MAC Meeting Agenda

January 15, 2009 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 20, 2008 Medical Advisory Committee Meeting [Attachment]

III. MAC Member Comments/Discussion

IV. Financial Report: Carrie Evans, Chief Financial Officer [Attachment] [Attachment]

V. Program Operations & Benefits Update: Becky Pasternik-Ikard, Chief Operating Officer [Attachment] [Attachment] [Attachment] [Attachment]

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

VII. Medical Home Update: Melody Anthony, Director of Provider Services

VIII. Independent Evaluation of the Insure Oklahoma Program, Buffy Heater, Manager, Planning and Development [Attachment]

IX. Healthcare Effectiveness Data and Information Set (HEDIS) Report: Lise DeShea, Ph.D., Statistician, Quality Assurance [Attachment] [Attachment]

X. Action Items: Traylor Rains, J.D., Senior Policy Specialist

Federally Initiated

1. Case Management
Summary of Changes
Inpatient Behavioral Health rules are revised to:
(1) Reclassify OKDHS and the Office of Juvenile Affairs (OJA) as Foster Care Agencies for purposes of delivering Residential Behavioral Management Services (this re-classification is necessary since OJA will lose their status as an Organized Health Care Delivery System following the implementation of the federal rules affecting Targeted Case Management (TCM) on April 1, 2009); (2) exclude employees and contractors of OJA and OKDHS as eligible providers for case management; (3) revoke the case management rules with respect to individuals over 21 which have been combined with the Under 21 rules to form an all inclusive rule for case management services and (4) revoke rules relating to TCM services provided by the Office of Juvenile Affairs and OKDHS which will no longer be compensable as of April 1, 2009. Changes are the result of agency compliance with Section 6052 of the Deficit Reduction Act. [Attachment]

OHCA Initiated

2. Outpatient Behavioral Health
Summary of Changes
Outpatient Behavioral Health rules are revised to:
(1) Remove references to billing & documentation details which will now be found in the Behavioral Health Provider Billing Manual in order to simplify the process for changing billing procedures and rates in the future; (2) add Multi-Systemic Therapy as a service option which will be provided by the Office of Juvenile Affairs staff who will also certify the state share; and (3) update terminology. [Attachment]

3. Third Party Liability
Summary of Changes
Eligibility rules are revised to allow for collection of cash medical support payments by non-custodial parents in accordance with 43 Okla. Stat. 118F. Cash medical support may be ordered to be paid to the OHCA by the non-custodial parent if there is no access to health insurance at a reasonable cost or if the health insurance is determined not accessible to the child according to OKDHS rules. Reasonable is deemed to be 5% or less of the non-custodial parent’s gross income. [Attachment]

4. Psychologist
Summary of Changes
Psychologist rules are revised to remove provider eligibility requirements from the coverage section as well as update terminology to bring rules in line with current OHCA practices. [Attachment]

5. Child Abuse
Summary of Changes
SoonerCare rules are revised to update sections of current policy which references an incorrect citation. Section 7103 of Title 10 of Oklahoma Statutes requires health care providers to report suspected abuse or neglect to the Oklahoma Department of Human Services. Section 7104 of Title 10 of Oklahoma Statutes requires health care providers to report criminally injurious conduct to the nearest law enforcement agency. [Attachment]

6. Living Choice
Summary of Changes
Living Choice program rules are revised regarding transition into the OKDHS/DDSD Community waiver for individuals with mental retardation. Current policy states that Living Choice program participants with mental retardation who transition into the community will receive a range of home and community based services for one year under the Living Choice program demonstration. Following the one year period, members will then transition into the OKDHS/DDSD Community waiver and continue receiving services in the community. Rule changes reflect that Living Choice participants with mental retardation will immediately be enrolled in the Community waiver on the first day they transition into the community. Living Choice participants will be exempt from the Community waiver waiting list. [Attachment]

7. Public Health Clean-up
Summary of Changes
Public Health Clinic rules are revised to reflect how the Oklahoma State Department of Health trains and certifies nurses to be case managers for first time mothers receiving assistance through county and city/county health departments. Case management training is required to ensure that nurses have the appropriate knowledge concerning the pregnancy cycle, child development and cultural differences which impact pregnancy. Certification also ensures that nurses are skilled in case management principles and techniques and interviewing techniques. The rules are also revised to add minimum standards for prenatal services provided by county and city/county health departments. These changes are being made to reflect current practices. [Attachment]

8. Wheeled Mobility
Summary of Changes
In accordance with the Consumer Protection for Wheeled Mobility Act, OHCA medical suppliers’ rules are revised to require either a specialty evaluation performed by a licensed or certified health care professional or direct in-person involvement in the wheelchair selection process by an assistive technology professional (ATP) for all wheelchairs purchased by SoonerCare. [Attachment]

OKDHS Initiated

9. Developmental Disabilities Services
Summary of Changes
Developmental Disabilities Services rules are revised to provide clarification relating to: (1) service utilization, provisions, authorizations, limitations, and eligibility requirements; (2) provider requirements and related activities of targeted case management to meet federal requirements; (3) provider responsibilities and limitations in the agency companion program; (4) devices and services allowable through assistive technology; (5) criteria for performance of architectural modifications and the requirements and standards thereof; (6) physical plant expectations for services provided in center-based settings; and (7) amend policy to reflect appropriate terminology. [Attachment]

10. ADvantage Waiver Administration
Summary of Changes
Rules are revised to change the references from the Long Term Care Authority Administrative Agent to ADvantage Administration. The Oklahoma Department of Human Services has discontinued contracting with the Long Term Care Authority of Tulsa to perform the functions of the Administrative Agent for the ADvantage Program. Rules are amended to change the designation of “AA” as “Administrative Agent” provided by the Long Term Care Authority to instead designate “ADvantage Administration” administered by the Oklahoma Department of Human Services. Rules are also amended to remove all references to “Long Term Care Authority” and “LTCA” from the ADvantage, State plan Personal Care and related rules. [Attachment]

XI. New Business

XII. Adjourn