Oklahoma Code § 56-4002.3a

Title 56. Poor Persons: Capitated contracts with contracted entities for
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delivery of Medicaid services.
A.  1.  The Oklahoma Health Care Authority (OHCA) shall enter
into capitated contracts with contracted entities for the delivery
of Medicaid services as specified in the Ensuring Access to Medicaid
Act to transform the delivery system of the state Medicaid program
for the Medicaid populations listed in this section.
2.  Unless expressly authorized by the Legislature, the
Authority shall not issue any request for proposals or enter into
any contract to transform the delivery system for the aged, blind,
and disabled populations eligible for SoonerCare.
B.  1.  The Oklahoma Health Care Authority shall issue a request
for proposals to enter into public-private partnerships with
contracted entities other than dental benefit managers to cover all
Medicaid services other than dental services for the following
Medicaid populations:
a. pregnant women,
b. children,
c. deemed newborns under 42 C.F.R., Section 435.117,
d. parents and caretaker relatives, and
e. the expansion population.
2.  The Authority shall specify the services to be covered in
the request for proposals referenced in paragraph 1 of this
subsection.  Capitated contracts referenced in this subsection shall
cover all Medicaid services other than dental services including:
a. physical health services including, but not limited
to:
(1) primary care,
(2) inpatient and outpatient services, and
(3) emergency room services,

b. behavioral health services, and
c. prescription drug services.
3.  The Authority shall specify the services not covered in the
request for proposals referenced in paragraph 1 of this subsection.
4.  Subject to the requirements and approval of the Centers for
Medicare and Medicaid Services, the implementation of the program
shall be no later than April 1, 2024.
C.  1.  The Authority shall issue a request for proposals to
enter into public-private partnerships with dental benefit managers
to cover dental services for the following Medicaid populations:
a. pregnant women,
b. children,
c. parents and caretaker relatives,
d. the expansion population, and
e. members of the Children’s Specialty Plan as provided
by subsection D of this section.
2.  The Authority shall specify the services to be covered in
the request for proposals referenced in paragraph 1 of this
subsection.
3.  Subject to the requirements and approval of the Centers for
Medicare and Medicaid Services, the implementation of the program
shall be no later than April 1, 2024.
D.  1.  Either as part of the request for proposals referenced
in subsection B of this section or as a separate request for
proposals, the Authority shall issue a request for proposals to
enter into public-private partnerships with one contracted entity to
administer a Children’s Specialty Plan.
2.  The Authority shall specify the services to be covered in
the request for proposals referenced in paragraph 1 of this
subsection.
3.  The contracted entity for the Children’s Specialty Plan
shall coordinate with the dental benefit managers who cover dental
services for its members as provided by subsection C of this
section.
4.  Subject to the requirements and approval of the Centers for
Medicare and Medicaid Services, the implementation of the program
shall be no later than April 1, 2024.
E.  The Authority shall not implement the transformation of the
Medicaid delivery system until it receives written confirmation from
the Centers for Medicare and Medicaid Services that a managed care
directed payment program utilizing average commercial rate
methodology for hospital services under the Supplemental Hospital
Offset Payment Program has been approved for Year 1 of the
transformation and will be included in the budget neutrality cap
baseline spending level for purposes of Oklahoma’s 1115 waiver
renewal; provided, however, nothing in this section shall prohibit
the Authority from exploring alternative opportunities with the

Centers for Medicare and Medicaid Services to maximize the average
commercial rate benefit.

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