2023 Oklahoma Statutes › Title 56. Poor Persons › §56-4002.3a. Capitated contracts with contracted entities for delivery of Medicaid services.

A. 1. The Oklahoma Health Care Authority (OHCA) shall enter into capitated contracts with contracted entities for the delivery of Medicaid services as specified in this act to transform the delivery system of the state Medicaid program for the Medicaid populations listed in this section.
2. Unless expressly authorized by the Legislature, the Authority shall not issue any request for proposals or enter into any contract to transform the delivery system for the aged, blind, and disabled populations eligible for SoonerCare.
B. 1. The Oklahoma Health Care Authority shall issue a request for proposals to enter into public-private partnerships with contracted entities other than dental benefit managers to cover all Medicaid services other than dental services for the following Medicaid populations:
a.
pregnant women,
b.
children,
c.
deemed newborns under 42 C.F.R., Section 435.117,
d.
parents and caretaker relatives, and
e.
the expansion population.
2. The Authority shall specify the services to be covered in the request for proposals referenced in paragraph 1 of this subsection. Capitated contracts referenced in this subsection shall cover all Medicaid services other than dental services including:
a.
physical health services including, but not limited to:
(1)
primary care,
(2)
inpatient and outpatient services, and
(3)
emergency room services,
b.
behavioral health services, and
c.
prescription drug services.
3. The Authority shall specify the services not covered in the request for proposals referenced in paragraph 1 of this subsection.
4. Subject to the requirements and approval of the Centers for Medicare and Medicaid Services, the implementation of the program shall be no later than October 1, 2023.
C. 1. The Authority shall issue a request for proposals to enter into public-private partnerships with dental benefit managers to cover dental services for the following Medicaid populations:
a.
pregnant women,
b.
children,
c.
parents and caretaker relatives,
d.
the expansion population, and
e.
members of the Children's Specialty Plan as provided by subsection D of this section.
2. The Authority shall specify the services to be covered in the request for proposals referenced in paragraph 1 of this subsection.
3. Subject to the requirements and approval of the Centers for Medicare and Medicaid Services, the implementation of the program shall be no later than October 1, 2023.
D. 1. Either as part of the request for proposals referenced in subsection B of this section or as a separate request for proposals, the Authority shall issue a request for proposals to enter into public-private partnerships with one contracted entity to administer a Children's Specialty Plan.
2. The Authority shall specify the services to be covered in the request for proposals referenced in paragraph 1 of this subsection.
3. The contracted entity for the Children's Specialty Plan shall coordinate with the dental benefit managers who cover dental services for its members as provided by subsection C of this section.
4. Subject to the requirements and approval of the Centers for Medicare and Medicaid Services, the implementation of the program shall be no later than October 1, 2023.
E. The Authority shall not implement the transformation of the Medicaid delivery system until it receives written confirmation from the Centers for Medicare and Medicaid Services that a managed care directed payment program utilizing average commercial rate methodology for hospital services under the Supplemental Hospital Offset Payment Program has been approved for Year 1 of the transformation and will be included in the budget neutrality cap baseline spending level for purposes of Oklahoma's 1115 waiver renewal; provided, however, nothing in this section shall prohibit the Authority from exploring alternative opportunities with the Centers for Medicare and Medicaid Services to maximize the average commercial rate benefit.
Added by Laws 2022, c. 395, § 3, eff. July 1, 2022.