Oklahoma 2023 Regular Session

Oklahoma Senate Bill SB563 Compare Versions

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4		-	An Act
5		-	ENROLLED SENATE
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
	30	+
	31	+	STATE OF OKLAHOMA
	32	+
	33	+	1st Session of the 59th Legislature (2023)
	34	+
	35	+	ENGROSSED SENATE
6	36		BILL NO. 563 By: Haste of the Senate
7	37
8	38		and
9	39
10	40		McEntire of the House
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15	45		An Act relating to the state Medicaid program;
16	46		amending 56 O.S. 2021, Section 4002.12, as amended by
17	47		Section 2, Chapter 334, O.S.L. 2022 (56 O.S. Supp.
18	48		2022, Section 4002.12), which relates to m inimum
19	49		rates of reimbursement ; requiring certain
20	50		reimbursement of anes thesia; clarifying authority of
21	51		anesthesia providers to enter into value-based
22	52		payment arrangements; updating statut ory reference;
23	53		and declaring an emergency.
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29		-	SUBJECT: Medicaid
30		-
31	59		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
32		-
33	60		SECTION 1. AMENDATORY 56 O.S. 2021, Section 4002.12, as
34	61		amended by Section 2, Chapter 334, O.S.L. 2022 (56 O.S. Supp. 20 22,
35	62		Section 4002.12), is amended to read as follows:
36		-
37	63		Section 4002.12. A. Until July 1, 2026, the Oklahoma Health
38	64		Care Authority shall establish minimum rates of reimbursement from
39	65		contracted entities to providers who elect not to enter into value-
40	66		based payment arrangements under subsec tion B of this section or
41	67		other alternative payment agreements for health care items and
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42	95		services furnished by such providers to enrollees of the state
43	96		Medicaid program. Except as provided by subsection I of this
44	97		section, until July 1, 2026, such reimburs ement rates shall be equal
45	98		to or greater than:
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48		-	ENR. S. B. NO. 563 Page 2
49	99		1. For an item or service provided by a participating provider
50	100		who is in the network of the contracted entity, one hundred percent
51	101		(100%) of the reimbursement rate for the applicable service in the
52	102		applicable fee schedule of the Authority; or
53		-
54	103		2. For an item or service provided by a non-participating
55	104		provider or a provider who is not in the network of the contracted
56	105		entity, ninety percent (90%) of the reimbursement rate for the
57	106		applicable service in the applic able fee schedule of the Authority
58	107		as of January 1, 2021.
59		-
60	108		B. A contracted entity shall offer value-based payment
61	109		arrangements to all providers in its network capable o f entering
62	110		into value-based payment arrangements. Such arrangements shall be
63	111		optional for the provider but shall be tied to reimbursement
64	112		incentives when quality metrics are met . The quality measures used
65	113		by a contracted entity to determine reimbursement amounts to
66	114		providers in value-based payment arrangements shall align with the
67	115		quality measures of the Authority for contracted entities.
68		-
69	116		C. Notwithstanding any other provision of this sec tion, the
70	117		Authority shall comply with payment methodologies require d by
71	118		federal law or regulation for specific types of providers including,
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	120	+	SB563 HFLR Page 3
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72	146		but not limited to, Federally Qualified Health Cent ers, rural health
73	147		clinics, pharmacies, Indian Health Care Provid ers and emergency
74	148		services.
75		-
76	149		D. A contracted entity shall offer all rural health clinics
77	150		(RHCs) contracts that reimburse RHCs using the methodology in plac e
78	151		for each specific RHC prior to Janu ary 1, 2023, including any and
79	152		all annual rate updates . The contracted entity shall comply with
80	153		all federal program rules and requ irements, and the transformed
81	154		Medicaid delivery system shall not interfere with the prog ram as
82	155		designed.
83		-
84	156		E. The Oklahoma Health Care Authority shall establish minimum
85	157		rates of reimbursemen t from contracted entities to Certified
86	158		Community Behavioral Health Clinic (CCBHC) providers who elect
87	159		alternative payment arrangements equal to the prospe ctive payment
88	160		system rate under the M edicaid State Plan.
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90		-
91		-	ENR. S. B. NO. 563 Page 3
92	161		F. The Authority shall establish an incenti ve payment under the
93	162		Supplemental Hospital Offset Payment Program t hat is determined by
94	163		value-based outcomes for providers other than hospitals.
95		-
96	164		G. Psychologist reimbursement shall reflect ou tcomes.
97	165		Reimbursement shall not be limited to therapy and shall include but
98	166		not be limited to testing and assessment.
99		-
100	167		H. Coverage for Medicaid ground transportation services by
101	168		licensed Oklahoma emergency medical serv ices shall be reimbursed at
102	169		no less than the published Medicaid rates as set by the Authority .
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103	197		All currently published Medicaid Healthcare Common Procedure Coding
104	198		System (HCPCS) codes paid by the Authority shall continue to be paid
105	199		by the contracted entit y. The contracted entity shall compl y with
106	200		all reimbursement policies established by the Authority f or the
107	201		ambulance providers. Contracted entities shall accept the m odifiers
108	202		established by the Centers for Medicare and Medicaid Services
109	203		currently in use by Medicare at the time of the transp ort of a
110	204		member that is dually eligible for Medicare and Medicai d.
111		-
112	205		I. 1. The rate paid to participating pharmacy providers is
113	206		independent of subsection A of this section and shall be the same as
114	207		the fee-for-service rate employed by the Authority for the Medicaid
115	208		program as stated in the payment methodology at OAC 317:30 -5-78,
116	209		unless the participating pharmacy provider elects to ente r into
117	210		other alternative payment agreements.
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119	211		2. A pharmacy or pharmacist shall receive direct payment or
120	212		reimbursement from the Authority or contracted entity when providing
121	213		a health care service to the Medicaid member at a rate no less than
122	214		that of other health care providers for providing the same service.
123		-
124	215		J. Notwithstanding any other pro vision of this section,
125	216		anesthesia shall continue to be rei mbursed equal to or greater than
126	217		the Anesthesia Fee Schedule established by the Authority as of
127	218		January 1, 2021. Anesthesia providers may also enter into value -
128	219		based payment arrangements under this section or alternative payment
129	220		arrangements for services furnished to Medicaid members.
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131	248		K. The Authority shall specify in the requests for proposals a
132	249		reasonable time frame in which a contracted entity shall have
133		-
134		-	ENR. S. B. NO. 563 Page 4
135	250		entered into a certain percentage , as determined by the Authority,
136	251		of value-based contracts with pr oviders.
137		-
138	252		K. L. Capitation rates established by the Oklahoma Health Care
139	253		Authority and paid to contracte d entities under capitated contracts
140	254		shall be updated annuall y and in accordance with 42 C.F.R., Section
141	255		438.3. Capitation rates shall be approved as a ctuarially sound as
142	256		determined by the Centers for Medicare and Medicaid Services in
143	257		accordance with 42 C .F.R., Section 438.4 and the following:
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145	258		1. Actuarial calculations must include utiliz ation and
146	259		expenditure assumptions consistent with industry and loc al
147	260		standards; and
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149	261		2. Capitation rates shall be risk -adjusted and shall include a
150	262		portion that is at ris k for achievement of quality and outcomes
151	263		measures.
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153	264		L. M. The Authority may establish a symmetric risk corridor for
154	265		contracted entities.
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156	266		M. N. The Authority shall establish a proce ss for annual
157	267		recovery of funds from, or assessment of penalties on, contracted
158	268		entities that do not meet the medical loss ratio standa rds
159	269		stipulated in Section 4002.5 of this title.
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161	270		N. O. 1. The Authority shall, through the financial reporting
162	271		required under subsection G of Section 17 of this act Section
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163	299		4002.12b of this title , determine the percentage of health care
164	300		expenses by each contracted entity on primary care services.
165		-
166	301		2. Not later than the end of the fourth year of the initial
167	302		contracting period, eac h contracted entity shall be currently
168	303		spending not less than eleven perc ent (11%) of its total health care
169	304		expenses on primary care services.
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171	305		3. The Authority shall monitor the primary care spending of
172	306		each contracted entity and require each contracted entity to
173	307		maintain the level of spending on primary care services stipulat ed
174	308		in paragraph 2 of this subsection.
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177		-	ENR. S. B. NO. 563 Page 5
178	309		SECTION 2. It being immediately n ecessary for the preservation
179	310		of the public peace, health or safety, an emergency is hereby
180	311		declared to exist, by reason whereof this act shall take effect and
181	312		be in full force from and after its passage and approval.
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184		-	ENR. S. B. NO. 563 Page 6
185		-	Passed the Senate the 23rd day of February, 2023.
186		-
187		-
188		-
189		-	Presiding Officer of the Senate
190		-
191		-
192		-	Passed the House of Representatives the 20th day of April, 2023.
193		-
194		-
195		-
196		-	Presiding Officer of the House
197		-	of Representatives
198		-
199		-	OFFICE OF THE GOVERNOR
200		-	Received by the Office of the Governor this ____________________
201		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
202		-	By: _______________________________ __
203		-	Approved by the Governor of the State of Oklahoma this _____ ____
204		-	day of _________________ __, 20_______, at _______ o' clock _______ M.
205		-
206		-	_________________________________
207		-	Governor of the State of Oklahoma
208		-
209		-
210		-	OFFICE OF THE SECRETARY OF STATE
211		-	Received by the Office of the Secretary of State this _______ ___
212		-	day of __________________, 20 _______, at _______ o'clock _______ M.
213		-	By: _______________________________ __
	314	+	COMMITTEE REPORT BY: COMMITTEE ON APPROPRIATIONS AND BUDGET , dated
	315	+	04/13/2023 - DO PASS.