North Carolina SB 613: Number of Medicaid Standard Plan Contracts.

Bill Text

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
S 1
SENATE BILL 613

Short Title: Number of Medicaid Standard Plan Contracts. (Public)
Sponsors: Senator Sawrey (Primary Sponsor).
Referred to: Rules and Operations of the Senate
March 26, 2025
*S613-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO ADJUST THE NUMBER OF MEDICAID STANDARD BENEFIT PLAN 2
CONTRACTS AWARDED DURING FUTURE AWARD CYCLES. 3
The General Assembly of North Carolina enacts: 4
SECTION 1. G.S. 108D-1 reads as rewritten: 5
"§ 108D-1. Definitions. 6
The following definitions apply in this Chapter: 7
... 8
(6e) Commercial plan. – As defined in G.S. 58-93-5. 9
... 10
(31e) Provider-led entity or PLE. – As defined in G.S. 58-93-5. 11
...." 12
SECTION 2. G.S. 108D-45 reads as rewritten: 13
"§ 108D-45. Number and nature of contracts for standard benefit plans. 14
(a) The For the initial standard benefit plan contracts required under G.S. 108D-65(6), 15
the number and nature of the contracts for standard benefit plans required under G.S. 108D-65(6) 16
those contracts shall be as follows: 17
(1) Four contracts between the Division of Health Benefits and PHPs to provide 18
coverage to Medicaid recipients statewide. 19
(2) Up to 12 contracts between the Division of Health Benefits and PLEs for 20
coverage of regions specified by the Division of Health Benefits pursuant to 21
G.S. 108D-65(2). Regional contracts shall be in addition to the four statewide 22
contracts required under subdivision (1) of this section. Each regional contract 23
shall provide coverage throughout the entire region for the Medicaid services 24
required by G.S. 108D-35. A PLE may bid for more than one regional 25
contract, provided that the regions are contiguous. 26
(3) Repealed by Session Laws 2023-134, s. 9E.22(i), effective October 3, 2023. 27
(4) Initial capitated PHP contracts may be awarded on staggered terms of three to 28
five years in duration to ensure against gaps in coverage that may result from 29
termination of a contract by the PHP or the State. 30
(b) For any standard benefit contracts required under G.S. 108D-65(6) that are awarded 31
subsequent to the initial standard benefit plan contracts, the number and nature of those contracts 32
shall be as follows: 33
(1) Four contracts between the Division of Health Benefits and commercial plans 34
to provide coverage to Medicaid recipients statewide. 35

General Assembly Of North Carolina Session 2025
Page 2 Senate Bill 613-First Edition
(2) Up to four contracts between the Division of Health Benefits and PLEs for 1
coverage of regions specified by the Division of Health Benefits pursuant to 2
G.S. 108D-65(2) or for statewide coverage, in accordance with all of the 3
following: 4
a. The contracts under this subdivision shall be in addition to the four 5
statewide contracts required under subdivision (1) of this subsection. 6
b. Each regional contract under this subdivision shall provide coverage 7
throughout the entire region for the Medicaid services required by 8
G.S. 108D-35. 9
c. A PLE may bid for more than one regional contract, provided that the 10
regions are contiguous. 11
d. If less than four PLEs submit a timely response meeting the minimum 12
requirements of the RFP to procure standard benefit plan contracts, as 13
determined by the Division of Health Benefits, then all PLEs that 14
submitted a timely response meeting the minimum requirements of the 15
RFP shall be awarded a standard benefit plan contract, either regional 16
or statewide, based on the area proposed to be served in the RFP 17
response. 18
e. If four or more PLEs submit a timely response meeting the minimum 19
requirements of the RFP to procure standard benefit plan contracts, as 20
determined by the Division of Health Benefits, then the Division of 21
Health Benefits shall award four standard benefit plan contracts to 22
PLEs, either regional or statewide, based on the area proposed to be 23
served in the RFP response." 24
SECTION 3. This act is effective when it becomes law. 25