1 STATE OF OKLAHOMA
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2 1st Session of the 58th Legislature (2021)
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3 SENATE BILL 434 By: McCortney
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5 AS INTRODUCED
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6 An Act relating to the state Medicaid program;
6 stating purpose of act; creating the I/T/U Shared
7 Savings Program; providing that certain services may
7 be subject to certain reimbursement; providing for
8 certain distribution and deposit of savings;
8 prohibiting certain use of fund; requiring certain
9 actions and distributions to be conducted in
9 accordance with certain federal guidance; specifying
10 criteria of care coordination agreements; providing
10 for promulgation of rules and execution of contracts
11 in accordance with certain requirements; requiring
11 the Oklahoma Health Care Authority to seek certain
12 federal approval; providing for termination of the
12 I/T/U Shared Savings Program under certain
13 conditions; creating the I/T/U Shared Savings
13 Revolving Fund; specifying purpose of fund and
14 revenue sources; requiring submission of certain
14 annual report; specifying criteria of report;
15 providing for codification; providing an effective
15 date; and declaring an emergency.
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17 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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18 SECTION 1. NEW LAW A new section of law to be codified
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19 in the Oklahoma Statutes as Section 5061.1 of Title 63, unless there
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20 is created a duplication in numbering, reads as follows:
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21 A. The purpose of this act is to maximize and direct the
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22 reinvestment of any savings to the Oklahoma Health Care Authority
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23 generated by enhanced federal matching authorized under Section
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24 1905(b) of the Social Security Act at a rate of one hundred percent
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 1 (100%) for covered services received through participating Indian
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2 Health Service, Tribal and Urban Indian (I/T/U) facilities.
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3 B. There is hereby created the I/T/U Shared Savings Program.
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4 Pursuant to guidance of the Centers for Medicare & Medicaid Services
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5 (CMS), authorized services provided by a non-I/T/U Medicaid provider
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6 to an American Indian or Alaska Native (AI/AN) Medicaid beneficiary
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7 as a result of a referral from an I/T/U facility provider may be
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8 eligible for the enhanced federal matching rate of one hundred
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9 percent (100%).
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10 C. 1. The Authority shall distribute up to fifty percent (50%)
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11 of any savings that result from the I/T/U Shared Savings Program
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12 provided for in this section to participating I/T/U facilities that
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13 have complied with the terms of this act and applicable federal law,
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14 but only after administrative costs incurred by the Authority in
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15 implementing the I/T/U Shared Savings Program have been fully
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16 satisfied.
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17 2. Distributions to participating I/T/U facilities shall be
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18 used to increase care coordination and to support health care
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19 initiatives for AI/AN populations.
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20 3. The Authority shall deposit any shared savings that remain
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21 after administrative costs have been fully paid, and after
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22 distributions have been made to participating I/T/U facilities, into
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23 the I/T/U Shared Savings Revolving Fund created in Section 2 of this
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24 act for the purpose of increasing Medicaid provider rates. Monies
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 1 in the fund shall not be used to replace other general revenues
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2 appropriated and funded by the Legislature or other revenues used to
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3 support Medicaid.
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4 D. 1. All actions taken by the Authority in implementing the
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5 I/T/U Shared Savings Program shall be made in accordance with
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6 applicable state and federal Medicaid law and CMS State Health
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7 Official letter (SHO) #16-002, issued on February 26, 2016, and CMS
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8 Frequently Asked Questions (FAQs) regarding "Federal Funding for
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9 Services 'Received Through' an IHS/Tribal Facility and Furnished to
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10 Medicaid-Eligible American Indians and Alaska Natives (SHO #16-002)"
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11 issued on January 18, 2017, and as such guidance may be hereinafter
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12 amended or modified.
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13 2. The Authority shall make distributions to a participating
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14 I/T/U facility in accordance with paragraph 1 of subsection C of
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15 this section, contingent upon the production of executed copies of
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16 Care Coordination Agreements (CCAs) for all services billed to
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17 Oklahoma Medicaid that were received through the I/T/U facility.
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18 CCAs must be executed between the I/T/U facility and the non-I/T/U
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19 provider and must include, at a minimum, assurances that care
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20 coordination shall involve:
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21 a. the I/T/U facility practitioner providing a request
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22 for specific services by electronic or other
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23 verifiable means and relevant information about the
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24 practitioner's patient to the non-I/T/U provider,
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 1 b. the non-I/T/U provider sending information about the
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2 care the non-I/T/U provider provides to the patient
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3 including the results of any screening, diagnostic or
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4 treatment procedures, to the I/T/U facility
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5 practitioner,
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6 c. the I/T/U facility practitioner continuing to assume
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7 responsibility for the patient's care by assessing the
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8 information and taking appropriate action including,
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9 when necessary, furnishing or requesting additional
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10 services, and
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11 d. the I/T/U facility incorporating the patient's
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12 information in the medical record through the
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13 statewide health information exchange or other agreed-
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14 upon means.
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15 E. The Oklahoma Health Care Authority Board is authorized to
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16 promulgate administrative rules and to enter into contractual
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17 agreements with I/T/U facilities as needed to effectuate the
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18 provisions of this act. As part of the rulemaking process, the
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19 Authority shall comply with the Tribal Consultation Requirements
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20 provided by the Medicaid State Plan.
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21 F. The Authority shall promptly seek any necessary federal
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22 approval for the implementation of this act. In the event that any
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23 necessary federal approval is not obtained, or in the event funding
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24 of Oklahoma Medicaid from state, federal or other sources is
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 1 withdrawn, reduced or limited in any way that affects implementation
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2 of the I/T/U Shared Savings Program, the I/T/U Shared Savings
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3 Program may be terminated immediately by the Authority, and no court
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4 or tribunal shall have jurisdiction to review such termination.
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5 SECTION 2. NEW LAW A new section of law to be codified
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6 in the Oklahoma Statutes as Section 5061.2 of Title 63, unless there
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7 is created a duplication in numbering, reads as follows:
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8 A. There is hereby created in the State Treasury a revolving
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9 fund for the Oklahoma Health Care Authority to be designated the
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10 "I/T/U Shared Savings Revolving Fund". The fund shall be a
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11 continuing fund, not subject to fiscal year limitations, and shall
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12 consist of all monies received by the Authority pursuant to this act
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13 and otherwise specified or authorized by law.
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14 All monies accruing to the credit of the fund are hereby
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15 appropriated and shall be budgeted and expended by the Authority to
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16 increase Medicaid provider rates, unless otherwise provided by law.
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17 Expenditures from the fund shall be made upon warrants issued by the
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18 State Treasurer against claims filed as prescribed by law with the
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19 Director of the Office of Management and Enterprise Services for
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20 approval and payment.
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21 B. An annual report shall be prepared by the Authority's Chief
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22 Financial Officer and shall be submitted to the Governor, the
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23 President Pro Tempore of the Senate and the Speaker of the House of
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 1 Representatives no later than thirty (30) days following the end of
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2 each State Fiscal Year. The annual report shall account for:
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3 1. The savings realized by the Authority as a result of the
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4 I/T/U Shared Savings Program;
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5 2. The administrative costs incurred by the Authority as a
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6 result of the I/T/U Shared Savings Program;
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7 3. The monies distributed to participating I/T/U facilities as
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8 a result of I/T/U Shared Savings Program including, but not limited
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9 to, a summary of all specific distributions;
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10 4. The balance of savings realized by the Authority as a result
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11 of the I/T/U Shared Savings Program and accruing to the credit of
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12 the fund after payment of administrative costs and distributions to
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13 participating I/T/U facilities; and
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14 5. The monies expended on increasing Medicaid provider rates
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15 including, but not limited to, identification of the types of
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16 providers affected and the percentage by which the providers' rates
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17 were increased.
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18 SECTION 3. This act shall become effective July 1, 2021.
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19 SECTION 4. It being immediately necessary for the preservation
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20 of the public peace, health or safety, an emergency is hereby
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21 declared to exist, by reason whereof this act shall take effect and
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22 be in full force from and after its passage and approval.
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24 58-1-627 DC 1/15/2021 6:10:37 PM
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