OHCA to propose provider rate cuts
March 29, 2016
OHCA Contacts: Jo Kilgore - (405) 522-7474
OHCA to propose provider rate cuts
The Oklahoma Health Care Authority (OHCA) will begin its public notification process to reduce SoonerCare (Oklahoma Medicaid) provider rates by 25 percent effective June 1, 2016, in anticipation of the state fiscal year 2017 appropriation.
It takes OHCA 60 days to implement rate changes because of public notification requirements. It takes 90 days for changes to impact the budget due to claim lag. It is imperative the agency achieves savings during the 12-month period; otherwise, the cut will be larger to achieve the savings during a shorter period of time. A 25 percent rate cut will put SoonerCare provider rates at 64.9 percent of the Medicare rate. It is also possible that if the agency’s appropriation is reduced more, additional provider rate cuts will be required. These cuts will affect all provider types including hospitals, physicians, pharmacy, durable medical equipment suppliers and nursing facilities.
The OHCA currently contracts with 46,129 providers. In addition to the 25 percent provider rate cut, the agency will also propose to eliminate payments for coinsurance and deductibles on crossover claims.
“I do not take these cuts lightly; as the state’s largest health insurer, the Oklahoma Health Care Authority underpins the entire fabric of the state’s health care system that serves all Oklahomans. I worry about the infrastructure of our health care system in light of these cuts. From a business standpoint, I’m afraid many providers will close their doors to our patients. In some cases, especially in rural parts of our state, health care professionals will have to move their business to larger communities in order to survive financially” said OHCA CEO Nico Gomez.
In addition to provider rate cuts, the agency is limiting all new professional service contracts and has implemented a hiring freeze. Over the past two years, the agency has cut administrative costs by $6.5 million in state funds (more than $26 million total) which includes cuts to existing contracts, reducing the payroll budget and the CEO took a voluntary reduction in his salary. Including the proposed reductions, there has been more than $868 million in state and federal funds reduced from the Oklahoma economy over the last two years and more than $1 billion in reductions over the last 10 years.
The provider rate cut notification process begins with required special meetings. Additional information about these meetings, including agendas, will be posted at www.okhca.org/calendar as the information becomes available.
Tribal Consultation (closed meeting)
State Plan Amendment Rate Committee (SPARC) (open meeting)
Medical Advisory Committee (MAC) (open meeting)
OHCA Board (open meeting)
All meetings will be held at the OHCA in the Charles (Ed) McFall Boardroom, 4345 N. Lincoln Blvd., Oklahoma City. Anyone interested in the SoonerCare program is encouraged to attend.
The Oklahoma Health Care Authority (OHCA) administers two key health programs for the state. The first is SoonerCare, Oklahoma’s Medicaid program. SoonerCare works to improve the health outcomes of Oklahomans by ensuring that medically necessary benefits and services are responsive to the health care needs of our members. Qualifying Oklahomans include certain low-income children, seniors, the disabled, those being treated for breast or cervical cancer and those seeking family planning services. The second program OHCA operates is Insure Oklahoma, which assists qualifying adults and small business employees in obtaining health care coverage for themselves and their families. OHCA strives to educate and engage our current 800,876 members regarding personal responsibilities for their health services utilization, behaviors, and outcomes in partnership with a state-wide network of 46,313 providers. For more information, visit www.okhca.org or www.insureoklahoma.org.