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North Carolina General Statutes Chapter 108D. Medicaid Managed Care for Behavioral Health Services § 108D-45. Number and nature of capitated PHP contracts

Current as of January 01, 2023 | Updated by Findlaw Staff

The number and nature of the contracts required under G.S. 108D-65(3) shall be as follows:

<Text of (1) eff. until contingency.>

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

<Text of (1) eff. upon contingency. See Notes.>

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

<Text of (2) eff. until contingency.>

(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 and NC Health Choice services required by G.S. 108D-35. A PLE may bid for more than one regional contract, provided that the regions are contiguous.

<Text of (2) eff. upon contingency. See Notes.>

(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) The limitations on the number of contracts established in this section shall not apply to BH IDD tailored plans described in G.S. 108D-60.

(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.

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Cite this article: FindLaw.com - North Carolina General Statutes Chapter 108D. Medicaid Managed Care for Behavioral Health Services § 108D-45. Number and nature of capitated PHP contracts - last updated January 01, 2023 | https://codes.findlaw.com/nc/chapter-108d-medicaid-managed-care-for-behavioral-health-services/nc-gen-st-sect-108d-45/

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