Section 5061.1 - I/T/U Shared Savings ProgramA. The purpose of this act is to maximize and direct the reinvestment of any savings to the Oklahoma Health Care Authority generated by enhanced federal matching authorized under Section 1905(b) of the Social Security Act at a rate of one hundred percent (100%) for covered services received through participating Indian Health Service, Tribal and Urban Indian (I/T/U) facilities. B. There is hereby created the I/T/U Shared Savings Program. Pursuant to guidance of the Centers for Medicare & Medicaid Services (CMS), authorized services provided by a non-I/T/U Medicaid provider to an American Indian or Alaska Native (AI/AN) Medicaid beneficiary as a result of a referral from an I/T/U facility provider may be eligible for the enhanced federal matching rate of one hundred percent (100%).C.1. The Authority shall distribute up to fifty percent (50%) of any savings that result from the I/T/U Shared Savings Program provided for in this section to participating I/T/U facilities that have complied with the terms of this act and applicable federal law, but only after administrative costs incurred by the Authority in implementing the I/T/U Shared Savings Program have been fully satisfied.2. Distributions to participating I/T/U facilities shall be used to increase care coordination and to support health care initiatives for AI/AN populations.3. The Authority shall deposit any shared savings that remain after administrative costs have been fully paid, and after distributions have been made to participating I/T/U facilities, into the I/T/U Shared Savings Revolving Fund created in Section 2 of this act for the purpose of increasing Medicaid provider rates. Monies in the fund shall not be used to replace other general revenues appropriated and funded by the Legislature or other revenues used to support Medicaid.D.1. All actions taken by the Authority in implementing the I/T/U Shared Savings Program shall be made in accordance with applicable state and federal Medicaid law and CMS State Health Official letter (SHO) #16-002, issued on February 26, 2016, and CMS Frequently Asked Questions (FAQs) regarding "Federal Funding for Services 'Received Through' an IHS/Tribal Facility and Furnished to Medicaid-Eligible American Indians and Alaska Natives (SHO #16-002)" issued on January 18, 2017, and as such guidance may be hereinafter amended or modified.2. The Authority shall make distributions to a participating I/T/U facility in accordance with paragraph 1 of subsection C of this section, contingent upon the production of executed copies of Care Coordination Agreements (CCAs) for all services billed to Oklahoma Medicaid that were received through the I/T/U facility. CCAs must be executed between the I/T/U facility and the non-I/T/U provider and must include, at a minimum, assurances that care coordination shall involve: a. the I/T/U facility practitioner providing a request for specific services by electronic or other verifiable means and relevant information about the practitioner's patient to the non-I/T/U provider,b. the non-I/T/U provider sending information about the care the non-I/T/U provider provides to the patient including the results of any screening, diagnostic or treatment procedures, to the I/T/U facility practitioner,c. the I/T/U facility practitioner continuing to assume responsibility for the patient's care by assessing the information and taking appropriate action including, when necessary, furnishing or requesting additional services, andd. the I/T/U facility incorporating the patient's information in the medical record through the statewide health information exchange or other agreed-upon means.E. The Oklahoma Health Care Authority Board is authorized to promulgate administrative rules and to enter into contractual agreements with I/T/U facilities as needed to effectuate the provisions of this act. As part of the rulemaking process, the Authority shall comply with the Tribal Consultation Requirements provided by the Medicaid State Plan.F. The Authority shall promptly seek any necessary federal approval for the implementation of this act. In the event that any necessary federal approval is not obtained, or in the event funding of Oklahoma Medicaid from state, federal or other sources is withdrawn, reduced or limited in any way that affects implementation of the I/T/U Shared Savings Program, the I/T/U Shared Savings Program may be terminated immediately by the Authority, and no court or tribunal shall have jurisdiction to review such termination.Okla. Stat. tit. 63, § 5061.1
Added by Laws 2021 , c. 568, s. 1, eff. 7/1/2021.