§56-4002.10. Readiness review.
The Oklahoma Health Care Authority shall require all contracted entities 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 contracted entity to perform satisfactorily in such areas as may be specified in 42 C.F.R., Section 438.66. Added by Laws 2021, […]
§56-4002.11. Scorecard comparing contracted entities and dental benefit managers.
No later than one (1) year following the execution of the delivery model transition described in the Ensuring Access to Medicaid Act, the Oklahoma Health Care Authority shall create a scorecard that compares each contracted entity and separately compares each dental benefit manager. The scorecard shall report the average speed of authorizations of services, rates […]
§56-4002.12. Minimum rates of reimbursement – Value-based payment arrangements.
A. Until July 1, 2026, the Oklahoma Health Care Authority shall establish minimum rates of reimbursement from contracted entities to providers who elect not to enter into value-based payment arrangements under subsection B of this section or other alternative payment agreements for health care items and services furnished by such providers to enrollees of the […]
§56-4002.12a. Dental benefit managers to maintain Medicaid Dental Advisory Committees.
A. All dental benefit managers shall maintain a Medicaid Dental Advisory Committee, comprised exclusively of Oklahoma-licensed dentists and specialists, to advise dental benefit managers regarding quality measures. B. Dental providers shall not be required to enter into capitated contracts with a dental benefit manager. Added by Laws 2022, c. 395, § 16, eff. July 1, […]
§56-4002.12b. Oklahoma Health Care Authority to ensure sustainability.
A. The Oklahoma Health Care Authority shall ensure the sustainability of the transformed Medicaid delivery system. B. The Authority shall ensure that existing revenue sources designated for the state share of Medicaid expenses are designed to maximize federal matching funds for the benefit of providers and the state. C. The Authority shall develop a plan, […]
§56-4002.13. Medicaid Delivery System Quality Advisory Committee.
A. The Oklahoma Health Care Authority shall establish a Medicaid Delivery System Quality Advisory Committee for the purpose of performing the duties specified in subsection B of this section. B. The Committee shall have the power and duty to make recommendations to the Administrator of the Oklahoma Health Care Authority and the Oklahoma Health Care […]
§56-4002.14. Uniform defined measures and goals – Provider quality metrics.
A. The transformed delivery system of the state Medicaid program and capitated contracts awarded under the transformed delivery system shall be designed with uniform defined measures and goals that are consistent across contracted entities including, but not limited to, adjusted health outcomes, social determinants of health, quality of care, member satisfaction, provider satisfaction, access to […]
§56-4002.15. Federal approval – Promulgation of rules.
A. 1. The Oklahoma Health Care Authority shall seek any federal approval necessary to implement the Ensuring Access to Medicaid Act. This shall include, but not be limited to, submission to the Centers for Medicare and Medicaid Services of any appropriate demonstration waiver application or Medicaid State Plan amendment necessary to accomplish the requirements of […]
§56-4002.6. Requirements for prior authorizations.
A. A contracted entity shall meet all requirements established by the Oklahoma Health Care Authority pertaining to prior authorizations. The Authority shall establish requirements that ensure timely determinations by contracted entities when prior authorizations are required including expedited review in urgent and emergent cases that at a minimum meet the criteria of this section. B. […]
§56-4002.7. Requirements for processing and adjudicating claims.
A. The Oklahoma Health Care Authority shall establish requirements for fair processing and adjudication of claims that ensure prompt reimbursement of providers by contracted entities. A contracted entity shall comply with all such requirements. B. A contracted entity shall process a clean claim in the time frame provided by Section 1219 of Title 36 of […]