Sen. Burgin files bill in North Carolina Senate to improve healthcare utilization reviews

A new bill filed by State Sen. Jim Burgin seeks to enhance transparency and efficiency in utilization reviews for healthcare services, ensuring timely decisions and professional oversight, according to the North Carolina State Senate.

The bill, filed as SB 315 on March 17 during the 2025 regular session, was formally listed with the short title: ‘More Transparency/Efficiency in Utiliz. Rev.’

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

In essence, this bill aims to enhance transparency and efficiency in utilization reviews associated with healthcare services. It mandates insurers to adhere to specific timelines for utilization review determinations, notably within 24 hours for urgent services post-receipt of necessary information. The bill restricts the use of artificial intelligence as the sole basis for making these determinations and requires licensed professionals to assess service necessity. It further outlines requirements for appeals, mandating that reviews be conducted by individuals matching specific professional criteria. Insurers must maintain clear and updated information regarding utilization review processes both online and in member communications. Additionally, prior authorizations must be valid for set periods under certain conditions, such as 90 days for a new health plan or six months for a chronic condition treatment. The State Health Plan must align its practices with these provisions before the start of the next plan year. Section 1(a) becomes effective Oct. 1, 2026, applying to applicable insurance contracts thereafter.

Of the three sponsors of this bill, Burgin and Amy S. Galey proposed the most bills (20) 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.

Burgin graduated from The University of Tennessee Knoxville with a BS.

Burgin, a Republican, was elected to the North Carolina State Senate in 2019 to represent the state’s 12th Senate district, replacing previous state senator Ronald Rabin.