OKLAHOMA CITY – State Rep. Carol Bush, R-Tulsa, today passed a bill in committee that would establish regulations for health care providers wishing to participate in Medicaid within Oklahoma.
House Bill 1091creates the Ensuring Access to Medicaid Act and establishes the conditions for which health care providers in Oklahoma will participate in the program, including the claims process, payment timeframes and rates, authorizations for treatment and more.
“If the state moves forward with a managed care model for Medicaid, we must ensure Oklahomans still have access to quality health care,” Bush said. “This bill would put in statute contract provisions the Health Care Authority would have to establish to protect the rights of qualifying participants.”
Oklahomans in June passed a state question allowing for the expansion of Medicaid to include low-income adults between the ages of 18 and 65 whose income does not exceed 133% of the federal poverty level and who are not already covered by Medicaid. The governor next directed the Oklahoma Health Care Authority (OHCA) to seek proposals from managed care organizations to manage the state’s Medicaid plan. The plan to this point has been managed by the OHCA. Last week, the governor announced he and the authority have selected four managed care organizations to run the program: Blue Cross Blue Shield of Oklahoma, Oklahoma Complete Health, Humana Health Horizons and UnitedHealthcare. His goal, he said, is to improve Oklahoman’s health outcomes.
The plan could still be contested by the Legislature, but in the meantime, Bush said her goal is to protect Oklahomans should the plan proceed.
HB 1091 requires that s a condition of any proposed or potential plan participating in capitated managed care, the OHCA shall require the following contract provisions:
- 90% of all claims shall be paid within 14 days of submission to the plan;
- Authorizations shall be facilitated within 24 hours for inpatients transferring to post- and long-term acute-care facilities;
- All plans shall offer network contracts to all community providers designated as essential by the Centers for Medicare and Medicaid Services;
- All plans shall offer payment rates to contracted providers that are no lower than the fee schedule of OHCA in effect on the date of service;
- All plans shall formally credential and re-credential physicians or other providers at a frequency that may be less than once in three years;
- All funds appropriated to OHCA shall be used in accordance with legislative intent; and
- Plan reviews and determinations for prior authorization must be timely and in accordance with established guidelines.
HB 1091 passed the House Appropriations and Budget Committee with a vote of 31-0. It now is eligible to be considered by the full House.