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 Oklahoma Statutes (Last Updated: September 18, 2014)
 Title 56. POOR PERSONS

  § 56-1010.3. Oklahoma Medicaid Healthcare Options System - Establishment - Administration - Transition of Medicaid delivery system to managed care system.  

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  • A.  1.  There is hereby established the Oklahoma Medicaid Healthcare Options System.  The Oklahoma Health Care Authority shall be responsible for converting the present system of delivery of the Oklahoma Medicaid Program to a managed care system.

    2.  The System shall be administered by the Oklahoma Health Care Authority and shall consist of a statewide system of managed care contracts with participating providers for the provision of hospitalization, eye care, dental care and medical care coverage to members and the administration, supervision, monitoring and evaluation of such contracts.  The contracts for the managed care health plans shall be awarded on a competitive bid basis.

    3.  The System shall use both full and partial capitation models to service the medical needs of eligible persons.  The highest priority shall be given to the development of prepaid capitated health plans provided, that prepaid capitated health plans shall be the only managed care model offered in the high density population areas of Oklahoma City and Tulsa.

    B.  The Oklahoma Medicaid Healthcare Options System shall initiate a process to provide for the orderly transition of the operation of the Oklahoma Medicaid Program to a managed care program within the System.

    C.  Except as hereinafter provided, the System shall develop managed care plans for all persons eligible for Title XIX of the federal Social Security Act, 42 U.S.C., Section 1396 et seq., as follows:

    1.  On or before January 1, 1996, managed care plans shall be developed for a minimum of fifty percent (50%) of the participants in the Temporary Assistance for Needy Families (TANF) program and participants categorized as noninstitutionalized medically needy.  On or before July 1, 1997, all participants in the Temporary Assistance for Needy Families (TANF) program and participants categorized as noninstitutionalized medically needy shall be enrolled in a managed care plan;

    2.  On or before July 1, 1999, managed care plans shall be developed for all participants categorized as aged, blind or disabled;

    3.  On or before July 1, 2001, managed care plans shall be developed for all participants who are institutionalized; provided, however, this requirement shall not apply to individuals who are developmentally disabled; and

    4.  On or before July 1, 2000, a proposal for a Medicaid waiver to implement a managed care pilot program for participants with long-term care needs shall be developed and presented to the Joint Legislative Oversight Committee established in Section 1010.7 of this title.  The pilot program shall provide a continuum of services for participants including, but not limited to, case management, supportive assistance in residential settings, homemaker services, home-delivered meals, adult day care, respite care, skilled nursing care, specialized medical equipment and supplies, and institutionalized long-term care.  Payment for these services shall be on a capitated basis.  The Joint Legislative Oversight Committee shall review the waiver application for the pilot program on or before December 1, 2000.  In no instance shall the waiver application be presented to the Health Care Financing Administration prior to the review by the Committee.

    D.  The Oklahoma Health Care Authority shall apply for any federal Medicaid waivers necessary to implement the System.  The application made pursuant to this subsection shall be designed to qualify for federal funding primarily on a prepaid capitated basis.  Such funds may only be used for eye care, dental care, medical care and related services for eligible persons.

    E.  Except as specifically required by federal law, the System shall only be responsible for providing care on or after the date that a person has been determined eligible for the System, and shall only be responsible for reimbursing the cost of care rendered on or after the date that the person was determined eligible for the System.

Added by Laws 1993, c. 336, § 3, eff. July 1, 1993.  Amended by Laws 1994, c. 282, § 1, eff. July 1, 1994; Laws 1995, c. 204, § 3, eff. July 1, 1995; Laws 1996, c. 321, § 1, emerg. eff. June 12, 1996; Laws 1997, c. 377, § 1, emerg. eff. June 10, 1997; Laws 1998, c. 338, § 1, eff. Nov. 1, 1998; Laws 1999, c. 348, § 4, eff. July 1, 1999; Laws 2000, c. 383, § 1, emerg. eff. June 7, 2000.