Bill > S613

This bill modifies the number and nature of Medicaid Standard Plan contracts in North Carolina, establishing two distinct contract award phases. For the initial contract phase, the bill maintains the existing structure of four statewide Prepaid Health Plan (PHP) contracts and up to 12 regional Provider-Led Entity (PLE) contracts, with provisions for staggered contract terms. For subsequent contract awards, the bill changes the framework to four statewide commercial plan contracts and up to four additional PLE contracts (either regional or statewide). The bill introduces specific rules for PLE contract awards, including provisions that if fewer than four PLEs submit acceptable proposals, all qualifying PLEs will receive contracts, and if four or more PLEs submit acceptable proposals, the Division of Health Benefits will select four for contracts based on their proposed service areas. The bill also adds definitions for "commercial plan" and "provider-led entity" to the existing legal code, providing clarity on these terms. These changes aim to refine the Medicaid standard benefit plan contracting process and potentially increase flexibility and competition among healthcare providers.

https://www.ncleg.gov/BillLookUp/2025/S613