A. The Oklahoma Health Care Authority shall establish minimum rates of reimbursement from managed care organizations and dental benefit managers to providers who elect not to enter into value-based payment arrangements under subsection B of this section for health care items and services furnished by such providers to enrollees of the state Medicaid program. Until July 1, 2026, such reimbursement rates shall be equal to or greater than:
1. For an item or service provided by a participating provider who is in the network of the managed care organization or dental benefit manager, one hundred percent (100%) of the reimbursement rate for the applicable service in the applicable fee schedule of the Authority; or
2. For an item or service provided by a non-participating provider or a provider who is not in the network of the managed care organization or dental benefit manager, ninety percent (90%) of the reimbursement rate for the applicable service in the applicable fee schedule of the Authority as of January 1, 2021.
B. A managed care organization or dental benefit manager shall offer value-based payment arrangements to all providers in its network capable of entering into value-based payment arrangements. Such arrangements shall be optional for the provider. The quality measures used by a managed care organization or dental benefit manager to determine reimbursement amounts to providers in value-based payment arrangements shall align with the quality measures of the Authority for managed care organizations or dental benefit managers.
C. Notwithstanding any other provision of this section, the Authority shall comply with payment methodologies required by federal law or regulation for specific types of providers including, but not limited to, Federally Qualified Health Centers, rural health clinics, pharmacies, Indian Health Care Providers and emergency services.
Added by Laws 2021, c. 542, § 12, eff. Sept. 1, 2021.