Criteria for PHP Contract Procurement.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 1
HOUSE BILL 558

Short Title: Criteria for PHP Contract Procurement. (Public)
Sponsors: Representatives Reeder, Potts, and Lambeth (Primary Sponsors).
For a complete list of sponsors, refer to the North Carolina General Assembly web site.
Referred to: Health, if favorable, Insurance, if favorable, Finance, if favorable, Rules,
Calendar, and Operations of the House
March 31, 2025
*H558-v-1*
A BILL TO BE ENTITLED 1
AN ACT TO UPDATE THE CRITERIA FOR PROCUR EMENT OF FUTURE MEDI CAID 2
PREPAID HEALTH PLAN CONTRACTS. 3
The General Assembly of North Carolina enacts: 4
SECTION 1. G.S. 108D-45 reads as rewritten: 5
"§ 108D-45. Number and nature of contracts for standard benefit plans. 6
(a) The For the initial standard benefit plan contracts required under G.S. 108D-65(6), 7
the number and nature of the contracts for standard benefit plans required under G.S. 108D-65(6) 8
those contracts shall be as follows: 9
(1) Four contracts between the Division of Health Benefits and PHPs to provide 10
coverage to Medicaid recipients statewide. 11
(2) Up to 12 contracts between the Division of Health Benefits and PLEs for 12
coverage of regions specified by the Division of Health Benefi ts pursuant to 13
G.S. 108D-65(2). Regional contracts shall be in addition to the four statewide 14
contracts required under subdivision (1) of this section. Each regional contract 15
shall provide coverage throughout the entire region for the Medicaid services 16
required by G.S. 108D-35. A PLE may bid for more than one regional 17
contract, provided that the regions are contiguous. 18
(3) Repealed by Session Laws 2023-134, s. 9E.22(i), effective October 3, 2023. 19
(4) Initial capitated PHP contracts may be awarded on staggered terms of three to 20
five years in duration to ensure against gaps in coverage that may result from 21
termination of a contract by the PHP or the State. 22
(b) For the standard benefit contracts required under G.S. 108D-65(6) that are awarded 23
subsequent to the initial standard benefit plan contracts, all of the following shall apply: 24
(1) All standard benefit plan contracts shall be to provide coverage to Medicaid 25
recipients statewide . There shall be no standard benefit plan contracts for 26
coverage of a region of the State that is less than statewide. 27
(2) There shall be n o more than four contracts between the Division of Health 28
Benefits and PHPs. 29
(3) The criteria the Division of Health Benefits uses to evaluate the responses to 30
the RFPs to procure contracts under this subsection shall assign higher weight 31
to responses received from the following entities: 32
a. PLEs. 33
General Assembly Of North Carolina Session 2025
Page 2 House Bill 558-First Edition
b. Bidders with higher provider satisfaction measures reported from 1
existing PHP contracts or similar data reported from Medicaid plans 2
in other insurance markets." 3
SECTION 2. This act is effective when it becomes law. 4