Medicaid; adverse determinations and procedures; review; appeal; requirements; psychologist; minimum rates of reimbursement, value-based payment arrangements, and payment methodologies; Oklahoma Health Care Authority; appeal; effective date.

HB 3626 updates Oklahoma's Medicaid appeal process and provider reimbursement rates. It requires human reviews (by licensed physicians or mental health professionals, not automated systems) for denied claims within six months, with reviewers meeting specific expertise and conflict-of-interest standards. The bill sets minimum reimbursement rates until July 2027: 100% of the fee schedule for network providers and 90% for out-of-network providers. It specifically mandates that psychologists receive full reimbursement for services including intake, testing, and assessments - not just therapy - and establishes new rates for psychologists who win appeals. These changes directly affect Medicaid providers, particularly mental health professionals, and the Oklahoma Health Care Authority.