1| SENATE FLOOR VERSION | | April 4, 2024 | 2| | | | 3|ENGROSSED HOUSE | |BILL NO. 3367 By: McEntire and Deck of the | 4| House | | | 5| and | | | 6| McCortney of the Senate | | | 7| | | | 8| | | | 9| | | | 10| An Act relating to poor persons; amending 56 O.S. | | 2021, Section 4002.2, as last amended by Section 1, | 11| Chapter 334, O.S.L. 2022 (56 O.S. Supp. 2023, Section | | 4002.2), which relates to ensuring access to Medicaid | 12| Act; clarifying definition; and providing an | | effective date. | 13| | | | 14| | | | 15| | | | 16|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 17| SECTION 1. AMENDATORY 56 O.S. 2021, Section 4002.2, as | | | 18|last amended by Section 1, Chapter 334, O.S.L. 2022 (56 O.S. Supp. | | | 19|2023, Section 4002.2), is amended to read as follows: | | | 20| Section 4002.2 As used in the Ensuring Access to Medicaid Act: | | | 21| 1. "Adverse determination" has the same meaning as provided by | | | 22|Section 6475.3 of Title 36 of the Oklahoma Statutes; | | | 23| | | | 24| | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 1 ___________________________________________________________________________
1| 2. "Accountable care organization" means a network of | | | 2|physicians, hospitals, and other health care providers that provides | | | 3|coordinated care to Medicaid members; | | | 4| 3. "Claims denial error rate" means the rate of claims denials | | | 5|that are overturned on appeal; | | | 6| 4. "Capitated contract" means a contract between the Oklahoma | | | 7|Health Care Authority and a contracted entity for delivery of | | | 8|services to Medicaid members in which the Authority pays a fixed, | | | 9|per-member-per-month rate based on actuarial calculations; | | | 10| 5. "Children's Specialty Plan" means a health care plan that | | | 11|covers all Medicaid services other than dental services and is | | | 12|designed to provide care to: | | | 13| a. children in foster care, | | | 14| b. former foster care children up to twenty-five (25) | | | 15| years of age, | | | 16| c. juvenile justice involved children,and| | | 17| d. children receiving adoption assistance, | | | 18| e. children involved in a Family Centered Services (FCS) | | | 19| case through the Child Welfare Services division of | | | 20| the Department of Human Services, | | | 21| f. children in the custody of the Department of Human | | | 22| Services and placed at home under court supervision, | | | 23| g. children who are placed at home in a trial | | | 24| | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 2 ___________________________________________________________________________
1| reunification plan administered by the Department of | | | 2| Human Services, and | | | 3| h. Medicaid enrolled parents and guardians whose | | | 4| children are in a Family Centered Services case, are | | | 5| in trial reunification, or are in the custody of the | | | 6| Department of Human Services in Foster Care or under | | | 7| court supervision; | | | 8| 6. "Clean claim" means a properly completed billing form with | | | 9|Current Procedural Terminology, 4th Edition or a more recent | | | 10|edition, the Tenth Revision of the International Classification of | | | 11|Diseases coding or a more recent revision, or Healthcare Common | | | 12|Procedure Coding System coding where applicable that contains | | | 13|information specifically required in the Provider Billing and | | | 14|Procedure Manual of the Oklahoma Health Care Authority, as defined | | | 15|in 42 C.F.R., Section 447.45(b); | | | 16| 7. "Commercial plan" means an organization or entity that | | | 17|undertakes to provide or arrange for the delivery of health care | | | 18|services to Medicaid members on a prepaid basis and is subject to | | | 19|all applicable federal and state laws and regulations; | | | 20| 8. "Contracted entity" means an organization or entity that | | | 21|enters into or will enter into a capitated contract with the | | | 22|Oklahoma Health Care Authority for the delivery of services | | | 23|specified in the Ensuring Access to Medicaid Act that will assume | | | 24|financial risk, operational accountability, and statewide or | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 3 ___________________________________________________________________________
1|regional functionality as defined in the Ensuring Access to Medicaid | | | 2|Act in managing comprehensive health outcomes of Medicaid members. | | | 3|For purposes of the Ensuring Access to Medicaid Act, the term | | | 4|contracted entity includes an accountable care organization, a | | | 5|provider-led entity, a commercial plan, a dental benefit manager, or | | | 6|any other entity as determined by the Authority; | | | 7| 9. "Dental benefit manager" means an entity that handles claims | | | 8|payment and prior authorizations and coordinates dental care with | | | 9|participating providers and Medicaid members; | | | 10| 10. "Essential community provider" means: | | | 11| a. a Federally Qualified Health Center, | | | 12| b. a community mental health center, | | | 13| c. an Indian Health Care Provider, | | | 14| d. a rural health clinic, | | | 15| e. a state-operated mental health hospital, | | | 16| f. a long-term care hospital serving children (LTCH-C), | | | 17| g. a teaching hospital owned, jointly owned, or | | | 18| affiliated with and designated by the University | | | 19| Hospitals Authority, University Hospitals Trust, | | | 20| Oklahoma State University Medical Authority, or | | | 21| Oklahoma State University Medical Trust, | | | 22| h. a provider employed by or contracted with, or | | | 23| otherwise a member of the faculty practice plan of: | | | 24| | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 4 ___________________________________________________________________________
1| (1) a public, accredited medical school in this | | | 2| state, or | | | 3| (2) a hospital or health care entity directly or | | | 4| indirectly owned or operated by the University | | | 5| Hospitals Trust or the Oklahoma State University | | | 6| Medical Trust, | | | 7| i. a county department of health or city-county health | | | 8| department, | | | 9| j. a comprehensive community addiction recovery center, | | | 10| k. a hospital licensed by the State of Oklahoma | | | 11| including all hospitals participating in the | | | 12| Supplemental Hospital Offset Payment Program, | | | 13| l. a Certified Community Behavioral Health Clinic | | | 14| (CCBHC), | | | 15| m. a provider employed by or contracted with a primary | | | 16| care residency program accredited by the Accreditation | | | 17| Council for Graduate Medical Education, | | | 18| n. any additional Medicaid provider as approved by the | | | 19| Authority if the provider either offers services that | | | 20| are not available from any other provider within a | | | 21| reasonable access standard or provides a substantial | | | 22| share of the total units of a particular service | | | 23| utilized by Medicaid members within the region during | | | 24| the last three (3) years, and the combined capacity of | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 5 ___________________________________________________________________________
1| other service providers in the region is insufficient | | | 2| to meet the total needs of the Medicaid members, | | | 3| o. a pharmacy or pharmacist, or | | | 4| p. any provider not otherwise mentioned in this | | | 5| paragraph that meets the definition of "essential | | | 6| community provider" under 45 C.F.R., Section 156.235; | | | 7| 11. "Material change" includes, but is not limited to, any | | | 8|change in overall business operations such as policy, process or | | | 9|protocol which affects, or can reasonably be expected to affect, | | | 10|more than five percent (5%) of enrollees or participating providers | | | 11|of the contracted entity; | | | 12| 12. "Governing body" means a group of individuals appointed by | | | 13|the contracted entity who approve policies, operations, profit/loss | | | 14|ratios, executive employment decisions, and who have overall | | | 15|responsibility for the operations of the contracted entity of which | | | 16|they are appointed; | | | 17| 13. "Local Oklahoma provider organization" means any state | | | 18|provider association, accountable care organization, Certified | | | 19|Community Behavioral Health Clinic, Federally Qualified Health | | | 20|Center, Native American tribe or tribal association, hospital or | | | 21|health system, academic medical institution, currently practicing | | | 22|licensed provider, or other local Oklahoma provider organization as | | | 23|approved by the Authority; | | | 24| | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 6 ___________________________________________________________________________
1| 14. "Medical necessity" has the same meaning as provided by | | | 2|rules promulgated by the Oklahoma Health Care Authority Board; | | | 3| 15. "Participating provider" means a provider who has a | | | 4|contract with or is employed by a contracted entity to provide | | | 5|services to Medicaid members as authorized by the Ensuring Access to | | | 6|Medicaid Act; | | | 7| 16. "Provider" means a health care or dental provider licensed | | | 8|or certified in this state or a provider that meets the Authority's | | | 9|provider enrollment criteria to contract with the Authority as a | | | 10|SoonerCare provider; | | | 11| 17. "Provider-led entity" means an organization or entity that | | | 12|meets the criteria of at least one of the following two | | | 13|subparagraphs: | | | 14| a. a majority of the entity's ownership is held by | | | 15| Medicaid providers in this state or is held by an | | | 16| entity that directly or indirectly owns or is under | | | 17| common ownership with Medicaid providers in this | | | 18| state, or | | | 19| b. a majority of the entity's governing body is composed | | | 20| of individuals who: | | | 21| (1) have experience serving Medicaid members and: | | | 22| (a) are licensed in this state as physicians, | | | 23| physician assistants, nurse practitioners, | | | 24| | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 7 ___________________________________________________________________________
1| certified nurse-midwives, or certified | | | 2| registered nurse anesthetists, | | | 3| (b) at least one board member is a licensed | | | 4| behavioral health provider, or | | | 5| (c) are employed by: | | | 6| i. a hospital or other medical facility | | | 7| licensed by this state and operating in | | | 8| this state, or | | | 9| ii. an inpatient or outpatient mental | | | 10| health or substance abuse treatment | | | 11| facility or program licensed or | | | 12| certified by this state and operating | | | 13| in this state, | | | 14| (2) represent the providers or facilities described | | | 15| in division (1) of this subparagraph including, | | | 16| but not limited to, individuals who are employed | | | 17| by a statewide provider association, or | | | 18| (3) are nonclinical administrators of clinical | | | 19| practices serving Medicaid members; | | | 20| 18. "Statewide" means all counties of this state including the | | | 21|urban region; and | | | 22| 19. "Urban region" means: | | | 23| | | | 24| | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 8 ___________________________________________________________________________
1| a. all counties of this state with a county population | | | 2| of not less than five hundred thousand (500,000) | | | 3| according to the latest Federal Decennial Census, and | | | 4| b. all counties that are contiguous to the counties | | | 5| described in subparagraph a of this paragraph, | | | 6|combined into one region. | | | 7| SECTION 2. This act shall become effective November 1, 2024. | | | 8|COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES | |April 4, 2024 - DO PASS | 9| | | | 10| | | | 11| | | | 12| | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | arsid11347040 SENATE FLOOR VERSION - HB3367 SFLR Page 9