1. A.

   1. 1. The Oklahoma Health Care Authority shall assess a quality assurance assessment fee upon each health maintenance organization that has a Medicaid managed care contract awarded by the state and administered by the Oklahoma Health Care Authority. The quality assurance assessment fee shall equal six percent (6%) of all annual non-Medicare premiums collected by a health maintenance organization.
   2. 2. The quality assurance assessment fee shall only be assessed on a health maintenance organization that has in effect a Medicaid managed care contract awarded by the state and administered by the Oklahoma Health Care Authority at the time of the assessment. A Medicaid managed care organization shall have thirty (30) days after the effective date of this act to determine if such organization will terminate its contract with the Oklahoma Health Care Authority. If a Medicaid managed care organization decides to terminate its contract with the Oklahoma Health Care Authority during the thirty-day period such an organization shall not be assessed any quality assurance assessment fee. If a Medicaid managed care organization terminates its contract with the Oklahoma Health Care Authority prior to the collection of a fee, the most current quarterly fee shall not be assessed or collected for the quarter in which the organization terminated its contract.

   3. 3.

      1. a. In lieu of terminating its contract with the Oklahoma Health Care Authority pursuant to the provisions of paragraph 2 of this subsection and in order to provide the Medicaid population with access to quality health care without disrupting caseload balances by and among Medicaid managed care organizations, a Medicaid managed care organization may, at its own expense, create a stand alone Medicaid managed care organization from its current book of business, provided the following criteria are met:

         1. (1) the Medicaid premium of the Medicaid managed care organization is less than twenty percent (20%) of its total premium for all business,
         2. (2) the Medicaid managed care organization is licensed in good standing pursuant to the provisions of Section 2501 et seq. of Title 63 of the Oklahoma Statutes and has been licensed pursuant to such provisions for at least eight (8) consecutive years,
         3. (3) the action will not result in substantive or material changes in policies or operation of the Medicaid managed care organization or the new entity,
         4. (4) the Medicaid managed care organization and the new entity will retain the same owners, management and board members, and
         5. (5) the Medicaid managed care organization and the new entity meet all requirements or conditions established by law for health maintenance organizations licensed to do business in this state.
      2. b. Notwithstanding the provisions of paragraph 3 of subsection A of Section 2504 of Title 63 of the Oklahoma Statutes and rules promulgated pursuant thereto, any Medicaid managed care organization electing to proceed under the provisions of this paragraph shall be entitled to a hearing within twenty (20) days from the date application is made to the State Department of Health. For purposes of this paragraph, the Department shall forward a copy of the application to the Insurance Commissioner who shall review the application for fiscal responsibility and fiducial integrity and make recommendations to the Department prior to the hearing date. If a response is not received from the Insurance Commissioner prior to the hearing date, the Department may proceed to make a determination upon the application as submitted. The Department shall have ten (10) days from the hearing date to grant or deny a license to the new Medicaid managed care organization.
   4. 4. As used in this subsection, "Medicaid managed care organization" means a health maintenance organization that has a Medicaid managed care contract awarded by the state and administered by the Oklahoma Health Care Authority.

2. B.

   1. 1. The quality assurance assessment fee shall be assessed on all annual non-Medicare premiums collected by each health maintenance organization described in subsection A of this section based on the health maintenance organization’s filings with the Oklahoma Insurance Commissioner pursuant to Section 629 of Title 36 of the Oklahoma Statutes. The quality assurance assessment fee shall be assessed after April 1, June 15, September 15, and December 15 of each year.
   2. 2. Except as otherwise provided by law, the quality assurance assessment fee shall be payable to the Oklahoma Health Care Authority on a quarterly basis. Each payment shall be due sixty (60) days after the filings of the estimates of premiums pursuant to Section 629 of Title 36 of the Oklahoma Statutes.
   3. 3. If a health maintenance organization does not have non-Medicare premium revenue listed in a filing under Section 629 of Title 36 of the Oklahoma Statutes, the assessment shall be based on an estimate by the Oklahoma Health Care Authority of the health maintenance organization’s annual non-Medicare premiums, assessed quarterly, and shall be payable upon receipt.

3. C. The quality assurance assessment fee collected pursuant to subsection A of this section and all federal matching funds attributed to the fee may be used by the Authority for the following purposes, including but not limited to:

   1. 1. The reinstatement of Medicaid service reductions made by the Oklahoma Health Care Authority from January 1, 2001, to January 1, 2003;
   2. 2. The restoration of Medicaid eligibility reductions promulgated by the Oklahoma Health Care Authority prior to January 1, 2003; and
   3. 3. The payment of actuarial sound rates, as determined by an independent qualified actuary, based on the benefit structure included in the SoonerCare Plus program.
4. D. In the event that federal financial participation pursuant to Title XIX of the Social Security Act is not available to the Oklahoma Medicaid program, for purposes of matching expenditures using the Medicaid managed care organization quality assurance assessment fee, at the approved federal medical assistance percentage for the applicable fiscal year, the Medicaid managed care organization quality assurance assessment fee shall be null and void as of the effective date of the invalidation.
5. E. If a health maintenance organization fails to pay the quality assurance assessment fee required under subsection A of this section, the Oklahoma Health Care Authority may assess the health maintenance organization a penalty of five percent (5%) of the assessment for each month that the assessment and penalty are not paid up to a maximum of fifty percent (50%) of the assessment. Such penalties may be recouped from Medicaid managed care organization payments made by the Oklahoma Health Care Authority.
6. F. The Oklahoma Health Care Authority shall deposit the revenue collected through the quality assurance assessment fee in the Medicaid revolving fund established by Section 5016 of Title 63 of the Oklahoma Statutes.

7. G. As used in this section:

   1. 1. "Medicaid" means Title XIX of the Social Security Act, 42 U.S.C., Section 1396 et seq.;
   2. 2. "Medicare" means Title XVIII of the Social Security Act 42 U.S.C, Section 1395 et seq.;
   3. 3. "Premium" shall mean the term described for purposes of calculating the Oklahoma premium tax under Section 624 of Title 36 of the Oklahoma Statutes; and
   4. 4. "Medicaid managed care organization" means the term as defined in 42 U.S.C., Section 1396b(m).

Added by Laws 2003, HB 1017, c. 2, § 4, emerg. eff. March 17, 2003.