By Joseph Edelen

DOVER — Under a proposal that awaits Gov. John Carney’s signature, Medicaid patients’ access to care will not be jeopardized due to prior-authorization clauses from third-party carriers.

Senate Bill 220 — prime-sponsored by Sen. Sarah McBride, D-Wilmington, and led in the House of Representatives by Majority Whip Kerri Evelyn Harris, D-Dover — received unanimous support from the General Assembly after its introduction Feb. 29.

During its March 6 hearing in the Senate Health & Social Services Committee, Sen. McBride called it a “technical cleanup” bill, putting state code in compliance with federal statutes under the Consolidated Appropriations Act of 2022.

The legislation addresses third-party liabilities related to Medicaid, as the joint federal-state program is typically the “payer of last resort,” which Sen. McBride described as a mechanism to cover item and service claims otherwise uncovered.

“If a third-party payer is requiring prior authorization for coverage of a service that has been approved by Medicaid, they must take the Medicaid prior authorization and not be able to deny through their own prior-authorization process the service that’s already been deemed medically necessary by Medicaid,” Sen. McBride said of the bill’s intent.

SB 220 was passed by the Senate on March 13 and sent to the House, where it was considered during a March 26 Economic Development/Banking/Insurance & Commerce Committee hearing.

Throughout its movement in both chambers, the proposal had little debate, with state Medicaid director Drew Slater explaining during its Senate committee hearing that, from a payer, patient and provider perspective, the policy is “effectively invisible.”

Further, during its House committee hearing, Rep. Harris said Delaware is one of 13 states who have yet to pass laws in accordance with the federal statute. She added that, if not passed, monetary penalties would arise.

“This does cost our nation, when third-party liability payers are not paying what they are expected to pay — an average of $130 million nationwide hitting our taxpayers. So, not only is this something they’re required to do but something that will help our state and our nation when it comes to health care costs,” Rep. Harris said.

The measure received its final passage just two days after House lawmakers voted it out of committee.

Additionally, it has received support from a number of organizations, such as the Delaware Healthcare Association, which represents five medical systems.