reglab/housing_qa huggingface dataset:
56 OK Stat § 56-3002.7 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-3002.7. Definitions - Options Counseling for Long-term Care Program - Consultation.

|A. As used in the Oklahoma Options Counseling for Long-term Care Program Act: |1. “Long-term care facility” means a nursing facility or assisted living facility;2. “Options counseling for long-term care” means the process of providing services pursuant to the Oklahoma Options Counseling for Long-term Care Program within the Aging and Disability Resource Consortium (ADRC); and3. “Representative” means a family member, attorney, hospital social worker, or any other person chosen by an individual to act on behalf of the individual:a.seeking a long-term care consultation, orb.admitted to a long-term care program or facility.B. The Options Counseling for Long-term Care Program is hereby created within the Department of Human Services Aging Services Division and administered within the Aging Services Division Aging and Disability Resource Consortium.C. Subject to available funding, the Options Counseling for Long-term Care Program, through its partner community agencies, shall provide individuals or their representatives, or both, with long-term care options consultation by phone or in person, which shall include at a minimum the following:1. A basic review of an individual’s need for information;2. A review of appropriate long-term care options and costs, if available;3. A review of providers who accept either public or private payment or both public and private payment for long-term care services;4. A summary of factors to consider when choosing among the available programs, services, and benefits; and5. A summary of opportunities and methods for maximizing the independence and self-reliance of the individual, including support services provided by the family and friends of the individual.D. Options counseling for long-term care under this section may be provided at any time, whether before or after the individual who is the subject of a long-term care consultation has been admitted to a long-term facility.E. Nothing in the Oklahoma Options Counseling for Long-term Care Program Act shall be used to implement any provisions of the federal Patient Protection and Affordable Care Act.Added by Laws 2011, c. 144, § 3, eff. Nov. 1, 2011.
56 OK Stat § 56-3003 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-3003. Contents of coordinated system - Implementation deadlines.

|A. The design of a coordinated system of information, referral and follow-up services for older Oklahomans shall: |1. Be based upon the coordination of existing state and local programs that provide information, referral and follow-up services for older Oklahomans;2. Conform with the requirements of the 1915c Medicaid Home and Community Based Waiver, commonly known as the "Advantage Program", and, to the extent possible and feasible, shall incorporate the forms and procedures developed for the implementation of the Waiver;3. Include, but not be limited to:a.delineation of agency responsibilities, and the methods of coordinating the delivery of services,b.identification of programs and procedures necessary for implementation, and adoption of such procedures by the responsible agencies,c.the adoption of common service procedures across program and agency lines,d.the use of common referral and other forms,e.the development of a shared, computerized data base to identify client information necessary to reduce duplication of effort and improve service delivery, including, but not limited to, a common intake data set,f.procedures for sharing of confidential information in accordance with state and federal laws, which shall include, but not be limited to, methods for restricting access to confidential information and for sharing confidential information between public and private agencies and individuals in accordance with the policies and procedures set forth in interagency agreements pursuant to the Coordination of Services for Older Oklahomans Act,g.joint training of personnel responsible for implementation of the system and delivery of services,h.methods for resolving disputes by mediation or other means,i.a funding and implementation plan, which may include phased-in implementation, andj.procedures for monitoring and improving services and data collection, and continued coordination of services and data.B. 1. Preliminary recommendations for the data base and coordinated system shall be completed on or before October 1, 1996.2. On or before January 1, 1997, the agencies subject to the provisions of the Coordination of Services for Older Oklahomans Act shall enter into interagency agreements to implement the coordinated system.The data base and coordinated system of information, referral and follow-up shall be fully implemented on or before January 1, 1998.Added by Laws 1996, c. 123, § 3, emerg. eff. April 23, 1996.
56 OK Stat § 56-3051 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-3051. Discontinuance of state-administered resource centers.

|A. The Department of Human Services shall develop a plan which contains targeted dates to change or discontinue the operation of state-administered resource centers. In developing the plan, the Department shall consult with the families and guardians of the residents as well as affected employees of the resource centers, and shall take into consideration the recommendations and concerns of the families and guardians of the residents and affected employees. |B. The plan shall be submitted no later than January 1, 2012. The plan shall be subject to disapproval by the Legislature on or before March 1, 2012. The plan shall not be implemented until after March 1, 2012.Added by Laws 2011, c. 315, § 1, eff. Nov. 1, 2011.
56 OK Stat § 56-4000 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4000. Oklahoma College Savings Plan exemption.

|An Oklahoma College Savings Plan account shall be exempt for purposes of determining eligibility for public assistance, provided that the federal rules for these programs permit such an exemption. |Added by Laws 2008, c. 118, § 1, eff. Nov. 1, 2008.
56 OK Stat § 56-4001.5 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4001.5. Exemption from levy and sale, garnishment, attachment and other processes – Exclusion from consideration for assistance or benefits.

|A. Account balances and distributions from savings accounts established pursuant to this act shall be exempt from levy and sale, garnishment, attachment or any other process whatsoever and shall be unassignable. |B. Money and assets residing in an account established pursuant to this act or residing in an ABLE account established in another state shall not be considered for purposes of determining eligibility for assistance or benefits or for determining the amount of assistance or benefits to be received from the Temporary Assistance for Needy Families program or from any other local or state means-tested public assistance programs.Added by Laws 2016, c. 354, § 6, eff. Jan. 1, 2017.
56 OK Stat § 56-4002.1 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.1. Short title - Ensuring Access to Medicaid Act.

|This act shall be known and may be cited as the "Ensuring Access to Medicaid Act". |Added by Laws 2021, c. 542, § 1, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.2 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.2. Definitions.

|As used in this act: |1. "Adverse determination" has the same meaning as provided by Section 6475.3 of Title 36 of the Oklahoma Statutes;2. "Claims denial error rate" means the rate of claims denials that are overturned on appeal;3. "Clean claim" means a properly completed billing form with Current Procedural Terminology, 4th Edition or a more recent edition, the Tenth Revision of the International Classification of Diseases coding or a more recent revision, or Healthcare Common Procedure Coding System coding where applicable that contains information specifically required in the Provider Billing and Procedure Manual of the Oklahoma Health Care Authority;4. "Dental benefit manager" means an entity under contract with the Oklahoma Health Care Authority to manage and deliver dental benefits and services to enrollees of the capitated managed care delivery model of the state Medicaid program;5. "Essential community provider" has the same meaning as provided by 45 C.F.R., Section 156.235;6. "Managed care organization" means a health plan under contract with the Oklahoma Health Care Authority to participate in and deliver benefits and services to enrollees of the capitated managed care delivery model of the state Medicaid program;7. "Material change" includes, but is not limited to, any change in overall business operations such as policy, process or protocol which affects, or can reasonably be expected to affect, more than five percent (5%) of enrollees or participating providers of the managed care organization or dental benefit manager;8. "Medical necessity" has the same meaning as provided by rules of the Oklahoma Health Care Authority Board;9. "Participating provider" means a provider who has a contract with or is employed by a managed care organization or dental benefit manager to provide services to enrollees under the capitated managed care delivery model of the state Medicaid program; and10. "Provider" means a health care or dental provider licensed or certified in this state.Added by Laws 2021, c. 542, § 2, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.3 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.3. Enrollment in a capitated managed care delivery model of the state Medicaid program.

|A. Unless expressly authorized by the Legislature, the Oklahoma Health Care Authority may only require enrollment in a capitated managed care delivery model of the state Medicaid program for eligible individuals from an enrollee population of the state Medicaid program delineated as a mandatory enrollment population in the SoonerSelect Request for Proposals awarded in January of 2021 or the SoonerSelect Dental Program Request for Proposals awarded in February of 2021. |B. 1. Unless expressly authorized by the Legislature, enrollment in a capitated managed care delivery model of the state Medicaid program shall be voluntary for eligible individuals from an enrollee population of the state Medicaid program delineated as a voluntary enrollment population in the SoonerSelect Request for Proposals awarded in January of 2021 or the SoonerSelect Dental Program Request for Proposals awarded in February of 2021.2. The Authority may only utilize an opt-in enrollment process for the voluntary enrollment of individuals in the American Indian/Alaska Native population.C. Unless expressly authorized by the Legislature, the Authority shall not:1. Require enrollment in a capitated managed care delivery model of the state Medicaid program for eligible individuals from any enrollee population of the state Medicaid program delineated as an excluded population in or omitted entirely from the SoonerSelect Request for Proposals awarded in January of 2021 or the SoonerSelect Dental Program Request for Proposals awarded in February of 2021; or2. Offer voluntary enrollment in a capitated managed care delivery model of the state Medicaid program to eligible individuals from any enrollee population of the state Medicaid program delineated as an excluded population in or omitted entirely from the SoonerSelect Request for Proposals awarded in January of 2021 or the SoonerSelect Dental Program Request for Proposals awarded in February of 2021.Added by Laws 2021, c. 542, § 3, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.4 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.4. Network adequacy standards for managed care organizations and dental benefit managers.

|A. The Oklahoma Health Care Authority shall develop network adequacy standards for all managed care organizations and dental benefit managers that, at a minimum, meet the requirements of 42 C.F.R., Sections 438.14 and 438.68. Network adequacy standards established under this subsection shall be designed to ensure enrollees covered by the managed care organizations and dental benefit managers who reside in health professional shortage areas (HPSAs) designated under Section 332(a)(1) of the Public Health Service Act (42 U.S.C., Section 254e(a)(1)) have access to in-person health care and telehealth services with providers, especially adult and pediatric primary care practitioners. |B. All managed care organizations and dental benefit managers shall meet or exceed network adequacy standards established by the Authority under subsection A of this section to ensure sufficient access to providers for enrollees of the state Medicaid program.C. All managed care organizations and dental benefit managers shall contract to the extent possible and practicable with all essential community providers, all providers who receive directed payments in accordance with 42 C.F.R., Part 438 and such other providers as the Authority may specify.D. All managed care organizations and dental benefit managers shall formally credential and recredential network providers at a frequency required by a single, consolidated provider enrollment and credentialing process established by the Authority in accordance with 42 C.F.R., Section 438.214.E. All managed care organizations and dental benefit managers shall be accredited in accordance with 45 C.F.R., Section 156.275 by an accrediting entity recognized by the United States Department of Health and Human Services.Added by Laws 2021, c. 542, § 4, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.5 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.5. Managed care organizations and dental benefit managers - Duties.

|A. A managed care organization or dental benefit manager shall promptly notify the Authority of all changes materially affecting the delivery of care or the administration of its program. |B. A managed care organization or dental benefit manager shall have a medical loss ratio that meets the standards provided by 42 C.F.R., Section 438.8.C. A managed care organization or dental benefit manager shall provide patient data to a provider upon request to the extent allowed under federal or state laws, rules or regulations including, but not limited to, the Health Insurance Portability and Accountability Act of 1996.D. A managed care organization or dental benefit manager or a subcontractor of such managed care organization or dental benefit manager shall not enforce a policy or contract term with a provider that requires the provider to contract for all products that are currently offered or that may be offered in the future by the managed care organization or dental benefit manager or subcontractor.E. Nothing in a contract between the Authority and a managed care organization or dental benefit manager shall prohibit the managed care organization or dental benefit manager from contracting with a statewide or regional accountable care organization to implement the capitated managed care delivery model of the state Medicaid program.Added by Laws 2021, c. 542, § 5, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.8 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.8. Uniform procedures for review and appeal for adverse determinations.

|A. A managed care organization or dental benefit manager shall utilize uniform procedures established by the Authority under subsection B of this section for the review and appeal of any adverse determination by the managed care organization or dental benefit manager sought by any enrollee or provider adversely affected by such determination. |B. The Authority shall develop procedures for enrollee or providers to seek review by the managed care organization or dental benefit manager of any adverse determination made by the managed care organization or dental benefit manager. A provider shall have six (6) months from the receipt of a claim denial to file an appeal. With respect to appeals of adverse determinations made by a managed care organization or dental benefit manager on the basis of medical necessity, the following requirements shall apply:1. Medical review staff of the managed care organization or dental benefit manager shall be licensed or credentialed health care clinicians with relevant clinical training or experience; and2. All managed care organizations and dental benefit managers shall use medical review staff for such appeals and shall not use any automated claim review software or other automated functionality for such appeals.C. Upon receipt of notice from the managed care organization or dental benefit manager that the adverse determination has been upheld on appeal, the enrollee or provider may request a fair hearing from the Authority. The Authority shall develop procedures for fair hearings in accordance with 42 C.F.R., Part 431.Added by Laws 2021, c. 542, § 8, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.9 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.9. Violations – Noncompliance remedies of the Oklahoma Health Care Authority.

|In addition to such other remedies or penalties as may be prescribed by law, a managed care organization or dental benefit manager found to be in violation of the provisions of or rules promulgated under this act or of the terms and conditions of the contract entered into between the managed care organization or dental benefit manager and the Oklahoma Health Care Authority shall be subject to one or more non-compliance remedies of the Authority. |Added by Laws 2021, c. 542, § 9, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.10 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.10. Readiness review.

|A. The Oklahoma Health Care Authority shall require a managed care organization or dental benefit manager to participate in a readiness review in accordance with 42 C.F.R., Section 438.66. The readiness review shall assess the ability and capacity of the managed care organization or dental benefit manager to perform satisfactorily in such areas as may be specified in 42 C.F.R., Section 438.66. In addition, the readiness review shall assess whether: |1. The managed care organization or dental benefit manager has entered into contracts with providers to the extent necessary to meet network adequacy standards prescribed by Section 4 of this act;2. The contracts described in paragraph 1 of this subsection offer, but do not require, value-based payment arrangements as provided by Section 12 of this act; and3. The managed care organization or dental benefit manager and the providers described in paragraph 1 of this subsection have established and tested data infrastructure such that exchange of patient data can reasonably be expected to occur within one hundred twenty (120) calendar days of execution of the transition of the delivery system described in subsection B of this section. The Authority shall assess its ability to facilitate the exchange of patient data, claims, coordination of benefits and other components of a managed care delivery model.B. The Oklahoma Health Care Authority may only execute the transition of the delivery system of the state Medicaid program to the capitated managed care delivery model of the state Medicaid program ninety (90) days after the Centers for Medicare and Medicaid Services has approved all contracts entered into between the Authority and all managed care organizations and dental benefit managers following submission of the readiness reviews to the Centers for Medicare and Medicaid Services.Added by Laws 2021, c. 542, § 10, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.11 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.11. Scorecard comparing managed care organizations and dental benefit managers.

|No later than one year following the execution of the delivery model transition described in Section 10 of this act, the Oklahoma Health Care Authority shall create a scorecard that compares managed care organizations and dental benefit managers. The scorecard shall report the average speed of authorizations of services, rates of denials of services, enrollee satisfaction survey results and such other criteria as the Authority may require. The scorecard shall be compiled quarterly and shall consist of the information specified in this section from the prior year. The Authority shall provide the most recent quarterly scorecard to all initial enrollees during enrollment choice counseling following the eligibility determination and prior to initial enrollment. The Authority shall provide the most recent quarterly scorecard to all enrollees at the beginning of each enrollment period. The Authority shall publish each quarterly scorecard on its Internet website. |Added by Laws 2021, c. 542, § 11, eff. Sept. 1, 2021.
56 OK Stat § 56-4002.12 (2021)
2021 Oklahoma Statutes|Title 56. Poor Persons|§56-4002.12. Minimum rates of reimbursement – Value-based payment arrangements.

|A. The Oklahoma Health Care Authority shall establish minimum rates of reimbursement from managed care organizations and dental benefit managers to providers who elect not to enter into value-based payment arrangements under subsection B of this section for health care items and services furnished by such providers to enrollees of the state Medicaid program. Until July 1, 2026, such reimbursement rates shall be equal to or greater than: |1. For an item or service provided by a participating provider who is in the network of the managed care organization or dental benefit manager, one hundred percent (100%) of the reimbursement rate for the applicable service in the applicable fee schedule of the Authority; or2. For an item or service provided by a non-participating provider or a provider who is not in the network of the managed care organization or dental benefit manager, ninety percent (90%) of the reimbursement rate for the applicable service in the applicable fee schedule of the Authority as of January 1, 2021.B. A managed care organization or dental benefit manager shall offer value-based payment arrangements to all providers in its network capable of entering into value-based payment arrangements. Such arrangements shall be optional for the provider. The quality measures used by a managed care organization or dental benefit manager to determine reimbursement amounts to providers in value-based payment arrangements shall align with the quality measures of the Authority for managed care organizations or dental benefit managers.C. Notwithstanding any other provision of this section, the Authority shall comply with payment methodologies required by federal law or regulation for specific types of providers including, but not limited to, Federally Qualified Health Centers, rural health clinics, pharmacies, Indian Health Care Providers and emergency services.Added by Laws 2021, c. 542, § 12, eff. Sept. 1, 2021.