A BILL TO BE ENTITLED
AN ACT TO ALLOW CERTAIN MEDICAID PREPAID HEALTH PLAN PRACTICES.
The General Assembly of North Carolina enacts:
SECTION 1.(a)  If House Bill 696, 2025 Regular Session, becomes law, then G.S. 108D‑65(b), as amended by Section 3C.15 of that act, reads as rewritten:
"(b)	Except as required by federal law or regulation, the Department shall not prohibit PHPs from doing any of the following:
(1)	Requiring itemized bills for inpatient hospital outlier claims that are greater than two hundred fifty thousand dollars ($250,000) or more than two standard deviations from the mean claim amount of the applicable billing code.
(2)	Aligning claims operations with national standards for coding, edits, and claims adjudication.
(3)	Directing inpatient hospital and inpatient hospital laboratory services to outpatient settings where appropriate, except that the Department may establish standards for when direction to outpatient settings is appropriate. The Department is authorized to adopt rules establishing these standards."
SECTION 1.(b)  If House Bill 696, 2025 Regular Session, does not become law by June 1, 2026, then G.S. 108D‑65 reads as rewritten:
"§ 108D‑65.  Role of the Department.
(a)	The role and responsibility of the Department during Medicaid transformation shall include the following activities and functions:
…
(b)	Except as required by federal law or regulation, the Department shall not prohibit PHPs from doing any of the following:
(1)	Requiring itemized bills for inpatient hospital outlier claims that are greater than two hundred fifty thousand dollars ($250,000) or more than two standard deviations from the mean claim amount of the applicable billing code.
(2)	Aligning claims operations with national standards for coding, edits, and claims adjudication.
(3)	Directing inpatient hospital and inpatient hospital laboratory services to outpatient settings where appropriate, except that the Department may establish standards for when direction to outpatient settings is appropriate. The Department is authorized to adopt rules establishing these standards."
SECTION 2.  This act is effective when it becomes law and applies to contracts entered into or amended on or after that date.