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Date:  October 12, 1995
For Release:  Immediately
Contact:  HCFA Press Office, (202) 690-6145

"By fostering the creation of a managed care infrastructure, Oklahoma will increase access for its Medicaid beneficiaries," said Secretary Shalala. "This project embodies the Clinton administration's commitment to work with states, and to develop innovative programs for all our citizens."

During the first year of the demonstration, all 342,000 Aid to Families with Dependent Children and AFDC-related Medicaid beneficiaries will be provided access to managed care programs. The 84,000 non-institutionalized aged, blind and disabled beneficiaries in Oklahoma will be enrolled in managed care during the second year.

In year three, for which the state will be submitting an amendment at a later time, SoonerCare will enroll long term care beneficiaries and persons with chronic mental illnesses into specially designed programs.

SoonerCare contains incentives for fully capitated urban managed care plans to network with rural providers as a key to rural managed care development. Urban plans that become certified as "Rural Partner" plans will be afforded greater flexibility under the demonstration than plans that do not establish linkage to rural areas.

Bruce C. Vladeck, administrator of the Health Care Financing Administration, said that "the SoonerCare program gives HCFA and the state the opportunity to test out innovative delivery systems for rural areas. Access to care for rural Medicaid beneficiaries is often limited and the new models that the state is testing will greatly increase access in rural areas."

In rural areas that cannot support a fully capitated managed care network, Oklahoma will introduce two partial capitation models. Depending on the availability of providers, the state will capitate primary care services only or, if appropriate, use an "outpatient network" that encompasses most or all outpatient services, including specialty care, diagnostic procedures and prescription drugs. Services not included in the capitation arrangements would continue to be covered on a fee-for-service basis.

To be certified as a "Rural Partner" plan, an urban plan must serve as contract manager for a capitated rural provider network, or contract with the state to enroll and serve SoonerCare beneficiaries in one or more rural service areas under an HMO or outpatient network model.

Alternatively, Rural Partner plan could serve as the specialist referral component for one or more rural HMOs or outpatient networks, establish and operate a telemedicine system for a minimum of 25 rural hospitals or propose an alternative method for increasing access to managed care in rural areas.

In addition to Oklahoma, and the long standing program in Arizona, 13 comprehensive health reform demonstration projects have been approved.