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MAC Meeting Agenda

March 27, 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. Presentation of Plaque

III. Approval of minutes of the January 17, 2008 Medical Advisory Committee Meeting [MAC Minutes-1-17-08]

IV. Financial Report and Requested Clarification of 14% Increase: Anne Garcia, Chief Financial Officer [January Financial Report]

V. Legislative Update: Nico Gomez, Director of Communication Services

  • HB2842 Status
  • FY09 Budget Request

VI. Program Operations & Benefits Update: Becky Pasternik-Ikard, Director of Program Operations [SoonerCare Programs 2008-01] [SoonerCare Programs 2008-02][BCC 2007 Annual Report] [Insure Oklahoma Monthly Stats]

VII. Provider Services Support Update and Medical Home Overview: Paul Keenan, MD, Chief Medical Officer [Provider FastFacts 02-2008] [Medical Home Proposal 2-20-08][SoonerExcel Transitional Payment Summary] [PMP CM Fee table 02-27-08]

VIII. Federal Regulation Changes to Targeted Case Management: Traylor Rains, Sr. Health Policy Specialist

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

DHS Initiated Rule - Emergency

1. DDSD - Rules are revised to provide current Home and Community Based Services Waiver provisions for respite care, including types of respite care.  Other revisions denote a new level of support, pervasive level of support, through agency companion services and agency companion services salary options. [Rule 1 DDSD]

OHCA Initiated Rule - Emergency

2. Pace Disenrollment - Rules are revised to clarify involuntary disenrollment provisions for members in the Program of All-Inclusive Care for the Elderly (PACE) program.  Disenrollment may occur if the caregiver or guardian of the PACE member fails to pay, or make satisfactory arrangements to pay, any premiums due to the PACE organization after a 30-day grace period or the caregiver or guardian of the member engages in disruptive or threatening behavior. [Rule 2 PACE Disenrollment]

3. Inpatient Behavioral Health (Plan of Care) - Rules are revised to change requirements for review of Individual Plan of Care for children residing in Inpatient Psychiatric Hospitals. Change would mandate plan reviews at least every seven calendar days but no less than every nine calendar days in acute care and at least every 14 calendar days but no less than every 16 calendar days in the longer term treatment program or specialty Psychiatric Residential Treatment Facilities (PRTF). [Rule 3 Inpatient Behavioral Health (Plan of Care)]

4. Outpatient Behavioral Health - Rules are revised to outline reimbursement methodology for services formerly reimbursed as a per diem under the Program of Assertive Community Treatment (PACT) program.  PACT services will now be billed as fee for service using already existing CPT codes which have modified rates to reflect the home based component of the PACT service.  The suggested rule change also rearranges the Outpatient Behavioral Health Rules by moving existing provisions into more appropriate sections within Part 21. [Rule 4 Outpatient Behavioral Health]

5. Insure Oklahoma / O-EPIC - Rules are revised to:  (1) update current rules with the new name, Insure Oklahoma/Oklahoma Employer and Employee Partnership for Insurance Coverage (O-EPIC); (2) expand current Insure Oklahoma/O-EPIC Employer Sponsored Insurance (ESI) and Individual Plan (IP) coverage to the children of non-disabled working adults whose household income is between 186% and 250% of the federal poverty level; and (3) expand ESI and IP coverage to Oklahoma college students who are 19 through 22 years of age and whose household income is less than 250% of the federal poverty level. [Rule 5 Insure Oklahoma (O-EPIC)

OHCA outstanding State Plan Amendment Update [SPA Summary]

OHCA Provider Update [Spring 2008]

X. Discussion

XI. New Business

XII. Adjourn


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