{"data":{"id":"us-ok/okla.-stat.-tit.-63-63-3241.2","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 63, § 63-3241.2","heading":"Definitions","body":"As used in the Supplemental Hospital Offset Payment Program Act:\n\n1. \"Authority\" means the Oklahoma Health Care Authority;\n\n2. \"Base year\" means a hospital's fiscal year as reported in\n\nthe Medicare Cost Report or as determined by the Authority if the\n\nhospital's data is not included in the Medicare Cost Report. The\n\nbase year data shall be used in all assessment calculations;\n\n3. \"Contracted entity\" has the same meaning as provided by\n\nSection 2 of Enrolled Senate Bill No. 1337 of the 2nd Session of the\n\n58th Oklahoma Legislature;\n\n4. \"Directed payments\" means payment arrangements allowed under\n\n42 C.F.R. Section 438.6(c) that permit states to direct specific\n\npayments made by managed care plans to providers under certain\n\ncircumstances and can assist states in furthering the goals and\n\npriorities of their Medicaid programs;\n\n5. \"Eligible hospital\" means a hospital physically located in\n\nthis state that is eligible to participate in the Supplemental\n\nHospital Offset Payment Program and not otherwise exempt pursuant to\n\nsubsection B of Section 3241.3 of this title;\n\n6. \"Hospital\" means an institution licensed by the State\n\nDepartment of Health as a hospital pursuant to Section 1-701 of this\n\ntitle maintained primarily for the diagnosis, treatment, or care of\n\npatients;\n\n7. \"Hospital Advisory Committee\" or \"Committee\" means the\n\nCommittee established to advise the Oklahoma Health Care Authority\n\nregarding the design and implementation of the Supplemental Hospital\n\nOffset Payment Program. The Committee shall be composed of five (5)\n\nmembers chosen from a list of recommendations submitted by a\n\nstatewide association representing rural and urban hospitals, as\n\nfollows:\n\na. one member, appointed by the Governor, who shall serve\n\nas chair, and\n\nb. two members appointed each by the President Pro\n\nTempore of the Senate and the Speaker of the House of\n\nRepresentatives.\n\nThe Committee shall meet no less than annually and shall be\n\nconsulted by the Authority at least thirty (30) days prior to\n\nsubmission of any proposed state plan amendment or proposed directed\n\npayment application and prior to adoption of any administrative rule\n\nthat may affect either the assessments or hospital access payments\n\nauthorized by this act;\n\n8. \"Managed care gap\" means the difference between:\n\na. the maximum amount that can be paid for hospital\n\ninpatient and outpatient services to Medicaid managed\n\ncare enrollees, and\n\nb. the total amount of Medicaid managed care base rate\n\nclaims payments for hospital inpatient and outpatient\n\nservices.\n\nIn calculating the managed care gap, the Authority shall use a\n\nninety percent (90%) average commercial rates benchmark for\n\ndetermining the maximum amount that will be paid for hospital\n\ninpatient and outpatient services, subject to approval by the\n\nfederal Centers for Medicare and Medicaid Services. The Authority\n\nmay make the calculation in this paragraph using good-faith\n\nreasonable estimates if complete data does not exist or is not\n\navailable;\n\n9. \"Medicaid\" means the medical assistance program established\n\nin Title XIX of the federal Social Security Act and administered in\n\nthis state by the Oklahoma Health Care Authority;\n\n10. \"Medicare Cost Report\" means the Hospital Cost Report, Form\n\nCMS-2552-10, or subsequent versions;\n\n11. \"Net hospital patient revenue\" means the gross hospital\n\nrevenue as reported on Worksheet G-2 (Columns 1 and 2, Lines \"Total\n\ninpatient routine care services\", \"Ancillary services\", and\n\n\"Outpatient services\") of the Medicare Cost Report, multiplied by\n\nthe hospital's ratio of total net to gross revenue, as reported on\n\nWorksheet G-3 (Column 1, Line \"Net patient revenues\") and Worksheet\n\nG-2 (Part I, Column 3, Line \"Total patient revenues\");\n\n12. \"Upper payment limit\" means the maximum ceiling imposed by\nices\", and\n\n\"Outpatient services\") of the Medicare Cost Report, multiplied by\n\nthe hospital's ratio of total net to gross revenue, as reported on\n\nWorksheet G-3 (Column 1, Line \"Net patient revenues\") and Worksheet\n\nG-2 (Part I, Column 3, Line \"Total patient revenues\");\n\n12. \"Upper payment limit\" means the maximum ceiling imposed by\n\n42 C.F.R., Sections 447.272 and 447.321 on hospital Medicaid fee-\n\nfor-service reimbursements for inpatient and outpatient services,\n\nother than to hospitals owned or operated by state government; and\n\n13. \"Upper payment limit gap\" means the difference between the\n\nupper payment limit and Medicaid fee-for-service payments made to\n\nall hospitals for hospital inpatient and outpatient services, other\n\nthan hospitals owned or operated by state government.","path":["OK Code","Title 63"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os63.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"5232f1f6e208d42e0d0570783c427e4c7ab9fcfd5b70c1fef75c9c14256a623a","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-63-63-3241.11","next":"us-ok/okla.-stat.-tit.-63-63-3241.3"},"notice":"GroundRules: Original legal text. Not legal advice."}