Okla. Stat. tit. 63, § 63-3241.2: Definitions

As used in the Supplemental Hospital Offset Payment Program Act:

1. "Authority" means the Oklahoma Health Care Authority;

2. "Base year" means a hospital's fiscal year as reported in

the Medicare Cost Report or as determined by the Authority if the

hospital's data is not included in the Medicare Cost Report. The

base year data shall be used in all assessment calculations;

3. "Contracted entity" has the same meaning as provided by

Section 2 of Enrolled Senate Bill No. 1337 of the 2nd Session of the

58th Oklahoma Legislature;

4. "Directed payments" means payment arrangements allowed under

42 C.F.R. Section 438.6(c) that permit states to direct specific

payments made by managed care plans to providers under certain

circumstances and can assist states in furthering the goals and

priorities of their Medicaid programs;

5. "Eligible hospital" means a hospital physically located in

this state that is eligible to participate in the Supplemental

Hospital Offset Payment Program and not otherwise exempt pursuant to

subsection B of Section 3241.3 of this title;

6. "Hospital" means an institution licensed by the State

Department of Health as a hospital pursuant to Section 1-701 of this

title maintained primarily for the diagnosis, treatment, or care of

patients;

7. "Hospital Advisory Committee" or "Committee" means the

Committee established to advise the Oklahoma Health Care Authority

regarding the design and implementation of the Supplemental Hospital

Offset Payment Program. The Committee shall be composed of five (5)

members chosen from a list of recommendations submitted by a

statewide association representing rural and urban hospitals, as

follows:

a. one member, appointed by the Governor, who shall serve

as chair, and

b. two members appointed each by the President Pro

Tempore of the Senate and the Speaker of the House of

Representatives.

The Committee shall meet no less than annually and shall be

consulted by the Authority at least thirty (30) days prior to

submission of any proposed state plan amendment or proposed directed

payment application and prior to adoption of any administrative rule

that may affect either the assessments or hospital access payments

authorized by this act;

8. "Managed care gap" means the difference between:

a. the maximum amount that can be paid for hospital

inpatient and outpatient services to Medicaid managed

care enrollees, and

b. the total amount of Medicaid managed care base rate

claims payments for hospital inpatient and outpatient

services.

In calculating the managed care gap, the Authority shall use a

ninety percent (90%) average commercial rates benchmark for

determining the maximum amount that will be paid for hospital

inpatient and outpatient services, subject to approval by the

federal Centers for Medicare and Medicaid Services. The Authority

may make the calculation in this paragraph using good-faith

reasonable estimates if complete data does not exist or is not

available;

9. "Medicaid" means the medical assistance program established

in Title XIX of the federal Social Security Act and administered in

this state by the Oklahoma Health Care Authority;

10. "Medicare Cost Report" means the Hospital Cost Report, Form

CMS-2552-10, or subsequent versions;

11. "Net hospital patient revenue" means the gross hospital

revenue as reported on Worksheet G-2 (Columns 1 and 2, Lines "Total

inpatient routine care services", "Ancillary services", and

"Outpatient services") of the Medicare Cost Report, multiplied by

the hospital's ratio of total net to gross revenue, as reported on

Worksheet G-3 (Column 1, Line "Net patient revenues") and Worksheet

G-2 (Part I, Column 3, Line "Total patient revenues");

12. "Upper payment limit" means the maximum ceiling imposed by

ices", and

"Outpatient services") of the Medicare Cost Report, multiplied by

the hospital's ratio of total net to gross revenue, as reported on

Worksheet G-3 (Column 1, Line "Net patient revenues") and Worksheet

G-2 (Part I, Column 3, Line "Total patient revenues");

12. "Upper payment limit" means the maximum ceiling imposed by

42 C.F.R., Sections 447.272 and 447.321 on hospital Medicaid fee-

for-service reimbursements for inpatient and outpatient services,

other than to hospitals owned or operated by state government; and

13. "Upper payment limit gap" means the difference between the

upper payment limit and Medicaid fee-for-service payments made to

all hospitals for hospital inpatient and outpatient services, other

than hospitals owned or operated by state government.