Okla. Stat. tit. 63 § 3241.2

Current through Laws 2024, c. 453.

Section 3241.2 - Definitions

As used in the Supplemental Hospital Offset Payment Program Act:

1. "Authority" means the Oklahoma Health Care Authority;

2. "Base year" means a hospital's fiscal year as reported in the Medicare Cost Report or as determined by the Authority if the hospital's data is not included in the Medicare Cost Report. The base year data shall be used in all assessment calculations;

3. "Contracted entity" has the same meaning as provided by Section 2 of Enrolled Senate Bill No. 1337 of the 2nd Session of the 58th Oklahoma Legislature;

4. "Directed payments" means payment arrangements allowed under 42 C.F.R. Section 438.6(c) that permit states to direct specific payments made by managed care plans to providers under certain circumstances and can assist states in furthering the goals and priorities of their Medicaid programs;

5. "Eligible hospital" means a hospital physically located in this state that is eligible to participate in the Supplemental Hospital Offset Payment Program and not otherwise exempt pursuant to subsection B of Section 3241.3 of this title;

6. "Hospital" means an institution licensed by the State Department of Health as a hospital pursuant to Section 1-701 of this title maintained primarily for the diagnosis, treatment, or care of patients;

7. "Hospital Advisory Committee" or "Committee" means the Committee established to advise the Oklahoma Health Care Authority regarding the design and implementation of the Supplemental Hospital Offset Payment Program. The Committee shall be composed of five (5) members chosen from a list of recommendations submitted by a statewide association representing rural and urban hospitals, as follows:

a. one member, appointed by the Governor, who shall serve as chair, and

b. two members appointed each by the President Pro Tempore of the Senate and the Speaker of the House of Representatives. The Committee shall meet no less than annually and shall be consulted by the Authority at least thirty (30) days prior to submission of any proposed state plan amendment or proposed directed payment application and prior to adoption of any administrative rule that may affect either the assessments or hospital access payments authorized by this act;

8. "Managed care gap" means the difference between:

a. the maximum amount that can be paid for hospital inpatient and outpatient services to Medicaid managed care enrollees, and

b. the total amount of Medicaid managed care base rate claims payments for hospital inpatient and outpatient services. In calculating the managed care gap, the Authority shall use a ninety percent (90%) average commercial rates benchmark for determining the maximum amount that will be paid for hospital inpatient and outpatient services, subject to approval by the federal Centers for Medicare and Medicaid Services. The Authority may make the calculation in this paragraph using good-faith reasonable estimates if complete data does not exist or is not available;

9. "Medicaid" means the medical assistance program established in Title XIX of the federal Social Security Act and administered in this state by the Oklahoma Health Care Authority;

10. "Medicare Cost Report" means the Hospital Cost Report, Form CMS-2552-10, or subsequent versions;

11. "Net hospital patient revenue" means the gross hospital revenue as reported on Worksheet G-2 (Columns 1 and 2, Lines "Total inpatient routine care services", "Ancillary services", and "Outpatient services") of the Medicare Cost Report, multiplied by the hospital's ratio of total net to gross revenue, as reported on Worksheet G-3 (Column 1, Line "Net patient revenues") and Worksheet G-2 (Part I, Column 3, Line "Total patient revenues");

12. "Upper payment limit" means the maximum ceiling imposed by 42 C.F.R., Sections 447.272 and 447.321 on hospital Medicaid fee-for-service reimbursements for inpatient and outpatient services, other than to hospitals owned or operated by state government; and

13. "Upper payment limit gap" means the difference between the upper payment limit and Medicaid fee-for-service payments made to all hospitals for hospital inpatient and outpatient services, other than hospitals owned or operated by state government.

Okla. Stat. tit. 63, § 3241.2

Amended by Laws 2022 , c. 398, s. 1, eff. 5/26/2022.

Amended by Laws 2021 , c. 518, s. 1, eff. 8/27/2021.

Amended by Laws 2019 , c. 56, s. 1, eff. 11/1/2019.

Amended by Laws 2016 , c. 345, s. 1, eff. 11/1/2016.

Amended by Laws 2013 , c. 132, s. 1, eff. 11/1/2013.

Added by Laws 2011 , HB 1381, c. 228, §2.