An Act
ENROLLED SENATE
BILL NO. 434 By: McCortney and Floyd of the
Senate
and
McEntire, Pittman and
Fugate 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 reimburse ment; 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 con tracts
in accordance with certain requirements; requiring
the Oklahoma Health Care Authority to seek cer tain
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 .
SUBJECT: Medicaid
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
ENR. S. B. NO. 434 Page 2
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Stat utes as Section 5061.1 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. The purpose of this act is to maximize and direct the
reinvestment of any s avings to the Oklahoma Health Care Aut hority
generated by enhanced f ederal 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.
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 rate of one hundred
percent (100%).
C. 1. The Authority shall distribute up to fifty percent (50%)
of any savings that result from t he 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 inc urred by the Authority in
implementing the I/T/U Shared Savings Progra m 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 savi ngs 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
act for the purpose of increasing Medicaid provider rates. Monies
in the fund shall not be used to rep lace other general revenues
appropriated and funded by the Le gislature or other revenues us ed 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
ENR. S. B. NO. 434 Page 3
applicable state and fe deral 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 production 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 facili ty and the non-I/T/U
provider and must include, at a minimum, assurances that care
coordination shall involve:
a. the I/T/U facility practiti oner providing a request
for specific services by electronic or other
verifiable means and relevant information abo ut 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 facilities as needed to effectuate the
ENR. S. B. NO. 434 Page 4
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
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 implementation
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 s uch termination.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5061.2 of Title 63, unless there
is created a duplication in num bering, reads as follows:
A. There is hereby created in the State Treas ury a revolving
fund for the Oklahoma Health Care Authority 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 authorized by law .
All monies accruing to the credit of the fund are hereby
appropriated and shall be budgeted and expended by the Autho rity to
increase Medicaid provider rates, unless otherwise provided by l aw.
Expenditures from the fund shall be made upon warrants issued by the
State Treasurer against claims fi led as prescribed by law with the
Director of the Office of Management and En terprise Services for
approval and payment.
B. An annual report shall b e prepared by the Authority's Chief
Financial Officer and shall be submitted to the Governor , the
President Pro Tempore of the Se nate 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 ;
ENR. S. B. NO. 434 Page 5
2. The administrative costs incurr ed 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 Savin gs Program and accruing to the credit of
the fund after payment of administrative costs and distributions to
participating I/T/U faciliti es; 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 providers' 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.
ENR. S. B. NO. 434 Page 6
Passed the Senate the 19th day of May, 2021.
Presiding Officer of the Senate
Passed the House of Representatives the 25th day of May, 2021.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this _______ _____________
day of _________________ __, 20_______, at _______ o'clock _______ M.
By: _______________________________ __
Approved by the Governor of the State of Oklahoma this _____ ____
day of _________________ __, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this _______ ___
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _________________________________