Medicaid; adverse determinations and procedures; review; appeal; requirements; psychologist; minimum rates of reimbursement, value-based payment arrangements, and payment methodologies; Oklahoma Health Care Authority; appeal; effective date.

Summary

It requires that any Medicaid claim denial be reviewed by a licensed physician or mental‑health professional rather than automated software, and gives providers six months to file an appeal. The legislation also establishes minimum payment rates for providers, with higher rates for network doctors and new rules for psychologist reimbursement and value‑based payments. These changes aim to make the appeal process fairer and ensure consistent payment levels across the Medicaid system.

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