1| STATE OF OKLAHOMA | | | 2| 2nd Session of the 60th Legislature (2026) | | | 3|HOUSE BILL 3361 By: Williams | | | 4| | | | 5| | | | 6| AS INTRODUCED | | | 7| An Act relating to Medicaid reimbursements; amending | | 56 O.S. 2021, Section 4002.12, as last amended by | 8| Section 7, Chapter 448, O.S.L. 2024 (56 O.S. Supp. | | 2025, Section 4002.12), which relates to minimum | 9| rates of reimbursements; making minimum rates of | | reimbursements discretionary; and providing and | 10| effective date. | | | 11| | | | 12| | | | 13|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 14| SECTION 1. AMENDATORY 56 O.S. 2021, Section 4002.12, as | | | 15|last amended by Section 7, Chapter 448, O.S.L. 2024 (56 O.S. Supp. | | | 16|2025, Section 4002.12), is amended to read as follows: | | | 17| Section 4002.12. A. Until July 1, 2027, the Oklahoma Health | | | 18|Care Authorityshallmay establish minimum rates of reimbursement | | | 19|from contracted entities to providers who elect not to enter into | | | 20|value-based payment arrangements under subsection B of this section | | | 21|or other alternative payment agreements for health care items and | | | 22|services furnished by such providers to enrollees of the state | | | 23|Medicaid program. Except as provided by subsection I of this | | | 24| | | | Req. No. 15741 Page 1 ___________________________________________________________________________
1|section, until July 1, 2027, such reimbursement ratesshallmay be | | | 2|equal to or greater than: | | | 3| 1. For an item or service provided by a participating provider | | | 4|who is in the network of the contracted entity, one hundred percent | | | 5|(100%) of the reimbursement rate for the applicable service in the | | | 6|applicable fee schedule of the Authority; or | | | 7| 2. For an item or service provided by a non-participating | | | 8|provider or a provider who is not in the network of the contracted | | | 9|entity, ninety percent (90%) of the reimbursement rate for the | | | 10|applicable service in the applicable fee schedule of the Authority | | | 11|as of January 1, 2021. | | | 12| B. A contracted entity shall offer value-based payment | | | 13|arrangements to all providers in its network capable of entering | | | 14|into value-based payment arrangements. Such arrangements shall be | | | 15|optional for the provider but shall be tied to reimbursement | | | 16|incentives when quality metrics are met. The quality measures used | | | 17|by a contracted entity to determine reimbursement amounts to | | | 18|providers in value-based payment arrangements shall align with the | | | 19|quality measures of the Authority for contracted entities. | | | 20| C. Notwithstanding any other provision of this section, the | | | 21|Authority shall comply with payment methodologies required by | | | 22|federal law or regulation for specific types of providers including, | | | 23|but not limited to, Federally Qualified Health Centers, rural health | | | 24| | | | Req. No. 15741 Page 2 ___________________________________________________________________________
1|clinics, pharmacies, Indian Health Care Providers and emergency | | | 2|services. | | | 3| D. A contracted entity shall offer all rural health clinics | | | 4|(RHCs) contracts that reimburse RHCs using the methodology in place | | | 5|for each specific RHC prior to January 1, 2023, including any and | | | 6|all annual rate updates. The contracted entity shall comply with | | | 7|all federal program rules and requirements, and the transformed | | | 8|Medicaid delivery system shall not interfere with the program as | | | 9|designed. | | | 10| E. The Oklahoma Health Care Authority shall establish minimum | | | 11|rates of reimbursement from contracted entities to Certified | | | 12|Community Behavioral Health Clinic (CCBHC) providers who elect | | | 13|alternative payment arrangements equal to the prospective payment | | | 14|system rate under the Medicaid State Plan. | | | 15| F. The Authority shall establish an incentive payment under the | | | 16|Supplemental Hospital Offset Payment Program that is determined by | | | 17|value-based outcomes for providers other than hospitals. | | | 18| G. Psychologist reimbursement shall reflect outcomes. | | | 19|Reimbursement shall not be limited to therapy and shall include but | | | 20|not be limited to testing and assessment. | | | 21| H. Coverage for Medicaid ground transportation services by | | | 22|licensed Oklahoma emergency medical services shall be reimbursed at | | | 23|no less than the published Medicaid rates as set by the Authority. | | | 24|All currently published Medicaid Healthcare Common Procedure Coding | | | Req. No. 15741 Page 3 ___________________________________________________________________________
1|System (HCPCS) codes paid by the Authority shall continue to be paid | | | 2|by the contracted entity. The contracted entity shall comply with | | | 3|all reimbursement policies established by the Authority for the | | | 4|ambulance providers. Contracted entities shall accept the modifiers | | | 5|established by the Centers for Medicare and Medicaid Services | | | 6|currently in use by Medicare at the time of the transport of a | | | 7|member that is dually eligible for Medicare and Medicaid. | | | 8| I. 1. The rate paid to participating pharmacy providers is | | | 9|independent of subsection A of this section and shall be the same as | | | 10|the fee-for-service rate employed by the Authority for the Medicaid | | | 11|program as stated in the payment methodology in OAC 317:30-5-78, | | | 12|unless the participating pharmacy provider elects to enter into | | | 13|other alternative payment agreements. | | | 14| 2. A pharmacy or pharmacist shall receive direct payment or | | | 15|reimbursement from the Authority or contracted entity when providing | | | 16|a health care service to the Medicaid member at a rate no less than | | | 17|that of other health care providers for providing the same service. | | | 18| J. Notwithstanding any other provision of this section, | | | 19|anesthesia shall continue to be reimbursed equal to or greater than | | | 20|the anesthesia fee schedule established by the Authority as of | | | 21|January 1, 2021. Anesthesia providers may also enter into | | | 22|value-based payment arrangements under this section or alternative | | | 23|payment arrangements for services furnished to Medicaid members. | | | 24| | | | Req. No. 15741 Page 4 ___________________________________________________________________________
1| K. The Authority shall specify in the requests for proposals a | | | 2|reasonable time frame in which a contracted entity shall have | | | 3|entered into a certain percentage, as determined by the Authority, | | | 4|of value-based contracts with providers. | | | 5| L. Capitation rates established by the Oklahoma Health Care | | | 6|Authority and paid to contracted entities under capitated contracts | | | 7|shall be updated annually and in accordance with 42 C.F.R., Section | | | 8|438.3. Capitation rates shall be approved as actuarially sound as | | | 9|determined by the Centers for Medicare and Medicaid Services in | | | 10|accordance with 42 C.F.R., Section 438.4 and the following: | | | 11| 1. Actuarial calculations must include utilization and | | | 12|expenditure assumptions consistent with industry and local | | | 13|standards; and | | | 14| 2. Capitation rates shall be risk-adjusted and shall include a | | | 15|portion that is at risk for achievement of quality and outcomes | | | 16|measures. | | | 17| M. The Authority may establish a symmetric risk corridor for | | | 18|contracted entities. | | | 19| N. The Authority shall establish a process for annual recovery | | | 20|of funds from, or assessment of penalties on, contracted entities | | | 21|that do not meet the medical loss ratio standards stipulated in | | | 22|Section 4002.5 of this title. | | | 23| O. 1. The Authority shall, through the financial reporting | | | 24|required under subsection G of Section 4002.12b of this title, | | | Req. No. 15741 Page 5 ___________________________________________________________________________
1|determine the percentage of health care expenses by each contracted | | | 2|entity on primary care services. | | | 3| 2. Not later than the end of the fourth year of the initial | | | 4|contracting period, each contracted entity shall be currently | | | 5|spending not less than eleven percent (11%) of its total health care | | | 6|expenses on primary care services. | | | 7| 3. The Authority shall monitor the primary care spending of | | | 8|each contracted entity and require each contracted entity to | | | 9|maintain the level of spending on primary care services stipulated | | | 10|in paragraph 2 of this subsection. | | | 11| SECTION 2. This act shall become effective November 1, 2026. | | | 12| | | | 13| 60-2-15741 TJ 01/04/26 | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | Req. No. 15741 Page 6