Req. No. 627 Page 1 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 293 By: Hall
AS INTRODUCED
An Act relating to hospitals; amending 63 O.S. 2021,
Section 1-701, which relates to def initions;
modifying and adding definitions; updatin g statutory
reference; amending 63 O.S. 2021, Section s 3241.3 and
3241.4, as amended by Section s 2 and 3, Chapter 398,
O.S.L. 2022 (63 O.S. Supp. 2022, Section s 3241.3 and
3241.4), which relate to the Supp lemental Hospital
Offset Payment Program; modifying applicability of
certain provisions; and providing an effect ive date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, Secti on 1-701, is
amended to read as follows:
Section 1-701. For the purposes of Section 1 -701 et seq. of
this title:
1. "Hospital" means any institution, place, building or agency,
public or private, whether organized for profit or not, primarily
engaged in the maintenance and operation o f facilities for the
diagnosis, treatment or care of patients admitted for overnight stay
or longer in order to obtain medical care, surgical care,
obstetrical care, or nursing care for illness, disease, injury,
Req. No. 627 Page 2 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
infirmity, or deformity. Except as otherwis e provided by paragraph
5 of this subsection paragraph 7 of this section , places where
pregnant females are admitted and receive care incident to
pregnancy, abortion or delivery shall be considered to be a
"hospital" within the meaning of this article, regardless of the
number of patients received or the duration of their stay. The term
"hospital" includes general medical surgical hospitals, specialized
hospitals, critical access and emergency hospitals, emergency
hospitals, rural emergency hospitals , and birthing centers;
2. "General medical surgical hospital " means a hospital
maintained for the purpose of providing hospital care in a broad
category of illness and injury;
3. "Specialized hospital " means a hospital maintaine d for the
purpose of providing hospital care in a c ertain category, or
categories, of illness and injury;
4. "Critical access hospital " means a hospital determined by
the State Department of He alth to be a necessary provider of health
care services to res idents of a rural community;
5. "Emergency hospital" means a hospital that provides
emergency treatment an d stabilization services on a twenty -four-hour
basis that has the ability to admit and treat patients for short
periods of time;
Req. No. 627 Page 3 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
6. "Rural emergency hospital" means a hospital that provides
emergency treatment and stabilization services for an average length
of stay of twenty-four hours or less;
7. "Birthing center" means any facility, pla ce or institution,
which is maintained or established primaril y for the purpose of
providing services of a certif ied midwife or licensed medical doctor
to assist or attend a woman in delivery and birth, and where a woman
is scheduled in advance to give bir th following a normal,
uncomplicated, low-risk pregnancy. Pro vided, however, lice nsure for
a birthing center sha ll not be compulsory;
7. 8. "Day treatment program " means nonresidential, partial
hospitalization programs, day treatment programs, and day ho spital
programs as defined by subsection A of Section 175.20 o f Title 10 of
the Oklahoma Statutes; and
8.
9. a. "Primarily engaged" means a hospital shall be
primarily engaged, defined by this section and as
determined by the State Department of Health, in
providing to inpatients the following care by or under
the supervision of physicians:
(1) diagnostic services an d therapeutic services for
medical diagnosis, treatment and care of injured,
disabled or sick persons, or
Req. No. 627 Page 4 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(2) rehabilitation services for the r ehabilitation of
injured, disabled or sick persons.
b. In reaching a determination as to whether an entity is
primarily engaged in providing inpatient hospital
services to inpatients of a hospital, the Department
shall evaluate the total facility operation s and
consider multiple factors as provided in subparagraphs
c and d of this subsection.
c. In evaluating the tot al facility operations, the
Department shall review the actual provision of care
and services to two or more inpatients, and the
effects of that care, to assess whether the care
provided meets the needs of individual patients by wa y
of patient outcomes.
d. The factors that the Department shall consider for
determination of whether an entity meets the
definition of primarily engaged include, but a re not
limited to:
(1) a minimum of four inpatient beds,
(2) the entity's average daily census (ADC),
(3) the average length of stay (ALOS),
(4) the number of off-site campus outpatient
locations,
Req. No. 627 Page 5 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(5) the number of provider -based emergency
departments for the entity,
(6) the number of inpatient beds related to the si ze
of the entity and the s cope of the services
offered,
(7) the volume of outpatient surgical procedures
compared to the inpatient surgical procedures, if
surgical services are provided,
(8) staffing patterns, and
(9) patterns of ADC by day of the week.
e. Notwithstanding any other provision of this sectio n,
an entity shall be considered primarily engaged in
providing inpatient hospital services to inpatients if
the hospital has had an ADC of at least two (2) and an
ALOS of at least two (2) midnights over t he past
twelve (12) months. A critical access hosp ital shall
be exempt from the ADC and ALOS determination. ADC
shall be calculated by adding the midnight daily
census for each day of the twel ve-month period and
then dividing the total number by days in the year. A
facility that has been operating for l ess than (12)
months at the time of the survey shall calculate its
ADC based on the number of months the facility has
been operational, but not less than three (3) months.
Req. No. 627 Page 6 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
If a first survey finds noncompl iance with the ADC and
ALOS, a second survey may be required by the
Department to demonstrate compliance with state
licensure.
SECTION 2. AMENDATORY 63 O.S. 2021, Section 3241.3, as
amended by Section 2, Chapter 398, O.S.L. 2022 ( 63 O.S. Supp. 2022,
Section 3241.3), is amended to read as follows:
Section 3241.3. A. For the purpose of assuring access to
quality care for Oklahoma Medicaid consumers, the Oklahoma Health
Care Authority, after considering input and recommendations from the
Hospital Advisory Committee, shall asse ss hospitals licensed in
Oklahoma, unless exempt under subsection B of this section, a
supplemental hospital offset payment program fee.
B. The following hospitals shall be exempt from the
supplemental hospital offset payment program fee:
1. A hospital that is owned or operated by the state or a state
agency, the federal government, a federally recognized Indian tribe,
or the Indian Health Service;
2. A hospital that provides more than fifty percent (50%) of
its inpatient days under a contract with a sta te agency other than
the Authority;
3. A hospital for which the majority of its inpatient days are
for any one of the following services, as determined by the
Authority using the Inpatient Discharge Data File published by the
Req. No. 627 Page 7 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
State Department of Health, or in the case of a hospital not
included in the Inpatient Discharge Data File, using subst antially
equivalent data provided by the hospital:
a. treatment of a neurological injury,
b. treatment of cancer,
c. treatment of cardiovascular disease,
d. obstetrical or childbirth services, and
e. surgical care, except that this exemption shall not
apply to any hospital located in a city of less than
five hundred thousand (500,000) population and for
which the majority of inpatient days are for back,
neck, or spine surgery;
4. A hospital that is certified by the federal Centers for
Medicare and Medicaid Services as a long-term acute care hospital or
as a children's hospital; and
5. A hospital that is certified by the federal Centers for
Medicare and Medicaid Services as a critical access hospital or
rural emergency hospital .
C. The supplemental hospital offset payment program fee shall
be an assessment imposed on each eligible hospital, except those
exempted under subsection B of this section, for each calendar year
in an amount calculated as a percentage of each eligible hospital's
net hospital patient revenue.
Req. No. 627 Page 8 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1. Funds generated by the supplemental hospital offset paym ent
program fee shall be disbursed for the following purposes in the
following priority order:
a. One Hundred Thirty Million Dollars ($130,000,000.00)
to be transferred annually to the M edical Payments
Cash Management Improvemen t Act Programs Disbursing
Fund to fund the state Medicaid program ,
b. the nonfederal share of:
(1) the upper payment limit gap,
(2) the managed care gap,
(3) the managed care provider incentive pool to
support health care quality assurance and access
improvement initiatives, with the pool amount
determined by the representative sharing ratio of
provider and hospital participation in Medicaid.
Provider eligibility shall be determined by the
Authority. For purposes of this division,
eligible providers shall not include those
employed by or contracted with, or otherwise a
member of, the faculty practice plan of either:
(a) a public, accredited Oklahoma medical
school, or
(b) a hospital or health care entity directly or
indirectly owned or operated by the entities
Req. No. 627 Page 9 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
created pursuant to Section 3224 or 3290 of
this title,
(4) the annual fee to be paid to the Authority under
subparagraph c of paragraph 1 of subsection G of
Section 3241.4 of this titl e, and
(5) Thirty Million Dollars ($30,000,000.00) annually
to be transferred by the Authority to the Medical
Payments Cash Management Improvement Act Programs
Disbursing Fund under subsection C of Section
3241.4 of this title.
If the nonfederal share generated by the supplemental
hospital offset payment program fee is not sufficient
to fully fund the disbursements described in divisions
1 through 5 of this subparagraph, the funds directed
toward such disbursements shall be reduced
proportionally, and
c. any remaining funds shall be deposit ed into the
Medicaid Health Improvement Revolving Fund created in
Section 23 of Enrolled Senate Bill No. 1337 of the 2nd
Session of the 58th Oklahoma Legislature.
2. The assessment rate until December 31, 2012, shall be fixed
at two and one-half percent (2.5%). For the calendar year ending
December 31, 2022, the assessment rate shall be fixed at three
percent (3%). For the calendar year ending December 31, 2023, the
Req. No. 627 Page 10 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
assessment rate shall be fixed at three and one-half percent (3.5%).
For the calendar year ending December 31, 2024 and for all
subsequent calendar years, the assessment rate shall be fixed at
four percent (4%).
3. Net hospital patient revenue shall be determined using the
data from each eligible hospital's Medicare Cost Report contained in
the federal Centers for Medicare and Medicaid Services' Healthcare
Cost Report Information System file.
a. Through 2013, the base year for assessment shall be
the eligible hospital's fiscal year that ended in
2009, as contained in the Healthcare Cost Report
Information System file date d December 31, 2010.
b. For years after 2013, the base year for assessment
shall be determined by rules established by the
Oklahoma Health Care Authority Board and beginning
January 1, 2022, the base year for assessment shall be
determined annually.
4. If an eligible hospital's applicable Medicare Cost Report is
not contained in the federal Centers for Medicare and Medicaid
Services' Healthcare Cost Report Information System file, the
eligible hospital shall submit a copy of its applicable Medicare
Cost Report to the Authority in order to allow the Authority to
determine the eligible hospital's net hospital patient revenue for
the base year.
Req. No. 627 Page 11 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
5. If an eligible hospital commenced opera tions after the due
date for a Medicare Cost Report, the eligible hospital shall submit
its initial Medicare Cost Report to the Authority in order to allow
the Authority to determine the hospital's net patient revenue for
the base year.
6. Partial year reports may be prorated for an annual basis.
7. In the event that an eligible hospital does not file a
uniform cost report under 42 U.S.C., Section 1396a(a) (40), the
Authority shall establish a uniform cost report for such facility
subject to the Supplemental Hospital Offset Payment Program provided
for in this section.
8. The Authority shall review which hospitals are eligible to
participate in the Supplemental Hospital Offset Payment Pro gram
provided for in this subsection and which hospitals are exempted
pursuant to subsection B of this section. Such review shall occur
at a fixed period of time. This review and decision shall occur
within twenty (20) days of the time of federal approval and annually
thereafter in November of each year.
9. The Authority shall review and determine the amount of the
annual assessment. Such review and determination shall occur within
the twenty (20) days of fe deral approval and annually thereafter in
November of each year.
D. An eligible hospital may not charge any patient for any
portion of the supplemental hospital offset payment program fee.
Req. No. 627 Page 12 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
E. Closure, merger and new hospitals.
1. If an eligible hospital ceases to be an eligible hospital
for any reason, the assessment for the year in which the cessation
occurs shall be adjusted by multiplying the annual assessment by a
fraction, the numerator of which is the number of days in the year
during which the hospital is subject to the assessment and the
denominator of which is 365. Immediately upon ceasing to be an
eligible hospital, the hospital shall pay the assessment for the
year as adjusted, to the extent not previously paid.
2. In the case of an eligible hospital that did not operate as
a hospital throughout the base year, its assessment and any
potential receipt of a hospital access payment will commence in
accordance with rules for impleme ntation and enforcement promulgated
by the Oklahoma Health Care Authority Board, after consideration of
the input and recommendations of the Hospital Advisory Committee.
F. 1. In the event that federal financial participation
pursuant to Title XIX of the Social Security Act is not available to
the Oklahoma Medicaid program for purposes of matching expend itures
from the Supplemental Hospital Offset Payment Program Fund at the
approved federal medical assistance percentage for the applicable
year for one or more of the purposes identified in division 1, 2, or
3 of subparagraph b of paragraph 1 of subsection C of this section,
the portion of the supplemental hospital offset payment program fee
attributable to any such purpose for which matching expenditures are
Req. No. 627 Page 13 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
unavailable shall be null and void as of the date of the
nonavailability of such federal funding through and during any
period of nonavailability.
2. In the event of an invalidation of the Supplemental Hospital
Offset Payment Program Act by any court of last resort, the
supplemental hospital offset payment program fee shall be null and
void as of the effective d ate of that invalidation.
3. In the event that the supplemental hospital offset payment
program fee is determined to be null and void for any of the reasons
enumerated in this subsection, any supplemental hospital offset
payment program fee assessed and collected for any period after such
invalidation shall be returned in full within twenty (20) days by
the Authority to the eligible hospital from which it was collected.
G. The Oklahoma Health Care Authority Board, after considering
the input and recommend ations of the Hospital Advisory Committee,
shall promulgate rules for the implementation and enforcement of the
supplemental hospital offset pa yment program fee. Unless otherwise
provided, the rules adopted under this subsection shall not grant
any exceptions to or exemptions from the hospital assessment imposed
under this section.
H. The Authority shall provide for administrative penalties in
the event a hospital fails to:
1. Submit the supplemental hospital offset payment program fee
in a timely manner; or
Req. No. 627 Page 14 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
2. Submit reports as required by this section in a timely
manner.
I. The Oklahoma Health Care Authority Board shall have the
power to promulgate emergency rules to implement the provisions of
the Supplemental Hospital Offset Payment Program Act.
SECTION 3. AMENDATORY 63 O.S. 2021, Section 3241.4, as
amended by Section 3, Chapter 398, O.S.L. 2022 (63 O.S. Supp. 2022,
Section 3241.4), is amended to read as follows:
Section 3241.4. A. There is hereby created in the State
Treasury a revolving fund to be designated the "Supplemental
Hospital Offset Payment Program Fund".
B. The fund shall be a continuing fund, not subject to fiscal
year limitations, be interest bearing and consisting of:
1. All monies received by the Oklahoma Health Care Authority
from eligible hospitals pursuant to the Supplemental Hospital Offset
Payment Program Act and otherwise specified o r authorized by law;
2. Any interest or penalties levied and collected in
conjunction with the administration of this section; and
3. All interest attributable to investment of money in the
fund.
C. The Oklahoma Health Care Authority is authorized to transfer
each fiscal quarter from the Supplemental Hospital Offset Payment
Program Fund to the Authority's Medical Payments Cash Management
Improvement Act Programs Disbursing Fund all funds remaining after
Req. No. 627 Page 15 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
accounting for the provisions of subparagraphs a and b of paragraph
1 of subsection C of Section 3241.3 of this title.
D. Notice of Assessment.
1. The Authority shall send an annual notice of assessment to
each eligible hospital informing the hospital of the assessment
rate, the net hospital patient revenue calcu lation, and the
assessment amount owed by the eligible hospital for the applicable
year.
2. The annual notice of assessment shall be sent to each
eligible hospital at least thirty (30) days before the due date f or
the first quarterly assessment payment of each year.
3. The first notice of assessment shall be sent within forty-
five (45) days after receipt by the Authority of notification from
the federal Centers for Medicare and Medicaid Services that the
assessments and payments required under the Suppl emental Hospital
Offset Payment Program Act and, if necessary, the waiver granted
under 42 C.F.R., Section 433.68 have been approved.
4. An eligible hospital shall have thirty (30) days from the
date of its receipt of an annual notice of assessment to notify the
Authority of any error in the notice.
5. An eligible hospital that has not been previously licensed
as a hospital in Oklahoma and that commences hospital operations
during a year shall pay the required assessment computed under
subsection E of Section 3241.3 of this title and shall be eligible
Req. No. 627 Page 16 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
for hospital access payme nts under subsection E of this section on
the date specified in rules promulgated by the Oklahoma Health Care
Authority Board after consideration of input and recommendations of
the Hospital Advisory Committee.
E. Quarterly Notice and Collection.
1. The annual assessment imposed under subsections A and C of
Section 3241.3 of this title shall be due and payable on a quarterly
basis. However, the first quarterly payment of an annual assessment
shall not be due and payable until:
a. the Authority issues written notice stating that the
annual assessment and payment methodologies required
under the Supplemental Hospital Offse t Payment Program
Act have been approved by the federal Centers for
Medicare and Medicaid Services and, if necessary, the
waiver under 42 C.F.R., Section 433.68 has been
granted by the federal Centers for Medicare and
Medicaid Services,
b. the thirty-day verification period requir ed by
paragraph 4 of subsection D of this section has
expired, and
c. the Authority issues a notice of assessment giving a
due date for the first quarterly payment.
2. After the first quarterly payment of an annual assessment
has been paid under this section, each subsequent quarterly payment
Req. No. 627 Page 17 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
shall be due and payable by the fifteenth day of the first month of
the applicable quarter.
3. If an eligible hospital fails to pay a quarterly payment
timely and in full, the eligible hospital shall pay the Authority:
a. a penalty fee equal to five percent (5%) of the
eligible hospital's unpaid quarterly payment, and
b. if the quarterly payment and penalty fee are not paid
in full by the end of the quarter, an additional
penalty fee of five percent (5%) of the eligible
hospital's unpaid quarterly payment.
4. The quarterly payment including applicable penalty fees must
be paid regardless of any administrative review requested by the
eligible hospital. If an eligible hospital fails to pay the
Authority the assessment within the time frames noted on the invoice
to the eligible hospital, the assessment, applicable penalty fees,
and interest will be deducted from the facility's payment. Any
change in payment amount resulting from an appeals decision will be
adjusted in future pa yments.
F. Medicaid Hospital Access Payments.
1. To preserve the qual ity and improve access to hospital
inpatient and outpatient services, the Authority shall make hospital
access payments to eligible hospitals and, critical access
hospitals, and rural emergency hospitals to supplement
reimbursements for inpatient and outpatient services that are
Req. No. 627 Page 18 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
provided through Medicaid on both a fee-for-service and managed care
basis.
2. On an annual basis prior to the start of each calendar year,
the Authority shall de termine:
a. the upper payment limit gap for inpatient services
payable on a Medicaid fee-for-service basis for all
hospitals,
b. the upper payment limit gap for outpatient services
payable on a Medicaid fee-for-service basis for all
hospitals,
c. the managed care gap for inpatient serv ices payable
through Medicaid managed care for all hospital s, and
d. the managed care gap for outpatient services payable
through Medicaid managed care for all hospitals.
3. In accordance with subsection C of Section 3241.3 of this
title, the Authority shall use assessment fees for the purposes of
accessing federal matching funds to make hospital access payments to
the eligible hospitals and the, critical access hospitals, and rural
emergency hospitals described in paragraph 5 of subsection B of
Section 3241.3 of this title. Hospital access payments shall be
made through supplemental payment arrangements for services provided
on a Medicaid fee-for-service basis and through directed p ayment
arrangements for services provided on a Medicaid managed care basis ,
Req. No. 627 Page 19 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
as approved by the federal Centers for Medicare and Medicaid
Services.
4. Hospital access payments shall be determined annually and
paid quarterly from the following funding pools:
a. a hospital inpatient fee-for-service payment pool
established from funds derived from the upper payment
limit gap for inpatient services,
b. a hospital inpatient managed care payment pool
established from funds derived from th e managed care
gap for inpatient services,
c. a hospital outpatient fee-for-service payment pool
established from funds derived from the upper payment
limit gap for outpatient services,
d. a hospital outpatient manag ed care payment pool
established from funds derived from the managed care
gap for outpatient services, and
e. (1) A critical access hospital and rural emergency
hospital payment pool established from funds
transferred from each pool established in
subparagraphs a through d of this paragraph.
(2) Prior to the start of each calendar year, the
Authority shall determine an estimated amount
that each critical acce ss hospital and rural
emergency hospital may be entitled to receive for
Req. No. 627 Page 20 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
providing Medicaid services, not to ex ceed that
critical access hospital 's or rural emergency
hospital's billed charges.
(3) The Authority shall fund the critical access
hospital and rural emergency hospital payment
pool in an amount equal to the total estimated
amount that all critical access hospitals and
rural emergency hospital s may be entitled to
receive for providing Medicai d services, as
calculated in division 2 of this subparagraph.
(4) The Authority shall consult with the Committee
regarding the calculations in divisions 2 and 3
of this subparagraph.
(5) The Authority shall fully fund the critical
access hospital and rural emergency hospital
payment pool prior to issuing any payment fr om
the pools established in subparagraphs a through
d of this paragraph.
5. In addition to any other funds paid to eligible hospitals
for inpatient hospital services to Medicaid patients, each eligible
hospital shall receive hospital access payments each quarter from
the hospital inpatient fee-for-service payment pool and the hospital
inpatient managed care payment pool in accordance with the following
methodologies:
Req. No. 627 Page 21 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
a. the amount an eligible hospital shall receive from the
hospital inpatient fee-for-service payment pool shall
be the eligible hospital's pro rata share of the
hospital inpatient fee-for-service payment pool
calculated as the eligible hospital's total fee-for-
service Medicaid payments for inpatient services
divided by the total Medicaid fee-for-service payments
for inpatient services of all eligible hospitals.
Each quarterly payment from the hospital inpatient
fee-for-service payment pool shall be paid to the
eligible hospital through a supplemental payment.
Prior to the start of a calendar year, the Authority
shall consult with the Com mittee to minimize potential
payment disparities to protect access to rural and
independent hospitals , and
b. an eligible hospital shall receive from the hospital
inpatient managed care payment pool a per-discharge
uniform add-on amount to be applied to each eligible
hospital's Medicaid managed care discharges for that
calendar year. The per-discharge uniform add -on
amount shall be calculated by dividing the managed
care gap by total managed care inpatient discharges at
eligible hospitals contained in the data used to
calculate the managed care gap. To assure timely
Req. No. 627 Page 22 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
payment, the Authority may make the calculation in
this subparagraph using good-faith reasonable
estimates if complete data does not exist or is not
available. Each quarterly payment from the hospital
inpatient managed care payment pool shall be paid to
the eligible hospital through a directed payment .
6. In addition to any other funds paid to eligible hospitals
for outpatient hospital services to Medicaid patients, each eligible
hospital shall receive hospital access payments each quarter from
the hospital outpatient fee-for-service payment pool and the
hospital outpatient managed care payment pool in accordance with the
following methodologies:
a. the amount an eligible hospital shall receive from the
hospital outpatient fee-for-service payment pool shall
be the eligible hospital's pro rata share of the
hospital's outpatient fee-for-service payment pool
calculated as the eligible hospital's total fee-for-
service Medicaid payments for outpatient services
divided by the total Medicaid fee-for-service payments
for outpatient services of all eligible hospitals.
Each quarterly payment from the hospital outpatient
fee-for-service payment pool s hall be paid to the
eligible hospital through a supplement al payment, and
Req. No. 627 Page 23 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
b. an eligible hospital shall receive from the hospital
outpatient managed care payment pool a uniform
percentage add-on amount to be applied to the base
rate claims payments for hospital outpatient Medicaid
managed care encounters at eligible hospitals for that
calendar year. The uniform percentage add-on amount
shall be calculated by dividing the managed care gap
by total managed care base rate claims payments for
eligible hospitals within the data used to calculate
the managed care gap. To assure timely payment, the
Authority may make the calculation in this
subparagraph using good-faith reasonable estimates if
complete data does not exist or is not available.
Each quarterly payment from the hospital outpatient
managed care payment pool shall be paid to the
eligible hospital through a directed payment.
7. In addition to any other f unds paid to critical access
hospitals or rural emergency hospitals for inpatient and outpatient
hospital services to Medicaid patients, each critical access
hospital and rural emergency hospital physically located in this
state shall receive hospital a ccess payments each quarter from the
critical access hospital and rural emergency hospital payment pool
as follows:
Req. No. 627 Page 24 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
a. each calendar year, a critical access hospital or
rural emergency hospital shall receive from the
critical access hospital and rural emergency hospital
payment pool quarterly amounts that shall total the
estimated amount the Authority calculated, not to
exceed billed charges, for that critical access
hospital or rural emergency hospital in accordance
with paragraph 4 of this subsection ,
b. the quarterly hospital access paymen ts made to each
critical access hospital and rural emergency hospital
shall be through supplemental payments and directed
payments in such proportions as necessary for the
Authority to make the total hospital access payments
to each critical access hospital and rural emergency
hospital in accordance with subparag raph a of this
paragraph, and
c. in the event Medicaid managed care is not implemented
on a statewide basis, the Author ity shall make
supplemental payments to critical access hospitals to
achieve one hundred one percent (101%) of Medicare's
critical access hospitals' costs and a directed
payment shall not be made.
8. The Authority shall pay each quarterly hospital access
payment referenced in paragraph 4 of this subsection within fourteen
Req. No. 627 Page 25 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
(14) calendar days of the date on which each quarterly payment of an
annual assessment is due as required in subsection E of this
section.
9. In processing directed payments through contracted entities,
the following requirements shall apply:
a. the Authority shall provide each contracted entity
with a listing of the hospital access payments to be
paid by each contracted entity to each eligible
hospital and, critical access hospital, and rural
emergency hospital in accordance with this subsection,
b. a contracted entity shall pay hospital access payments
to eligible hospitals and, critical access hospitals,
and rural emergency hospital s within five (5) business
days of receiving a supp lemental capitation payment
from the Authority,
c. a contracted entity is prohibited from withholding or
delaying the payment of a hospi tal access payment for
any reason, and
d. the Authority shall utilize administrative discretion
regarding the mechanisms of payment that may be
necessary to assure that ea ch eligible hospital and,
critical access hospital, and rural emergency hospital
receives full payment of all hospit al access payments
to which it is entitled pursuant to this subsection.
Req. No. 627 Page 26 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
10. A hospital access payme nt shall not be used to offset any
other payment for hospital inpatient or o utpatient services to
Medicaid beneficiaries including without limitation any fee-for-
service, managed care, per diem, private hospital inpatient
adjustment, or cost-settlement payment.
11. Notwithstanding any other pr ovision of law to the contrary:
a. the supplemental payment programs in this section
shall not be implemented if federal financial
participation is not available or if the provider
assessment waiver is not approved,
b. an eligible hospital's obligation to pay the portion
of the assessment attributable to the nonfederal share
of the upper payment limit gap and the nonfederal
share of the managed care gap as required by Section
3241.3 of this title and this section shall be reduced
in the event the federal Centers for Medicare and
Medicaid Services determines that federal financial
participation is not available to make hospital access
payments in accordanc e with this section. The
assessment on eligible hospitals shall be reduced to a
percentage that permits the Authority to obtain from
eligible hospitals an amount of nonfederal matching
funds for which federal financial participation is
available to implement any portion of hospital access
Req. No. 627 Page 27 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
payments that the federal Centers for Medicare and
Medicaid Services approves, and
c. any assessments received by the Authority that cannot
be matched with federal funds shall be returned pro
rata to the eligible hospitals that paid the
assessments.
12. If the federal Centers for Medicare and Medicaid Services
disallows any hospital access payments made pursuant to this section
on the basis that such payments exceed the maximum allowable under
federal law, each hospital receiving such disallowed payments shall
refund to the Authority an amount equal to that hospital 's pro rata
share of the recouped federal funds that is proportionate to the
hospital's positive contribution to the disallowed payment. The
refund shall be required only if the disallowance is considered
final and all appeals have been exhausted.
G. All monies accruing to the credit of the Supplemental
Hospital Offset Payment Program Fund are hereby appropriated and
shall be budgeted and expended by the Authority after consideration
of the input and recommendation of the Hospital Advisory Committee.
1. Monies in the Supple mental Hospital Offset Payment Program
Fund shall be used for:
a. transfers to the Medical Payments Cash Management
Improvement Act Programs Disbursing Fund for the state
share of supplemental or directed payments or both for
Req. No. 627 Page 28 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
Medicaid and SCHIP inpatient and outpatient services
to hospitals that participate in the assessment,
b. transfers to the Medical Payments Cash Management
Improvement Act Programs Disbursing Fund for the state
share of supplemental or directed payments or both for
critical access hospitals or rural emergency
hospitals,
c. transfers to the Administrative Revolving Fund for the
state share of payment of administrative expenses
incurred by the Authority or its agents and employees
in performing the activities authorized by the
Supplemental Hospital Offset Payment Prog ram Act but
not more than Two Hundred Thousand Dollars
($200,000.00) each year,
d. transfers to the Medical Payments Cash Management
Improvement Act Programs Disbursing Fund each fiscal
quarter in accordance with subse ction C of Section
3241.3 of this title, and
e. the reimbursement of monies collected by the Authority
from hospitals through error or mistake in perform ing
the activities authorized under the Supplemental
Hospital Offset Payment Program Act .
Req. No. 627 Page 29 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
2. The Authority shall pay from the Supplemental Hospital
Offset Payment Program Fund quarterly installment payments to
hospitals as set forth in this section .
3. Monies in the Supplemental Hospital Offset Payment Program
Fund shall not be used to replace other general revenues
appropriated and funded by the Legislature or other revenues used to
support Medicaid.
4. The Supplemental Hospital Offset Payment Program Fund and
the program specified in the Supplemental Hospital Offset Payment
Program Act are exempt from budgetary reductions or eliminations
caused by the lack of general revenue funds or other fun ds
designated for or appropriated to the Authority.
5. No hospital shall be guaranteed, expressly or otherwise,
that any additional costs reimbursed to the facility will equal or
exceed the amount of the supplemental hospital offset payment
program fee paid by the hospital.
H. After considering input and recommendations from the
Hospital Advisory Committee, the Oklahoma Health Care Authority
Board shall promulgate rules that:
1. Allow for an appeal of the annual assessment of the
Supplemental Hospital Of fset Payment Program payable under the
Supplemental Hospital Offset Payme nt Program Act; and
2. Allow for an appeal of an assessment of any fees or
penalties determined.
Req. No. 627 Page 30 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
SECTION 4. This act shall become effective October 1, 2023.
59-1-627 DC 1/12/2023 12:57:25 PM