NC H656

Modifies Chapter 108D to establish prepaid health plan (PHP) enrollment and disenrollment procedures for Medicaid and NC Health Choice beneficiaries, including ground-based and expedited disenrollment options.

Creates grievance and appeal processes for managed care entities, with specific timeframes (30 days for standard appeals, 72 hours for expedited appeals) and mediation requirements before contested case hearings at the Office of Administrative Hearings.

Extends appeal filing deadline from 30 to 120 days after notice of resolution and establishes managed care entity provider network requirements, including mandatory inclusion of essential providers like federally qualified health centers and rural health centers.

Codifies provisions from S.L. 2015-245 related to Medicaid transformation into new Article 4 of Chapter 108D, establishing standards for prepaid health plan contracts, capitation rates, and coverage of behavioral health and intellectual/developmental disability services.

Effective October 1, 2019, for appeals and grievances received on or after that date; establishes that Division of Medical Assistance references are replaced with Division of Health Benefits references effective July 1, 2019.