MAC Meeting Agenda
March 19, 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 January 15, 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
- American Recovery and Reinvestment Act (ARRA)
VII. Provider Services Support Update: Paul Keenan, MD, Chief Medical Officer
VIII. Covering the Uninsured Update: Cindy Roberts, Deputy Chief Executive Officer
IX. Action Items: Traylor Rains, J.D., Sr. Policy Specialist
09-01 – MFM Ultrasound Limits: Physician rules are revised to limit the number of ultrasounds performed by an active candidate or Board Certified diplomate in Maternal-Fetal Medicine (MFM) to a maximum of 6 follow-up ultrasounds and to require a prior authorization thereafter. Currently there is an inconsistency in the regular obstetrical care policy which does not state any limitation on the number of ultrasounds permitted without authorization if performed by a MFM while the high risk policy states a limit of 6 for the same provider type.
09-09 – Anesthesiologist Assistants: Rules are amended to include a new provider type – Anesthesiologist Assistant. New legislation was passed last session creating the Oklahoma Anesthesiologist Assistant Act. This Act allowed the Oklahoma Medical Licensing Board to promulgate rules to enforce the provisions of the Act which became effective 11/1/08. AA’s will be allowed to perform anesthesiologist services under the direct supervision of a licensed anesthesiologist.
09-11 – Audit Rule: Program integrity audit/review rules are revised to give providers the option of requesting OHCA to perform a full-scope audit or utilize an extrapolation method to determine overpayments, if during a review a sample indicates an error rate greater than 10 percent of paid claims. If the full scope audit produces an error rate less than the initial error rate, OHCA will bear the cost of the audit. However, if it produces an error rate equal to or greater than that of the initial audit, the provider will bear the cost of the full scope audit. In either case however, the provider will be responsible for repayment of the identified overpayment resulting from the review method chosen.
09-13 - Removal of 5 Year Bar for Pregnant Women and Children: As part of the Children's Health Insurance Program Reauthorization Act of 2009, Section 214 permits states to waive certain restrictions which result in a five-year wait for coverage of necessary health services for children and pregnant women lawfully residing in the United States. SoonerCare rules are revised to remove this population from the five-year enrollment bar requirement.
09-15 – Income/Resource Disregards for Certain Unemployment Benefits: Oklahoma took the option of allowing an additional $25.00 per week in unemployment compensation for unemployed Oklahomans, as allowed by the American Recovery and Reinvestment Act of 2009. The additional $25.00 per week will be paid to unemployed Oklahomans for a limited time. The bill mandates that this additional compensation as well as the amount of any Emergency Unemployment Compensation (UEC) benefits shall not be considered when determining eligibility for Title XIX and Title XXI benefits. OHCA rules are revised to state that the $25.00 of additional weekly unemployment compensation as well as UEC benefits will be disregarded when determining eligibility. The disregard shall be in effect through June 31, 2010 for the additional weekly benefit and May 31, 2010 for UEC.
X. New Business