NC S231

Requires the Department of Health and Human Services to enter into capitated contracts with at least two prepaid dental plans for providing dental services to Medicaid and NC Health Choice recipients.

Contract requirements include statewide coverage in all 100 counties, licensing as a prepaid ambulatory health plan, claims processing and care management functions, and prohibition on outsourcing without DHHS authorization.

Mandates that at least 85% of contracting fees be used for direct patient care and quality improvements, with no more than 15% allowed for administrative costs.

Requires prepaid dental plans and providers to submit data through the Health Information Exchange Network and track operational metrics including patient access, provider networks, claims processing timelines, and improvements to enrollee oral health outcomes.

Directs DHHS to consult with the Joint Legislative Oversight Committee on Medicaid and NC Health Choice before issuing requests for proposals and to submit necessary waiver applications to CMS by January 1, 2018.