Okla. Stat. tit. 56, § 56-4002.4
This is the official text of Okla. Stat. tit. 56, § 56-4002.4, part of Oklahoma’s Stat. tit. 56, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 56,." Browse the sections below, each linked to its official government source.
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Network adequacy standards for contracted entities
Official statutory text
A. The Oklahoma Health Care Authority shall develop network
adequacy standards for all contracted entities that, at a minimum,
meet the requirements of 42 C.F.R., Sections 438.3 and 438.68.
Network adequacy standards established under this subsection shall
include distance and time standards and shall be designed to ensure
members covered by the contracted entities who reside in health
professional shortage areas (HPSAs) designated under Section
332(a)(1) of the Public Health Service Act (42 U.S.C., Section
254e(a)(1)) have access to in-person health care and telehealth
services with providers, especially adult and pediatric primary care
practitioners.
B. The Authority shall require all contracted entities to offer
or extend contracts with all essential community providers, all
providers who receive directed payments in accordance with 42
C.F.R., Part 438 and such other providers as the Authority may
specify. The Authority shall establish such requirements as may be
necessary to prohibit contracted entities from excluding essential
community providers, providers who receive directed payments in
accordance with 42 C.F.R., Part 438 and such other providers as the
Authority may specify from contracts with contracted entities.
C. To ensure models of care are developed to meet the needs of
Medicaid members, each contracted entity must contract with at least
one local Oklahoma provider organization for a model of care
containing care coordination, care management, utilization
management, disease management, network management, or another model
of care as approved by the Authority. Such contractual arrangements
must be in place within twelve (12) months of the effective date of
the contracts awarded pursuant to the requests for proposals
authorized by Section 4002.3a of this title.
D. All contracted entities shall formally credential and
recredential network providers at a frequency required by a single,
consolidated provider enrollment and credentialing process
established by the Authority in accordance with 42 C.F.R., Section
438.214. A contracted entity shall complete credentialing or
recredentialing of a provider within sixty (60) calendar days of
receipt of a completed application.
Oklahoma Statutes - Title 56. Poor Persons Page 306
E. All contracted entities shall be accredited in accordance
with 45 C.F.R., Section 156.275 by an accrediting entity recognized
by the United States Department of Health and Human Services.
F. 1. If the Authority awards a capitated contract to a
provider-led entity or provider-owned entity for the urban region
under Section 4002.3b of this title, the provider-led entity or
provider-owned entity shall expand its coverage area to every county
of this state within the time frame set by the Authority under
subsection E of Section 4002.3b of this title.
2. The expansion of the provider-led entity’s or provider-owned
entity’s coverage area beyond the urban region shall be subject to
the approval of the Authority. The Authority shall approve
expansion to counties for which the provider-led entity or provider-
owned entity can demonstrate evidence of network adequacy as
required under 42 C.F.R., Sections 438.3 and 438.68. When approved,
the additional county or counties shall be added to the provider-led
entity’s or provider-owned entity’s region during the next open
enrollment period.
adequacy standards for all contracted entities that, at a minimum,
meet the requirements of 42 C.F.R., Sections 438.3 and 438.68.
Network adequacy standards established under this subsection shall
include distance and time standards and shall be designed to ensure
members covered by the contracted entities who reside in health
professional shortage areas (HPSAs) designated under Section
332(a)(1) of the Public Health Service Act (42 U.S.C., Section
254e(a)(1)) have access to in-person health care and telehealth
services with providers, especially adult and pediatric primary care
practitioners.
B. The Authority shall require all contracted entities to offer
or extend contracts with all essential community providers, all
providers who receive directed payments in accordance with 42
C.F.R., Part 438 and such other providers as the Authority may
specify. The Authority shall establish such requirements as may be
necessary to prohibit contracted entities from excluding essential
community providers, providers who receive directed payments in
accordance with 42 C.F.R., Part 438 and such other providers as the
Authority may specify from contracts with contracted entities.
C. To ensure models of care are developed to meet the needs of
Medicaid members, each contracted entity must contract with at least
one local Oklahoma provider organization for a model of care
containing care coordination, care management, utilization
management, disease management, network management, or another model
of care as approved by the Authority. Such contractual arrangements
must be in place within twelve (12) months of the effective date of
the contracts awarded pursuant to the requests for proposals
authorized by Section 4002.3a of this title.
D. All contracted entities shall formally credential and
recredential network providers at a frequency required by a single,
consolidated provider enrollment and credentialing process
established by the Authority in accordance with 42 C.F.R., Section
438.214. A contracted entity shall complete credentialing or
recredentialing of a provider within sixty (60) calendar days of
receipt of a completed application.
Oklahoma Statutes - Title 56. Poor Persons Page 306
E. All contracted entities shall be accredited in accordance
with 45 C.F.R., Section 156.275 by an accrediting entity recognized
by the United States Department of Health and Human Services.
F. 1. If the Authority awards a capitated contract to a
provider-led entity or provider-owned entity for the urban region
under Section 4002.3b of this title, the provider-led entity or
provider-owned entity shall expand its coverage area to every county
of this state within the time frame set by the Authority under
subsection E of Section 4002.3b of this title.
2. The expansion of the provider-led entity’s or provider-owned
entity’s coverage area beyond the urban region shall be subject to
the approval of the Authority. The Authority shall approve
expansion to counties for which the provider-led entity or provider-
owned entity can demonstrate evidence of network adequacy as
required under 42 C.F.R., Sections 438.3 and 438.68. When approved,
the additional county or counties shall be added to the provider-led
entity’s or provider-owned entity’s region during the next open
enrollment period.
Status: in_force · Read it on the official government site
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