§56-4002.14. Uniform defined measures and goals - Provider quality
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/ok/title-56-poor-persons/56-4002-14·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
metrics.
A. The transformed delivery system of the state Medicaid program and capitated contracts awarded under the transformed delivery system shall be designed with uniform defined measures and goals that are consistent across contracted entities including, but not limited to, adjusted health outcomes, social determinants of health, quality of care, member satisfaction, provider satisfaction, access to care, network adequacy, and cost.
B. Prior to implementation of the transformed Medicaid delivery system, each contracted entity shall use nationally recognized, standardized provider quality metrics as established by the Oklahoma Health Care Authority and, where applicable, may use additional quality metrics if the measures are mutually agreed upon by the Authority, the contracted entity, and participating providers. The Authority shall develop processes for determining quality metrics and cascading quality metrics from contracted entities to subcontractors and providers.
C. The Authority may use consultants, organizations, or measures used by health plans, the federal government, or other states to develop effective measures for outcomes and quality including, but not limited to, the National Committee for Quality Assurance
(NCQA)or the Healthcare Effectiveness Data and Information Set (HEDIS) established by NCQA, the Physician Consortium for Performance Improvement
(PCPI)or any measures developed by PCPI.
D. Each component of the quality metrics established by the Authority shall be subject to specific accountability measures including, but not limited to, penalties for noncompliance. Added by Laws 2022, c. 395, § 19, eff. July 1, 2022.