MAC Meeting Agenda
July 16, 2009 at 1 p.m.
OHCA Board Room
4545 N. Linicoln, Suite 124
Oklahoma City, OK 73105
I. Welcome, Roll Call, and Public Comment Instructions
II. Approval of minutes of the May 21, 2009 Medical Advisory Committee Meeting
III. MAC Member Comments/Discussion
IV. Legislative Update: Nico Gomez, Deputy Chief Executive Officer
V. Financial Report: Carrie Evans, Chief Financial Officer
VI. FY’2010 Budget Work Program, Juarez McCann, Chief Budget Officer
VII. Program Operations & Benefits Update: Becky Pasternik-Ikard, Chief Operating Officer
VIII. Provider Services Support Update: Paul Keenan, MD, Chief Medical Officer
IX. ARRA Opportunities, Carrie Evans, Chief Financial Officer
X. HIT Loan Adoption Program, John Calabro, Chief Information Officer
XI. Action Items: Brent Johnson, Sr. Policy Specialist
09-04 - Self Directed Services: Agency Model - This rule standardizes the operation of all self directed service programs implemented through the SoonerCare program. The rule sets forth minimum requirements that all self directed service programs must adhere to. Self direction is a method of service delivery that allows members to determine what services and supports they need to live successfully in a home and community based setting.
09-10 - Metabolic Disorders - Rules are revised to provide clarification and consistency with practices for coverage for certain nutritional formulas and bars for children diagnosed with certain metabolic disorders. Currently rules only indicate nutritional formula and bars are covered for persons diagnosed with PKU. OHCA practice is that certain nutritional formulas and bars are covered with the diagnosis of certain metabolic disorders and prior authorization.
09-19 - Member Responsibilities - The purpose of this rule is to clarify SoonerCare member responsibilities regarding the reporting of third party liability, utilization of private insurance and notification to medical providers of SoonerCare coverage. Additionally, the rule revision provides notification to members of their agreement to allow sharing of medical information, if needed, to State or Federal agencies, medical providers, or an OHCA designee upon their acceptance of medical services provided through the SoonerCare program.
09-28 - General Coverage Revisions - General coverage rules are revised to make OHCA rules consistent with reimbursement practices and make coverage rules more consistent throughout policy. Revisions include allowing separate payment for the insertion and/or implantation of contraceptive devices during a physician office visit, the removal of physician supervision of hemodialysis or peritoneal dialysis as a general coverage exclusion for both adults and children, the clarification of intent in regards to general coverage and general coverage exclusions for both adults and children, the removal of follow-up consultations, the removal of tympanometry as a general coverage exclusion for children, the clarification of covered critical care guidelines, and general policy cleanup as it relates to these sections.
09-29 - PRTF Exemption - Behavioral Health rules are revised to allow licensing requirements exceptions for hospitals and residential psychiatric treatment centers that are operated by the state mental hospital. Persons between the ages of 18-21 currently are eligible to receive residential psychiatric treatment services but the licensing agency in Oklahoma is only able to license facilities for persons up to the age of 18. OHCA rules deem that facilities have to be licensed. Title 63 O.S. § 63-1-702 exempts hospitals operated by the federal government, state mental hospitals and community-based structured crisis centers from licensing requirements.
09-32 - DME Clarification - DME rules are revised to make OHCA rules consistent with reimbursement practices and provide consistency throughout policy. Revisions include clarifying the intent of wheelchair coverage for members residing in a long term care facility or ICF/MR and the elimination of the OHCA Certificate of Medical Necessity (CMN) as a document requirement for requesting prior authorization or determining medical necessity for wheelchairs.
09-34 – Observation/Treatment Clarification - Agency rules are modified to provide clarification for providers billing for observation/treatment services. The modification provides examples of outpatient observation services that are not covered when they are provided. This change provides clarification and education to providers.
09-37 - Chapter 1 Clean-up - Rules are revised to remove policy regarding certain federal civil rights requirements, to correct references to federal laws and state statutes, amend policy on open records requirements and include the process for ensuring proper review and approval/ disapproval of rate methodologies by the State Plan Amendment Rate Committee (SPARC).
09-38 - Prenatal Assessment Form - Rules are being revised to allow flexibility in the types of prenatal assessment forms that may be used. Currently rule specifies that American College of Obstetricians and Gynecologist (ACOG) assessment form must be used.
09-43 - Irrevocable Burial to 10,000 - SoonerCare eligibility rules are revised to comply with Senate Bill 987 of the 1st Session of the 52nd Oklahoma Legislature (2009) by increasing certain burial trust account thresholds from $7,500 to $10,000 effective November 1, 2009. Oklahoma law provides that a purchaser of a prepaid funeral contract may elect to make the contract irrevocable. Current rules stipulate that the face value amount in an irrevocable contract cannot exceed $7,500 plus accrued interest. When the amount is in excess of $7,500, the individual is ineligible for SoonerCare. Senate Bill 987 increases the irrevocable burial contract limit from $7,500 to $10,000 effective November 1, 2009.
XII. New Business