{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-1011.9a","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-1011.9A","heading":"Claims payable to providers of Medicaid home and","body":"community-based services — OHCA prohibited from utilizing certain\n\naudit methods — Development and refinement with DOH of audit\n\nmethodology.\n\nA. As used in this section:\n\n1. \"Error rate\" means the percentage of dollars of audited\n\nclaims found to be billed in error;\n\n2. \"Extrapolation\" means the methodology of estimating an\n\nunknown value by projecting, with a calculated precision, i.e.,\n\nmargin of error, the results of a probability sample to the universe\n\nfrom which the sample was drawn;\n\n3. \"Probability sample\" means the standard statistical\n\nmethodology in which a sample is selected based on the mathematical\n\ntheory of probability;\n\n4. \"Sample\" means a statistically valid number of claims\n\nobtained from the universe of claims audited or reviewed; and\n\n5. \"Universe\" means all paid claims or types of paid claims\n\naudited or reviewed during a specified time frame.\n\nB. For claims payable to providers of Medicaid home and\n\ncommunity-based services submitted on or after January 27, 2020, but\n\nnot later than November 1, 2027, the Oklahoma Health Care Authority\n\nshall not use:\n\n1. Extrapolation or any other statistical method for the\n\nauditing of such claims that can result in a determination that a\n\nprovider is required to repay any amount paid to such provider in\n\nexcess of the amount of the audited claim, regardless of the claims\n\nerror rate; or\n\n2. Statistical sampling to audit submitted claims in a manner\n\nthat can result in a liability amount in excess of the total amount\n\nof claims used in a statistical sample.\n\nC. The use by the Oklahoma Health Care Authority of any\n\nmethodology as described in subsection A of this section prior to\n\nthe effective date of this act, and which was performed pursuant to\n\nthe provisions of Oklahoma Administrative Code 317:30-3-2.1 with\n\nrespect to an audit period beginning on or after January 27, 2020,\n\nthrough November 1, 2025, shall be deemed as invalid and any demand\n\nfor payment made to a provider on the basis of such methodology\n\nshall be null and void. The Oklahoma Health Care Authority shall\n\nnot have authority to make any demand for repayment from a provider\n\nwith respect to an audit the effect of which has been nullified\n\npursuant to the provisions of this subsection or to impose a\n\nfinancial penalty upon such provider with respect to any such audit.\n\nD. The Oklahoma Health Care Authority shall comply with the\n\nrequirements of Section 249 of Title 56 of the Oklahoma Statutes\n\nwith respect to the reporting of alleged fraud.\n\nE. The Oklahoma Health Care Authority and the Department of\n\nHuman Services shall work in conjunction to develop and refine an\n\naudit methodology with respect to claims submitted for payment by\n\nproviders in the Home and Community Based Waivers related programs.\n\nThe agencies shall develop an information and training program so\n\nthat affected providers and their authorized agents have an\n\nopportunity to become familiar with the audit standards and have a\n\nclear and consistent set of guidelines with respect to the claims\n\nsubmission process and any possible audit activity. The joint\n\nprogram shall be complete and ready for presentation to providers\n\nand their authorized agents not later than November 1, 2027.","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":"1b85aa6174b644a189f230115ffb88cbd884c6ca7fbb4d1566262c35ce9b8424","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-1011.9","next":"us-ok/okla.-stat.-tit.-56-56-1012.1"},"notice":"GroundRules: Original legal text. Not legal advice."}