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MAC Meeting Agenda

November 17, 2010 - 1 p.m.
Ponca Conference Room
2401 NW 23rd St, Suite 1A
Oklahoma City, OK 73107

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Tentative Agenda

I. Welcome, Roll Call, and Public Comment Instructions

II. Approval of minutes of the September 16, 2010 Medical Advisory Committee Meeting

III. MAC Member Comments/Discussion

IV. Financial Report: Carrie Evans, Chief Financial Officer

Budget Request, Juarez McCann, Chief Budget Officer 

V. SoonerCare Operations Update: Dr. Nancy Nesser, Director of Pharmacy

VI. EHRs and Incentives for Optometrists: John Calabro

VII. Policy Rulemaking Review: John Giles

VIII. Action Items: Traylor Rains, Policy Development Coordinator

OHCA Initiated

10-53 Partial Hospitalization Program – Outpatient Behavioral Health rules are revised to add Partial Hospitalization Programs (PHP) as a SoonerCare covered service for children. PHP consists of a package of therapeutically intensive clinical services offered in community and family based programs.  PHP services are a component of the behavioral health psychiatric residential treatment facility (PRTF) diversion project, which focuses on alternative levels of treatment services aimed at stepping individuals down from inpatient facilities and into clinically appropriate settings offering lower levels of care.  

Budget Impact – The agency estimates a SFY 2011 budget impact of $4,447,776 with a state share of $1,160,925.

Federally Initiated

10-54 SoonerCare Hospice Revisions – Hospice rules are revised to allow for the provision of hospice services to children eligible for SoonerCare without forgoing any treatment services for the terminal condition.  This change ensures compliance with Public Laws 111-148 and 111-152. Congress enacted this provision to remove the restriction of having to elect hospice services in lieu of standard Medicaid services that have the objective to treat or cure the terminal illness.

Budget Impact – The agency estimates a minimal impact due to the number of hospice case per year and the duration of days members are on hospice. On average there are ten or less hospice cases per year.

10-55 Home and Community Based Services Waiver Hospice Revisions - The purpose of this rule is to include a requirement for re-evaluation of members receiving hospice services in the HCBS Waivers.  ADvantage, Medically Fragile, My Life, My Choice and Sooner Seniors HCBS waivers currently have no set authorization limits for hospice care, allowing members to receive hospice services for an unlimited period of time.  Rules are revised to include a re-authorization process after the initial 6 months of hospice care.  A re-evaluation of the member will be performed and additional hospice care authorized for a period not to exceed 60 days.  A re-evaluation will be performed every 60 days as needed. The revision is required by Public Laws 111-148 and 111-152.  

DHS Budget Impact - $868,000 total annual savings; $217,000 state share savings; OKDHS is responsible for any state share costs/savings associated with the ADvantage Waiver Program.  

IX. New Business

2011 Meeting dates

X. Adjourn

Next Meeting: Thursday, January 20, 2011

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