The Oklahoma Health Care Authority (OHCA) will assess the ability and capacity of each contracted entity (CE), or health/dental plan, to ensure they can meet the needs of Oklahoma SoonerCare members and meet the requirements outlined in the contract and federal regulations.
CMS requires states to assess if CEs are “ready” to provide services to SoonerSelect enrollees before implementation. The process ensures accountability and strengthens program integrity safeguards.
OHCA will conduct this review by evaluating materials and information submitted by each CE and during OHCA staff site visits to each CE’s office.
OHCA will assess CEs on their ability and capacity to perform in four broad areas (in accordance with 42 CFR § 438.66(d)(4)):
- Service Delivery
- Financial Management
- Systems Management
OHCA will submit the findings to CMS for review and approval.
The readiness review process is integral to supporting delivery system reform while effectively managing costs and practicing fiscal responsibility.
This months-long process ensures plans are ready to serve SoonerSelect enrollees.