The Oklahoma Health Care Authority shall have the following powers, duties, and responsibilities with respect to the development of the program established in Section 2 of this act:

1. 1. The consumer education component shall include the following:

   1. a. to develop a choice counseling system to ensure that the choice counseling process and related material are designed to provide consumers an understanding of both public and private health insurance options provided by this act including incentives through face-to-face interaction, by telephone, and in writing, and through other forms of relevant media,
   2. b. to develop a system to ensure that there is record of recipient acknowledgment that choice counseling has been provided, and
   3. c. to develop a choice counseling system that promotes health literacy and includes an educational component that is intended to promote proper utilization of the health care system;

2. 2. The consumer choice component shall include the following:

   1. a. to develop a system to enable insurable Medicaid consumers to access commercial health insurance policies,
   2. b. to develop an actuarially sound cost per Medicaid consumer within different age groups and other relevant categories including health status to provide medically necessary services which may be separated to cover comprehensive care, enhanced services, and catastrophic care. This cost would be converted into a credit or instrument of value for the Medicaid consumer to purchase qualified health insurance policies,
   3. c. in conjunction with the Oklahoma Insurance Department, to determine benefits and standards for commercial insurers accessed by Medicaid consumers,
   4. d. to allow consumers to purchase health care coverage through an employer-sponsored health insurance plan instead of through a qualified health insurance plan. This provision shall be known as the employee choice option. A recipient who chooses the Medicaid employee choice option shall have an opportunity for a specified period of time, as authorized by the Centers for Medicare and Medicaid Services, to select and enroll in a qualified health insurance plan,
   5. e. to develop a process for Medicaid consumers to select commercial health insurance options, the Oklahoma Health Care Authority shall develop a plan to implement a personal health account system as an enhanced benefit. Monies deposited into a personal health account shall only be used by the recipient to defray health-care-related costs including, but not limited to, copayments, noncovered benefits, and wellness initiatives. The Health Care Authority shall promulgate rules guiding personal health account transactions; and
3. 3. To provide a grievance-resolution process for Medicaid consumers enrolled in a health plan. This process shall include a mechanism for an expedited review of a grievance if the life of a Medicaid recipient is in imminent and emergent jeopardy.
4. 4. To provide a grievance-resolution process for health care providers employed by or contracted with a health plan to settle disputes among the provider and the health plan or the provider and the Oklahoma Health Care Authority.
5. 5. By July 1, 2008, the Oklahoma Health Care Authority shall institute cost-sharing methods and/or benefit modifications within federal limitations to eligible persons whose family income is between one hundred thirty-three percent (133%) and one hundred eighty-five percent (185%) of the federal poverty level. The benefits shall be no less than the state-sponsored health care coverage through the state premium assistance program authorized in subsection D of Section 1010.1 of Title 56 of the Oklahoma Statutes.
6. 6. Notwithstanding any other provision of this section, coverage, cost sharing, and any other component of employer-sponsored health insurance shall be governed by applicable state and federal laws.
7. 7. The Oklahoma Health Care Authority shall develop a system to ensure that the implementation of the provisions of this act do not negatively affect the ability of American Indian or Alaska Native beneficiaries to access services at Indian Health Service facilities, tribally operated health facilities and Urban Indian Health Programs.
8. 8. The Oklahoma Health Care Authority shall develop a system to ensure that the implementation of the provisions of this act do not negatively affect the reimbursement structure between the Oklahoma Health Care Authority and the Indian Health Service facilities, tribally operated health facilities and urban health programs.
9. 9. The Oklahoma Health Care Authority shall develop mechanisms through intergovernmental transfers which will allow tribally operated facilities that elect to provide services to beneficiaries other than American Indian or Alaska Native beneficiaries to receive reimbursement for such services.

Added by Laws 2006, HB 2842, c. 315, § 3, emerg. eff. June 9, 2006.