3RD PARTY CAPITATED MANAGED CARE
On June 18, 2020, Governor Kevin Stitt and Oklahoma Health Care Authority (OHCA) CEO Kevin Corbett announced the state would seek proposals from qualified managed care organizations (MCOs) to improve health outcomes, increase access to care, and increase system accountability in the Medicaid program (SoonerCare). The Request for Proposals (RFP) is currently in development, with a planned release this fall and an anticipated implementation date of October 1, 2021.
A MCO program will allow the state to coordinate SoonerCare members’ needs with the best provider to meet those needs, while containing costs through a capitated, risk-based model.
GOALS:
- Enhance care coordination efforts to improve health outcomes and member experience
- Provide value-add services to address social determinants of health and barriers to treatment
- Modernize payment model from fee-for-service to a model that incentivizes value and outcomes
POPULATIONS:
- Children, including foster children, low-income parents, pregnant women, and adults ages 19-65 (expansion population) will be enrolled.
- Individuals enrolled in SoonerCare due to their status as “aged, blind or disabled (ABD)” will initially remain in fee-for-service and will be phased in at the appropriate time.
- Senior citizens and people enrolled in both Medicare and Medicaid will initially remain in fee-for-service.
- American Indian/Alaska Native members are considered voluntary and will have the option to opt in to a managed care plan.
- To ensure each member has a health plan responsible for their care and health, the SoonerCare application will include a choice of plans. People who do not choose a plan will have one assigned to them. Members will have opportunities to switch their plan. OHCA will seek at least 3 plans to provide statewide network coverage.
COVERED SERVICES:
- MCOs will be required to cover services under appropriate OHCA State Plan and Waiver authority.
- Major services included: Behavioral Health, Pharmacy
- Excluded: Dental services will be administered through a separate RFP process to run concurrently with the medical managed care RFP.
TIMELINES:
- The request for proposals (RFP) is expected to be released mid-October 2020
- RFPs for MCOs will be awarded and announced in January/February 2021
- Expansion population joins fee-for-service population in July 2021
- MCOs will begin facilitating services and implementing health plans in October 2021
RESOURCES:
Last Modified on
Dec 10, 2020
