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SB 287

North Carolina - Session 2025

Senate in_committee 2025-03-17
Bill Details

Title: Safeguard Health Ins. Utilization Reviews.

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.

Sponsor
Gale Adcock
Official Source Back to Bills
Actions Timeline
Date Event Detail
2025-03-13 Introduced Bill introduced
2025-03-17 Status in_committee
2025-03-17 Latest Action Ref To Com On Rules and Operations of the Senate
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