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North Carolina Bill Regulates Health Insurance Utilization Reviews and Sets Timelines for Prior Authorizations
Original title: Lower Healthcare Costs.
Last action · April 6, 2026: Conferees Changed (House action)Sponsors: John Bell and 59 others
Bill progressHistory & official text ↓
Introduced
Committee
Floor Vote
Passed
Law
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What This Bill Proposed
North Carolina health insurers and organizations are required to use licensed medical doctors of the same specialty for care denials, adhere to strict turnaround timelines of 24 to 48 hours for review decisions, and report annual utilization metrics starting October 1, 2025.
Why it matters
Patients and healthcare providers gain faster coverage determinations, mandatory specialist oversight for treatment denials, and streamlined appeal processes, while insurers face daily fines and disciplinary oversight from the North Carolina Medical Board for non-compliance.
Background
- Utilization review processes govern how health insurance companies approve or deny medical treatments and procedures requested by doctors and patients. context
- The North Carolina State Health Plan provides health coverage for teachers, state employees, and their dependents. context
Who It Would Have Affected
Groups the bill's text would have affected, as described in the record. Being affected is not a position for or against it.
Directly affected
Covered persons
Covered individuals experience defined response timelines for treatment requests, mandatory specialist review for denials, and guaranteed continuity of care during plan transitions.
Directly affected
Health insurers
Insurers must update utilization review programs, employ same-specialty physicians for denials, publish monthly statistics, and report annual data to the Commissioner under penalty of fines.
Directly affected
Healthcare providers
Providers receive direct consultation rights prior to denials, standardized timelines for decisions, and potential exemptions from prior authorization if approval rates exceed 80%.
Directly affected
North Carolina Medical Board
The Board acquires explicit subpoena authority over insurers and utilization review organizations to inspect records concerning physician involvement in review processes.
Key Facts
- Insurers must render determinations and notify providers within 48 hours for non-urgent healthcare services and within 24 hours for urgent services after obtaining necessary information.
- Noncertifications must be made by a licensed medical doctor who is in the same specialty as the provider and has experience treating the condition.
- Emergency services cannot be subjected to prior authorization or utilization review, and providers have a 24-hour notification window following emergency admission.
- Emergency post-evaluation or post-stabilization services must receive a utilization review determination within 60 minutes, or they are deemed approved.
Show all 11 facts
- Insurers failing to meet deadlines or other requirements are deemed to have automatically approved the requested healthcare services.
- Insurers must submit annual utilization review data reports to the Commissioner no later than March 1 of each year, with failure subject to a $5,000 per day fine.
- Performing utilization review tasks required of a physician is legally defined as the practice of medicine under G.S. 90-1.1(5).
- The North Carolina Medical Board is granted authority to subpoena insurers and utilization review organizations for records concerning physician involvement in reviews.
- Insurers cannot revoke a prior certification if care is provided within 45 business days, subject to specific exceptions such as eligibility lapse or material misrepresentation.
- Insurers must honor a prior utilization review determination granted by a previous insurer for at least 90 calendar days when a person changes health benefit plans.
- Providers who achieve an 80% or higher certification approval rate over a 12-month period qualify for an exemption from prior authorization requirements.
Frequently Asked Questions
What happens if an insurer fails to respond to a utilization review request within the required deadline?
Any failure by an insurer or its organization to comply with the deadlines and requirements results in the healthcare services being automatically deemed authorized.
Who is qualified to issue a denial or noncertification for a medical service?
s must be issued by a medical doctor licensed to practice medicine in North Carolina who shares the same specialty as the managing healthcare provider and has experience treating that condition.
Are emergency services subject to prior authorization under this measure?
No. and are explicitly prohibited for prehospital transportation and the provision of emergency services.
What else do you want to know?
News Coverage
No news coverage found yet. Articles are indexed twice daily.
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Votes, people, money & the original sourceWhere This Stands
This bill did not become law - Failed in the House.
Procedural history
33 actions- Apr 6, 2026HouseConferees Changed
- Jun 24, 2025SenateConf Com Appointed
- Jun 24, 2025HouseConf Com Appointed
- Jun 17, 2025HouseFailed Concur In S Com Sub
- Jun 16, 2025HousePlaced On Cal For 06/17/2025
- Jun 16, 2025HouseWithdrawn From Com
Show 27 earlier actions
- Jun 9, 2025HouseRef To Com On Rules, Calendar, and Operations of the House
- Jun 5, 2025HouseRegular Message Received For Concurrence in S Com Sub
- Jun 5, 2025SenateRegular Message Sent To House
- Jun 4, 2025SenatePassed 3rd Reading
- Jun 4, 2025SenatePassed 2nd Reading
- Jun 3, 2025SenateReptd Fav
- May 22, 2025SenateRe-ref Com On Rules and Operations of the Senate
- May 22, 2025SenateCom Substitute Adopted
- May 22, 2025SenateReptd Fav Com Substitute
- May 19, 2025SenateRe-ref to Health Care. If fav, re-ref to Rules and Operations of the Senate
- May 19, 2025SenateWithdrawn From Com
- May 1, 2025SenateRef To Com On Rules and Operations of the Senate
- May 1, 2025SenatePassed 1st Reading
- May 1, 2025SenateRegular Message Received From House
- May 1, 2025HouseRegular Message Sent To Senate
- Apr 30, 2025HousePassed 3rd Reading
- Apr 30, 2025HousePassed 2nd Reading
- Apr 28, 2025HousePlaced On Cal For 04/30/2025
- Apr 28, 2025HouseCal Pursuant Rule 36(b)
- Apr 28, 2025HouseReptd Fav
- Apr 16, 2025HouseRe-ref Com On Rules, Calendar, and Operations of the House
- Apr 16, 2025HouseReptd Fav
- Apr 15, 2025HouseRe-ref Com On Insurance
- Apr 15, 2025HouseReptd Fav
- Mar 19, 2025HouseRef to the Com on Health, if favorable, Insurance, if favorable, Rules, Calendar, and Operations of the House
- Mar 19, 2025HousePassed 1st Reading
- Mar 18, 2025HouseIntroducedFiled
Version history
Only one version on file - nothing to compare yet. As later stages (committee substitute, engrossed, enrolled) are captured, the redline appears here.
View official text →Voting Record
M11 Not Concur
Total
115
- Yes
- 110
- No
- 0
- Present
- 0
- Not voting
- 5
- Abstain
- 0
How they voted (115)
Dudley GreeneParty not recordedyes
Donna WhiteParty not recordedyes
Amber BakerParty not recordedyes
Donny LambethParty not recordedyes
Abe JonesParty not recordedyes
Charles SmithParty not recordedyes
Ted DavisParty not recordedyes
Cynthia BallParty not recordedyes
John TorbettParty not recordedyes
Tim ReederParty not recordedyes
Karl GillespieParty not recordedyes
Joe PikeParty not recordedyes
Alan BransonParty not recordedyes
John BellParty not recordedyes
Robert ReivesParty not recordedyes
John BlustParty not recordedyes
von HaefenParty not recordedyes
Tim LongestParty not recordedyes
Mark PlessParty not recordedyes
Erin ParéParty not recordedyes
Bill WardParty not recordedyes
Jay AdamsParty not recordedyes
Dean ArpParty not recordedyes
Tricia CothamParty not recordedyes
91 more members
Charlie MillerParty not recordedyes
Garland PierceParty not recordedyes
Kyle HallParty not recordedyes
Heather RhyneParty not recordedyes
Pricey HarrisonParty not recordedyes
Carson SmithParty not recordedyes
Deb ButlerParty not recordedyes
Ed GoodwinParty not recordedyes
Steve TysonParty not recordedyes
Mark BrodyParty not recordedyes
Becky CarneyParty not recordedyes
Grant CampbellParty not recordedyes
Phil ShepardParty not recordedyes
Brian EchevarriaParty not recordedyes
Blair EddinsParty not recordedyes
Carolyn LoganParty not recordedyes
Laura BuddParty not recordedyes
Jeff ZengerParty not recordedyes
Sarah CrawfordParty not recordedyes
Ray PickettParty not recordedyes
Cody HuneycuttParty not recordedabsent
Mike ColvinParty not recordedyes
Vernetta AlstonParty not recordedyes
Julia GreenfieldParty not recordedyes
Phil RubinParty not recordedyes
Nasif MajeedParty not recordedyes
Terry BrownParty not recordedyes
Jonathan AlmondParty not recordedyes
Rodney PierceParty not recordedyes
Wyatt GableParty not recordedyes
Diane WheatleyParty not recordedyes
John SaulsParty not recordedabsent
Hugh BlackwellParty not recordedyes
Jordan LopezParty not recordedyes
David WillisParty not recordedabsent
Zack HawkinsParty not recordedyes
Kanika BrownParty not recordedyes
Sam WatfordParty not recordedyes
Aisha DewParty not recordedabsent
Jake JohnsonParty not recordedyes
Neal JacksonParty not recordedyes
Maria CervaniaParty not recordedyes
Donnie LoftisParty not recordedyes
Larry PottsParty not recordedyes
Jeff McNeelyParty not recordedyes
Monika Johnson-HostlerParty not recordedyes
Ya LiuParty not recordedyes
Kelly HastingsParty not recordedyes
Carla CunninghamParty not recordedyes
Dennis RiddellParty not recordedyes
Matthew WinslowParty not recordedyes
Dante PittmanParty not recordedyes
James RobersonParty not recordedyes
Renée PriceParty not recordedyes
Ben MossParty not recordedyes
Eric AgerParty not recordedyes
Brian TurnerParty not recordedabsent
Stephen RossParty not recordedyes
Bryan CohnParty not recordedyes
Frances JacksonParty not recordedyes
Amos QuickParty not recordedyes
Jimmy DixonParty not recordedyes
Larry StricklandParty not recordedyes
Tracy ClarkParty not recordedyes
Brenden JonesParty not recordedyes
Keith KidwellParty not recordedyes
Brandon LoftonParty not recordedyes
Mike SchietzeltParty not recordedyes
Julia HowardParty not recordedyes
Beth Gardner HelfrichParty not recordedyes
William BrissonParty not recordedyes
Allen BuansiParty not recordedyes
Shelly WillinghamParty not recordedyes
Reece PyrtleParty not recordedyes
Celeste CairnsParty not recordedyes
Allison DahleParty not recordedyes
Mary BelkParty not recordedyes
Howard PennyParty not recordedyes
Jennifer BalkcomParty not recordedyes
Todd CarverParty not recordedyes
Brian BiggsParty not recordedyes
Lindsey PratherParty not recordedyes
Allen ChesserParty not recordedyes
Harry WarrenParty not recordedyes
Marcia MoreyParty not recordedyes
Mitchell SetzerParty not recordedyes
Gloristine BrownParty not recordedyes
Ray JeffersParty not recordedyes
Chris HumphreyParty not recordedyes
Paul ScottParty not recordedyes
Frank IlerParty not recordedyes
Show 2 earlier roll calls
Second Reading
Total
47
- Yes
- 39
- No
- 3
- Present
- 0
- Not voting
- 5
- Abstain
- 0
How they voted (47)
Vickie SawyerParty not recordedyes
Michael LeeParty not recordedyes
Jay ChaudhuriParty not recordedyes
DeAndrea SalvadorParty not recordedabsent
Ted AlexanderParty not recordedyes
Norman SandersonParty not recordedyes
Kandie SmithParty not recordedyes
Michael LazzaraParty not recordedyes
Mark HolloParty not recordedyes
Tom McInnisParty not recordedabsent
Gale AdcockParty not recordedno
Warren DanielParty not recordedyes
Tim MoffittParty not recordedyes
Natalie MurdockParty not recordedno
Val ApplewhiteParty not recordedyes
Michael GarrettParty not recordedyes
Julie MayfieldParty not recordedyes
Gladys RobinsonParty not recordedyes
Chris MeasmerParty not recordedyes
Lisa BarnesParty not recordedabsent
Buck NewtonParty not recordedyes
Sophia ChitlikParty not recordedno
Phil BergerParty not recordedyes
Steve JarvisParty not recordedyes
23 more members
Todd JohnsonParty not recordedyes
Bob BrinsonParty not recordedabsent
Ralph HiseParty not recordedyes
Benton SawreyParty not recordedyes
Eddie SettleParty not recordedyes
Amy GaleyParty not recordedyes
Caleb TheodrosParty not recordedyes
Joyce WaddellParty not recordedyes
Lisa GrafsteinParty not recordedyes
Woodson BradleyParty not recordedyes
Jim BurginParty not recordedyes
Dan BlueParty not recordedyes
Dave CravenParty not recordedabsent
Paul LoweParty not recordedyes
Kevin CorbinParty not recordedyes
Danny BrittParty not recordedyes
Brent JacksonParty not recordedyes
Carl FordParty not recordedyes
Brad OvercashParty not recordedyes
Dana JonesParty not recordedyes
Mujtaba MohammedParty not recordedyes
Sydney BatchParty not recordedyes
Bill RabonParty not recordedyes
Second Reading
Total
115
- Yes
- 104
- No
- 1
- Present
- 0
- Not voting
- 10
- Abstain
- 0
How they voted (115)
Sam WatfordParty not recordedyes
Brenden JonesParty not recordedyes
John BellParty not recordedabsent
Deb ButlerParty not recordedabsent
Tricia CothamParty not recordedyes
Julia GreenfieldParty not recordedyes
William BrissonParty not recordedyes
Erin ParéParty not recordedyes
Abe JonesParty not recordedyes
Terry BrownParty not recordedyes
Allen ChesserParty not recordednot voting
Brian EchevarriaParty not recordedyes
Laura BuddParty not recordedyes
Carolyn LoganParty not recordedyes
Larry PottsParty not recordedyes
Phil ShepardParty not recordedyes
Frank IlerParty not recordedyes
Beth Gardner HelfrichParty not recordedyes
Jeff McNeelyParty not recordedyes
Monika Johnson-HostlerParty not recordedyes
Donna WhiteParty not recordedyes
Dean ArpParty not recordedyes
Harry WarrenParty not recordedyes
Jonathan AlmondParty not recordedyes
91 more members
Larry StricklandParty not recordedyes
Neal JacksonParty not recordedyes
Ben MossParty not recordedyes
Steve TysonParty not recordedyes
Diane WheatleyParty not recordedyes
Aisha DewParty not recordedyes
Allen BuansiParty not recordedyes
Marcia MoreyParty not recordedyes
Hugh BlackwellParty not recordedyes
Carla CunninghamParty not recordedyes
Heather RhyneParty not recordedyes
Reece PyrtleParty not recordedyes
Brandon LoftonParty not recordedyes
Mike SchietzeltParty not recordedyes
Carson SmithParty not recordedyes
Jordan LopezParty not recordedyes
Cynthia BallParty not recordedyes
John BlustParty not recordedyes
Amber BakerParty not recordedyes
Zack HawkinsParty not recordedyes
Gloristine BrownParty not recordedyes
Cody HuneycuttParty not recordedyes
Julia HowardParty not recordedyes
Mark BrodyParty not recordedyes
Mary BelkParty not recordedyes
Dennis RiddellParty not recordedyes
Jeff ZengerParty not recordedyes
Brian BiggsParty not recordedyes
Bill WardParty not recordedyes
Celeste CairnsParty not recordedyes
Pricey HarrisonParty not recordedabsent
Ray JeffersParty not recordedyes
Charles SmithParty not recordedyes
Rodney PierceParty not recordedyes
Sarah CrawfordParty not recordedyes
Mike ColvinParty not recordedyes
Matthew WinslowParty not recordedyes
Wyatt GableParty not recordedabsent
Paul ScottParty not recordedyes
Eric AgerParty not recordedyes
Ed GoodwinParty not recordedyes
Garland PierceParty not recordedabsent
Dante PittmanParty not recordedyes
Robert ReivesParty not recordednot voting
Jennifer BalkcomParty not recordedyes
Becky CarneyParty not recordedyes
Ted DavisParty not recordedyes
Kyle HallParty not recordedyes
von HaefenParty not recordedyes
Ya LiuParty not recordedyes
Kelly HastingsParty not recordedyes
Tracy ClarkParty not recordedyes
Donnie LoftisParty not recordedyes
James RobersonParty not recordedyes
Mark PlessParty not recordedyes
Todd CarverParty not recordedyes
Mitchell SetzerParty not recordedyes
Brian TurnerParty not recordedyes
Tim LongestParty not recordedyes
Phil RubinParty not recordedyes
Joe PikeParty not recordedyes
Chris HumphreyParty not recordedyes
Keith KidwellParty not recordedyes
Jimmy DixonParty not recordedyes
John TorbettParty not recordedyes
Maria CervaniaParty not recordedyes
Jay AdamsParty not recordedyes
Allison DahleParty not recordedyes
Renée PriceParty not recordedyes
Grant CampbellParty not recordedyes
Alan BransonParty not recordedyes
Charlie MillerParty not recordedyes
Bryan CohnParty not recordedyes
Lindsey PratherParty not recordedyes
Dudley GreeneParty not recordedyes
Jake JohnsonParty not recordedyes
Nasif MajeedParty not recordedyes
Kanika BrownParty not recordedabsent
Vernetta AlstonParty not recordedno
Ray PickettParty not recordedyes
Donny LambethParty not recordedyes
Karl GillespieParty not recordedyes
Amos QuickParty not recordedabsent
John SaulsParty not recordedyes
Howard PennyParty not recordedyes
Shelly WillinghamParty not recordedyes
Stephen RossParty not recordedabsent
Tim ReederParty not recordedyes
Blair EddinsParty not recordedyes
David WillisParty not recordedyes
Frances JacksonParty not recordedyes
Lobbying Activity
No state lobbying filings in our records match this bill. Federal lobbying reports (LDA) cover Congress, so they are not listed on state bills.
Full breakdown
Who this bill affects and the strongest case for and against it, written only from the bill’s own text.
Sponsors
Show 55 more sponsors
BrockmanHouseCosponsorNo profile match
ClampittHouseCosponsorNo profile match
Discoveries
Patterns POLISCOPE noticed across the record. These are observations to investigate, not conclusions.
policy shift99% confidence
Medical Board Subpoena Authority
The legislation expands the enforcement powers of the North Carolina Medical Board, giving it explicit authority to subpoena insurers and utilization review organizations regarding physician involvement.
Connected Entities
OrganizationHealth Insurance Smart NC“Program providing consumer assistance to covered persons”Map →
OrganizationDepartment of Health and Human Services“Consulted regarding substance use treatment criteria”Map →
OrganizationNorth Carolina Medical Board“Granted subpoena authority over insurers and utilization review organizations re”Map →
OrganizationNorth Carolina State Health Plan for Teachers and State Employees“State health plan required to comply with utilization review parity provisions”Map →
Sources
Open source document
www.ncleg.gov
Analysis Score
0–100- Significance20Lowered because this bill did not pass (its text scored 85)
- Controversy65Intensity of disagreement among stakeholders
- Entertainment10Compellingness for a non-policy-wonk reader
- Buzz40Current news / social attention level
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