health-related legislation and maintains an active and visible presence in Legislative Hall on your behalf. We strive to constantly improve our communications. Please reach out to us with any feedback or suggestions.

The Medical Society of Delaware Legislative e-Updates are a benefit to our members, providing information on legislative activity of interest in the 153rd General Assembly in Dover. If you would prefer to not receive these communications, please contact Mary.LaJudice@medsocdel.org.