Oklahoma 2022 Regular Session

Oklahoma House Bill HB2322 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1		-	An Act
2		-	ENROLLED HOUSE
3		-	BILL NO. 2322 By: McEntire, Frix, Sims,
4		-	Sneed, and Roberts (Eric)
5		-	of the House
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	27	+
	28	+	STATE OF OKLAHOMA
	29	+
	30	+	2nd Session of the 58th Legislature (2022)
	31	+
	32	+	CONFERENCE COMMITTEE
	33	+	SUBSTITUTE
	34	+	FOR ENGROSSED
	35	+	HOUSE BILL NO. 2322 By: Frix, Sims, Sneed, and
	36	+	Roberts (Eric) of the House
6	37
7	38		and
8	39
9		-	~~Taylor, Bullard,~~ Pemberton,
10		-	~~and Garvin of~~ the Senate
	40	+	Bullard and Pemberton of
	41	+	the Senate
11	42
12	43
13	44
14	45
15		-
	46	+	CONFERENCE COMMITTEE SUBSTITUTE
16	47
17	48		An Act relating to the state Medicaid program;
18	49		amending 56 O.S. 2021, Section 4002. 2, as amended by
19	50		Section 2 of Enrolled Senate Bill No. 1337 of the 2nd
20	51		Session of the 58th Oklahoma Legislature , which
21	52		relates to definitions used in the Ensuring Access to
22	53		Medicaid Act; broadening certain definition; amendi ng
23	54		56 O.S. 2021, Section 4002.12, as amended by Section
24	55		15 of Enrolled Senate Bill No. 1337 of the 2nd
25	56		Session of the 58th Oklahoma Legislature , which
26	57		relates to reimbursement of providers; requiring
27	58		certain reimbursement for phar macist; providing an
28	59		effective date; declaring an emergency ; and creating
29	60		contingent effectiveness.
30	61
31	62
32	63
33	64
34		-	SUBJECT: State Medicaid program
35	65
36	66		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
37		-
38	67		SECTION 1. AMENDATORY 56 O.S. 2021, Section 4 002.2, as
39	68		amended by Section 2 of Enrolled Senate Bill No. 1337 of the 2nd
40	69		Session of the 58th Oklahoma Legislat ure, is amended to read as
41	70		follows:
42	71
43		-	Section 4002.2 As used in the Ensuring Access to Me dicaid Act:
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44	96
	97	+	Section 4002.2. As used in the Ensuring Access to Me dicaid Act:
45	98		1. "Adverse determination" has the same meaning as provided by
46		-	Section 6475.3 of Tit le 36 of the Oklahoma Statutes; ENR. H. B. NO. 2322 Page 2
47		-
	99	+	Section 6475.3 of Tit le 36 of the Oklahoma Statutes;
48	100		2. "Accountable care organization " means a network of
49	101		physicians, hospitals, and other health care providers that provides
50	102		coordinated care to Medic aid members;
51		-
52	103		3. "Claims denial error rate" means the rate of claims denial s
53	104		that are overturned on appeal;
54		-
55	105		4. "Capitated contract" means a contract between the Oklahoma
56	106		Health Care Authority and a contracted entity for delivery of
57	107		services to Medicaid members in which the Authority pays a fixed,
58	108		per-member-per-month rate based on actuarial calculations;
59		-
60	109		5. "Children's Specialty Plan" means a health care plan that
61	110		covers all Medicaid services other than den tal services and is
62	111		designed to provide care to:
63		-
64	112		a. children in foster care,
65		-
66	113		b. former foster care children up to twenty-five (25)
67	114		years of age,
68		-
69	115		c. juvenile justice involved children, and
70		-
71	116		d. children receiving adoption assistance;
72		-
73	117		6. "Clean claim" means a properly completed billing form with
74	118		Current Procedural Terminology, 4th Edition or a more recent
75	119		edition, the Tenth Revision of the International Classification of
76	120		Diseases coding or a more re cent revision, or Healthcare Common
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77	147		Procedure Coding Syste m coding where applicable that contains
78	148		information specifically required in the Provider Billing and
79	149		Procedure Manual of the Oklahoma Health Care Authority, as defined
80	150		in 42 C.F.R., Section 447.45 (b);
81		-
82	151		7. "Commercial plan" means an organization or entity that
83	152		undertakes to provide or arrange for the delivery of health care
84	153		services to Medicaid members on a prepaid basis and is subject to
85	154		all applicable federal a nd state laws and regulations;
86		-
87	155		8. "Contracted entity" means an organization or entity that
88	156		enters into or will ente r into a capitated contract with the
89	157		Oklahoma Health Care Authority for the delivery of services
90	158		specified in this act the Ensuring Access to Medicai d Act that will
91		-	assume financial risk, operational accountability , and statewide or ~~ENR. H. B. NO. 2322 Page 3~~
	159	+	assume financial risk, operational accountability , and statewide or
92	160		regional functionality as defined in this act the Ensuring Access to
93	161		Medicaid Act in managing comprehensive health outcomes of Medicaid
94	162		members. For purposes of this act the Ensuring Access to Medicai d
95	163		Act, the term contracted entit y includes an accountable care
96	164		organization, a provider-led entity, a commercial plan, a dental
97	165		benefit manager, or any other entity as determined by t he Authority;
98		-
99	166		9. "Dental benefit manager" means an entity that handles claims
100	167		payment and prior authorizations and coordinates dental care with
101	168		participating provider s and Medicaid members;
102		-
103	169		10. "Essential community provider" means:
104		-
105	170		a. a Federally Qualified Health Center,
106	171
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107	197		b. a community mental health center,
108		-
109	198		c. an Indian Health Care Provider,
110		-
111	199		d. a rural health clinic,
112		-
113	200		e. a state-operated mental health hospital,
114		-
115	201		f. a long-term care hospital ser ving children (LTCH-C),
116		-
117	202		g. a teaching hospital owned, jointly owned, or
118	203		affiliated with and designated by the University
119	204		Hospitals Authority, University Hospitals Trust,
120	205		Oklahoma State Univers ity Medical Authority, or
121	206		Oklahoma State University Medical Trus t,
122		-
123	207		h. a provider employed by or contracted with, or
124	208		otherwise a member of the f aculty practice plan of:
125		-
126	209		(1) a public, accredited medical school in this
127	210		state, or
128		-
129	211		(2) a hospital or health care entity directly or
130	212		indirectly owned or operated by the Universit y
131	213		Hospitals Trust or the Oklahoma State University
132	214		Medical Trust,
133		-
134	215		i. a county department of health or city-county health
135	216		department,
136		-	ENR. H. B. NO. 2322 Page 4
137	217		j. a comprehensive community addiction recovery center,
138		-
139	218		k. a hospital licensed by the State of Oklahoma including
140	219		all hospitals participating in the Supplemental
141	220		Hospital Offset Payment Program ,
142	221
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143	247		l. a Certified Community Behavioral Health Clinic
144	248		(CCBHC),
145		-
146	249		m. a provider employed by or contracted with a primary
147	250		care residency program accredited by the Accreditation
148	251		Council for Graduate Medical Education,
149		-
150	252		n. any additional Medicaid provider as approved by the
151	253		Authority if the provider either offe rs services that
152	254		are not available from any other provider within a
153	255		reasonable access standard or provides a substantial
154	256		share of the total units of a particular service
155	257		utilized by Medicaid members within the region during
156	258		the last three (3) years, and the combined capacity of
157	259		other service providers in the region is insufficient
158	260		to meet the total needs of the Medicaid mem bers, or
159		-
160	261		o. a pharmacy or pharmacist, or
161		-
162	262		p. any provider not otherwise mentioned in this p aragraph
163	263		that meets the defini tion of "essential community
164	264		provider" under 45 C.F.R., Section 156.235;
165		-
166	265		11. "Material change" includes, but is not limited to, any
167	266		change in overall business operations such as policy, process or
168	267		protocol which affects, or can re asonably be expected to affect ,
169	268		more than five percent (5%) of enrollees or participating pro viders
170	269		of the contracted entity;
171	270
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172	296		12. "Governing body" means a group of individuals appointed by
173	297		the contracted entity who approve policies, operations, pro fit/loss
174	298		ratios, executive employment decisio ns, and who have overall
175	299		responsibility for the operations of the contracted entity of which
176	300		they are appointed;
177		-
178	301		13. "Local Oklahoma provider organization" means any state
179	302		provider association, accountable care organization, Certified
180	303		Community Behavioral Health Clinic, Federally Qualified Health
181		-	Center, Native American tribe or tribal association, hospital or ~~ENR. H. B. NO. 2322 Page 5~~
	304	+	Center, Native American tribe or tribal association, hospital or
182	305		health system, academ ic medical institution, currently practicing
183	306		licensed provider, or other local Oklahoma provider organization as
184	307		approved by the Authority;
185		-
186	308		14. "Medical necessity" has the same meaning as provided by
187	309		rules promulgated by the Oklahoma Health Care Author ity Board;
188		-
189	310		15. "Participating provider" means a provider who has a
190	311		contract with or is employed by a contracted entity to provide
191	312		services to Medicaid members as authorized by this act the Ensuring
192	313		Access to Medicaid Act;
193		-
194	314		16. "Provider" means a health care or dental provider licensed
195	315		or certified in this state or a provider that meets the Authority's
196	316		provider enrollment criteria to contract with the Authority as a
197	317		SoonerCare provider;
198		-
199	318		17. "Provider-led entity" means an organization or entity that
200	319		meets the criteria of at least one of following two subparagraphs:
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201	345
202	346		a. a majority of the entity's ownership is held by
203	347		Medicaid providers in this state or is held by an
204	348		entity that directly or indirectly owns or is unde r
205	349		common ownership with Medicaid providers in thi s
206	350		state, or
207		-
208	351		b. a majority of the entity's governing body is composed
209	352		of individuals who:
210		-
211	353		(1) have experience serving Medicaid members and:
212		-
213	354		(a) are licensed in this state as physicians,
214	355		physician assistants, nurse practitioners,
215	356		certified nurse-midwives, or certified
216	357		registered nurse anesthetists,
217		-
218	358		(b) at least one board member is a licensed
219	359		behavioral health provider , or
220		-
221	360		(c) are employed by:
222		-
223	361		i. a hospital or other medical faci lity
224	362		licensed by this state and operating in
225	363		this state, or
226		-	ENR. H. B. NO. 2322 Page 6
227	364		ii. an inpatient or outpatient mental
228	365		health or substance abuse treatment
229	366		facility or program licensed or
230	367		certified by this stat e and operating
231	368		in this state,
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233	395		(2) represent the providers or facili ties described
234	396		in division (1) of this subparagraph including ,
235	397		but not limited to, individuals who are employed
236	398		by a statewide provider association, o r
237		-
238	399		(3) are nonclinical administrators of cl inical
239	400		practices serving Medicaid members;
240		-
241	401		18. "Statewide" means all counties of this state inclu ding the
242	402		urban region; and
243		-
244	403		19. "Urban region" means:
245		-
246	404		a. all counties of this state with a county population of
247	405		not less than five hundred thousand (500,000)
248	406		according to the latest Federal Decennial Census, and
249		-
250	407		b. all counties that are contiguous to the counties
251	408		described in subparagraph a of this paragraph ,
252		-
253	409		combined into one region.
254		-
255	410		SECTION 2. AMENDATORY 56 O.S. 2021, Section 4002.12, as
256	411		amended by Section 15 of Enrolled Sen ate Bill No. 1337 of the 2nd
257	412		Session of the 58th Oklahoma Legislature, is amended to read as
258	413		follows:
259		-
260		-	Section 4002.12 A. Until July 1, 2026, the Oklahoma Health
	414	+	Section 4002.12. A. Until July 1, 2026, the Oklahoma Health
261	415		Care Authority shall establish minimum rates of reimbursement from
262	416		contracted entities to providers who elect not to enter into value-
263	417		based payment arrangements under subsection B of this section or
264	418		other alternative payment agreements for health care items and
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265	445		services furnished by such providers to enrollees of the state
266	446		Medicaid program. Except as provided by subsectio n I of this
267	447		section, until July 1, 2026, such reimbursement rates shall be equal
268	448		to or greater than:
269		-
270	449		1. For an item or service provided by a participating provider
271		-	who is in the network of the contracted entity, one hundred percent ~~ENR. H. B. NO. 2322 Page 7~~
	450	+	who is in the network of the contracted entity, one hundred percent
272	451		(100%) of the reimbursement rate for the applicable service in the
273	452		applicable fee schedule of the Authority; or
274		-
275	453		2. For an item or service p rovided by a non-participating
276	454		provider or a provider who is not in the network of the contracted
277	455		entity, ninety percent (90%) of the reimbursement rate for the
278	456		applicable service in the applicable fee schedule of the Authority
279	457		as of January 1, 2021.
280		-
281	458		B. A contracted entity shall offer value-based payment
282	459		arrangements to all providers in its network capable of enter ing
283	460		into value-based payment arrange ments. Such arrangements shall be
284	461		optional for the provider but shall be tied to r eimbursement
285	462		incentives when quality metrics are met . The quality measures used
286	463		by a contracted entity to determine reimbursement amount s to
287	464		providers in value-based payment arrangements shall align with the
288	465		quality measures of the Authority for contracted entities.
289		-
290	466		C. Notwithstanding any other provision of this sec tion, the
291	467		Authority shall comply with payment methodologies required by
292	468		federal law or regulation for specific types of providers including,
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293	495		but not limited to, Federally Qualified Health Cente rs, rural health
294	496		clinics, pharmacies, Indian Health Care Provid ers and emergency
295	497		services.
296		-
297	498		D. A contracted entity shall offer all rural health clinics
298	499		(RHCs) contracts that reimburse RHCs using the methodology in place
299	500		for each specific RHC prior to Janua ry 1, 2023, including any and
300	501		all annual rate updates. The con tracted entity shall comply with
301	502		all federal program rules and requirement s, and the transformed
302	503		Medicaid delivery system shall not interfere with the program as
303	504		designed.
304		-
305	505		E. The Oklahoma Heal th Care Authority shall e stablish minimum
306	506		rates of reimbursemen t from contracted entities to Certified
307	507		Community Behavioral Health Clinic (CCBHC) providers who elect
308	508		alternative payment arrangements equal to the prospective payment
309	509		system rate under the Me dicaid State Plan.
310		-
311	510		F. The Authority shall establish an incenti ve payment under the
312	511		Supplemental Hospital Offset Payment Program that is determined by
313	512		value-based outcomes for providers other than hospitals.
314		-	ENR. H. B. NO. 2322 Page 8
315	513		G. Psychologist reimbursement shall reflect out comes.
316	514		Reimbursement shall not be limited to therapy and shall include but
317	515		not be limited to testing and assessment.
318		-
319	516		H. Coverage for Medicaid ground transportation service s by
320	517		licensed Oklahoma emergency medical services shall be reimbursed at
321	518		no less than the published Medicaid rates as set by the Authority.
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322	545		All currently published Medicaid Healthcare Common Procedure Coding
323	546		System (HCPCS) codes paid by the Authority shal l continue to be paid
324	547		by the contracted entity. The contracted entity shall comply with
325	548		all reimbursement policies established by the Authority f or the
326	549		ambulance providers. Contracted entities shall accept the modifier s
327	550		established by the Centers for Med icare and Medicaid Services
328	551		currently in use by Medicare at the time of the transpo rt of a
329	552		member that is dually eligible for Medicare and Medicai d.
330		-
331	553		I. 1. The rate paid to participating pharmacy providers is
332	554		independent of subsection A of this section an d shall be the same as
333	555		the fee-for-service rate employed by the Authority for th e Medicaid
334	556		program as stated in the payment methodology at OAC 317:30 -5-78,
335	557		unless the participating pharmacy provider elects to enter into
336	558		other alternative payment agreements .
337		-
338	559		2. A pharmacy or pharmacist shall receive direct payment or
339	560		reimbursement from t he Authority or contracte d entity when providing
340	561		a healthcare service to the Medicaid member at a rate no less than
341	562		that of other healthc are providers for providing the same service.
342		-
343	563		J. The Authority shall specify in the requests for proposals a
344	564		reasonable time frame in which a c ontracted entity shall have
345	565		entered into a certain percentage , as determined by the Authority,
346	566		of value-based contracts with providers.
347		-
348	567		K. Capitation rates established by the Oklahoma Health Care
349	568		Authority and paid to contracted e ntities under capitated c ontracts
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	594	+
350	595		shall be updated annually and in accordance with 42 C.F.R., Section
351	596		438.3. Capitation rates shall be a pproved as actuarially sound as
352	597		determined by the Centers for Medicare and Medicaid Services in
353	598		accordance with 42 C.F. R., Section 438.4 and the following:
354		-
355	599		1. Actuarial calculations must include utiliz ation and
356	600		expenditure assumptions consistent with indu stry and local
357	601		standards; and
358		-	ENR. H. B. NO. 2322 Page 9
359	602		2. Capitation rates shall be risk -adjusted and shall include a
360	603		portion that is at risk f or achievement of quality and outcomes
361	604		measures.
362		-
363	605		L. The Authority may establish a symmetric risk corridor for
364	606		contracted entities.
365		-
366	607		M. The Authority shall establish a proce ss for annual recovery
367	608		of funds from, or assessment of penalties on, contracted ent ities
368	609		that do not meet the medical loss ratio standards stipulated in
369	610		Section 4002.5 of this title.
370		-
371	611		N. 1. The Authority shall, through the financial reporting
372		-	required under subsection G of Section 17 of this act, determine the
373		-	percentage of health care expenses by each contracted entity on
374		-	primary care services.
375		-
	612	+	required under subsection G of Section 17 of this act 4002.13 of
	613	+	this title, determine the perc entage of health care exp enses by each
	614	+	contracted entity on primary care services.
376	615		2. Not later than the end of the fourth year of the i nitial
377	616		contracting period, each contracted entity shall be currently
378	617		spending not less than eleven percent (11%) of its total health care
379	618		expenses on primary care services.
380	619
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381	645		3. The Authority shall monitor the primary care spending of
382	646		each contracted entity and require each contracted entity to
383	647		maintain the level of spending on primary care services stipulated
384	648		in paragraph 2 of this subsection.
385		-
386	649		SECTION 3. This act shall become effective July 1, 2022.
387		-
388	650		SECTION 4. It being immediately necessary for the preservation
389	651		of the public peace, health or safety, an emergency is hereb y
390	652		declared to exist, by reason whereof this a ct shall take effect and
391	653		be in full force from and after its passage and approval.
392		-
393	654		SECTION 5. The provisions of this act shall be contingent upon
394	655		the enactment of Enrolled Senate Bill No. 1337 of the 2nd Session of
395	656		the 58th Oklahoma Legislature and shall not become effective as law
396	657		otherwise.
397	658
	659	+	58-2-11604 KN 05/18/22
398	660
399		-	ENR. H. B. NO. 2322 Page 10
400		-
401		-	Passed the House of Representatives the 19th day of May, 2022.
402		-
403		-
404		-
405		-
406		-	Presiding Officer of the House
407		-	of Representatives
408		-
409		-
410		-	Passed the Senate the 20th day of May, 2022.
411		-
412		-
413		-
414		-
415		-	Presiding Officer of the Senate
416		-
417		-
418		-
419		-	OFFICE OF THE GOVERNOR
420		-	Received by the Office of the Governor this ____________________
421		-	day of ___________________, 20_______, at _______ o'clock _______ M.
422		-	By: _________________________________
423		-	Approved by the Governor of the State of Oklahoma this _________
424		-	day of ___________________, 20_______, at _______ o'clock _______ M.
425		-
426		-
427		-	_________________________________
428		-	Governor of the State of Oklahoma
429		-
430		-	OFFICE OF THE SECRETARY OF STATE
431		-	Received by the Office of the S ecretary of State this __________
432		-	day of ___________________, 20_______, at _______ o'clock _______ M.
433		-	By: _________________________________