Bill > S727

This bill modifies the number and nature of Medicaid standard benefit plan contracts in North Carolina, specifically addressing how these contracts will be awarded in initial and subsequent contract cycles. For the initial contract cycle, the bill maintains the existing structure of four statewide contracts with Prepaid Health Plans (PHPs) and up to 12 regional contracts with Provider-Led Entities (PLEs). For subsequent contract cycles, the bill changes the structure to four statewide contracts with commercial plans and up to four additional contracts with PLEs, either for regional or statewide coverage. The bill introduces specific provisions for how PLE contracts will be awarded, including a mechanism that ensures all qualified PLEs receive contracts if fewer than four submit timely and compliant proposals, or a competitive selection process if four or more qualified PLEs apply. The bill also adds definitions for "Commercial plan" and "Provider-Led Entity" to the existing legal code, providing clarity and specificity to the contracting process. These changes aim to create a more flexible and competitive framework for Medicaid standard benefit plan contracts in North Carolina.

https://www.ncleg.gov/BillLookUp/2025/S727