North Carolina § 108D-45 Number and nature of contracts for standard benefit plans

North Carolina Statutes

§ 108D-45 — Number and nature of contracts for standard benefit plans

North Carolina·Ch. 108D Medicaid Managed Care Program·Art. 4 Prepaid Health Plans

The number and nature of the contracts for standard benefit plans required under G.S. 108D-65(6) shall be as follows:

(1)Four contracts between the Division of Health Benefits and PHPs to provide coverage to Medicaid recipients statewide.

(2)Up to 12 contracts between the Division of Health Benefits and PLEs for coverage of regions specified by the Division of Health Benefits pursuant to G.S. 108D-65(2). Regional contracts shall be in addition to the four statewide contracts required under subdivision (1) of this section. Each regional contract shall provide coverage throughout the entire region for the Medicaid services required by G.S. 108D-35. A PLE may bid for more than one regional contract, provided that the regions are contiguous.

(3)Repealed by Session Laws 2023-134, s. 9E.22(i)

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The number and nature of the contracts for standard benefit plans required under G.S. 108D-65(6) shall be as follows:
(1) Four contracts between the Division of Health Benefits and PHPs to provide coverage to Medicaid recipients statewide.
(2) Up to 12 contracts between the Division of Health Benefits and PLEs for coverage of regions specified by the Division of Health Benefits pursuant to G.S. 108D-65(2). Regional contracts shall be in addition to the four statewide contracts required under subdivision (1) of this section. Each regional contract shall provide coverage throughout the entire region for the Medicaid services required by G.S. 108D-35. A PLE may bid for more than one regional contract, provided that the regions are contiguous.
(3) Repealed by Session Laws 2023-134, s. 9E.22(i), effective October 3, 2023.
(4) Initial capitated PHP contracts may be awarded on staggered terms of three to five years in duration to ensure against gaps in coverage that may result from termination of a contract by the PHP or the State. (2015-245, s. 4; 2016-121, s. 2(b); 2018-48, s. 1; 2019-81, s. 14(a); 2022-74, s. 9D.15(z); 2023-134, s. 9E.22(i).)

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