NC H156

Creates new Article 93 in Chapter 58 requiring Medicaid prepaid health plans (PHPs) to obtain a license from the Department of Insurance, establishing minimum capital and surplus requirements of $1,000,000 and working capital of $1,500,000.

Establishes PHP licensing requirements including application fees (up to $2,000), annual continuation fees (up to $5,000), deposit requirements ($500,000 minimum), financial statements, plan of operation, and management qualifications subject to Commissioner oversight.

Exempts existing licensed health organizations (HMOs, full service corporations, certain insurers) from PHP application requirements but subjects them to remaining regulatory requirements including deposits and capital/surplus standards.

Adds provisions authorizing PHPs and insurers to implement lock-in programs requiring beneficiaries with excessive opioid or benzodiazepine prescriptions to select a single prescriber and pharmacy, with beneficiary notification and appeal rights.

Modifies Medicaid transformation timeline and PHP contract requirements to allow phased enrollment over five months, cap withhold arrangements at 3.5% of capitation after initial 18 months, exclude certain populations (nursing facility residents, dual-eligible Medicare/Medicaid beneficiaries) from PHP coverage for up to five years, and require specific provider-related contract terms.