The bill amends the Oklahoma Medicaid program to enhance the delivery of Medicaid services through capitated contracts, specifically excluding prescription drug and dental services from certain provisions. The Oklahoma Health Care Authority (OHCA) is tasked with issuing requests for proposals to establish public-private partnerships aimed at serving specific populations, such as pregnant women and children. Key changes include the introduction of a fee-for-service model for prescription drug services, transitioning coverage from contracted entities to direct coverage by the OHCA. The bill also emphasizes the need for a shared governance structure among contracted entities, establishes minimum reimbursement rates for providers, and allows for value-based payment arrangements, all aimed at improving the efficiency and effectiveness of the Medicaid program.

Additionally, the bill outlines reimbursement methodologies for various health care providers, mandating that contracted entities offer contracts to rural health clinics that comply with pre-existing reimbursement methodologies and federal rules. It requires the OHCA to set minimum reimbursement rates for Certified Community Behavioral Health Clinic providers and implement incentive payments based on value-based outcomes. The bill includes several deletions and insertions to update existing law, such as removing previous provisions regarding pharmacy provider reimbursement rates and establishing new requirements for value-based contracts. It also mandates annual updates to capitation rates and ensures that at least 11% of total health care expenses are allocated to primary care by the end of the fourth year of the initial contracting period. The act is set to take effect on November 1, 2025.

Statutes affected:
Introduced: 56-4002.5, 56-4002.12