Bill > H558

This bill updates the criteria for procuring Medicaid Prepaid Health Plan (PHP) contracts in North Carolina, modifying existing law to establish new guidelines for both initial and subsequent standard benefit plan contracts. For the initial contracts, the bill maintains the provision for four statewide PHP contracts and allows up to 12 regional contracts for Provider-Led Entities (PLEs), with regional contracts covering entire specified regions and allowing PLEs to bid on contiguous regions. For subsequent standard benefit plan contracts, the bill introduces significant changes: all contracts must now provide statewide coverage, eliminating regional-only contracts, and the total number of contracts is limited to four. Importantly, the bill instructs the Division of Health Benefits to assign higher evaluation weights in the Request for Proposal (RFP) process to responses from PLEs and bidders with higher provider satisfaction measures from existing PHP contracts or similar Medicaid plans in other insurance markets. The bill aims to streamline and improve the procurement process for Medicaid health plans by prioritizing entities with proven track records and local provider leadership.

Health and Social Services

https://www.ncleg.gov/BillLookUp/2025/H558