HB 4362 requires the Oklahoma Health Care Authority to apply for a federal 1115 waiver to expand Medicaid coverage for medical respite care (short-term recovery support after hospital stays) and supportive housing (housing with health services). This bill directly affects Oklahoma Medicaid beneficiaries who need these specific services but currently lack coverage. The key provision mandates the state to seek federal approval for this expansion, which would allow more vulnerable residents to access these critical care options. The change would take effect on November 1, 2026, if the waiver is approved.
HB 3699 requires Oklahoma's Medicaid agency (OHCA) to seek federal approval for a supplemental reimbursement rate for physician practices, community health workers, and nonprofits already enrolled in Oklahoma's patient-centered medical home program. This rate specifically supports pediatric care for children from birth to age four, covering wellness visits and funding interdisciplinary staff needed to implement team-based care aligned with Bright Futures screening guidelines (at 9, 18, and 30 months). Providers must verify ongoing participation in evidence-based pediatric practice models through annual documentation. The bill mandates OHCA to periodically review the rate during future Medicaid physician service rate adjustments and takes effect November 1, 2026.
HB 3361 sets minimum reimbursement rates for Medicaid providers in Oklahoma through July 2027. It requires contracted entities to pay participating providers 100% of the standard fee schedule rate and non-participating providers 90% of the 2021 rate. The bill mandates value-based payment plans for providers tied to quality metrics, while ensuring specific protections for pharmacies, rural health clinics, behavioral health clinics, and emergency medical services. It also requires contracted entities to spend at least 11% of healthcare expenses on primary care and updates capitation rates annually based on federal standards. The bill takes effect November 1, 2026.
SB 1807 eliminates a reduced assessment rate for nursing facilities under Oklahoma's Medicaid program, replacing it with a uniform per-patient day fee calculation. This fee, based on total annual patient gross receipts divided by patient days, directly affects licensed nursing facilities (excluding those operated by the Oklahoma Department of Veterans Affairs). The bill updates funding mechanisms, requiring the fee to fund specific Medicaid services including increasing personal needs allowances for nursing home residents from $30 to $50 monthly. It also clarifies that the fee must align with federal Medicaid reimbursement rules and ensures funds are exempt from budget cuts.
SB 1559 requires Oklahoma's Medicaid program to test a direct primary care model through a 36-month pilot program serving up to 1,000 Medicaid beneficiaries. It mandates the Oklahoma Health Care Authority to contract directly with qualified providers using monthly payments per patient (not traditional capitated contracts) and establish quality benchmarks aligned with federal rules. The program requires annual reports tracking access, patient satisfaction, clinical outcomes, and costs, with recommendations for future Medicaid policy. This pilot aims to evaluate how direct primary care - where patients pay a flat fee for services - could improve care within Medicaid, without changing existing Medicaid coverage.
HB 3650 sets minimum reimbursement rates for healthcare providers treating Oklahoma Medicaid enrollees, requiring contracted entities to pay in-network providers 100% and out-of-network providers 90% of the 2021 fee schedule rates until 2035. It mandates value-based payment arrangements for providers (with quality-based incentives), requires 11% of contracted entities' healthcare spending to go toward primary care, and includes specific payment rules for rural health clinics, behavioral health centers, pharmacies, and ambulance services. The bill also establishes annual capitation rate updates and medical loss ratio penalties for non-compliant entities. It becomes effective November 1, 2026.
HB 3975 establishes the Oklahoma Rural Health Transformation Program (ORHT) to manage federal funds for rural health initiatives, designating the Oklahoma State Department of Health (ODH) as the lead agency responsible for overseeing these funds and reporting to state officials. The bill creates an Oklahoma Rural Health Transformation Revolving Fund to hold federal funds, requiring ODH to submit annual reports to state leaders and quarterly public updates on fund expenditures and project progress. It mandates ODH to align program outcomes with federal reporting requirements to ensure proper oversight of funds received through the Centers for Medicare and Medicaid Services (CMS).
SB 1645 establishes new rules for auditing long-term care providers (like nursing homes and Medicaid home-care agencies) under Oklahoma's Medicaid program. It requires the Oklahoma Health Care Authority to give providers 1 week's notice before audits, limits audits to 50 claims or 0.25% of annual claims, and prohibits holding providers liable for simple clerical errors (like typos) as fraud. Providers must be allowed 60 days to correct claims after an audit, and recoupments (recovery of overpaid funds) can only apply to corrected claims, not original billing errors. The bill also creates a two-step appeals process, allowing providers to challenge audit results through the Authority and then to an administrative law judge.
This bill changes Oklahoma Medicaid rules for autism treatment coverage. It requires a diagnosis of autism spectrum disorder by specific licensed providers (like neurologists, developmental pediatricians, or psychologists) to qualify for applied behavior analysis (ABA) therapy. The bill prohibits Medicaid from requiring re-diagnoses after an initial diagnosis and mandates in-person ABA services while allowing remote supervision via telehealth. It directly affects Oklahoma Medicaid recipients with autism spectrum disorder seeking ABA therapy.
SB 1563 prevents Oklahoma Medicaid and state employee health plans from applying stricter coverage rules to nonopioid pain medications than to opioids. It requires that FDA-approved nonopioid drugs for pain management cannot face more restrictive prior authorization or step therapy requirements than opioid options. The law applies to all Medicaid formularies and state flexible benefit plans, ensuring nonopioid drugs aren't disadvantaged in coverage decisions. It takes effect January 1, 2027.
