Denial, suspension, nonrenewal, and termination of credentialing [Effective Jan. 1, 2028].
Del. Code tit. 18, § 3310B
in effect(a) (1) A carrier may not deny, suspend, nonrenew, or terminate a health-care professional’s credentials unless the carrier provides a written explanation prior to the termination or nonrenewal that include all of the following:
a. The reason or reasons for the proposed action in sufficient detail to permit the health-care professional to respond.
b. Reference to the evidence or documentation underlying the carrier’s decision to pursue the proposed action.
c. Notice that the health-care professional has the right to request, within 30 days of receipt of the written explanation, a hearing before a panel appointed by the carrier.
(2) If the health-care professional requests a hearing pursuant to paragraph (a)(1)c. of this section, all of the following apply:
a. A hearing date must be within 30 days of the date of receipt of a request for a hearing.
b. A hearing panel must be composed of at least 3 health-care professionals appointed by the carrier, and 1 person on the hearing panel must be a clinical peer in the same discipline and the same or similar specialty as the health-care professional under review. A hearing panel may be composed of more than 3 health-care professionals if the number of clinical peers on the hearing panel constitutes ⅓ or more of the total membership of the panel. Any compensation paid to the panel may not be contingent upon the outcome of the review.
c. A hearing panel must render a decision on the proposed action in a timely manner. This decision must be either the reinstatement of the health-care professional by the carrier, the provisional reinstatement of the health-care professional subject to conditions established by the carrier, or uphold the termination or nonrenewal of the health-care professional’s credentials.
d. A decision by a hearing panel to terminate or nonrenew a health-care professional’s credentials may not become effective less than 60 days after the receipt by the health-care professional of the hearing panel’s decision.
(b) Termination or nonrenewal of credentials may not be effective earlier than 60 days from the receipt of the notice of termination or nonrenewal.
(c) This section does not apply to termination cases involving imminent harm to patient care, a final determination of fraud by a governmental agency, or a final disciplinary action by a state licensing board or other governmental agency that impairs the ability of a health-care professional to practice.
(d) A carrier may deny, suspend, nonrenew, or terminate a health-care professional’s credentials for any activity that could disqualify a health-care professional from credentialing in accordance with NCQA standards.
(e) A carrier may not deny, suspend, nonrenew, or terminate a health-care professional’s credentialing based solely on the health-care professional’s provision of legally protected health-care activity, or aiding and assisting with legally protected health-care activity, provided that the care provided by the health-care professional was consistent with the applicable professional standard of care and did not violate Delaware law.
Source: DE Code (Official Site)URL: https://delcode.delaware.gov/title18/c033b/index.htmlFetched: 10/4/2026