The Oklahoma Health Care Authority (OHCA) has chosen three Managed Care Organizations (MCO’s) also referred to as “Contracted Entities (CE)”, Aetna Better Health of Oklahoma, Humana Healthy Horizons of Oklahoma, and Oklahoma Complete Health (a Centene Corporation subsidiary), to implement its comprehensive health care model, SoonerSelect, for specific SoonerCare members. The move aims to shift from a fee-for-service model to a new delivery system, emphasizing quality of service and health outcomes while ensuring fiscal responsibility. SoonerSelect will incentivize health outcomes, maintain oversight of Oklahoma’s Medicaid program, and strengthen local providers’ voices. The transition is expected to improve health outcomes, move toward value-based payment, enhance member satisfaction, contain costs through preventive and primary care, and increase cost predictability. The selected organizations, chosen through competitive bids, will work with OHCA through June 30, 2025, with renewal options. Pending approval by the Centers for Medicare and Medicaid Services, the medical and children’s specialty plans are set to launch in April 2024, and dental plans in February 2024.
MCO’s will reach out to providers to begin building their proposed provider network. MCO’s are not required to accept every provider in their network. However, under federal regulation they are prohibited from excluding the following provider types:
a, FQHCs and RHCs
b. Family planning providers (Title X family planning clinics and Title X “look-alike” family planning clinics)
c. IHCPs
d. County health departments or city-county health departments
e. Government-funded/operated CMHCs/CCBHCs
f. Government-operated state mental health hospitals
g. State agencies including but not limited to OJA, OSDH and OHS
h. Local, regional and state educational services agencies
i. Local health departments
j. Long-term care hospitals serving children (LTCHs-C)
k. A teaching hospital owned, jointly owned, or affiliated with and designated by the University Hospitals Authority, University Hospitals Trust, Oklahoma State University Medical Authority, or Oklahoma State University Medical Trust
l. A provider employed by or contracted with, or otherwise a member of the faculty practice plan of a public, accredited medical school in this state or a hospital/health care entity directly or indirectly owned or operated by the University Hospitals Trust or the Oklahoma State University Medical Trust
m. A provider employed by or contracted with a primary care residency program accredited by the Accreditation Council for Graduate Medical Education
n. A comprehensive community addiction recovery center
o. A hospital licensed by the state of Oklahoma, including all hospitals participating the in the Supplemental Hospital Offset Payment Program
p. Certified Community Behavioral Health Clinics (CCBHCs)
q. Other entities certified by CMS as an essential community as specified under 45 C.F.R. § 156.235
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