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MAC Meeting Agenda

January 17, 2008 at 1 p.m.
OHCA Board Room
4545 N. Linicoln, Suite 124
Oklahoma City, OK 73105

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Tentative Agenda

I. Welcome, Roll Call, and Public Comment Instructions

II. Approval of minutes of the November 15, 2007 Medical Advisory Committee Meeting [Attachment]

III. Financial Report: Anne Garcia, Chief Financial Officer [Attachment]

IV. 2008 Legislative Session Outlook: Nico Gomez, Director of Communication Services

V. Program Operations & Benefits Update: Becky Pasternik-Ikard, Director of Program Operations [Attachment]

VI. Provider Services Support Update: Paul Keenan, MD, Chief Medical Officer [Attachment]

VII. Focus on Excellence Update: Cassell Lawson, Director of Opportunities for Living Life

VIII. SCHIP Update: Stephen Weiss, Sr. Policy Advisor of Federal/State Policy on Appropriations

IX. Federal Regulatory Alert: Charles Brodt, OHCA Deputy Director [Attachment]

X. Action Items: Cindy Roberts, Director of Program Integrity & Planning

OHCA Initiated - Emergency

1. Ambulatory Surgical Centers and Outpatient Hospitals - Rules are revised to clarify that when multiple surgeries are performed at the same setting, the second and subsequent surgeries may be reimbursed at a discounted rate. [Attachment]

OHCA Initiated - Permanent

2. Surgery Modifiers - Rules are revised to remove the list of medical and surgical modifiers and refer providers to the Physicians’ Current Procedural Terminology (CPT) book for guidance in billing surgery claims.  Further, revisions are made to remove duplicative language found in the surgery sections that are also in other sections of policy which are more appropriate and fitting. [Attachment]

3. Opportunities for Living Life (OLL) - Rules are revised to update OLL policy to make it consistent with policy found at OAC 317:30-5-211.16. The DME policy states prior authorization is not required for oxygen; however, the LTC policy still states that prior authorization is required. [Attachment]

4. Psychiatry Services - Rules are revised to update terminology, clarify correct billing procedures for general physicians performing psychiatric services, and remove language requiring submission of documentation of training to the Oklahoma Health Care Authority. [Attachment]

5. Residential Behavioral Management Services (RBMS) - Rules are revised to eliminate obsolete provisions and set out required qualifications for individual providers who render Individual Rehabilitative Treatment services for redevelopment therapy in a foster care setting.[Attachment]

6. Dental - Rules are revised to: (1) add definitions for certain terminology, (2) clarify that permanent restoration is not billable to the OHCA when performing Pulpotomy or Pupal debridement on a permanent tooth, (3) clarify a clinical examination must precede any radiographs, and consider patient history, prior radiographs, caries risk assessment and both dental and general health needs of the patient, (4) clarify Panoramic films are allowable once in a three year period and (5) clarify placement of a stainless steel crown includes all related follow up service for a period of two years. [Attachment]

7. Opportunities for Living Life - Rules are revised to: (1) remove outdated section with allowed days and requirements for hospital leave that were replaced, (2) add language to mirror Section 2002, Title 56 of the Oklahoma Statutes freezing the Quality of Care Fee at levels in effect July 1, 2004 and implementing 5.5% as a maximum, as per federal law, (3) add language to include additional items needed in the QOC Report in order to implement the Focus on Excellence Program, (4) change language to add the requirement to file cost reports on the Secure Website and change the due date from September 1 to October 31 and (5) define the report requirement for partial year reports. [Attachment]

DHS Initiated - Permanent

8. ADvantage Program - Waiver Services rules are revised to add Assisted Living services as a compensable service under the ADvantage Waiver program. [Attachment]

Federally Initiated - Permanent

9. Program of Assertive Community Treatment (PACT) Services - Rules revised to reflect PACT services will not be a compensable service after June 30, 2008. [Attachment]

OHCA Board Meeting Minutes [October] [November]

DUR Board Meeting Agenda [November]

December 2007 Provider Update [Winter]

XI. Discussion

XII. New Business

XIII. Adjourn


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