1| STATE OF OKLAHOMA | | | 2| 2nd Session of the 60th Legislature (2026) | | | 3|SENATE BILL 1559 By: McIntosh | | | 4| | | | 5| | | | 6| AS INTRODUCED | | | 7| An Act relating to the state Medicaid program; | | defining term; requiring the Oklahoma Health Care | 8| Authority to conduct certain pilot program; | | describing pilot program; stipulating certain | 9| requirements related to contracts; requiring certain | | competitive bidding process; providing certain | 10| qualifications for direct primary care providers; | | requiring certain annual reports; providing for | 11| codification; and providing an effective date. | | | 12| | | | 13| | | | 14|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 15| SECTION 1. NEW LAW A new section of law to be codified | | | 16|in the Oklahoma Statutes as Section 1011.16 of Title 56, unless | | | 17|there is created a duplication in numbering, reads as follows: | | | 18| A. As used in this section, "direct primary care provider" has | | | 19|the same meaning as provided in Section 4605 of Title 36 of the | | | 20|Oklahoma Statutes. | | | 21| B. The Oklahoma Health Care Authority shall conduct a pilot | | | 22|program to test a direct primary care model for members of the state | | | 23|Medicaid program as provided in this section. The pilot program | | | 24|shall: | | | Req. No. 2385 Page 1 ___________________________________________________________________________
1| 1. Operate for a period of thirty-six (36) months, beginning no | | | 2|later than six (6) months following the effective date of this act; | | | 3| 2. Serve a cohort of up to one thousand Medicaid beneficiaries; | | | 4| 3. Include one or more direct primary care providers, selected | | | 5|based on criteria established by the Authority; and | | | 6| 4. Utilize per-member-per-month payments to direct primary care | | | 7|providers and quality benchmarks compliant with federal regulations | | | 8|to promote value-based care. | | | 9| C. Contracts entered into for the pilot program established | | | 10|under this section shall: | | | 11| 1. Be executed directly between the Oklahoma Health Care | | | 12|Authority and one or more direct primary care providers, independent | | | 13|of capitated contracts entered into by the Authority and contracted | | | 14|entities under the Ensuring Access to Medicaid Act; | | | 15| 2. Specify: | | | 16| a. the primary care services to be provided, | | | 17| b. the target populations to be served, | | | 18| c. the terms of per-member-per-month payments for direct | | | 19| primary care providers, and | | | 20| d. quality benchmarks to ensure accountability and | | | 21| performance; and | | | 22| 3. Be compliant with federal regulations including 42 C.F.R., | | | 23|Part 438. | | | 24| | | | Req. No. 2385 Page 2 ___________________________________________________________________________
1| D. 1. The Authority shall establish a competitive bidding | | | 2|process to select direct primary care providers for the pilot | | | 3|program. The selection process shall account for the distinct | | | 4|operational model of direct primary care, facilitating effective | | | 5|integration of direct primary care into the Medicaid framework. | | | 6| 2. To qualify for the pilot program, a direct primary care | | | 7|provider shall meet federal enrollment and quality standards as | | | 8|provided in 42 C.F.R., Section 455.410 and 42 C.F.R., Part 438, with | | | 9|credentialing processes tailored to accommodate the noninsurance | | | 10|framework of direct primary care. | | | 11| E. During the operation of and at the conclusion of the pilot | | | 12|program, the Authority shall electronically submit annual reports to | | | 13|the President Pro Tempore of the Senate, the Speaker of the House of | | | 14|Representatives, and the Governor detailing: | | | 15| 1. Access to primary care services; | | | 16| 2. Patient satisfaction; | | | 17| 3. Clinical outcomes; | | | 18| 4. Cost outcomes; and | | | 19| 5. Recommendations for policy changes, particularly regarding | | | 20|the integration of direct primary care models into the state | | | 21|Medicaid program. | | | 22| SECTION 2. This act shall become effective November 1, 2026. | | | 23| | | | 24| 60-2-2385 DC 1/12/2026 8:28:02 PM | | | Req. No. 2385 Page 3