Oklahoma 2023 Regular Session

Oklahoma House Bill HB1650 Compare Versions

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	3	+	HB1650 HFLR Page 1
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28		-	ENGROSSED HOUSE
29		-	BILL NO. 1650 By: McEntire of the House
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
	30	+
	31	+	STATE OF OKLAHOMA
	32	+
	33	+	1st Session of the 59th Legislature (2023)
	34	+
	35	+	HOUSE BILL 1650 By: McEntire of the House
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31	37		and
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33	39		Haste of the Senate
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	45	+	AS INTRODUCED
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40	47		An Act relating to managed care; amending 56 O.S.
41	48		2021, Section 4002.12, as last amended by Section 2,
42	49		Chapter 334, O.S.L. 2022 (56 O.S . Supp. 2022, Section
43	50		4002.12), which relates to minimum rates of
44	51		reimbursement; extending the date the Oklahoma Health
45	52		Care Authority shall e stablish minimum rates of
46	53		reimbursement; adding reimbursement fee schedule
47	54		relating to anesthesia; and providing an effective
48	55		date.
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54	61		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
55	62		SECTION 1. AMENDATORY 56 O.S. 2021, Section 4002.12, as
56	63		last amended by Section 2, Chapter 334, O.S.L. 2022 (56 O.S. Supp.
57	64		2022, Section 4002.12), is amended to read as follows:
58	65		Section 4002.12 A. Until July 1, 2026 2031, the Oklahoma
59	66		Health Care Authority shall establish minimum rat es of reimbursement
60	67		from contracted entities to providers who elect not to ente r into
61	68		value-based payment arrangemen ts under subsection B C of this
62		-	section or other alternative payment agreements for health care
63		-	items and services furnished by such provide rs to enrollees of the
64		-	state Medicaid program. Except as provided by subsectio n I J of
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66		-	ENGR. H. B. NO. 1650 Page 2 1
	70	+	HB1650 HFLR Page 2
	71	+	BOLD FACE denotes Committee Amendments. 1
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	96	+	section or other alternative payment agreements for health care
	97	+	items and services furnished by such provide rs to enrollees of the
	98	+	state Medicaid program. Except as provided by subsectio n I J of
91	99		this section, until July 1, 2026 2031, such reimbursement rates
92	100		shall be equal to or grea ter than:
93	101		1. For an item or service provided by a participating provider
94	102		who is in the network of the contracted entity, one hundred percent
95	103		(100%) of the reimbursement rate for the applicable service in the
96	104		applicable fee schedule of the Authority; or
97	105		2. For an item or service provided by a non-participating
98	106		provider or a provider who is not in the network of the contracted
99	107		entity, ninety percent (90%) of the reimbursement rate for the
100	108		applicable service in the applicable fee schedule of the Authority
101	109		as of January 1, 2021.
102	110		B. Notwithstanding any other provision in this section,
103	111		anesthesia will continue to be reimbursed equal to or greater than
104	112		the anesthesia fee schedule established by the Aut hority as of
105	113		January 1, 2021. Anesthesia providers m ay also enter into value -
106	114		based payment arrangements for services furnished to enrollees t o
107	115		the state Medicaid progra m.
108	116		C. A contracted entity shall offer value-based payment
109	117		arrangements to all provider s in its network capable of entering
110	118		into value-based payment arrangements. Such arrangements shall be
111	119		optional for the provider but shall be tied to reimbursement
112		-	incentives when quality metrics are met . The quality measures used
113		-	by a contracted entity to determine reimbursement amounts to
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115		-	ENGR. H. B. NO. 1650 Page 3 1
	121	+	HB1650 HFLR Page 3
	122	+	BOLD FACE denotes Committee Amendments. 1
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	147	+	incentives when quality metrics are met . The quality measures used
	148	+	by a contracted entity to determine reimbursement amounts to
140	149		providers in value-based payment arrangements shall align with the
141	150		quality measures of the Authority f or contracted entities.
142	151		C. D. Notwithstanding any other provision of this sec tion, the
143	152		Authority shall comply with payment methodologies required by
144	153		federal law or regulation f or specific types of providers including,
145	154		but not limited to, Federally Qualifie d Health Centers, rural health
146	155		clinics, pharmacies, Indian Health Care Provid ers and emergency
147	156		services.
148	157		D. E. A contracted entity shall offer all rural health clinics
149	158		(RHCs) contracts that reimburse RHCs using the methodology in place
150	159		for each specific RH C prior to January 1, 2023, including any and
151	160		all annual rate updates . The contracted entity shall comply with
152	161		all federal program rules and requirements, and the transformed
153	162		Medicaid delivery system shall not interfere with the program as
154	163		designed.
155	164		E. F. The Oklahoma Health Care Authority shall establish
156	165		minimum rates of reimburse ment from contracted entities to Ce rtified
157	166		Community Behavioral Health Clinic (CCBHC) providers who elect
158	167		alternative payment arrangements equal to the prospective payment
159	168		system rate under the Medicaid State Plan.
160		-	F. G. The Authority shall establish an i ncentive payment under
161		-	the Supplemental Hospital Offset Payment Program that is determined
162		-	by value-based outcomes for providers other than hospitals.
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164		-	ENGR. H. B. NO. 1650 Page 4 1
	170	+	HB1650 HFLR Page 4
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	196	+	F. G. The Authority shall establish an i ncentive payment under
	197	+	the Supplemental Hospital Offset Payment Program that is determined
	198	+	by value-based outcomes for providers other than hospitals.
189	199		G. H. Psychologist reimburse ment shall reflect ou tcomes.
190	200		Reimbursement shall not be limited to therapy and shall include, but
191	201		not be limited to, testing and assessment.
192	202		H. I. Coverage for Medicaid ground transp ortation services by
193	203		licensed Oklahoma emergency medical services shall be reimbursed at
194	204		no less than the published Medicaid rates as set by the Aut hority.
195	205		All currently published Me dicaid Healthcare Common Procedure Coding
196	206		System (HCPCS) codes paid by th e Authority shall continue to be paid
197	207		by the contracted entity . The contracted entity shall com ply with
198	208		all reimbursement policies established by t he Authority for the
199	209		ambulance providers. Contracted entities shall accept the modifiers
200	210		established by the Centers for Medicare and Medicaid Services
201	211		currently in use by Medicare at the time of the tran sport of a
202	212		member that is dually eligible for Medica re and Medicaid.
203	213		I. J. 1. The rate paid to participating pharmacy providers is
204	214		independent of subsection A o f this section and shall be the same as
205	215		the fee-for-service rate employed by the Authority for the Medicaid
206	216		program as stated in the payment metho dology at OAC 317:30-5-78,
207	217		unless the participating pharmacy provider elects to enter into
208	218		other alternative payment agreements.
209		-	2. A pharmacy or pharmacist shall receive direct payme nt or
210		-	reimbursement from the Authority or contracted entity when providing
211		-	a health care service to the Me dicaid member at a rate no less than
212		-	that of other health care providers for providing the same service.
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214		-	ENGR. H. B. NO. 1650 Page 5 1
	220	+	HB1650 HFLR Page 5
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	246	+	2. A pharmacy or pharmacist shall receive direct payme nt or
	247	+	reimbursement from the Authority or contracted entity when providing
	248	+	a health care service to the Me dicaid member at a rate no less than
	249	+	that of other health care providers for providing the same service.
239	250		J. K. The Authority shall specify in the requ ests for proposals
240	251		a reasonable time frame in which a contracted entity shall have
241	252		entered into a certain percentage, as determined by the Authority,
242	253		of value-based contracts with pr oviders.
243	254		K. L. Capitation rates established by the Oklahoma Health Care
244	255		Authority and paid to contracted entities under capitated contracts
245	256		shall be updated annually and in accor dance with 42 C.F.R., Section
246	257		438.3. Capitation rates shall be approved as act uarially sound as
247	258		determined by the Centers for Medicare and Medicaid Ser vices in
248	259		accordance with 42 C.F.R., Section 438.4 and the following:
249	260		1. Actuarial calculations must inc lude utilization and
250	261		expenditure assumptions consistent with industry and loca l
251	262		standards; and
252	263		2. Capitation rates shall be risk -adjusted and shall inc lude a
253	264		portion that is at risk for achievement of quality and outcomes
254	265		measures.
255	266		L. M. The Authority may establish a symmetric risk corridor for
256	267		contracted entities.
257	268		M. N. The Authority shall establish a proce ss for annual
258	269		recovery of funds from, or assess ment of penalties on, contracted
259		-	entities that do not meet the medical loss ratio standards
260		-	stipulated in Section 4002.5 of this title.
261		-	N. O. 1. The Authority shall, through the finan cial reporting
262		-	required under subsection G of Section 17 4002.12b of this act
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264		-	ENGR. H. B. NO. 1650 Page 6 1
	271	+	HB1650 HFLR Page 6
	272	+	BOLD FACE denotes Committee Amendments. 1
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	297	+	entities that do not meet the medical loss ratio standards
	298	+	stipulated in Section 4002.5 of this title.
	299	+	N. O. 1. The Authority shall, through the finan cial reporting
	300	+	required under subsection G of Section 17 4002.12b of this act
289	301		title, determine the percentage of health care expenses by each
290	302		contracted entity on primar y care services.
291	303		2. Not later than the end of the fourth year of the initial
292	304		contracting period, eac h contracted entity shall be currently
293	305		spending not less than eleven per cent (11%) of its total health care
294	306		expenses on primary care services.
295	307		3. The Authority shall monitor the primary care spending of
296	308		each contracted entity and require each contracted entity to
297	309		maintain the level of spending on primary care services stipula ted
298	310		in paragraph 2 of this subsection.
299	311		SECTION 2. This act shall become effective November 1, 2023.
300		-	Passed the House of Representatives the 9th day of March, 2023.
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305		-	Presiding Officer of the House
306		-	of Representatives
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309		-	Passed the Senate the ____ day of __________, 2023.
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314		-	Presiding Officer of the Senate
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	313	+	COMMITTEE REPORT BY: COMMITTEE ON APPROPRIATIONS AND BUDGET , dated
	314	+	03/02/2023 - DO PASS, As Coauthored.