2016 Oklahoma Statutes
Title 56. Poor Persons
§56-1011.2. Program to improve service delivery system - Waivers of federal laws - Implementation of phase one of act - Independent evaluation - Purpose.

A. The Oklahoma Health Care Authority is authorized to seek waivers and/or other federal authorizations to create a statewide program to provide for a more efficient and effective service delivery system that enhances quality of care and client outcomes in the Oklahoma Medicaid Program.

B. The Oklahoma Health Care Authority shall develop and submit for approval, applications for waivers of applicable federal laws and regulations as necessary to implement the provisions of the Oklahoma Medicaid Reform Act of 2006. Copies of all waivers submitted to and approved by the United States Centers for Medicare and Medicaid Services under this section shall be provided to the Legislature within ten (10) days of their approval. The Oklahoma Health Care Authority shall submit a plan containing a recommended timeline for implementation of any waivers and budgetary projections of the effect of the Oklahoma Medicaid Reform Act of 2006. This implementation plan shall be submitted to the Governor, the Speaker of the House of Representatives and the President Pro Tempore of the Senate.

C. 1. For the purposes of this subsection:

a.“rural” means outside the corporate limits of any municipal corporation and includes open country, unincorporated communities, and any municipality having a population of ten thousand (10,000) or less according to the latest Federal Decennial Census, and

b.“urban” means any area which is not rural.

2. By July 1, 2010, phase one of this act shall be implemented within an area of the state with rural and urban characteristics. The Oklahoma Health Care Authority shall contract for an independent evaluation and report findings of this phase of the act to the Governor and the Legislature. After an independent evaluation and report to the Governor and Legislature, if it is determined that the evaluation establishes improved access to health care, improved health care outcomes, and improved cost efficiencies, it is the intent of the Legislature that components of the act be phased in statewide.

D. Upon this evaluation and determination of improvement by the Governor and Legislature, the Oklahoma Health Care Authority shall negotiate a plan for statewide expansion of the act from the Centers for Medicare and Medicaid Services.

E. The Oklahoma Health Care Authority may contract with a pay-for-performance program provider. The purpose of the program is to test a program’s value proposition that offers financial incentives to both the health care provider and the patient for incorporating evidence-based medicine guidelines and information therapy prescriptions in the rendering and utilizing of health care. This program may offer the health care provider the flexibility to use the health care provider’s clinical judgment to adhere to or deviate from the program’s guidelines and still receive a financial incentive as long as the health care provider prescribes information therapy to the patient. The program shall offer a financial reward to the patient for responding to the information therapy prescription by demonstrating the patient’s understanding of the patient’s health condition, by demonstrating adherence to recommended care, and by judging the quality of care given to the patient against these guidelines. The program shall be offered and administered through an Internet application. This demonstration project shall collect and analyze data over a period of two (2) years or other reasonable time frame in order to determine its effectiveness.

F. The purpose of the Oklahoma Medicaid Reform Act of 2006 is to:

1. Stabilize Medicaid expenditures in the act areas compared to Medicaid expenditures in the test areas for the three (3) years preceding implementation of the act, while ensuring:

a.consumer education and choice,

b.access to medically necessary services,

c.coordination of preventative, acute, and long-term care services, and

d.reductions in unnecessary service utilization;

2. Provide an opportunity to evaluate the progress of statewide implementation of the Oklahoma Medicaid Reform Act of 2006 as a replacement for the current Medicaid system; and

3. Introduce competition as a factor that lowers the cost of the act.

Added by Laws 2006, c. 315, § 2, emerg. eff. June 9, 2006. Amended by Laws 2008, c. 412, § 2, eff. Nov. 1, 2008.