Powers, duties and responsibilities of Health Care Authority – Program opt-out option.

  1. Law
  2. Oklahoma Statutes
  3. Poor Persons
  4. Powers, duties and responsibilities of Health Care Authority – Program opt-out option.

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A. The Oklahoma Health Care Authority shall have the following powers, duties, and responsibilities with respect to the development of the program established in Section 1011.2 of this title:

1. The consumer education component shall include the following:

  • a.to develop a choice counseling system to ensure that the choice counseling process and related material are designed to provide consumers an understanding of both public and private health insurance options provided by this act including incentives through face-to-face interaction, by telephone, and in writing, and through other forms of relevant media,
  • b.to develop a system to ensure that there is record of recipient acknowledgment that choice counseling has been provided, and
  • c.to develop a choice counseling system that promotes health literacy and includes an educational component that is intended to promote proper utilization of the health care system;

2. The consumer choice component shall include a comprehensive feasibility study to allow individuals more choices in their health care coverage including, but not limited to, employer-sponsored insurance options, and may include the following:

  • a.to develop a system to enable Medicaid consumers to opt out of their current Medicaid program and purchase health care coverage through their employer-sponsored health insurance plan or access commercial health insurance policies for their eligible family members,
  • b.to develop an actuarially sound average cost per Medicaid consumer to provide medically necessary services. This value shall be used for a voucher system to subsidize Medicaid consumers’ premium costs for their employer-sponsored or commercial health insurance option,
  • c.to develop a process for Medicaid consumers to select commercial health insurance options, the Oklahoma Health Care Authority may develop a plan to implement a personal health account system as an enhanced benefit. Monies deposited into a personal health account shall only be used by the recipient to defray health-care-related costs including, but not limited to, copayments, noncovered benefits, and wellness initiatives. The Health Care Authority shall promulgate rules guiding personal health account transactions;

3. To provide a grievance-resolution process for Medicaid consumers enrolled in a health plan. This process shall include a mechanism for an expedited review of a grievance if the life of a Medicaid recipient is in imminent and emergent jeopardy; and

4. To provide a grievance-resolution process for health care providers employed by or contracted with a health plan to settle disputes among the provider and the health plan or the provider and the Oklahoma Health Care Authority.

B. Medicaid consumers electing to opt out of the current program shall be subject to cost-sharing requirements, preexisting-condition clauses and the possibility of different benefits of their employer-sponsored insurance or selected commercial health care provider. The consumer shall also be responsible to pay for any cost differential between the state subsidy and their premium cost should their premium cost be higher. If the cost is lower than the state subsidy, then the difference may be placed into a personal health account.

C. Notwithstanding any other provision of this section, coverage, cost sharing, and any other component of employer-sponsored health insurance shall be governed by applicable state and federal laws.

D. The Oklahoma Health Care Authority shall develop a system to ensure that the implementation of the provisions of this act do not negatively affect the ability of American Indian or Alaska Native beneficiaries to access services at Indian Health Service facilities, tribally operated health facilities and Urban Indian Health Programs.

E. The Oklahoma Health Care Authority shall develop a system to ensure that the implementation of the provisions of this act do not negatively affect the reimbursement structure between the Oklahoma Health Care Authority and the Indian Health Service facilities, tribally operated health facilities and urban health programs.

F. The Oklahoma Health Care Authority shall develop mechanisms through intergovernmental transfers which will allow tribally operated facilities that elect to provide services to beneficiaries other than American Indian or Alaska Native beneficiaries to receive reimbursement for such services.

Added by Laws 2006, c. 315, § 3, emerg. eff. June 9, 2006. Amended by Laws 2008, c. 412, § 3, eff. Nov. 1, 2008.


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