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MAC Meeting Agenda

November 20, 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 September 20, 2007 Medical Advisory Committee Meeting [Attachment]

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

IV. Program Operations & Benefits Update and ER Program Update: Becky Pasternik-Ikard, Director of Program Operations [Attachment]

V. Provider Services Support Update: Paul Keenan, MD, Chief Medical Officer [Attachment]

VI. Transformation Grant: Derek Lieser, Project / Planning Manager [Attachment]

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

Federal Mandate Emergency

1. Physician Administered Drugs - Rules are revised to comply with Section 6002 of the Deficit Reduction Act of 2005 requiring the National Drug Code (NDC) to be collected on multiple source, physician administered drugs in order to secure drug rebates. Revisions are needed to require providers to bill the appropriate NDC for physician administered drugs in addition to HCPCS J-code. [Attachment]

OHCA Initiated Emergency

2. Insure Oklahoma / O-EPIC Expansion – Rules are revised to expand current Insure Oklahoma/ O-EPIC ESI and IP from 200% of the Federal Poverty Level to 250% and from 50 employee size to 250. * Will be presented to the OHCA Board upon waiver approval. [Attachment]

3. Insure Oklahoma / O-EPIC Partial Premium Payments – Rules are revised to allow partial IP premium payments for up to 60 days without being disenrolled in the program. 

4. Stretcher Services - Rules are revised to remove exclusion of stretcher services in SoonerRide program. Stretcher services will now be a part of services offered under the broker contract.

5. Eligibility - SoonerCare eligibility rules are revised to exempt the $90 VA pension when calculating the member's share of the nursing facility vendor payment.

6. Psychiatric Residential Treatment Facility (PRTF) - Rules are revised to add language to policy that protects PRTFs from having to pay billed charges when they must use other providers.

7. Vision Services - Rules are revised to limit payments for lenses and frames to one pair of glasses per 12 month period unless medically necessary or glasses are lost or damaged beyond repair. In addition, rule revisions separate the refraction service from the medical evaluation in order to be consistent with current CPT guidelines as well as Medicare and other third-party payers.

OHCA Initiated Permanent

8. Indian Health Rules - Rules are revised to update current Indian health rules and add a Section regarding inpatient medical care by IHS facilities.

9. Outpatient Behavioral Health - Rules are revised to strike current outpatient behavior health reimbursement language and replace it with language that refers to the State Plan.

DHS Initiated Permanent

10. ADvantage Waiver - ADvantage eligibility rules are revised to require the State to redetermine level of care annually for members participating in the ADvantage program. 

11. DDSD - DDSD rules are revised to: (1) reflect current services in the Home and Community-Based Services (HCBS) Waivers; (2) reflect changes in prescreening requirements and home standards in the home profile process; (3) allow experienced designated DDSD staff to complete certain architectural modification assessments; (4) specify dental services for members receiving services through HCBS Waivers; (5) clarify individual placement for job coaching services and update requirements for employment services through HCBS Waivers; (6) update terminology; (7) eliminate obsolete provisions; and (8) correct scrivener's errors.

Rule Making Process [Attachment]

OHCA Board Meeting Minutes [August] [September]

DUR Board Meeting Agenda [October]

VIII.  Discussion

IX.  New Business

X. Proposed 2008 MAC Meeting Dates:

  • January 17, 2008
  • March 20, 2008
  • May 15, 2008
  • July 17, 2008
  • September 18, 2008
  • November 20, 2008

XI.  Adjourn


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