Oklahoma § 56-1011.3 - Powers, duties and responsibilities of Health Care

§ 56-1011.3. Powers, duties and responsibilities of Health Care

Authority – Program opt-out option.

A. The Oklahoma Health Care Authority shall have the following

powers, duties, and responsibilities with respect to the development

of the program established in Section 1011.2 of this title:

1. The consumer education component shall include the

following:

a.

to develop a choice counseling system to ensure that

the choice counseling process and related material are

designed to provide consumers an understanding of both

public and private health insurance options provided

by this act including incentives through face-to-face

interaction, by telephone, and in writing, and through

other forms of relevant media,

b.

to develop a system to ensure that there is record of

recipient acknowledgment that choice counseling has

been provided, and

c.

to develop a choice counseling system that promotes

health literacy and includes an educational component

that is intended to promote proper utilization of the

health care system;

2. The consumer choice component shall include a comprehensive

feasibility study to allow individuals more choices in their health

care coverage including, but not limited to, employer-sponsored

insurance options, and may include the following:

Oklahoma Statutes - Title 56. Poor Persons

a.

to develop a system to enable Medicaid consumers to

opt out of their current Medicaid program and purchase

health care coverage through their employer-sponsored

health insurance plan or access commercial health

insurance policies for their eligible family members,

b.

to develop an actuarially sound average cost per

Medicaid consumer to provide medically necessary

services. This value shall be used for a voucher

system to subsidize Medicaid consumers’ premium costs

for their employer-sponsored or commercial health

insurance option,

c.

to develop a process for Medicaid consumers to select

commercial health insurance options, the Oklahoma

Health Care Authority may develop a plan to implement

a personal health account system as an enhanced

benefit. Monies deposited into a personal health

account shall only be used by the recipient to defray

health-care-related costs including, but not limited

to, copayments, noncovered benefits, and wellness

initiatives. The Health Care Authority shall

promulgate rules guiding personal health account

transactions;

3. To provide a grievance-resolution process for Medicaid

consumers enrolled in a health plan. This process shall include a

mechanism for an expedited review of a grievance if the life of a

Medicaid recipient is in imminent and emergent jeopardy; and

4. To provide a grievance-resolution process for health care

providers employed by or contracted with a health plan to settle

disputes among the provider and the health plan or the provider and

the Oklahoma Health Care Authority.

B. Medicaid consumers electing to opt out of the current

program shall be subject to cost-sharing requirements, preexistingcondition clauses and the possibility of different benefits of their

employer-sponsored insurance or selected commercial health care

provider. The consumer shall also be responsible to pay for any

cost differential between the state subsidy and their premium cost

should their premium cost be higher. If the cost is lower than the

state subsidy, then the difference may be placed into a personal

health account.

C. Notwithstanding any other provision of this section,

coverage, cost sharing, and any other component of employersponsored health insurance shall be governed by applicable state and

federal laws.

D. The Oklahoma Health Care Authority shall develop a system to

ensure that the implementation of the provisions of this act do not

negatively affect the ability of American Indian or Alaska Native

beneficiaries to access services at Indian Health Service

Oklahoma Statutes - Title 56. Poor Persons

facilities, tribally operated health facilities and Urban Indian

Health Programs.

E. The Oklahoma Health Care Authority shall develop a system to

ensure that the implementation of the provisions of this act do not

negatively affect the reimbursement structure between the Oklahoma

Health Care Authority and the Indian Health Service facilities,

tribally operated health facilities and urban health programs.

F. The Oklahoma Health Care Authority shall develop mechanisms

through intergovernmental transfers which will allow tribally

operated facilities that elect to provide services to beneficiaries

other than American Indian or Alaska Native beneficiaries to receive

reimbursement for such services.

Added by Laws 2006, c. 315, § 3, emerg. eff. June 9, 2006. Amended

by Laws 2008, c. 412, § 3, eff. Nov. 1, 2008.