{"data":{"id":"us-ok/okla.-stat.-tit.-63-63-3241.4","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 63, § 63-3241.4","heading":"Supplemental Hospital Offset Payment Program Fund","body":"A. There is hereby created in the State Treasury a revolving\n\nfund to be designated the \"Supplemental Hospital Offset Payment\n\nProgram Fund\".\n\nB. The fund shall be a continuing fund, not subject to fiscal\n\nyear limitations, be interest bearing and consisting of:\n\n1. All monies received by the Oklahoma Health Care Authority\n\nfrom eligible hospitals pursuant to the Supplemental Hospital Offset\n\nPayment Program Act and otherwise specified or authorized by law;\n\n2. Any interest or penalties levied and collected in\n\nconjunction with the administration of this section; and\n\n3. All interest attributable to investment of money in the\n\nfund.\n\nC. The Oklahoma Health Care Authority is authorized to transfer\n\neach fiscal quarter from the Supplemental Hospital Offset Payment\n\nProgram Fund to the Authority's Medical Payments Cash Management\n\nImprovement Act Programs Disbursing Fund all funds remaining after\n\naccounting for the provisions of subparagraphs a and b of paragraph\n\n1 of subsection C of Section 3241.3 of this title.\n\nD. Notice of Assessment.\n\n1. The Authority shall send an annual notice of assessment to\n\neach eligible hospital informing the hospital of the assessment\n\nrate, the net hospital patient revenue calculation, and the\n\nassessment amount owed by the eligible hospital for the applicable\n\nyear.\n\n2. The annual notice of assessment shall be sent to each\n\neligible hospital at least thirty (30) days before the due date for\n\nthe first quarterly assessment payment of each year.\n\n3. The first notice of assessment shall be sent within forty-\n\nfive (45) days after receipt by the Authority of notification from\n\nthe federal Centers for Medicare and Medicaid Services that the\n\nassessments and payments required under the Supplemental Hospital\n\nOffset Payment Program Act and, if necessary, the waiver granted\n\nunder 42 C.F.R., Section 433.68 have been approved.\n\n4. An eligible hospital shall have thirty (30) days from the\n\ndate of its receipt of an annual notice of assessment to notify the\n\nAuthority of any error in the notice.\n\n5. An eligible hospital that has not been previously licensed\n\nas a hospital in Oklahoma and that commences hospital operations\n\nduring a year shall pay the required assessment computed under\n\nsubsection E of Section 3241.3 of this title and shall be eligible\n\nfor hospital access payments under subsection E of this section on\n\nthe date specified in rules promulgated by the Oklahoma Health Care\n\nAuthority Board after consideration of input and recommendations of\n\nthe Hospital Advisory Committee.\n\nE. Quarterly Notice and Collection.\n\n1. The annual assessment imposed under subsections A and C of\n\nSection 3241.3 of this title shall be due and payable on a quarterly\n\nbasis. However, the first quarterly payment of an annual assessment\n\nshall not be due and payable until:\n\na. the Authority issues written notice stating that the\n\nannual assessment and payment methodologies required\n\nunder the Supplemental Hospital Offset Payment Program\n\nAct have been approved by the federal Centers for\n\nMedicare and Medicaid Services and, if necessary, the\n\nwaiver under 42 C.F.R., Section 433.68 has been\n\ngranted by the federal Centers for Medicare and\n\nMedicaid Services,\n\nb. the thirty-day verification period required by\n\nparagraph 4 of subsection D of this section has\n\nexpired, and\n\nc. the Authority issues a notice of assessment giving a\n\ndue date for the first quarterly payment.\n\n2. After the first quarterly payment of an annual assessment\n\nhas been paid under this section, each subsequent quarterly payment\n\nshall be due and payable by the fifteenth day of the first month of\n\nthe applicable quarter.\n\n3. If an eligible hospital fails to pay a quarterly payment\n\ntimely and in full, the eligible hospital shall pay the Authority:\n\na. a penalty fee equal to five percent (5%) of the\npaid under this section, each subsequent quarterly payment\n\nshall be due and payable by the fifteenth day of the first month of\n\nthe applicable quarter.\n\n3. If an eligible hospital fails to pay a quarterly payment\n\ntimely and in full, the eligible hospital shall pay the Authority:\n\na. a penalty fee equal to five percent (5%) of the\n\neligible hospital's unpaid quarterly payment, and\n\nb. if the quarterly payment and penalty fee are not paid\n\nin full by the end of the quarter, an additional\n\npenalty fee of five percent (5%) of the eligible\n\nhospital's unpaid quarterly payment.\n\n4. The quarterly payment including applicable penalty fees must\n\nbe paid regardless of any administrative review requested by the\n\neligible hospital. If an eligible hospital fails to pay the\n\nAuthority the assessment within the time frames noted on the invoice\n\nto the eligible hospital, the assessment, applicable penalty fees,\n\nand interest will be deducted from the facility's payment. Any\n\nchange in payment amount resulting from an appeals decision will be\n\nadjusted in future payments.\n\nF. Medicaid Hospital Access Payments.\n\n1. To preserve the quality and improve access to hospital\n\ninpatient and outpatient services, the Authority shall make hospital\n\naccess payments to eligible hospitals and critical access hospitals\n\nto supplement reimbursements for inpatient and outpatient services\n\nthat are provided through Medicaid on both a fee-for-service and\n\nmanaged care basis.\n\n2. On an annual basis prior to the start of each calendar year,\n\nthe Authority shall determine:\n\na. the upper payment limit gap for inpatient services\n\npayable on a Medicaid fee-for-service basis for all\n\nhospitals,\n\nb. the upper payment limit gap for outpatient services\n\npayable on a Medicaid fee-for-service basis for all\n\nhospitals,\n\nc. the managed care gap for inpatient services payable\n\nthrough Medicaid managed care for all hospitals, and\n\nd. the managed care gap for outpatient services payable\n\nthrough Medicaid managed care for all hospitals.\n\n3. In accordance with subsection C of Section 3241.3 of this\n\ntitle, the Authority shall use assessment fees for the purposes of\n\naccessing federal matching funds to make hospital access payments to\n\neligible hospitals and the critical access hospitals described in\n\nparagraph 5 of subsection B of Section 3241.3 of this title.\n\nHospital access payments shall be made through supplemental payment\n\narrangements for services provided on a Medicaid fee-for-service\n\nbasis and through directed payment arrangements for services\n\nprovided on a Medicaid managed care basis, as approved by the\n\nfederal Centers for Medicare and Medicaid Services.\n\n4. Hospital access payments shall be determined annually and\n\npaid quarterly from the following funding pools:\n\na. a hospital inpatient fee-for-service payment pool\n\nestablished from funds derived from the upper payment\n\nlimit gap for inpatient services,\n\nb. a hospital inpatient managed care payment pool\n\nestablished from funds derived from the managed care\n\ngap for inpatient services,\n\nc. a hospital outpatient fee-for-service payment pool\n\nestablished from funds derived from the upper payment\n\nlimit gap for outpatient services,\n\nd. a hospital outpatient managed care payment pool\n\nestablished from funds derived from the managed care\n\ngap for outpatient services, and\n\ne. (1) A critical access hospital payment pool\n\nestablished from funds transferred from each pool\n\nestablished in subparagraphs a through d of this\n\nparagraph.\n\n(2) Prior to the start of each calendar year, the\n\nAuthority shall determine an estimated amount\n\nthat each critical access hospital may be\n\nentitled to receive for providing Medicaid\n\nservices, not to exceed that critical access\n\nhospital's billed charges.\naccess hospital payment pool\n\nestablished from funds transferred from each pool\n\nestablished in subparagraphs a through d of this\n\nparagraph.\n\n(2) Prior to the start of each calendar year, the\n\nAuthority shall determine an estimated amount\n\nthat each critical access hospital may be\n\nentitled to receive for providing Medicaid\n\nservices, not to exceed that critical access\n\nhospital's billed charges.\n\n(3) The Authority shall fund the critical access\n\nhospital payment pool in an amount equal to the\n\ntotal estimated amount that all critical access\n\nhospitals may be entitled to receive for\n\nproviding Medicaid services, as calculated in\n\ndivision 2 of this subparagraph.\n\n(4) The Authority shall consult with the Committee\n\nregarding the calculations in divisions 2 and 3\n\nof this subparagraph.\n\n(5) The Authority shall fully fund the critical\n\naccess hospital payment pool prior to issuing any\n\npayment from the pools established in\n\nsubparagraphs a through d of this paragraph.\n\n5. In addition to any other funds paid to eligible hospitals\n\nfor inpatient hospital services to Medicaid patients, each eligible\n\nhospital shall receive hospital access payments each quarter from\n\nthe hospital inpatient fee-for-service payment pool and the hospital\n\ninpatient managed care payment pool in accordance with the following\n\nmethodologies:\n\na. the amount an eligible hospital shall receive from the\n\nhospital inpatient fee-for-service payment pool shall\n\nbe the eligible hospital's pro rata share of the\n\nhospital inpatient fee-for-service payment pool\n\ncalculated as the eligible hospital's total fee-for-\n\nservice Medicaid payments for inpatient services\n\ndivided by the total Medicaid fee-for-service payments\n\nfor inpatient services of all eligible hospitals.\n\nEach quarterly payment from the hospital inpatient\n\nfee-for-service payment pool shall be paid to the\n\neligible hospital through a supplemental payment.\n\nPrior to the start of a calendar year, the Authority\n\nshall consult with the Committee to minimize potential\n\npayment disparities to protect access to rural and\n\nindependent hospitals, and\n\nb. an eligible hospital shall receive from the hospital\n\ninpatient managed care payment pool a per-discharge\n\nuniform add-on amount to be applied to each eligible\n\nhospital's Medicaid managed care discharges for that\n\ncalendar year. The per-discharge uniform add-on\n\namount shall be calculated by dividing the managed\n\ncare gap by total managed care inpatient discharges at\n\neligible hospitals contained in the data used to\n\ncalculate the managed care gap. To assure timely\n\npayment, the Authority may make the calculation in\n\nthis subparagraph using good-faith reasonable\n\nestimates if complete data does not exist or is not\n\navailable. Each quarterly payment from the hospital\n\ninpatient managed care payment pool shall be paid to\n\nthe eligible hospital through a directed payment.\n\n6. In addition to any other funds paid to eligible hospitals\n\nfor outpatient hospital services to Medicaid patients, each eligible\n\nhospital shall receive hospital access payments each quarter from\n\nthe hospital outpatient fee-for-service payment pool and the\n\nhospital outpatient managed care payment pool in accordance with the\n\nfollowing methodologies:\n\na. the amount an eligible hospital shall receive from the\n\nhospital outpatient fee-for-service payment pool shall\n\nbe the eligible hospital's pro rata share of the\n\nhospital's outpatient fee-for-service payment pool\n\ncalculated as the eligible hospital's total fee-for-\n\nservice Medicaid payments for outpatient services\n\ndivided by the total Medicaid fee-for-service payments\n\nfor outpatient services of all eligible hospitals.\n\nEach quarterly payment from the hospital outpatient\n\nfee-for-service payment pool shall be paid to the\n\neligible hospital through a supplemental payment, and\n\nb. an eligible hospital shall receive from the hospital\nhospital's total fee-for-\n\nservice Medicaid payments for outpatient services\n\ndivided by the total Medicaid fee-for-service payments\n\nfor outpatient services of all eligible hospitals.\n\nEach quarterly payment from the hospital outpatient\n\nfee-for-service payment pool shall be paid to the\n\neligible hospital through a supplemental payment, and\n\nb. an eligible hospital shall receive from the hospital\n\noutpatient managed care payment pool a uniform\n\npercentage add-on amount to be applied to the base\n\nrate claims payments for hospital outpatient Medicaid\n\nmanaged care encounters at eligible hospitals for that\n\ncalendar year. The uniform percentage add-on amount\n\nshall be calculated by dividing the managed care gap\n\nby total managed care base rate claims payments for\n\neligible hospitals within the data used to calculate\n\nthe managed care gap. To assure timely payment, the\n\nAuthority may make the calculation in this\n\nsubparagraph using good-faith reasonable estimates if\n\ncomplete data does not exist or is not available.\n\nEach quarterly payment from the hospital outpatient\n\nmanaged care payment pool shall be paid to the\n\neligible hospital through a directed payment.\n\n7. In addition to any other funds paid to critical access\n\nhospitals for inpatient and outpatient hospital services to Medicaid\n\npatients, each critical access hospital physically located in this\n\nstate shall receive hospital access payments each quarter from the\n\ncritical access hospital payment pool as follows:\n\na. each calendar year, a critical access hospital shall\n\nreceive from the critical hospital payment pool\n\nquarterly amounts that shall total the estimated\n\namount the Authority calculated, not to exceed billed\n\ncharges, for that critical access hospital in\n\naccordance with paragraph 4 of this subsection,\n\nb. the quarterly hospital access payments made to each\n\ncritical access hospital shall be through supplemental\n\npayments and directed payments in such proportions as\n\nnecessary for the Authority to make the total hospital\n\naccess payments to each critical access hospital in\n\naccordance with subparagraph a of this paragraph, and\n\nc. in the event Medicaid managed care is not implemented\n\non a statewide basis, the Authority shall make\n\nsupplemental payments to critical access hospitals to\n\nachieve one hundred one percent (101%) of Medicare's\n\ncritical access hospitals' costs and a directed\n\npayment shall not be made.\n\n8. The Authority shall pay each quarterly hospital access\n\npayment referenced in paragraph 4 of this subsection within fourteen\n\n(14) calendar days of the date on which each quarterly payment of an\n\nannual assessment is due as required in subsection E of this\n\nsection.\n\n9. In processing directed payments through contracted entities,\n\nthe following requirements shall apply:\n\na. the Authority shall provide each contracted entity\n\nwith a listing of the hospital access payments to be\n\npaid by each contracted entity to each eligible\n\nhospital and critical access hospital in accordance\n\nwith this subsection,\n\nb. a contracted entity shall pay hospital access payments\n\nto eligible hospitals and critical access hospitals\n\nwithin five (5) business days of receiving a\n\nsupplemental capitation payment from the Authority,\n\nc. a contracted entity is prohibited from withholding or\n\ndelaying the payment of a hospital access payment for\n\nany reason, and\n\nd. the Authority shall utilize administrative discretion\n\nregarding the mechanisms of payment that may be\n\nnecessary to assure that each eligible hospital and\n\ncritical access hospital receives full payment of all\n\nhospital access payments to which it is entitled\n\npursuant to this subsection.\n\n10. A hospital access payment shall not be used to offset any\n\nother payment for hospital inpatient or outpatient services to\n\nMedicaid beneficiaries including without limitation any fee-for-\npayment that may be\n\nnecessary to assure that each eligible hospital and\n\ncritical access hospital receives full payment of all\n\nhospital access payments to which it is entitled\n\npursuant to this subsection.\n\n10. A hospital access payment shall not be used to offset any\n\nother payment for hospital inpatient or outpatient services to\n\nMedicaid beneficiaries including without limitation any fee-for-\n\nservice, managed care, per diem, private hospital inpatient\n\nadjustment, or cost-settlement payment.\n\n11. Notwithstanding any other provision of law to the contrary:\n\na. the supplemental payment programs in this section\n\nshall not be implemented if federal financial\n\nparticipation is not available or if the provider\n\nassessment waiver is not approved,\n\nb. an eligible hospital's obligation to pay the portion\n\nof the assessment attributable to the nonfederal share\n\nof the upper payment limit gap and the nonfederal\n\nshare of the managed care gap as required by Section\n\n3241.3 of this title and this section shall be reduced\n\nin the event the federal Centers for Medicare and\n\nMedicaid Services determines that federal financial\n\nparticipation is not available to make hospital access\n\npayments in accordance with this section. The\n\nassessment on eligible hospitals shall be reduced to a\n\npercentage that permits the Authority to obtain from\n\neligible hospitals an amount of nonfederal matching\n\nfunds for which federal financial participation is\n\navailable to implement any portion of hospital access\n\npayments that the federal Centers for Medicare and\n\nMedicaid Services approves, and\n\nc. any assessments received by the Authority that cannot\n\nbe matched with federal funds shall be returned pro\n\nrata to the eligible hospitals that paid the\n\nassessments.\n\n12. If the federal Centers for Medicare and Medicaid Services\n\ndisallows any hospital access payments made pursuant to this section\n\non the basis that such payments exceed the maximum allowable under\n\nfederal law, each hospital receiving such disallowed payments shall\n\nrefund to the Authority an amount equal to that hospital's pro rata\n\nshare of the recouped federal funds that is proportionate to the\n\nhospital's positive contribution to the disallowed payment. The\n\nrefund shall be required only if the disallowance is considered\n\nfinal and all appeals have been exhausted.\n\nG. All monies accruing to the credit of the Supplemental\n\nHospital Offset Payment Program Fund are hereby appropriated and\n\nshall be budgeted and expended by the Authority after consideration\n\nof the input and recommendation of the Hospital Advisory Committee.\n\n1. Monies in the Supplemental Hospital Offset Payment Program\n\nFund shall be used for:\n\na. transfers to the Medical Payments Cash Management\n\nImprovement Act Programs Disbursing Fund for the state\n\nshare of supplemental or directed payments or both for\n\nMedicaid and SCHIP inpatient and outpatient services\n\nto hospitals that participate in the assessment,\n\nb. transfers to the Medical Payments Cash Management\n\nImprovement Act Programs Disbursing Fund for the state\n\nshare of supplemental or directed payments or both for\n\ncritical access hospitals,\n\nc. transfers to the Administrative Revolving Fund for the\n\nstate share of payment of administrative expenses\n\nincurred by the Authority or its agents and employees\n\nin performing the activities authorized by the\n\nSupplemental Hospital Offset Payment Program Act but\n\nnot more than Two Hundred Thousand Dollars\n\n($200,000.00) each year,\n\nd. transfers to the Medical Payments Cash Management\n\nImprovement Act Programs Disbursing Fund each fiscal\n\nquarter in accordance with subsection C of Section\n\n3241.3 of this title, and\n\ne. the reimbursement of monies collected by the Authority\n\nfrom hospitals through error or mistake in performing\n\nthe activities authorized under the Supplemental\n\nHospital Offset Payment Program Act.\neach year,\n\nd. transfers to the Medical Payments Cash Management\n\nImprovement Act Programs Disbursing Fund each fiscal\n\nquarter in accordance with subsection C of Section\n\n3241.3 of this title, and\n\ne. the reimbursement of monies collected by the Authority\n\nfrom hospitals through error or mistake in performing\n\nthe activities authorized under the Supplemental\n\nHospital Offset Payment Program Act.\n\n2. The Authority shall pay from the Supplemental Hospital\n\nOffset Payment Program Fund quarterly installment payments to\n\nhospitals as set forth in this section.\n\n3. Monies in the Supplemental Hospital Offset Payment Program\n\nFund shall not be used to replace other general revenues\n\nappropriated and funded by the Legislature or other revenues used to\n\nsupport Medicaid.\n\n4. The Supplemental Hospital Offset Payment Program Fund and\n\nthe program specified in the Supplemental Hospital Offset Payment\n\nProgram Act are exempt from budgetary reductions or eliminations\n\ncaused by the lack of general revenue funds or other funds\n\ndesignated for or appropriated to the Authority.\n\n5. No hospital shall be guaranteed, expressly or otherwise,\n\nthat any additional costs reimbursed to the facility will equal or\n\nexceed the amount of the supplemental hospital offset payment\n\nprogram fee paid by the hospital.\n\nH. After considering input and recommendations from the\n\nHospital Advisory Committee, the Oklahoma Health Care Authority\n\nBoard shall promulgate rules that:\n\n1. Allow for an appeal of the annual assessment of the\n\nSupplemental Hospital Offset Payment Program payable under the\n\nSupplemental Hospital Offset Payment Program Act; and\n\n2. Allow for an appeal of an assessment of any fees or\n\npenalties determined.","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":"d181e9e55e6eb0a38fb732d2ca303bc3eac312cf30ad8c40b4d037b19e287efc","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-63-63-3241.3","next":"us-ok/okla.-stat.-tit.-63-63-3241.5"},"notice":"GroundRules: Original legal text. Not legal advice."}