House Sends Securing Access to Medicaid Act to Senate
Mike Seals - March 11, 2021 11:13 am
OKLAHOMA CITY – The Ensuring Access to Medicaid Act, which would establish regulations for health care providers wishing to participate in Medicaid within Oklahoma passed out of the House today.
House Bill 1091 by Rep. Carol Bush, R-Tulsa, specifies how claims are to be processed, ensures payments made to providers are timely and that rates are following the fee schedules in effect at the date of service. It also details how quickly treatment must be authorized.
“No matter what Medicaid delivery system the state chooses to move forward with – whether managed care or a state model – we must ensure Oklahomans can access quality health care,” Bush said. “This bill determines the contract provisions the Health Care Authority must establish to protect the rights of qualifying participants.”
Oklahomans in June passed a state question allowing for the expansion of Medicaid to include low-income adults between the ages of 18 and 65 whose income does not exceed 133% of the federal poverty level and who are not already covered by Medicaid.
The governor in conjunction with the Oklahoma Health Care Authority (OHCA) has selected multiple managed care organizations to administer the state’s Medicaid plan. The plan to this point has been managed by the OHCA.
The plan could still be contested by the Legislature, but in the meantime, Bush said her goal is to protect Oklahomans should the plan proceed.
HB 1091 requires that s a condition of any proposed or potential plan participating in capitated managed care, the OHCA shall require the following contract provisions:
- 90% of all claims shall be paid within 14 days of submission to the plan;
- Authorizations shall be facilitated within 24 hours for inpatients transferring to post- and long-term acute-care facilities;
- All plans shall offer network contracts to all community providers designated as essential by the Centers for Medicare and Medicaid Services;
- All plans shall offer payment rates to contracted providers that are no lower than the fee schedule of OHCA in effect on the date of service;
- All plans shall formally credential and re-credential physicians or other providers at a frequency that may be less than once in three years;
- All funds appropriated to OHCA shall be used in accordance with legislative intent; and
- Plan reviews and determinations for prior authorization must be timely and in accordance with established guidelines.
HB 1091 passed the House with a vote of 81-13. It is being carried in the state Senate by Sen. Chris Kidd, R-Waurika.