Bill Summary for S 287 (2025-2026)

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Summary date: 

Mar 13 2025

Bill Information:

View NCGA Bill Details(link is external)2025-2026 Session
Senate Bill 287 (Public) Filed Thursday, March 13, 2025
AN ACT TO ENSURE THAT HEALTH BENEFIT PLAN DETERMINATIONS OF THE MEDICAL NECESSITY OR APPROPRIATENESS OF HEALTHCARE SERVICES CONTINUE TO BE MADE BY LICENSED AND QUALIFIED HEALTHCARE PROVIDERS.
Intro. by Adcock.

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Bill summary

Prevents an insurer under GS 58-50-61 (utilization reviews) from using an artificial intelligence-based algorithm as the sole basis for a utilization review determination to, in whole or in part, deny, delay, or modify any healthcare services for an insured. Requires insurers to verify that all third-party contacts for conducting utilization reviews are not in violation of the act. Emphasizes that only individuals meeting the licensing and qualification requirements for participating in the utilization review process can make a determination regarding the medical necessity or appropriateness of any healthcare service. Extends liability for violation of the section to agents of the insurer. Directs the State Treasurer and the Executive Administrator of the State Health Plan to review all practices of the State Health Plan and all contracts with, and practices of, any third party conducting any utilization review on behalf of the State Health Plan to ensure compliance with GS 58-50-61, as amended by the act. Effective 30 days after the act becomes law.