This bill amends existing laws related to the state Medicaid program, specifically focusing on capitated contracts and reimbursement rates. It establishes that contracted entities will be ineligible for capitated contracts if they fail to meet certain minimum expense requirements, particularly regarding primary care spending. The bill introduces new provisions that require the Oklahoma Health Care Authority to ensure that at least one capitated contract is awarded to provider-led and provider-owned entities, provided they demonstrate the ability to fulfill contract requirements. Additionally, it mandates that a contracted entity currently holding a capitated contract will be ineligible for future awards if it does not meet the minimum primary care expense requirement.

The bill also outlines the reimbursement rates for various healthcare services, ensuring that they meet or exceed specified thresholds. It emphasizes the importance of value-based payment arrangements and requires the Authority to monitor and enforce compliance with these standards. The effective date for the bill is set for July 1, 2025, and it includes an emergency clause for immediate implementation upon passage and approval. Overall, the legislation aims to enhance the quality of care provided to Medicaid members by enforcing stricter financial accountability among contracted entities.

Statutes affected:
Introduced: 56-4002.12