{"data":{"id":"us-ok/okla.-stat.-tit.-56-56-4002.4","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 56, § 56-4002.4","heading":"Network adequacy standards for contracted entities","body":"A. The Oklahoma Health Care Authority shall develop network\n\nadequacy standards for all contracted entities that, at a minimum,\n\nmeet the requirements of 42 C.F.R., Sections 438.3 and 438.68.\n\nNetwork adequacy standards established under this subsection shall\n\ninclude distance and time standards and shall be designed to ensure\n\nmembers covered by the contracted entities who reside in health\n\nprofessional shortage areas (HPSAs) designated under Section\n\n332(a)(1) of the Public Health Service Act (42 U.S.C., Section\n\n254e(a)(1)) have access to in-person health care and telehealth\n\nservices with providers, especially adult and pediatric primary care\n\npractitioners.\n\nB. The Authority shall require all contracted entities to offer\n\nor extend contracts with all essential community providers, all\n\nproviders who receive directed payments in accordance with 42\n\nC.F.R., Part 438 and such other providers as the Authority may\n\nspecify. The Authority shall establish such requirements as may be\n\nnecessary to prohibit contracted entities from excluding essential\n\ncommunity providers, providers who receive directed payments in\n\naccordance with 42 C.F.R., Part 438 and such other providers as the\n\nAuthority may specify from contracts with contracted entities.\n\nC. To ensure models of care are developed to meet the needs of\n\nMedicaid members, each contracted entity must contract with at least\n\none local Oklahoma provider organization for a model of care\n\ncontaining care coordination, care management, utilization\n\nmanagement, disease management, network management, or another model\n\nof care as approved by the Authority. Such contractual arrangements\n\nmust be in place within twelve (12) months of the effective date of\n\nthe contracts awarded pursuant to the requests for proposals\n\nauthorized by Section 4002.3a of this title.\n\nD. All contracted entities shall formally credential and\n\nrecredential network providers at a frequency required by a single,\n\nconsolidated provider enrollment and credentialing process\n\nestablished by the Authority in accordance with 42 C.F.R., Section\n\n438.214. A contracted entity shall complete credentialing or\n\nrecredentialing of a provider within sixty (60) calendar days of\n\nreceipt of a completed application.\n\nE. All contracted entities shall be accredited in accordance\n\nwith 45 C.F.R., Section 156.275 by an accrediting entity recognized\n\nby the United States Department of Health and Human Services.\n\nF. 1. If the Authority awards a capitated contract to a\n\nprovider-led entity or provider-owned entity for the urban region\n\nunder Section 4002.3b of this title, the provider-led entity or\n\nprovider-owned entity shall expand its coverage area to every county\n\nof this state within the time frame set by the Authority under\n\nsubsection E of Section 4002.3b of this title.\n\n2. The expansion of the provider-led entity’s or provider-owned\n\nentity’s coverage area beyond the urban region shall be subject to\n\nthe approval of the Authority. The Authority shall approve\n\nexpansion to counties for which the provider-led entity or provider-\n\nowned entity can demonstrate evidence of network adequacy as\n\nrequired under 42 C.F.R., Sections 438.3 and 438.68. When approved,\n\nthe additional county or counties shall be added to the provider-led\n\nentity’s or provider-owned entity’s region during the next open\n\nenrollment period.","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":"153a2ef944315a9efc3b8ff97d45d2eb13cb25c358687444081a2d251acd8c2c","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-56-56-4002.3d","next":"us-ok/okla.-stat.-tit.-56-56-4002.4a"},"notice":"GroundRules: Original legal text. Not legal advice."}