Bill > SB1559

This bill mandates that the Oklahoma Health Care Authority, the state agency that manages the Medicaid program, establish and operate a pilot program for direct primary care for up to one thousand Medicaid beneficiaries for a period of thirty-six months, beginning no later than six months after the bill becomes effective. Direct primary care is a model where patients pay a recurring fee for comprehensive primary care services, rather than paying per service or through traditional insurance. The pilot program will involve per-member-per-month payments to selected direct primary care providers, who must meet specific federal enrollment and quality standards and have credentialing processes adapted to the direct primary care model, which operates outside of traditional insurance. Contracts for the pilot will be directly between the Authority and the providers, independent of other Medicaid contracts, and will outline services, target populations, payment terms, and quality benchmarks to ensure value-based care and accountability, all in compliance with federal regulations. The Authority is required to conduct a competitive bidding process to select providers, considering the unique operational aspects of direct primary care, and will submit annual reports to legislative leaders and the Governor detailing access, patient satisfaction, clinical and cost outcomes, and recommendations for integrating direct primary care into the broader Medicaid program. This act is set to become effective on November 1, 2026.

Health and Social Services

http://www.oklegislature.gov/BillInfo.aspx?Bill=sb1559&Session=2600