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MAC Meeting Agenda

July 17, 2008 at 1 p.m.
OHCA Board Room
4545 N. Lincoln, 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 May 15, 2008 Medical Advisory Committee Meeting [MAC Minutes]

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

IV. SFY09 Budget Work Program:  Juarez McCann, Chief Budget Officer

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

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

VII. Medical Home Update:  Melody Anthony, Director of Provider Services [Case Management Fee Tiers] [HAN Defined]

VIII. Focus on Excellence Website:  Cassell Lawson, Director, OLL

IX. Moratorium:  Cindy Roberts, Director of Program Integrity & Planning

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

OHCA Initiated Rule

1. Soon to be Sooners Notice - Rules are revised to clarify that eligibility, denial and closure computer generated notices are mailed to the member receiving pregnancy related benefits under Title XXI and not the provider. [Rule 1 Soon to be Sooners Notice]

2. Eligibility - Eligibility rules are revised to clarify members categorically related to pregnancy are excluded from a resource test when determining eligibility. [Rule 2 Eligibility]

3. Joint Injections - Physician rules are revised to clarify that additional reimbursement is not allowed for joint injection codes that have a global coverage designation. [Rule 3 Joint Injections]

4. Ambulance - Rules are revised to remove specific payment methodology from the reimbursement language in the ambulance rules and replace it with the general statement that payment is based on the lower of the provider’s usual and customary charge or the OHCA fee schedule for SoonerCare compensable services. [Rule 4 Ambulance]

5. Citizenship - Eligibility rules are revised to add tribal membership cards and Certificate of Degree of Indian Blood (CDIB) cards for Native Americans; and Oklahoma Voter Registration Cards as acceptable documentation to establish citizenship and/or identity. [Rule 5 Citizenship]

6. Medical Home - SoonerCare rules are revised to incorporate the patient-centered medical home model of care in which providers are paid a monthly case management fee in addition to reimbursement for SoonerCare compensable services at the fee-for-service rate.  Rules are also amended to:  (1) require provider or physician groups to designate a medical director to serve as primary contact with OHCA; (2) include a section on provider networks; and (3) include language regarding the development of a payment for excellence program. [Rule 6 Medical Home]

Federally Initiated

7. Usual and Customary Fees - Rules are revised to clarify provider payment is based on the amount billed up to the maximum allowable. [Rule 7 Usual and Customary Fees]

XI. Discussion

XII. New Business

Cindy Roberts:  OHCA Board Retreat

XIII. Adjourn


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