The 2024 legislative session starts April 24, and the NCMS advocacy team is already working hard on behalf of our members.

One of the Medical Society’s highest advocacy priorities is to REFORM PRIOR AUTHORIZATION NOW. Jumping through the time-intensive and costly prior auth hoops is burdensome for clinicians and dangerous for their patients.

Latest Legislative News

On Monday, April 17, 2023, HB 649, an Act to Ensure Timely and Clinically Sound Utilization Reviews and that Medical Decisions are Made by Health Care Providers, was introduced in the NC House of Representatives.

The bill is the direct result of NCMS member engagement. After hearing increased frustration with patient care delays and increased administrative burden associated with many of the largest commercial payors in the state, the NCMS Payor Relations Task Force (Task Force) was formed to hear input from members in a wide range of practice areas,  The goal was to identify shared concerns and recommend a framework for proposed solutions. Prior authorization quickly rose as one of the top concerns.

HB 649 seeks to incorporate many of the recommendations made by the Task Force to address prior authorization reform.

If passed, the improved requirements would include the following and more:

  • Insurers would be required to talk with a clinician before refusing to pay for prescribed medical care, if medical necessity is being questioned.
  • Time limits would be set for reviews based on medical care level and timeframes would be provided to insurers for decision making.
  • Physicians issuing approvals and denials must be licensed in North Carolina, actively practicing, and have experience in that specialty or patient treatment.
  • Continuity of care requirements, previous prior authorizations must be honored for a time, ensuring coverage for related services.

The NCMS is especially grateful for the support of the bill’s sponsors: NCMS Member Representative Kristin Baker, MD, NCMS Member Representative Tim Reeder, MD, Representative Larry Potts, and Representative Wayne Sasser. Please join us in extending our appreciation to these patient champions!

Why is reform needed?

Let these healthcare professionals’ stories demonstrate why.

Recently, some NCMS members and their staff shared how prior authorization has negatively impacted their practices and their patients. Their conclusions?

Prior authorization is…

  • Leading to greater rates of burnout
  • Causing administrative burdens and roadblocks
  • Interfering with optimal care
  • Causing dangerous and sometimes deadly delays in treatment

Get the full story:
Click here to download (3 pages)

Get Involved

How can you help prior auth reform efforts?

Attend the NCMS White Coat Day and Legislative Reception June 12 – Come to Raleigh, learn about the issues and get the talking points you need to advocate for reform with your legislator. Learn more here.

Become a Key Contact – Key Contacts are NCMS members who are willing to build relationships with a legislator either at the State or Federal level of government. By signing up to become a Key Contact you are agreeing to the following actions with your assigned legislators: place a phone call at the start of session, meet either in person or virtually at least once, write a personal note at the end of session, and respond to NCMS Action Alerts. Sign up here.

Make sure your NCMS membership is up-to-date by renewing. Not a member? Join today! The stronger our membership, the stronger our voice.