Okla. Admin. Code § 317:1-3-4 - State Plan Amendment and Rate Committee
(a)
Definitions. Unless the
context clearly indicates otherwise, the following words and terms when used in
this section are defined as follows:
(1)
Public Process. means a process as defined by federal law under
42 U.S.C. §
1396(a)(13)A.
(2)
State Plan Amendment. means
the document described in the Federal Regulations at
42 C.F.R. §
430.10.
(3)
State Plan Amendment and
Rate Committee (SPARC). means a committee comprised of administrative and
executive level staff designated by the Chief Executive Officer for the
Oklahoma Health Care Authority. The SPARC facilitates the rate setting process
by conducting public hearings at which the public, vendors, and OHCA staff are
afforded the opportunity to provide testimony and documented evidence in
support of rate recommendations. The SPARC only operates to make
recommendations for changes to rates that necessitate a State Plan Amendment
and/or Waiver Amendment . Rates that do not necessitate a State Plan Amendment
and/or Waiver Amendment do not require a hearing.
(4)
Rate Change. means a change
that affects the numerical value of payment from the Medicaid agency to the
provider including the application of pre-existing factors that increase or
decrease a rate. A rate change is not a method change. Rates found in contracts
are excluded from the definition of rate change because they are set
consensually in a contract. A method or methodology change, as defined below,
is not a rate change.
(5)
Method Change or Methodology Change. means a change to how the
rate is calculated, not the end result of the rate. In Medicaid rate setting
the application of pre-existing factors many times, results in rate changes.
The application of pre-existing factors, even if it results in a different rate
is not a method change. A method change occurs when OHCA adds, subtracts or
alters the factors used to construct the rate.
(b)
Meeting of the State Plan Amendment
and Rate Committee (SPARC). In certain instances the SPARC meets to hold
public hearings regarding rates set by the Oklahoma Health Care Authority.
Under certain provisions of federal law, the agency is required to hold a
public hearing to gather public comment regarding proposed method changes or
methodology changes regarding the rates it pays its medical providers.
(1) The SPARC only meets when a method change
or methodology change occurs in a rate paid from OHCA to a medical
provider.
(2) The SPARC does not
meet to establish any contractually set rate to a contractor or a contractually
bid rate nor does the SPARC meet to hear rate changes.
(c)
SPARC public hearing
process.
(1) The seven person panel
conducts an open meeting under the Oklahoma Open Meetings Act.
(2) The proceedings are recorded.
(3) The panel hears agency presentations of
proposals for method changes or methodology changes and considers comments of
any member of the public who desires to comment upon the rate. The Chairperson
controls both the agency presentation of proposals and the presentation of
comments on the proposed method change.
(4) The panel votes to approve or disapprove
the proposed method change in the open meeting, but may adjourn the meeting to
gather further information, if necessary. The panel also may adjourn for legal
advice during the proceeding. The OHCA board will vote to approve or disapprove
the rate methodology upon approval by the SPARC.
(d)
Composition of the SPARC.
The Chief Executive Officer appoints officials to serve on the SPARC. Officials
may consist of OHCA employees and other state agency employees whose agencies
assist in the administration of the Medicaid State Plan and/or Waiver programs
. A regular alternate for each official may be approved. In such cases an
official is unable to attend a committee meeting, he or she must notify the
regular alternate and OHCA Chairperson.
Notes
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