RALEIGH — House Bill 649 has cleared another hurdle!  The NCMS aided bill to modify the prior authorization process was passed by the House Health Committee Tuesday morning and is now headed to the Rules Committee.  It could be heard by the Rules Committee today.

The bill has multiple provisions that ensure that patients will receive timely medical care and requires that medical decisions for patients be made by qualified health care providers. Examples of these requirements include the following:  

  • 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. 

It could be heard by the Rules Committee this week.  NCMS will keep you updated.

NCMS has put together helpful information on Prior Authorization and what the bill introduces to reform it.

Click here to read more and for a link to contact your legislator!