Bill
Bill > SB131
OK SB131
OK SB131State Medicaid program; creating the "Ensuring Access to Medicaid Act"; creating certain requirements for and prohibiting certain actions by the Oklahoma Health Care Authority, managed care organizations and dental benefit managers; creating MC Quality Advisory Committee. Effective date.
summary
Introduced
02/01/2021
02/01/2021
In Committee
04/08/2021
04/08/2021
Crossed Over
03/03/2021
03/03/2021
Passed
05/20/2021
05/20/2021
Dead
Signed/Enacted/Adopted
05/27/2021
05/27/2021
Introduced Session
2021 Regular Session
Bill Summary
An Act relating to the state Medicaid program; creating the "Ensuring Access to Medicaid Act"; defining terms; authorizing Oklahoma Health Care Authority to require enrollment in certain delivery model for certain individuals; providing for voluntary enrollment by certain individuals; specifying enrollment process for certain individuals; prohibiting requirement or offer of enrollment for certain individuals; directing Authority to develop certain network adequacy standards; requiring managed care organizations and dental benefit managers to meet or exceed network adequacy requirements; requiring contracting with certain providers; requiring certain credentialing and recredentialing process for providers; requiring accreditation for managed care organizations and dental benefit managers; requiring certain notification for material change; requiring medical loss ratio to meet certain standards; requiring certain provision of patient data upon request; prohibiting enforcement of certain policy or contract term; prohibiting contract from disallowing certain contract with accountable care organization; stipulating timeframes for certain authorizations; providing for peer-to-peer review; requiring Authority to ensure timely offering of authorized services; setting certain requirements for processing and adjudication of claims; requiring managed care organizations and dental benefit managers to utilize certain procedures for review and appeal; directing Authority to develop certain procedures; providing requirements for appeal of adverse determination based on medical necessity; providing for fair hearing; providing for non-compliance remedies; requiring managed care organization or dental benefit manager to participate in readiness review; specifying criteria of readiness review; allowing execution of transition of certain delivery system under certain condition; directing Authority to create certain quarterly scorecard; specifying criteria of scorecard; requiring Authority to provide scorecard to enrollees and publish on its Internet website; directing Authority to establish minimum rates of reimbursement for certain providers; setting minimum rates for certain time period; requiring managed care organization or dental benefit manager to offer value-based payment arrangements to certain providers; requiring use of certain quality measures for value-based payments; directing Authority to comply with federally required payment methodologies; creating the MC Quality Advisory Committee; providing for duties, membership, selection of chair and vice chair, meetings, quorum and staff support; prohibiting compensation; providing for codification; and providing an effective date. SUBJECT: Medicaid
AI Summary
This bill creates the "Ensuring Access to Medicaid Act" and establishes several requirements and prohibitions related to Oklahoma's Medicaid program, including:
- Limiting the Oklahoma Health Care Authority's ability to require or offer enrollment in the state's capitated managed care delivery model for certain Medicaid populations.
- Requiring the Authority to develop network adequacy standards for managed care organizations and dental benefit managers, and requiring them to contract with certain providers.
- Imposing requirements on managed care organizations and dental benefit managers related to notification of changes, medical loss ratios, data sharing, and contracting with accountable care organizations.
- Establishing timeframes for authorization reviews and appeals, and requiring peer-to-peer review processes.
- Setting requirements for the processing and adjudication of claims, including provisions related to clean claims, claim denials, and postpayment audits.
- Creating a quality advisory committee to make recommendations on quality measures used by managed care organizations and dental benefit managers.
- Requiring the Authority to establish minimum reimbursement rates for providers and to offer value-based payment arrangements.
The bill also directs the Authority to seek any necessary federal approval and to promulgate rules to implement the act, which is set to become effective on September 1, 2021.
Committee Categories
Health and Social Services
Sponsors (19)
Jessica Garvin (R)*,
Greg McCortney (R)*,
Marcus McEntire (R)*,
Carol Bush (R),
Rusty Cornwell (R),
Bob Culver (R),
Scott Fetgatter (R),
Andy Fugate (D),
Justin Humphrey (R),
Mark Lawson (R),
T.J. Marti (R),
Kevin McDugle (R),
Anthony Moore (R),
Carl Newton (R),
Daniel Pae (R),
Cindy Roe (R),
John Talley (R),
Greg Treat (R),
John Waldron (D),
Last Action
Becomes law without Governor's signature 05/27/2021 (on 05/27/2021)
Official Document
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