House Bill 649 Summary

• Requires insurers to make utilization review determinations within specific timeframes: 48 hours for non-urgent services, 24 hours for urgent services, and 60 minutes for post-emergency stabilization services.

• Mandates that noncertifications must be made by a medical doctor of the same specialty as the treating physician with experience treating the relevant medical condition.

• Requires insurers to notify providers within five business days if questioning medical necessity and give providers an opportunity to discuss the determination by telephone before issuing a noncertification.

• Establishes an exemption allowing providers who receive at least 80% approval rate over 12 months to bypass utilization review requirements for that service.

• Creates an automatic approval ("deemed approval") if an insurer fails to meet required decision timeframes or request additional information within specified deadlines.