Library: Policy
317:55-3-14. Primary care requirements
Revised 7-1-23
(a) Primary care spending/expenses. No later than the end of the fourth (4th) year of the initial contracting period, each CE shall be currently spending not less than eleven percent (11%) of its total health care expenses on primary care services.
(b) Primary care expenditure reporting requirements.
(1) The CEs must submit a primary care implementation plan which describes the CEs strategies for increasing the percentage of total medical expenditures allocated to primary care over the initial four (4) year contract period.
(2) The plan shall include target annual percentage increases over the previous year baseline data that demonstrate the CEs ability to achieve eleven percent (11%) by the end of year four (4).
(c) Primary care expenditure calculations.
(1) CEs shall submit data on an annual basis for primary care and total medical expenditures made through paid claims amounts and non-claims payments to the OHCA, in the manner and timeline prescribed in the SoonerSelect Contract.
(2) The OHCA will consider non-claims-based investments into primary care including but not limited to investments in electronic health record (EHR) systems, health information exchange (HIE) costs, care coordination activities and systems, and recruitment/retention incentives for primary care providers in rural and medically underserved areas.
(3) Other non-claims-based investments may be reviewed and approved by the OHCA.
(4) The OHCA may impose a cap on the amount of non-claims-based investment considered in the primary care expenditure calculation.
