North Carolina Rep. Cotham’s CARE FIRST Act on health insurance utilization reviews passes House and Senate

Passed bill sponsored by State Rep. Tricia Ann Cotham aims to update and standardize health insurance utilization review processes in North Carolina, enhancing transparency, accountability, and continuity of care, according to the North Carolina State House.

In the House, 42 Democrats and 67 Republicans voted in favor of the bill, while one Democrat opposed it.

Meanwhile, in the Senate, 16 Democrats and 26 Republicans voted in favor of the bill, while three Democrats voted against it.

Cotham filed the bill in the North Carolina House on March 18 during the 2025 regular session.

The legislation, known as HB 434, was passed on June 4 during the 2025 regular session.

According to the North Carolina General Assembly site, the bill’s official text 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.

The bill was sponsored by Rep. John R. Bell, IV (Republican-10th District), Rep. Timothy Reeder, MD (Republican-9th District), and Rep. Tricia Ann Cotham (Republican-105th District), along with one other sponsor.

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.

Cotham graduated from the University of North Carolina, Charlotte with a BA.

Cotham, a Republican, was elected to the North Carolina State House in 2025 to represent the state’s 105th House district, replacing previous state representative Wesley Harris.

Under North Carolina law, bills must receive three readings in each chamber. According to the UNC School of Government, once a bill “passes its constitutionally required second reading and moves to its constitutionally required third reading,” additional debate can occur, but the final stage is often treated as a formality. Unless a legislator requests a roll-call, the third reading may be approved by voice vote or unanimous consent without a separate recorded tally.