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2022 Legislative Session: OHCA to Move to Managed Care Medicaid
LEGISLATIVE LOOP
Legislative Overview & Political Update
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2022 Legislative Session:
Oklahoma Healthcare Authority to Move to Managed Care Medicaid
By: Scott Adkins, ODA Contract Lobbyist
The 2022 Oklahoma Legislative session formally ended on Friday, May 27, with the Sine Die adjournment of the House of Representatives and the Oklahoma State Senate. Most legislation was finalized, and the budget passed, on Friday the 20th, to provide the Legislature with the required five legislative days for the Governor to sign or veto the final round of bills. The Oklahoma Constitution mandates that the legislature convene on the first Monday in February and must adjourn by 5:00 pm on the last Friday in May of each year. Our state budget continues to be very strong. Oklahoma’s resistance to a complete COVID-19 economic shutdown, the rapid return of business activity, and a staggering amount of federal stimulus have resulted in huge budget surpluses for the coming fiscal year and likely the next. Total appropriations from the Legislature totaled $9.8 billion and still left almost $2 billion unspent. In one of the final acts of the 2022 legislative session, the Oklahoma House and Senate passed SB 1337. This will provide the framework for the Oklahoma Healthcare Authority (OHCA) to begin the transformation of the state Medicaid program into a managed care delivery system. While almost every state has some sort of managed Medicaid scheme, most healthcare providers in Oklahoma have opposed moving to managed care. Over the last decade, there have been many attempts to change Medicaid. The ODA has always strongly opposed moving to a managed care delivery system and has never supported passage of SB 1337. But as a result of our decade long fight, we knew what to watch for and some things to anticipate. While it’s not the outcome that we wanted, the ODA fought hard for many protections for dentists and their offices. Full implementation is set for October 1, 2023. Below, are some details of provisions specific to oral health and dentistry. Dentistry will be separated from hospitals and most providers and carved out into our own program. The OHCA will issue two requests for proposals; one will handle hospitals, medical and the more comprehensive components, and a second will be issued that is specifically to dentistry. A minimum of two dental benefit managers (managed care organizations) will be chosen by the OHCA to manage Medicaid dental services. As a result of efforts by the ODA, Oklahoma dentists will still operate under a fee for service delivery system, as capitation in a traditional sense, has been prohibited in the dental sections of the bill.
Until July 1, 2026, a rate floor will be established by the OHCA with minimum reimbursement requirements. All managed care organizations and dental benefit managers will be prohibited from reducing reimbursements below that level. All dental benefit managers shall maintain a Medicaid Dental Advisory Committee, comprising EXCLUSIVELY Oklahomalicensed dentists and specialists, to advise dental benefit managers regarding metrics and quality measures. Dental providers shall not be required to enter into any capitated contracts with any dental benefit manager. No later than one year after implementation, the OHCA shall create a scorecard that separately compares each dental benefit manager. The scorecard shall report the average speed of authorization of services, rates of denials, member satisfaction survey results, provider satisfaction survey results, and possibly other reimbursement metrics. The scorecard will be published quarterly and will be provided to all members and published on the OHCA website. The Oklahoma Dental Association will be engaging with the OHCA through every step of the process to ensure that our Medicaid providers are represented. While many protections, such as prompt pay provisions from last year’s efforts, are also in place, the ODA will be holding the agency accountable to our members. We will keep you updated as details emerge from the potential RFPs (requests for proposals) and our meetings with the Governor and the OHCA administration. As always, the focus of the Oklahoma Dental Association will be on the oral health of our citizens and on ensuring that our dentists have every resource available to manage their practice and provide exceptional patient care.
The ADA supports HR 4726, the Student Loan Interest Deduction Act of 2021, which would increase the student loan interest deduction from $2,500 to $5,000 and remove income limits so borrowers living in high-cost areas can receive the benefit. Dentists now have an average of nearly $305,000 in educational debt when they graduate, which can be a financial burden, especially for those who have nonpaying or low-paying residencies. HR 4726 will not replace comprehensive student loan reform, but will make debt more manageable. Learn more at ada.org/advocacy/student-debt.
