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STATE OF OKLAHOMA
2nd Session of the 60th Legislature (2026)
SENATE BILL 1559 By: McIntosh
AS INTRODUCED
An Act relating to the state Medicaid program;
defining term; requiring the Oklahoma Health Care
Authority to conduct certain pilot program;
describing pilot program; stipulating certain
requirements related to contracts; requiring certain
competitive bidding process; providing certain
qualifications for direct primary care providers;
requiring certain annual reports; providing for
codification; and providing an effective date.
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 1011.16 of Title 56, unless
there is created a duplication in numbering, reads as follows:
A. As used in this section, “direct primary care provider” has
the same meaning as provided in Section 4605 of Title 36 of the
Oklahoma Statutes.
B. The Oklahoma Health Care Authority shall conduct a pilot
program to test a direct primary care model for members of the state
Medicaid program as provided in this section. The pilot program
shall:
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1. Operate for a period of thirty-six (36) months, beginning no
later than six (6) months following the effective date of this act;
2. Serve a cohort of up to one thousand Medicaid beneficiaries;
3. Include one or more direct primary care providers, selected
based on criteria established by the Authority; and
4. Utilize per-member-per-month payments to direct primary care
providers and quality benchmarks compliant with federal regulations
to promote value-based care.
C. Contracts entered into for the pilot program established
under this section shall:
1. Be executed directly between the Oklahoma Health Care
Authority and one or more direct primary care providers, independent
of capitated contracts entered into by the Authority and contracted
entities under the Ensuring Access to Medicaid Act;
2. Specify:
a. the primary care services to be provided,
b. the target populations to be served,
c. the terms of per-member-per-month payments for direct
primary care providers, and
d. quality benchmarks to ensure accountability and
performance; and
3. Be compliant with federal regulations including 42 C.F.R.,
Part 438.
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D. 1. The Authority shall establish a competitive bidding
process to select direct primary care providers for the pilot
program. The selection process shall account for the distinct
operational model of direct primary care, facilitating effective
integration of direct primary care into the Medicaid framework.
2. To qualify for the pilot program, a direct primary care
provider shall meet federal enrollment and quality standards as
provided in 42 C.F.R., Section 455.410 and 42 C.F.R., Part 438, with
credentialing processes tailored to accommodate the noninsurance
framework of direct primary care.
E. During the operation of and at the conclusion of the pilot
program, the Authority shall electronically submit annual reports to
the President Pro Tempore of the Senate, the Speaker of the House of
Representatives, and the Governor detailing:
1. Access to primary care services;
2. Patient satisfaction;
3. Clinical outcomes;
4. Cost outcomes; and
5. Recommendations for policy changes, particularly regarding
the integration of direct primary care models into the state
Medicaid program.
SECTION 2. This act shall become effective November 1, 2026.
60-2-2385 DC 1/12/2026 6:45:16 PM