Oklahoma Medicaid managed care: what plans must pay
Managed-care plans don't publish their provider fee schedules. What is public is the rule each plan must follow, set in Oklahoma's plan contracts, statutes and notices. For 18 of 21 service lines, plans must follow a rule tied to the state's published rates.
- Lines with a binding rule
- 18of 21
- Plans on record
- 5
- Directed payments
- 0
- Capitation cells
- 1,511$0.03–$2,716.82 PMPM
Who sets the rate, by service line
| Service line | Main rule for plans | Rates | Also applies |
|---|---|---|---|
| Physician & professional | Plans must pay at least thisPlans must pay at least the published rate | 9,309 | |
| Hospital outpatient | Plans must pay at least thisPlans must pay at least the published rate | 5,972 | |
| Equipment & supplies | Plans must pay at least thisPlans must pay at least the published rate | 4,594 | Paid by the state, outside plans |
| Hospital inpatient | Plans must pay at least thisPlans must pay at least the published rate | 1,897 | |
| Radiology | Plans must pay at least thisPlans must pay at least the published rate | 1,762 | |
| Lab & pathology | Plans must pay at least thisPlans must pay at least the published rate | 1,716 | |
| Nursing facility | Paid by the state, outside plansPaid directly by the state, outside managed care | 1,140 | |
| Pharmacy | State sets the plan rateThe state sets the rate plans pay | 996 | |
| Other | Plans must pay at least thisPlans must pay at least the published rate | 677 | |
| Dental | Plans must pay at least thisPlans must pay at least the published rate | 579 | |
| Behavioral health | Plans must pay at least thisPlans must pay at least the published rate | 549 | |
| IDD services | Paid by the state, outside plansPaid directly by the state, outside managed care | 257 | |
| Other home & community services | Plans must pay at least thisPlans must pay at least the published rate | 203 | Paid by the state, outside plans |
| Vision & hearing | Plans must pay at least thisPlans must pay at least the published rate | 176 | |
| Therapy (PT/OT/speech) | Plans must pay at least thisPlans must pay at least the published rate | 43 | Paid by the state, outside plans |
| Transportation | Plans must pay at least thisPlans must pay at least the published rate | 39 | Paid by the state, outside plans |
| Personal care & attendant | Paid by the state, outside plansPaid directly by the state, outside managed care | 15 | Plans must pay at least this |
| Home health | Paid by the state, outside plansPaid directly by the state, outside managed care | 11 | |
| ABA / autism services | Plans must pay at least thisPlans must pay at least the published rate | 8 | |
| Hospice | Plans must pay at least thisPlans must pay at least the published rate | 6 | |
| Private duty nursing | Paid by the state, outside plansPaid directly by the state, outside managed care | 5 | Plans must pay at least this |
Frequently asked questions
Do Oklahoma Medicaid plans have to pay the state fee schedule?
For some services. Plans must follow a rule tied to the state's rates for: Physician & professional, Hospital outpatient, Equipment & supplies, Hospital inpatient, Radiology, Lab & pathology, Pharmacy, Other, Dental, Behavioral health, Other home & community services, Vision & hearing, Therapy (PT/OT/speech), Transportation, Personal care & attendant, ABA / autism services, Hospice, Private duty nursing. For other lines, plans negotiate rates with providers.
Where do these rules come from?
From Oklahoma's managed-care plan contracts, state statutes and regulations, provider notices and CMS-approved directed-payment filings. Each rate in the workspace carries its citation.
Can I see what each plan actually pays?
No plan publishes its provider fee schedule. The closest public signals are the binding rules above, state-set rates, directed payments and the state's own payment-level estimates in its directed-payment filings.