GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2001
H	1
HOUSE BILL 1032
     

 
Short Title:	Health Ins./UR Retrospective Review Limit.	()	
Sponsors:	Representatives Nye; and Smith.	
Referred to:	Insurance.	
April 9, 2001

A BILL TO BE ENTITLED
AN ACT LIMITING RETROSPECTIVE REVIEWS UNDER UTiLIZATION REVIEW IN HEALTH BENEFIT PLANS.

The General Assembly of North Carolina enacts:
SECTION 1.  G.S. 58‑50‑61(g) reads as rewritten:
"(g)	Retrospective Reviews. – As used in this subsection, "necessary information" includes the results of any patient examination, clinical evaluation, or second opinion that may be required. For retrospective review determinations, an insurer shall make the determination within 30 days after receiving all necessary information. For a certification, the insurer may give written notification to the covered person's provider. For a noncertification, the insurer shall give written notification to the covered person and the covered person's provider within five business days after making the noncertification. An insurer may use retrospective review for the certification or noncertification of coverage only if the covered person or provider acting on behalf of the covered person fails to comply with the applicable notification requirements for prospective or concurrent review, or, after meeting the requirements for timely notification, fails to modify care as required by applicable standards or protocols communicated to the provider."
SECTION 2.  This act is effective when it becomes law.