Rep. Campbell files bill in North Carolina House to update health insurance review rules

A new bill filed by State Rep. Campbell in the North Carolina House seeks to enhance transparency and standards in health insurance utilization reviews, according to the North Carolina State House.

The bill, filed as HB 434 on March 18 during the 2025 regular session, was formally listed with the short title: ‘Lower Healthcare Costs.’

The following is our breakdown, based on the actual bill text, and may include interpretation to clarify its provisions.

In essence, this bill, titled the CARE FIRST Act, updates the regulations surrounding health insurance utilization reviews in North Carolina. It outlines detailed definitions and standards for terms such as clinical review criteria, covered services, and emergency services. The bill mandates that insurers maintain utilization review programs, setting specific criteria for clinical review and requiring periodic assessments to ensure efficacy. Insurers must provide transparent processes and maintain records for each review and appeal, implementing timelines for urgent and non-urgent service reviews. The bill also stipulates that any determinations made are valid for the treatment’s duration, and specifies continuity of care requirements. Penalties are detailed for non-compliance with reporting standards, and insurers must publicize statistics on their website. Effective Oct. 1, 2025, for new or amended contracts, it also introduces HVAC compliance reviews to ensure physician involvement in critical decisions, bolstering accountability within healthcare assessments.

Of the four sponsors of this bill, Campbell proposed the most bills (30) during the 2025 regular session.

Bills in North Carolina follow a multi-step process before becoming law. A lawmaker starts by filing a bill, which is assigned to a committee for review. The bill must be read three times in each chamber. If one chamber changes the bill after the other passes it, both must agree on the final version. Once both chambers approve the same bill, it goes to the governor, who has 10 days (or 30 if the legislature is not in session) to sign, veto, or let it become law without a signature.

You can read more about the bills and other measures here.

Campbell graduated from the University of North Carolina at Chapel Hill in 1993 with a BS.

Campbell, a Republican, was elected to the North Carolina State House in 2025 to represent the state’s 83rd House district, replacing previous state representative Kevin Crutchfield.