SB 875: State Medicaid program; making contracted entities ineligible for capitated contracts for failure to meet certain minimum expense requirement. Effective date. Emergency. - Oklahoma

Floor (House) → Floor (Senate) · 5 edits

MODERATE

The Senate version of SB 875 modifies Oklahoma's Medicaid capitated contract requirements to prioritize provider-led and provider-owned entities through preferential scoring in procurement processes. It also introduces new provisions for regional contract selection, contract extension flexibility, and eligibility restrictions for entities failing to meet minimum primary care expense requirements.

Scope change

The bill's scope expanded to include specific requirements for urban region contracts and added eligibility restrictions for entities under the Ensuring Access to Medicaid Act.

REQUIREMENT

Added preferential scoring methodology in procurement to favor provider-led and provider-owned entities based on factors like governance structure, care coordination experience, and alternative payment model experience.

Added new provision allowing the Authority to select at least one provider-led or provider-owned entity for the urban region if they demonstrate ability to expand coverage area and develop operational readiness within five years.

Added requirement that the Authority solicit and award new contracts at the end of the contracting period as provided by the section and Section 4002.3a.

ELIGIBILITY

Established that entities currently holding capitated contracts under the Ensuring Access to Medicaid Act become ineligible for subsequent contracts if they fail to meet minimum primary care expense requirements.

TIMELINE

Added authority for the Authority to approve delays in contract implementation to ensure financial and operational readiness, subject to notice to the Legislature and CMS.

Enrolled (final version) → SB875 (3-24-25) (ROSINO) FS FA1.PDF · 2 edits

MINOR

The bill was reformatted from an enrolled Senate bill to a floor substitute version with updated page numbering and formatting. The substantive policy content regarding Medicaid capitated contracts, reimbursement rates, and provider requirements appears unchanged in the visible portions of the diff.

TECHNICAL

Document formatting and page numbering were updated from enrolled version to floor substitute version

Bill header information was restructured with updated session details and sponsor attribution

Engrossed → Enrolled (final version) · 1 edit · May 6, 2025

MINOR

This bill transitions from an 'Engrossed' draft to its final 'Enrolled' version with minor formatting updates to the header and sponsor information. The substantive policy language regarding Medicaid capitated contracts, reimbursement rates, and provider requirements remains unchanged between the two versions.

TECHNICAL

Header formatting was updated to reflect the final enrolled version, including adding additional House sponsors (Deck and Menz) and changing the title from 'ENGROSSED SENATE' to 'ENROLLED SENATE'.

Introduced → Engrossed · 6 edits · Mar 26, 2025

MODERATE

This bill modifies Oklahoma's Medicaid capitated contract requirements by adding penalties for entities that fail to meet minimum primary care expense thresholds, defining new terms, and adjusting the Medicaid Delivery System Quality Advisory Committee's powers. The changes aim to ensure provider-led and provider-owned entities receive preferential treatment in contract awards while enforcing minimum service expense requirements.

Scope change

The bill expands the scope by adding new penalty provisions and eligibility requirements for capitated contracts, and modifies the duties of the Medicaid Delivery System Quality Advisory Committee.

ENFORCEMENT

New penalties established for contracted entities that fail to meet minimum primary care expense requirements, including scoring penalties and ineligibility for future contracts.

REQUIREMENT

Added requirements for provider-led and provider-owned entities to demonstrate ability to expand coverage areas and develop statewide operational readiness within five years.

Modified scoring methodology to include preferential scoring for provider-led and provider-owned entities based on specific factors like care coordination experience and value-based payment arrangements.

Modified the Medicaid Delivery System Quality Advisory Committee's powers and duties related to contract oversight.

DEFINITION

Added new definitions section to clarify key terms used throughout the bill.

TIMELINE

Added provisions allowing the Authority to delay implementation of capitated contracts to ensure financial and operational readiness.

State Medicaid program; making contracted entities ineligible for capitated contracts for failure to meet certain minimum expense requirement. Effective date. Emergency.

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