Oklahoma § 56-4002.14 - Uniform defined measures and goals - Provider quality

§ 56-4002.14. Uniform defined measures and goals - Provider quality

metrics.

A. The transformed delivery system of the state Medicaid

program and capitated contracts awarded under the transformed

delivery system shall be designed with uniform defined measures and

goals that are consistent across contracted entities including, but

not limited to, adjusted health outcomes, social determinants of

health, quality of care, member satisfaction, provider satisfaction,

access to care, network adequacy, and cost.

B. Prior to implementation of the transformed Medicaid delivery

system, each contracted entity shall use nationally recognized,

standardized provider quality metrics as established by the Oklahoma

Health Care Authority and, where applicable, may use additional

quality metrics if the measures are mutually agreed upon by the

Authority, the contracted entity, and participating providers. The

Authority shall develop processes for determining quality metrics

and cascading quality metrics from contracted entities to

subcontractors and providers.

Oklahoma Statutes - Title 56. Poor Persons

C. The Authority may use consultants, organizations, or

measures used by health plans, the federal government, or other

states to develop effective measures for outcomes and quality

including, but not limited to, the National Committee for Quality

Assurance (NCQA) or the Healthcare Effectiveness Data and

Information Set (HEDIS) established by NCQA, the Physician

Consortium for Performance Improvement (PCPI) or any measures

developed by PCPI.

D. Each component of the quality metrics established by the

Authority shall be subject to specific accountability measures

including, but not limited to, penalties for noncompliance.

Added by Laws 2022, c. 395, § 19, eff. July 1, 2022.