OHCA outlines Sooner Select rollout, sets 11% primary-care spending and two-year rate floors

Ellen Bittner, chief executive officer of the Oklahoma Health Care Authority, and State Medicaid Director Traylor Raines laid out the agency’s Sooner Select managed-care transition and timeline at an Oklahoma City provider town hall.

The program aims to prioritize members and shift payment toward value-based arrangements. Under state legislation cited by OHCA officials, contracted entities must spend 11% of their medical spend on primary care—"close to triple" current levels—intended to increase prevention and reduce avoidable emergency care, officials said.

Traylor Raines said OHCA will retain oversight and compliance responsibilities and has written detailed contract requirements, including weekly payment traditions and a requirement that a clean claim submitted to a contracting plan be paid within 14 days. Contracts and legislation also require rate floors for the first two years, meaning plans cannot reimburse below the OHCA’s current fee schedule during that period, officials said.

OHCA described administrative changes intended to reduce burden on providers: the plans agreed to collaborate on a single, streamlined provider portal for eligibility checks, billing and prior authorization, plus a centralized credentialing verification process to avoid duplicate credentialing steps. Raines said the portal will show a member’s assigned plan; members will receive plan-specific ID cards and OHCA’s eligibility checks will indicate plan affiliation.

OHCA said pharmacy benefits will be included in Sooner Select but that the agency will keep authority over the drug list and retain prescription-drug rebates for the state program. OHCA also described a quality advisory committee of roughly 15–16 members to help set outcome measures, and noted that state-directed supplemental payments tied to quality are being transitioned into the managed-care model.

Raines cited Senate Bill 1337 as creating an additional community provider supplemental pool "around $100,000,000" that will be directed toward community providers and tied to quality outcomes; OHCA said the exact distribution and measures are under development and will be informed by the quality advisory committee.

On timing, Raines said dental plans are expected to go live in February 2024 and the medical plans in April 2024; both launches are explicitly contingent on approval from the Centers for Medicare & Medicaid Services and successful readiness reviews, including site visits. OHCA said it will not send member notices until it is confident the readiness steps are complete.

OHCA officials said some populations are excluded from Sooner Select: aged, blind and disabled populations, long-term care and nursing facility residents, many waiver populations and members dually eligible for Medicare and Medicaid. American Indian and Alaska Native members may opt in but will not be automatically enrolled, officials said.

The agency directed providers to a Sooner Select website and said it will publish benefit-comparison guidance and retrain choice-counseling staff to help members select plans. Officials also noted an auto-assignment process for members who do not choose a plan during enrollment and a deadline window during which members can change an auto-assigned plan.

The town hall concluded with an invitation for providers to follow up with plan representatives and OHCA staff to resolve implementation questions.

The next procedural steps for the program are OHCA’s readiness work with CMS, completion of the quality-measure decisions by the advisory committee, final contract mechanics for PBMs and other vendors, and publication of benefit comparisons and member notices once readiness is confirmed. (Meeting date not specified in the event materials.)