{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-1011.5","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-1011.5","heading":"Nursing facility incentive reimbursement rate plan","body":"A. 1. The Oklahoma Health Care Authority shall develop an\n\nincentive reimbursement rate plan for nursing facilities focused on\n\nimproving resident outcomes and resident quality of life.\n\n2. Under the current rate methodology, the Authority shall\n\nreserve Five Dollars ($5.00) per patient day designated for the\n\nquality assurance component that nursing facilities can earn for\n\nimprovement or performance achievement of resident-centered outcomes\n\nmetrics. To fund the quality assurance component, Two Dollars\n\n($2.00) shall be deducted from each nursing facility's per diem\n\nrate, and matched with Three Dollars ($3.00) per day funded by the\n\nAuthority. Payments to nursing facilities that achieve specific\n\nmetrics shall be treated as an \"add back\" to their net reimbursement\n\nper diem. Dollar values assigned to each metric shall be determined\n\nso that an average of the five-dollar-quality incentive is made to\n\nqualifying nursing facilities.\n\n3. Pay-for-performance payments may be earned quarterly and\n\nbased on facility-specific performance achievement of four equally-\n\nweighted, Long-Stay Quality Measures as defined by the Centers for\n\nMedicare and Medicaid Services (CMS).\n\n4. Contracted Medicaid long-term care providers may earn\n\npayment by achieving either five percent (5%) relative improvement\n\neach quarter from baseline or by achieving the National Average\n\nBenchmark or better for each individual quality metric.\n\n5. Pursuant to federal Medicaid approval, any funds that remain\n\nas a result of providers failing to meet the quality assurance\n\nmetrics shall be pooled and redistributed to those who achieve the\n\nquality assurance metrics each quarter. If federal approval is not\n\nreceived, any remaining funds shall be deposited in the Nursing\n\nFacility Quality of Care Fund authorized in Section 2002 of this\n\ntitle.\n\n6. The Authority shall establish an advisory group with\n\nconsumer, provider and state agency representation to recommend\n\nquality measures to be included in the pay-for-performance program\n\nand to provide feedback on program performance and recommendations\n\nfor improvement. The quality measures shall be reviewed annually\n\nand shall be subject to change every three (3) years through the\n\nagency's promulgation of rules. The Authority shall insure\n\nadherence to the following criteria in determining the quality\n\nmeasures:\n\na. provides direct benefit to resident care outcomes,\n\nb. applies to long-stay residents, and\n\nc. addresses a need for quality improvement using the\n\nCenters for Medicare and Medicaid Services (CMS)\n\nranking for Oklahoma.\n\n7. The Authority shall begin the pay-for-performance program\n\nfocusing on improving the following CMS nursing home quality\n\nmeasures:\n\na. percentage of long-stay, high-risk residents with\n\npressure ulcers,\n\nb. percentage of long-stay residents who lose too much\n\nweight,\n\nc. percentage of long-stay residents with a urinary tract\n\ninfection, and\n\nd. percentage of long-stay residents who got an\n\nantipsychotic medication.\n\nB. The Oklahoma Health Care Authority shall negotiate with the\n\nCenters for Medicare and Medicaid Services to include the authority\n\nto base provider reimbursement rates for nursing facilities on the\n\ncriteria specified in subsection A of this section.\n\nC. The Oklahoma Health Care Authority shall audit the program\n\nto ensure transparency and integrity.\n\nD. The Oklahoma Health Care Authority shall provide an annual\n\nreport of the incentive reimbursement rate plan to the Governor, the\n\nSpeaker of the House of Representatives, and the President Pro\n\nTempore of the Senate by December 31 of each year. The report shall\n\ninclude, but not be limited to, an analysis of the previous fiscal\n\nyear including incentive payments, ratings, and notable trends.","path":["OK Code","Title 56"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os56.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"381143f65a959e4b560a14d1cb969ebcbceb11fc243cc742baaec428be160ab1","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-1011.4","next":"us-ok/okla.-stat.-tit.-56-56-1011.6"},"notice":"GroundRules: Original legal text. Not legal advice."}