Oklahoma Administrative Code › Title 317 - Oklahoma Health Care Authority › Chapter 30 - Medical Providers-Fee for Service › Subchapter 5 - Individual Providers and Specialties › Part 110 - INDIAN HEALTH SERVICES, TRIBAL PROGRAMS, AND URBAN INDIAN CLINICS (I/T/Us) › Section 317:30-5-1101 - I/T/U Shared Savings Program

Current through Vol. 41, No. 20, July 1, 2024
(a)
Description.
In accordance
				  with state and federal law, the I/T/U Shared Savings Program is a program that
				  direct the reinvestment of any savings to the Oklahoma Health Care Authority
				  (OHCA) generated by enhanced federal matching authorized under Section 1905(b)
				  of the Social Security Act at a rate of one hundred percent (100%) for covered
				  services received through participating Indian Health Service, Tribal and Urban
				  Indian (I/T/U) facilities.
(1)
Eligibility.
Authorized services provided by a non-I/T/U Medicaid
				  provider to an American Indian or Alaska Native (AI/AN) Medicaid member as a
				  result of a referral from an I/T/U facility provider may be eligible for the
				  enhanced federal matching rate of one hundred percent (100%).
(2)
Distribution criteria.
OHCA
				  will distribute up to fifty percent (50%) of any savings that result from the
				  I/T/U Shared Savings Program to the referring I/T/U, but only after
				  administrative costs incurred by OHCA in implementing the program have been
				  fully satisfied. Distributions issued will ensure the following:
(A) Distributions to participating I/T/U
				  facilities will be used to increase care coordination and to support health
				  care initiatives for AI/AN populations;
(B) OHCA will deposit any shared savings that
				  remain after administrative costs have been fully paid, and after distributions
				  have been made to participating I/T/U facilities, into the I/T/U Shared Savings
				  Revolving Fund for the purpose of increasing Medicaid provider rates;
(C) Monies in the fund will not be used to
				  replace other general revenues appropriated and funded by the Oklahoma
				  Legislature or other revenues used to support Medicaid; or
(D) OHCA will make distributions on a
				  quarterly basis to participating I/T/U facilities based on claims data. The
				  calculation will include the paid claims from the non-I/T/U provider that a
				  member was referred to by an I/T/U. The referring ITU provider will need to be
				  listed on the claim, and there must be an active Care Coordination Agreement
				  (CCA) on file with OHCA. A CCA must be executed between the I/T/U facility and
				  the non-I/T/U provider. A CCA must include, but not limited to the following:
(i) The I/T/U facility provider providing a
				  request for specific services by electronic or other verifiable means and
				  relevant information about the practitioner's member to the non-I/T/U
				  provider;
(ii) The non-I/T/U
				  provider sending information about the care the non-I/T/U provider provides to
				  the patient including the results of any screening, diagnostic or treatment
				  procedures, to the I/T/U facility provider;
(iii) The I/T/U facility provider continuing
				  to assume responsibility for the member's care by assessing the information and
				  taking appropriate action including, when necessary, furnishing or requesting
				  additional services; and
(iv) The
				  I/T/U facility incorporating the member's information in the medical record
				  through the statewide health information exchange or other agreed-upon
				  means.