Identical to S 613, filed 3/25/25.

Amends GS 108D-1 by defining the terms commercial plan and provider-led entity as they apply to GS Chapter 108D, Medicaid Managed Care Program.

Amends GS 108D-45, governing the number and nature of contracts for a standard benefit plan, so that those existing provisions are applicable to the initial standard benefit plan. Requires the following of any standard benefit contracts that are awarded subsequent to the initial standard benefit plan contracts: (1) four contracts between the Division of Health Benefits and commercial plans to provide coverage to Medicaid recipients statewide; (2) up to four contracts between the Division of Health Benefits and PLEs for coverage of regions specified by the Division or for statewide coverage, in accordance with all of the following: a. these contracts are in addition to the four statewide contracts, b. each regional contract must provide coverage throughout the entire region for the Medicaid services required by GS 108D-35, c. a PLE may bid for more than one regional contract, so long as the regions are contiguous, d. if less than four PLEs submit a timely response meeting the minimum requirements of the RFP to procure standard benefit plan contracts, then all PLEs that submitted a timely response meeting the minimum requirements of the RFP shall be awarded a standard benefit plan contract, e. if four or more PLEs submit a timely response meeting the minimum requirements of the RFP to procure standard benefit plan contracts, then the Division of Health Benefits must award four standard benefit plan contracts to PLEs, either regional or statewide.