Medicaid; extending certain termination dates; establishing certain reimbursement rates for multistate contracts; effective date.
HB3650 amends Oklahoma’s Medicaid reimbursement statute to extend several existing payment protections and requirements from July 1, 2027 to July 1, 2028. The bill keeps in place minimum reimbursement floors for providers that do not enter value-based payment arrangements, including network and out-of-network provider rates tied to the Oklahoma Health Care Authority fee schedule. It also continues and expands rules for specific provider types such as rural health clinics, certified community behavioral health clinics, pharmacies, psychologists, anesthesia providers, ambulance and ground transportation services, and certain federally required payment methodologies.
The bill also adds or clarifies payment rules for managed care and contracted entities. It requires annual capitation updates, actuarial soundness, risk adjustment, and a quality/outcomes component in capitation rates. It authorizes a symmetric risk corridor, directs the Authority to monitor medical loss ratio compliance, and requires contracted entities to spend at least 11% of total health care expenses on primary care by the end of the fourth year of the initial contract period. In addition, it creates a specific reimbursement rule for multistate contracts, under which payment for covered services is the lesser of the multistate contract rate or the Authority’s fee schedule, and allows the Authority Board to adopt rules defining and limiting that provision.
HB3650 primarily affects the Oklahoma Health Care Authority, Medicaid contracted entities, and providers participating in the state Medicaid program. It extends existing minimum reimbursement requirements and preserves several provider-specific payment protections, while also adding new authority for rulemaking and clarifying how multistate managed care contracts are paid. The bill amends 56 O.S. 2021, Section 4002.12, and its changes are scheduled to take effect November 1, 2026.
The bill appears to have broad support overall. It passed House and Senate committee stages unanimously or near-unanimously, and it cleared the Senate floor without opposition. The House floor vote was also strongly favorable, though not unanimous, indicating some limited dissent but no major organized resistance in the recorded votes.
The main policy tension is between preserving provider reimbursement floors and giving the Oklahoma Health Care Authority flexibility to manage Medicaid contracts, especially for value-based payment arrangements and multistate contracts. Providers such as pharmacies, ambulance services, rural health clinics, psychologists, and anesthesia providers benefit from explicit payment protections, while contracted entities may view the new primary care spending target, medical loss ratio enforcement, and multistate contract reimbursement cap as constraints. The only notable floor opposition appears in the House third-reading vote, suggesting some members had concerns about the bill’s fiscal or administrative effects even though the bill advanced comfortably.