Okla. Stat. tit. 56, § 56-1011.2: Program to improve service delivery system - Waivers of

federal laws - Implementation of phase one of act - Independent

evaluation - Purpose.

A. The Oklahoma Health Care Authority is authorized to seek

waivers and/or other federal authorizations to create a statewide

program to provide for a more efficient and effective service

delivery system that enhances quality of care and client outcomes in

the Oklahoma Medicaid Program.

B. The Oklahoma Health Care Authority shall develop and submit

for approval, applications for waivers of applicable federal laws

and regulations as necessary to implement the provisions of the

Oklahoma Medicaid Reform Act of 2006. Copies of all waivers

submitted to and approved by the United States Centers for Medicare

and Medicaid Services under this section shall be provided to the

Legislature within ten (10) days of their approval. The Oklahoma

Health Care Authority shall submit a plan containing a recommended

timeline for implementation of any waivers and budgetary projections

of the effect of the Oklahoma Medicaid Reform Act of 2006. This

implementation plan shall be submitted to the Governor, the Speaker

of the House of Representatives and the President Pro Tempore of the

Senate.

C. 1. For the purposes of this subsection:

a. “rural” means outside the corporate limits of any

municipal corporation and includes open country,

unincorporated communities, and any municipality

having a population of ten thousand (10,000) or less

according to the latest Federal Decennial Census, and

b. “urban” means any area which is not rural.

2. By July 1, 2010, phase one of this act shall be implemented

within an area of the state with rural and urban characteristics.

The Oklahoma Health Care Authority shall contract for an independent

evaluation and report findings of this phase of the act to the

Governor and the Legislature. After an independent evaluation and

report to the Governor and Legislature, if it is determined that the

evaluation establishes improved access to health care, improved

health care outcomes, and improved cost efficiencies, it is the

intent of the Legislature that components of the act be phased in

statewide.

D. Upon this evaluation and determination of improvement by the

Governor and Legislature, the Oklahoma Health Care Authority shall

negotiate a plan for statewide expansion of the act from the Centers

for Medicare and Medicaid Services.

E. The Oklahoma Health Care Authority may contract with a pay-

for-performance program provider. The purpose of the program is to

test a program’s value proposition that offers financial incentives

to both the health care provider and the patient for incorporating

evidence-based medicine guidelines and information therapy

prescriptions in the rendering and utilizing of health care. This

program may offer the health care provider the flexibility to use

the health care provider’s clinical judgment to adhere to or deviate

from the program’s guidelines and still receive a financial

incentive as long as the health care provider prescribes information

therapy to the patient. The program shall offer a financial reward

to the patient for responding to the information therapy

prescription by demonstrating the patient’s understanding of the

patient’s health condition, by demonstrating adherence to

recommended care, and by judging the quality of care given to the

patient against these guidelines. The program shall be offered and

administered through an Internet application. This demonstration

project shall collect and analyze data over a period of two (2)

years or other reasonable time frame in order to determine its

effectiveness.

F. The purpose of the Oklahoma Medicaid Reform Act of 2006 is

to:

1. Stabilize Medicaid expenditures in the act areas compared to

Medicaid expenditures in the test areas for the three (3) years

tered through an Internet application. This demonstration

project shall collect and analyze data over a period of two (2)

years or other reasonable time frame in order to determine its

effectiveness.

F. The purpose of the Oklahoma Medicaid Reform Act of 2006 is

to:

1. Stabilize Medicaid expenditures in the act areas compared to

Medicaid expenditures in the test areas for the three (3) years

preceding implementation of the act, while ensuring:

a. consumer education and choice,

b. access to medically necessary services,

c. coordination of preventative, acute, and long-term

care services, and

d. reductions in unnecessary service utilization;

2. Provide an opportunity to evaluate the progress of statewide

implementation of the Oklahoma Medicaid Reform Act of 2006 as a

replacement for the current Medicaid system; and

3. Introduce competition as a factor that lowers the cost of

the act.