North Carolina HB 390: Medicaid Prepaid Health Plan Practices.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 3
HOUSE BILL 390
Senate Health Care Committee Substitute Adopted 4/30/26
Third Edition Engrossed 5/6/26

Short Title: Medicaid Prepaid Health Plan Practices. (Public)
Sponsors:
Referred to:
March 13, 2025
*H390-v-3*
A BILL TO BE ENTITLED 1
AN ACT TO ALLOW CERTAIN MEDICAID PREPAID HEALTH PLAN PRACTICES. 2
The General Assembly of North Carolina enacts: 3
SECTION 1. G.S. 108D-65(b), as amended by Section 3C.15 of S.L. 2026-1, reads 4
as rewritten: 5
"(b) Except as required by federal law or regulation, the Department shall not prohibit 6
PHPs from requiring doing any of the following: 7
(1) Requiring itemized bills for inpatient hospital outlier claims that are greater 8
than two hundred fifty thousand dollars ($250,000) or more than two standard 9
deviations from the median mean claim amount of the applicable billing code. 10
(2) Aligning claims operations with national standards for coding, edits, and 11
claims adjudication, except that the Department may set parameters to ensure 12
consistent claims coding among PHPs. 13
(3) Directing inpatient hospital and inpatient hospital laboratory services to 14
outpatient settings where appropriate, except that the Department may 15
establish standards for when direction to outpatient settings is appropriate. The 16
Department is authorized to adopt rules establishing these standards." 17
SECTION 2. This act is effective when it becomes law and applies to contracts 18
entered into or amended on or after that date. 19