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MAC Meeting Agenda

May 17, 2007 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 March 15, 2007 Medical Advisory Committee Meeting [attachment]

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

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

V. Program Operations & Benefits Update: Becky Pasternik-Ikard, Director of SoonerCare Program Operations & Benefits [attachment 1] [attachment 2]

VI. Provider Services Support Update: Paul Keenan, MD, Director of Provider Services Support [attachment]

VII. Money Follows the Person Grant Update: Cassell Lawson, Director of Opportunities for Living Life

VIII. Perinatal Dental Access Program: Leon Bragg, DDS, Dental Services [attachment]

IX. Electronic NB-1 Project: Richard Evans, Sr. Data Integrity Specialist [attachment]

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


1. DRA Long Term Care [attachment]
Rules are revised to comply with Sections of the Deficit Reduction Act of 2005 regarding long-term care services. Changes include the following:

  • Section 6012 of the DRA requires a change in the disclosure and treatment of annuities purchased on or after February 8, 2006.
  • Section 6014 of the DRA establishes an upper limit for the excluded value of a home.
  • Section 6016(c) requires that included in the definition of “assets” are funds used to purchase a promissory note, loan, or mortgage, unless certain circumstances exist.
  • Section 6016(d) redefines “assets” to include the purchase of a life estate interest in another individual’s home.


2. Prior Authorizations for Physical Therapy, Occupational Therapy and Speech & Hearing Services [attachment]
Rule change to remove the prior authorization requirement for the initial evaluation of physical and occupational therapy. Speech and hearing rules are revised to specify that services beyond the initial evaluation and six units of service require prior authorization.

3. Deeming Newborn for O-EPIC [attachment]
This rule change will allow OKDHS to deem a child, newly born to an O-EPIC IP member, eligible for SoonerCare Choice, the same as when a child is born to a SoonerCare member.

4. Dental Services for Special Needs Children [attachment]
This rule change allows prior authorization information for periodontal scaling and root planing to be submitted after the services are provided in cases where the members have special needs (certain forms of cancer, or members who are behaviorally or emotionally challenged) and must be sedated in order to obtain needed requirements for the prior authorization.

5. ICF/MR Criteria for Children [attachment]
This rule change establishes guidelines for ICF/MR institutional level of care eligibility determinations for TEFRA.

Minutes from OHCA Board Meetings [February] [March]

DUR Board Meeting Agendas [April] [May]

Provider Update [Spring]

VIII. Discussion

IX. New Business

XIII. Adjourn


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