{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-4002.3a","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-4002.3a","heading":"Capitated contracts with contracted entities for","body":"delivery of Medicaid services.\n\nA. 1. The Oklahoma Health Care Authority (OHCA) shall enter\n\ninto capitated contracts with contracted entities for the delivery\n\nof Medicaid services as specified in the Ensuring Access to Medicaid\n\nAct to transform the delivery system of the state Medicaid program\n\nfor the Medicaid populations listed in this section.\n\n2. Unless expressly authorized by the Legislature, the\n\nAuthority shall not issue any request for proposals or enter into\n\nany contract to transform the delivery system for the aged, blind,\n\nand disabled populations eligible for SoonerCare.\n\nB. 1. The Oklahoma Health Care Authority shall issue a request\n\nfor proposals to enter into public-private partnerships with\n\ncontracted entities other than dental benefit managers to cover all\n\nMedicaid services other than dental services for the following\n\nMedicaid populations:\n\na. pregnant women,\n\nb. children,\n\nc. deemed newborns under 42 C.F.R., Section 435.117,\n\nd. parents and caretaker relatives, and\n\ne. the expansion population.\n\n2. The Authority shall specify the services to be covered in\n\nthe request for proposals referenced in paragraph 1 of this\n\nsubsection. Capitated contracts referenced in this subsection shall\n\ncover all Medicaid services other than dental services including:\n\na. physical health services including, but not limited\n\nto:\n\n(1) primary care,\n\n(2) inpatient and outpatient services, and\n\n(3) emergency room services,\n\nb. behavioral health services, and\n\nc. prescription drug services.\n\n3. The Authority shall specify the services not covered in the\n\nrequest for proposals referenced in paragraph 1 of this subsection.\n\n4. Subject to the requirements and approval of the Centers for\n\nMedicare and Medicaid Services, the implementation of the program\n\nshall be no later than April 1, 2024.\n\nC. 1. The Authority shall issue a request for proposals to\n\nenter into public-private partnerships with dental benefit managers\n\nto cover dental services for the following Medicaid populations:\n\na. pregnant women,\n\nb. children,\n\nc. parents and caretaker relatives,\n\nd. the expansion population, and\n\ne. members of the Children’s Specialty Plan as provided\n\nby subsection D of this section.\n\n2. The Authority shall specify the services to be covered in\n\nthe request for proposals referenced in paragraph 1 of this\n\nsubsection.\n\n3. Subject to the requirements and approval of the Centers for\n\nMedicare and Medicaid Services, the implementation of the program\n\nshall be no later than April 1, 2024.\n\nD. 1. Either as part of the request for proposals referenced\n\nin subsection B of this section or as a separate request for\n\nproposals, the Authority shall issue a request for proposals to\n\nenter into public-private partnerships with one contracted entity to\n\nadminister a Children’s Specialty Plan.\n\n2. The Authority shall specify the services to be covered in\n\nthe request for proposals referenced in paragraph 1 of this\n\nsubsection.\n\n3. The contracted entity for the Children’s Specialty Plan\n\nshall coordinate with the dental benefit managers who cover dental\n\nservices for its members as provided by subsection C of this\n\nsection.\n\n4. Subject to the requirements and approval of the Centers for\n\nMedicare and Medicaid Services, the implementation of the program\n\nshall be no later than April 1, 2024.\n\nE. The Authority shall not implement the transformation of the\n\nMedicaid delivery system until it receives written confirmation from\n\nthe Centers for Medicare and Medicaid Services that a managed care\n\ndirected payment program utilizing average commercial rate\n\nmethodology for hospital services under the Supplemental Hospital\n\nOffset Payment Program has been approved for Year 1 of the\n\ntransformation and will be included in the budget neutrality cap\n\nbaseline spending level for purposes of Oklahoma’s 1115 waiver\n\nrenewal; provided, however, nothing in this section shall prohibit\na managed care\n\ndirected payment program utilizing average commercial rate\n\nmethodology for hospital services under the Supplemental Hospital\n\nOffset Payment Program has been approved for Year 1 of the\n\ntransformation and will be included in the budget neutrality cap\n\nbaseline spending level for purposes of Oklahoma’s 1115 waiver\n\nrenewal; provided, however, nothing in this section shall prohibit\n\nthe Authority from exploring alternative opportunities with the\n\nCenters for Medicare and Medicaid Services to maximize the average\n\ncommercial rate benefit.","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":"266b21fde8332125e37898b5b219d8a7079d7e70ffb3ebeac017f0ffa1ab13a8","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-4002.2","next":"us-ok/okla.-stat.-tit.-56-56-4002.3b"},"notice":"GroundRules: Original legal text. Not legal advice."}