Read the full stored bill text
An Act
ENROLLED HOUSE
BILL NO. 2797 By: Caldwell (Trey) and Kane of
the House
and
Hall and Haste of the
Senate
An Act relating to the Oklahoma Health Care
Authority; defining terms; prohibiting use of certain
methodology by the Oklahoma Health Care Authority;
nullifying results from certain audits using specific
methodology; specifying certain time periods;
prohibiting certain actions with respect to
repayments or penalties; requiring compliance with
respect to fraud reporting; requiring joint
collaboration between the Oklahoma Department of
Mental Health and Substance Abuse Services and the
Department of Human Services; requiring training
materials for certain presentation; amending 56 O.S.
2021, Section 1020, which relates to duties of the
Oklahoma Department of Human Services; specifying
certain duties with respect to the Oklahoma Health
Care Authority; providing for codification; and
declaring an emergency.
SUBJECT: Oklahoma Health Care Authority
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 1011.9A of Title 56, unless
there is created a duplication in numbering, reads as follows:
A. As used in this section:
ENR. H. B. NO. 2797 Page 2
1. "Error rate" means the percentage of dollars of audited
claims found to be billed in error;
2. "Extrapolation" means the methodology of estimating an
unknown value by projecting, with a calculated precision, i.e.,
margin of error, the results of a probability sample to the universe
from which the sample was drawn;
3. "Probability sample" means the standard statistical
methodology in which a sample is selected based on the mathematical
theory of probability;
4. "Sample" means a statistically valid number of claims
obtained from the universe of claims audited or reviewed; and
5. "Universe" means all paid claims or types of paid claims
audited or reviewed during a specified time frame.
B. For claims payable to providers of Medicaid home and
community-based services submitted on or after January 27, 2020, but
not later than November 1, 2027, the Oklahoma Health Care Authority
shall not use:
1. Extrapolation or any other statistical method for the
auditing of such claims that can result in a determination that a
provider is required to repay any amount paid to such provider in
excess of the amount of the audited claim, regardless of the claims
error rate; or
2. Statistical sampling to audit submitted claims in a manner
that can result in a liability amount in excess of the total amount
of claims used in a statistical sample.
C. The use by the Oklahoma Health Care Authority of any
methodology as described in subsection A of this section prior to
the effective date of this act, and which was performed pursuant to
the provisions of Oklahoma Administrative Code 317:30-3-2.1 with
respect to an audit period beginning on or after January 27, 2020,
through November 1, 2025, shall be deemed as invalid and any demand
for payment made to a provider on the basis of such methodology
shall be null and void. The Oklahoma Health Care Authority shall
not have authority to make any demand for repayment from a provider
with respect to an audit the effect of which has been nullified
pursuant to the provisions of this subsection or to impose a
financial penalty upon such provider with respect to any such audit.
ENR. H. B. NO. 2797 Page 3
D. The Oklahoma Health Care Authority shall comply with the
requirements of Section 249 of Title 56 of the Oklahoma Statutes
with respect to the reporting of alleged fraud.
E. The Oklahoma Health Care Authority and the Department of
Human Services shall work in conjunction to develop and refine an
audit methodology with respect to claims submitted for payment by
providers in the Home and Community Based Waivers related programs.
The agencies shall develop an information and training program so
that affected providers and their authorized agents have an
opportunity to become familiar with the audit standards and have a
clear and consistent set of guidelines with respect to the claims
submission process and any possible audit activity. The joint
program shall be complete and ready for presentation to providers
and their authorized agents not later than November 1, 2027.
SECTION 2. AMENDATORY 56 O.S. 2021, Section 1020, is
amended to read as follows:
Section 1020. A. The Director of the Department of Human
Services shall, within the constraints of funding appropriated to
the Department, establish and maintain a community-based program of
services that includes, but is not limited to, establishment of
foster care and supported living arrangements for persons affected
by Prader-Willi syndrome. The purpose of this section of law shall
be to improve the quality of life of persons with developmental
disabilities and to integrate such persons into the mainstream of
society by ensuring availability of community services.
B. The programs established pursuant to this section shall be
administered by the Developmental Disabilities Service Division.
The Commission for Human Services shall promulgate rules for the
operation of community-based programs for persons with developmental
disabilities including, but not limited to, rules regarding the
delivery of:
1. Health-related services. As used in this section, health-
related services means services provided by community services
providers or community services workers to persons with
developmental disabilities, and includes, but is not limited to:
a. personal hygiene,
b. transferring,
ENR. H. B. NO. 2797 Page 4
c. range of motion,
d. supervision or assistance with activities of daily
living,
e. basic nursing care, such as taking the person's
temperature, pulse or respiration, positioning,
incontinent care, and identification of signs and
symptoms of disease. Certain tasks that may be
performed as basic nursing care by community services
workers require appropriate training provided or
approved by the Department, written agreement by the
service recipient's personal support team, and the
primary care physician's acknowledgment and specific
order related to the task. Under such circumstances,
basic nursing care may include, but need not be
limited to:
(1) nutrition, including meals by gastrostomy tube or
jejeunostomy jejunostomy tube,
(2) blood glucose monitoring,
(3) ostomy bag care,
(4) oral suctioning, and
(5) administration of oral metered dose inhalers and
nebulizers;
2. Supportive assistance, which means the service rendered to
persons with developmental disabilities that is sufficient to enable
such person to meet an adequate level of daily living. Supportive
assistance includes, but is not limited to, training and supervision
of persons with developmental disabilities, assistance in
housekeeping, assistance in the preparation of meals, and assistance
in activities of daily living as necessary for the health and
comfort of persons with developmental disabilities; and
3. Safe storage and administration of medications, first aid
treatments and nutrition by oral, rectal, vaginal, otic, ophthalmic,
nasal, skin, topical, transdermal and gastrostomy tube routes by
community service workers who have successfully completed
competency-based training approved by the Department.
ENR. H. B. NO. 2797 Page 5
C. The Department shall undertake to identify and utilize any
and all federal funding which may be available for such services.
D. The Department is authorized to accept any gift of real or
personal property made for the use or benefit of any program or
services established pursuant to this section. Such gift may only
be utilized for the purpose or purposes for which it is given.
E. The Department shall be the agency responsible for annual
performance audits of community-based services provided through Home
and Community-Based Medicaid Waivers. The Oklahoma Health Care
Authority (OHCA) shall be responsible for auditing claims to confirm
that the services billed by contract providers have been delivered
per requirements from the Centers for Medicare and Medicaid Services
(CMS).
SECTION 3. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
ENR. H. B. NO. 2797 Page 6
Passed the House of Representatives the 20th day of May, 2025.
Presiding Officer of the House
of Representatives
Passed the Senate the 22nd day of May, 2025.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________