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MAC Meeting Agenda

May 21, 2009 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 19, 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. Program Operations & Benefits Update: Becky Pasternik-Ikard, Chief Operating Officer

VII. Provider Services Support Update: Paul Keenan, MD, Chief Medical

VIII. Impact of a State Medicaid ‘Lock-In’ Program Upon Member Use of Health Care System Resources: Shellie Keast, Pharm.D., M.S., OU College of Pharmacy

IX. Action Items:  LeKenya Samilton, Sr. Policy Specialist

OHCA Initiated

09-16 Addition of Services for Native Americans – Indian Health Rules are revised to add Indian Health Service Facilities, Tribally Operated Facilities and Urban Indian Clinics (I/T/U’s) as distant site providers for telemedicine, allowing segments of the Native American population in rural areas access to specialty healthcare services. Revisions also add public heath nursing as an allowable service for qualifying individuals in the Native American population on a statewide basis.

09-22 Census Income Disregard – Agency eligibility rules are revised to disregard the earned income from temporary census employment.  Every ten years, the Census Bureau conducts the decennial census.  For the 2010 Census, the Census Bureau expects to hire more than 900,000 employees over the course of the census.  Most of these employees are enumerators that conduct fieldwork who are hired very locally and who only work for a brief period of time.  States are given the option by CMS to disregard this temporary income, which Oklahoma has done for the last several decennial censuses.  This disregard has been added to our state plan and rules must be revised to agree with the plan.

09-23 Insure Oklahoma IP Agent Enrollment Fee - Insure Oklahoma/O-EPIC rules are revised to allow insurance agents who meet eligibility guidelines to contract with OHCA.  Once contracted, these insurance agents will be eligible to receive reimbursement for enrollment services under the Individual Plan (IP) program.  Reimbursement will be established by rates that are determined and set by OHCA for completed and certified IP applications that result in actual member enrollment.

09-24 Chapter 2 Cleanup – Agency rules are revised to include language regarding member and provider appeals processes, specifically concerning the time frames allowed for responses to appeals from the Oklahoma Health Care Authority and the Administrative Law Judge.  Additionally, the rule revisions clarify the process for administrative sanction appeals and the process for provider suspension or termination.

09-26 DME Oxygen Cleanup – DME rules are revised to revoke an outdated DME policy related to oxygen and oxygen equipment and the requirements for prior authorization.  Current DME rules already clarify that no prior authorization is required for oxygen and oxygen equipment.  Revoking this rule will alleviate confusion and make rules consistent.

09-27 Bariatric Surgery Clarification - Insure Oklahoma/O-EPIC rules are revised to clarify the intent of non-covered benefits related to weight loss intervention and treatment including bariatric surgical procedures, other weight loss surgeries and procedures, drugs primarily used for weight loss, and nutrition services prescribed only for the intent of weight loss under the Individual Plan (IP) program.  These benefits have never been covered under IP program; this simply provides the clarification.

OKDHS DDSD Initiated

09-21 Agency Companion Services Provider Responsibilities – DDSD rules are revised to change incorrect references in policy regarding incident reporting and quality assurance for Agency Companion Services for the developmentally disabled.  The current references direct the reader to sections that do not exist. Additionally, “service recipient” is changed to “member” throughout this section.

X. New Business

XI. Adjourn


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