NCMS IS INSTRUMENTAL IN INTRODUCTION OF BILL ADDRESSING PRIOR AUTHORIZATION!
Legislators are back in Raleigh after spring break this week and NCMS is excited to announce that we have aided in the writing and introduction of a bill addressing prior authorization! HB 649: Ensure Timely/Clinically Sound Utiliz. Review, modifies the prior authorization process required by insurers and consequently benefits patients in our state.
HB 649 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.