House committee substitute to the 1st edition makes the following changes.
Deletes the changes to GS 58-50-61 (Utilization review) which would have defined “urgent healthcare service”, created a new timeline for utilization reviews of non-urgent healthcare services and urgent healthcare services, and required insurers to disclose utilization review documents in detail and in easily understandable language, as well as requiring that an insurer make current utilization review requirements and restrictions readily accessible on its website.
Removes the requirement of the State Treasurer and Executive Administrator of the State Health Plan to review all practices and all contracts with and practices of third parties conducting any utilization review on behalf of the State Health Plan to ensure they comply with the changes of this act. Removes the appropriation to the Department of State Treasurer for the State Health Plan.
Removes the provision that required DHB to ensure urgent prior authorization requests are approved or denied within 24 hours after DHB receives all information necessary to complete a review and for DHB to complete all non-urgent prior authorization requests within 72 hours after DHB receives all information necessary to complete a review.
Statutes affected: Filed: 135-48.51
Edition 1: 135-48.51
Edition 2: 135-48.51