RALEIGH —  The North Carolina Medical Society is thrilled to announce that it has successfully introduced legislation seeking to reform the overused and burdensome prior authorization process!

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!

The bill still needs your support and cosponsors.  Click here to take action and let your representative know how you feel.