HB 212 DE

0likes☆Favorite🔕SubscribeShare

Became Law

This Substitute for House Bill No. 212 corrects a technical drafting error to underline new language contained in Section 2 of the Act, and is otherwise identical to House Bill No. 212, which does the following: Section 1 of this Act amends the time period during which health insurers may initiate overpayment recovery efforts from 24 months to 12 months of a claim being paid. This Act also amends one of the exemptions to the overpayment recovery deadline to require an indication of fraud, abuse, or other intentional misconduct based on a physical review or review of claims data or statements as opposed to merely having a reasonable belief of such fraud, abuse or other intentional misconduct. It aligns requirements for provider-oriented clawbacks with those for pharmacies. Section 2 of this Act requires written notice from pharmacy benefit managers or entities conducting pharmacy audits. Because Department examinations have indicated that PBMs misuse this provision in the law to conduct audits outside the parameters of the Pharmacy Audit Integrity Program, Section 3 of this Act amends the exclusions to the applicability of the pharmacy audit rules to require that pharmacy benefits managers have more definitive proof, based on physical review of claims data or other investigative methods, to believe misconduct has occurred before the rules related to the Pharmacy Audit Integrity Program become inapplicable to an investigative audit. This Act also makes technical corrections to existing law to conform to the requirements of the Delaware Legislative Drafting Manual.

• William Bush Democratic · primary
• Spiros Mantzavinos Democratic · primary
• Bryan Townsend Democratic · primary
• Darius J. Brown Democratic · primary
• Claire Snyder-Hall Democratic · primary
• Nicole Poore Democratic · primary
• David L. Wilson Republican · primary

1. Jun 18, 2025 was introduced and adopted in lieu of HB 212 · lower
2. Jun 24, 2025 Passed By House. Votes: 40 YES 1 VACANT · lower
3. Jun 24, 2025 Assigned to Banking, Business, Insurance & Technology Committee in Senate · upper
4. Jun 25, 2025 Reported Out of Committee (Banking, Business, Insurance & Technology) in Senate with 7 On Its Merits · upper
5. Jun 30, 2025 Passed By Senate. Votes: 21 YES · upper
6. Sep 3, 2025 Signed by Governor · executive