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ENGROSSED HOUSE AMENDME NTS
TO
ENGROSSED SENATE BILL NO . 434 By: McCortney of the Senate
and
McEntire of the House
An Act relating to the state Medicaid program;
stating purpose of act; creating the I/T/U Shared
Savings Program; providing that c ertain services may
be subject to certain reimbursement; providing for
certain distribution and deposit of savings;
prohibiting certain use of fund; requiring certain
actions and distributions to be conducted in
accordance with certain federal guidance; sp ecifying
criteria of care coordination agreements; providing
for promulgation of rules and execution of contracts
in accordance with certain requirements; requiring
the Oklahoma Health Care Authority to seek certain
federal approval; providing for terminat ion of the
I/T/U Shared Savings Program under certain
conditions; creating the I/T/U Shared Savings
Revolving Fund; specifying purpose of fund and
revenue sources; requiring submission of certain
annual report; specifying criteria of report;
providing for codification; providing an effective
date; and declaring an emergency.
AUTHOR: Add the following House Coauthor: Pittman
AMENDMENT NO. 1. Page 1, Lines 6 through 15 1/2, strike the title
to read:
"[ Medicaid – creating the I/T/U Shared Savings
Program – specifying criteria of care coordination
agreements – creating the I/T/U Shared Savings
Revolving Fund – specifying purpose of fund and
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revenue sources – effective date -
emergency ]"
AMENDMENT NO. 2. Page 1, Line 1 8, strike the enacting clause
Passed the House of Representatives the 21st day of April, 2021.
Presiding Officer of the House of
Representatives
Passed the Senate the ____ day of __________, 2021.
Presiding Officer of the Senate
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ENGROSSED SENATE
BILL NO. 434 By: McCortney of the Senate
and
McEntire of the House
An Act relating to the state Medicaid program;
stating purpose of act; creating the I/T/U Shared
Savings Program; providing that certain services may
be subject to certain reimbursement; providing for
certain distribution and deposit of savings;
prohibiting certain use of fund; requiring certain
actions and distributions to be conducted in
accordance with certain federal guidance; specifying
criteria of care coordination agreements; providing
for promulgation of rules and execution of contracts
in accordance with certain requirements; requiring
the Oklahoma Health Care Authority to seek certain
federal approval; providing for termination of the
I/T/U Shared Savings Program under certain
conditions; creating the I/T/U Shared Savings
Revolving Fund; specifying purpose of fund and
revenue sources; requiring submission of certain
annual report; specifying criteria of report;
providing for codification; providing an effective
date; and declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5061.1 of Title 63, unless there
is created a duplication in numbering, reads as f ollows:
A. The purpose of this act is to maximize and direct the
reinvestment of any savings to the Oklahoma Health Care Authority
generated by enhanced federal matching authorized under Section
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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.
B. There is hereby created the I/T/U Shared Savings Program.
Pursuant to guidance of the Centers for Medicare & Medicaid Services
(CMS), authorized services provided by a non -I/T/U Medicaid provider
to an American Indian or Alaska Native (AI/AN) Medicaid beneficiary
as a result of a referral from an I/T/U facility provider may be
eligible for the enhanced federal matching r ate of one hundred
percent (100%).
C. 1. The Authority shall distribute up to fifty percent (50%)
of any savings that result from the I/T/U Shared Savings Program
provided for in this section to participating I/T/U facilities that
have complied with the terms of this act and applicable federal law,
but only after administrative costs incurred by the Authority in
implementing the I/T/U Shared Savings Program have been fully
satisfied.
2. Distributions to participating I/T/U facilities shall be
used to increase care coordination and to support health care
initiatives for AI/AN populations.
3. The Authority shall 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 created in Section 2 of this
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act for the purpose of increasing Medicaid provider rates. Monies
in the fund shall not be used to replace other general revenues
appropriated and funded by the Legi slature or other revenues used to
support Medicaid.
D. 1. All actions taken by the Authority in implementing the
I/T/U Shared Savings Program shall be made in accordance with
applicable state and federal Medicaid law and CMS State Health
Official letter (SHO) #16-002, issued on February 26, 2016, and CMS
Frequently Asked Questions (FAQs) regarding "Federal Funding for
Services 'Received Through' an IHS/Tribal Facility and Furnished to
Medicaid-Eligible American Indians and Alaska Natives (SHO #16 -002)"
issued on January 18, 2017, and as such guidance may be hereinafter
amended or modified.
2. The Authority shall make distributions to a participating
I/T/U facility in accordance with paragraph 1 of subsection C of
this section, contingent upon the producti on of executed copies of
Care Coordination Agreements (CCAs) for all services billed to
Oklahoma Medicaid that were received through the I/T/U facility.
CCAs must be executed between the I/T/U facility and the non -I/T/U
provider and must include, at a min imum, assurances that care
coordination shall involve:
a. the I/T/U facility practitioner providing a request
for specific services by electronic or other
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verifiable means and relevant information about the
practitioner's patient to the non -I/T/U provider,
b. 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
practitioner,
c. the I/T/U facility practitioner continuing to assume
responsibility for the patient's care by assessing the
information and taking appropriate action including,
when necessary, furnishing or requesting additional
services, and
d. the I/T/U facility incorporating the patient's
information in the medical record through the
statewide health information exchange or other agreed -
upon means.
E. The Oklahoma Health Care Authority Board is authorized to
promulgate administrative rules and to enter into contractual
agreements with I/T/U facilitie s as needed to effectuate the
provisions of this act. As part of the rulemaking process, the
Authority shall comply with the Tribal Consultation Requirements
provided by the Medicaid State Plan.
F. The Authority shall promptly seek any necessary federal
approval for the implementation of this act. In the event that any
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necessary federal approval is not obtained, or in the event funding
of Oklahoma Medicaid from state, federal or other sources is
withdrawn, reduced or limited in any way that affects imple mentation
of the I/T/U Shared Savings Program, the I/T/U Shared Savings
Program may be terminated immediately by the Authority, and no court
or tribunal shall have jurisdiction to review such termination.
SECTION 2. NEW LAW A new se ction of law to be codified
in the Oklahoma Statutes as Section 5061.2 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. There is hereby created in the State Treasury a revolving
fund for the Oklahoma Health Care Author ity to be designated the
"I/T/U Shared Savings Revolving Fund". The fund shall be a
continuing fund, not subject to fiscal year limitations, and shall
consist of all monies received by the Authority pursuant to this act
and otherwise specified or authoriz ed by law.
All monies accruing to the credit of the fund are hereby
appropriated and shall be budgeted and expended by the Authority to
increase Medicaid provider rates, unless otherwise provided by law.
Expenditures from the fund shall be made upon warra nts issued by the
State Treasurer against claims filed as prescribed by law with the
Director of the Office of Management and Enterprise Services for
approval and payment.
B. An annual report shall be prepared by the Authority's Chief
Financial Officer an d shall be submitted to the Governor, the
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President Pro Tempore of the Senate and the Speaker of the House of
Representatives no later than thirty (30) days following the end of
each State Fiscal Year. The annual report shall account for:
1. The savings realized by the Authority as a result of the
I/T/U Shared Savings Program;
2. The administrative costs incurred by the Authority as a
result of the I/T/U Shared Savings Program;
3. The monies distributed to participating I/T/U facilities as
a result of I/T/U Shared Savings Program including, but not limited
to, a summary of all specific distributions;
4. The balance of savings realized by the Authority as a result
of the I/T/U Shared Savings Program and accruing to the credit of
the fund after payment of administrative costs and distributions to
participating I/T/U facilities; and
5. The monies expended on increasing Medicaid provider rates
including, but not limited to, identification of the types of
providers affected and the percentage by which the pr oviders' rates
were increased.
SECTION 3. This act shall become effective July 1, 2021.
SECTION 4. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
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Passed the Senate the 10th day of March, 2021.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of _ _________,
2021.
Presiding Officer of the House
of Representatives