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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 18, 2008 Medical Advisory Committee Meeting (Attachment)

III. MAC Member Comments/Discussion

IV. Financial Report: Anne Garcia, Chief Financial Officer (September Financial Summary) (September Financials)

 a. Introduction of new CFO effective 2/1/2009

V. Budget Request 2010 Update: Juarez McCann, Chief Budget Officer (Attachment)

VI.  Program Operations & Benefits Update: Becky Pasternik-Ikard, Chief Operating Officer (SoonerCare Programs 2008-09) (SC Ops Report 11-08)

VII.  Provider Services Support Update: Paul Keenan, MD, Chief Medical Officer (Provider FastFacts)

VIII. Medical Home Update:  Melody Anthony, Director of Provider Services (Attachment)

IX.  Indiana Marketing for “Healthy Indiana”: Matthew Lucas, Director of Insure Oklahoma

X.  Healthcare Effectiveness Data and Information Set (HEDIS) Report: Lise DeShea, Ph.D., Statistician, Quality Assurance (HEDIS) (HEDIS 2)

XI.  State Health Access Data Assistance Center (SHADAC) Information: Buffy Heater, Manager Planning & Development

XII.  Glaucoma Intervention:  Shelly Gorman-Keast, Pharm.D., OU College of Pharmacy

XIII. Changes to future MAC Rules presentations: Cindy Roberts, Deputy Chief Executive Officer

XIV. Action Items: Tywanda Cox, Policy Development Coordinator

Federally Initiated

1. Eligibility rules are revised to allow time-limited coverage for Iraqis and Afghans with special immigrant status pursuant to Public Law 110-161 and 110-181. (Attachment)

OHCA Initiated

2. Grievance Procedures and Process rules are revised to reflect current practice for provider appeals.  (Attachment)

3. Dental rules are revised to allow prior authorization for a second set of panoramic films taken within three years of the first set and to allow prior authorization for a second provider to correct poorly rendered restorative procedures by the original provider of services.  Additionally, rules are revised to restrict the application of ceramic based and cast metal crowns to natural teeth only. (Attachment)

4. Outpatient Hospital and Free-Standing Ambulatory Surgery Center rules are revised to reflect upcoming changes to the reimbursement methodology for outpatient surgery services. (Attachment)

5. Non-Emergency Transportation rules are revised to remove specific reimbursement language from policy and refer to the state plan. (Attachment)

OKDHS Initiated

6. Personal Care rules are revised to transfer responsibilities, for the authorization of service units and monitoring of service provisions, from OKDHS nurses to agency provider nurses. (Attachment)

7. ADvantage Waiver Services rules are revised to add private duty nursing as a compensable service under the waiver program.  (Attachment)

8. Personal Care rules are revised to require the use of the new Interactive Voice Response Authentication (IVRA) time and attendance system for providers of personal care services. (Attachment)

XV.  Discussion

XVI. New Business

a.  2009 MAC Meeting Dates (2009 MAC Dates)

XVII. Adjourn

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