Archived Proposed Policy Changes
2021 - Present
The Oklahoma Health Care Authority (OHCA) seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed policy page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.
All comments regarding proposed administrative rules will be considered during the rulemaking process and become a part of the official work folder. All rule changes are subject to the Oklahoma Administrative Procedures Act.
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APA WF # 24-14 and OK SPA # 24-0020 Hospice Benefit Expansion -
OK SPA # 24-0019 Tracheostomy Rate for Nursing Facilities -
APA WF# 24-22 Tracheostomy Rate for Nursing Facilities -
APA WF# 24-23 Applied Behavioral Analysis (ABA) Changes -
APA WF # 24-18 TPL for School Based Services -
OK SPA 24-0002 & APA WF # 24-20 Pharmacists as Providers -
APA WF# 24-26A&B Developmental Disabilities Services Revisions -
APA WF# 24-25 Psychological Testing Limit Increase -
OK SPA 24-0021 & APA WF# 24-21 CRNA Rate Equalization -
APA WF# 24-24 Medication Assisted Treatment Clarification -
APA WF# 24-19 Updating Abortion Policy -
1915(c) HCBS Waiver Program Amendments -
OK SPA 24-0018 Coverage of Prescribed Drugs -
OK SPA 24-0014 Emergency Interim Payments -
OK SPA 24-0013 Annual Nursing Facility Rebasing -
OK SPA 24-0011 & APA WF# 24-15 TPL Prior Authorization -
1915(c) HCBS Waiver Program Amendments -
OK SPA 24-0009 and APA WF # 24-12 Medication Limits -
OK SPA 24-0008 Electronic Visit Verification for Home Health Services -
OK SPA 24-0004 State Plan Personal Care Rate Revision -
OK SPA 24-0010 CHIP Vaccines -
APA WF 24-02 Federally Qualified Health Center (FQHC) Substance Use Disorder (SUD) Certification Requirements -
APA WF 24-09 Continuous Eligibility for Children -
OK SPA 24-0001 Behavioral Health Workforce Case Manager -
APA WF 23-19 Adult Day Health Services Revisions -
APA WF 23-14 Audio-only Telecommunications Health Service Delivery -
24-0007 Potentially Preventable Readmissions SPA Page Revocation -
APA WF 23-06B Transition to SoonerSelect -
APA WF 23-06A Transition to SoonerSelect -
APA WF 24-05 Private Duty Nursing Coverage & Limitations -
Hospital-Administered Emergency Opioid Antagonist (OK SPA 24-0005 & APA WF 24-04) -
APA WF 24-03 Collaborative Care Model Reimbursement -
APA WF 24-06 Living Choice Timeline Clarification -
APA WF 23-24 Update Policy for Prosthetic Hearing Implants and Audiology Services -
APA WF 23-10 Add Doula Services for SoonerCare Members -
APA WF 23-17 Implement Changes to the Health Information Exchange -
APA WF 23-27 DDS Updates -
APA WF 23-26 340b Non-Compliant Providers -
APA WF 23-25 ADvantage and SPPC Revisions -
APA WF 23-20 TEFRA and ICF/IID Level of Care Reevaluations -
APA WF 23-16 Minimum Age for Enrollment into ADvantage Waiver -
APA WF 23-15 Biosimilar Reimbursement -
APA WF 23-08 Non-Payment of Provider Preventable Conditions -
APA WF 23-23 Update Hospital Services Policy -
APA WF 23-21 Quarterly Payments for Orthodontic Services -
APA WF 23-13 Add Secure Mental Health Transportation for SoonerCare Members -
APA WF 23-02 Update to Insure Oklahoma Policy -
APA WF 23-01 Policy Additions to State Plan Personal Care Services -
APA WF 23-22 Streamline Behavioral Health Workforce Credentialling -
APA WF 23-12 Intermediate Care Facilities Payment Program -
APA WF 23-09 Update Services Exempt from Copayment -
APA WF 23-11 Private Duty Nursing Reimbursement -
APA WF 23-05 SoonerCare Application Timeframe -
Quarterly Payments for Orthodontic Services -
Opioid Overdose Reversal Agents -
Human Immunodeficiency Virus (HIV) Counseling -
Eligibility for Reproductive Health & Family Planning Services (SoonerPlan) -
Lower Minimum Age for Enrollment into ADvantage Waiver -
2023 IMD Waiver Post Award Forum -
Psychological Evaluations and Level of Care Evaluations for TEFRA (Tax Equity and Fiscal Responsibility Act of 1982) Eligibility -
2023 SoonerCare Choice Post Award Form -
Adult Day Health Services Revisions -
Twelve-Months Continuous Eligibility for Children in Medicaid and CHIP -
Behavioral Health Acute/Acute II Rate Increases -
State plan personal care (SPPC) Rate Revision for Nurse Assessment/Evaluation Visit -
Mental Health Transportation (APA WF 23-13 & OK SPA 23-0021) -
Non-Payment of Provider Preventable Conditions (APA WF 23-08 & OK SPA 23-0008) -
Annual Nursing Facility & Intermediate Care Facility Rate Rebasing -
1915(c) HCBS ADvantage Waiver Amendment -
Statewide HIE (APA WF 23-17) -
Adult Expansion Alternative Benefit Plan (ABP) Benefits & Delivery System Update -
Substance Abuse Screening (OK SPA 23-0017) -
Reach Out and Read Oral Health Service Initiative (OK SPA 23-0023) -
American Rescue Plan (ARP) Policy Revisions -
Medicare Part B Reimbursement (OK SPA 23-0011 & APA WF 23-15) -
Supplemental Drug Rebate Agreement (OK SPA 23-0026) -
ICF/IID Enhanced Payment Program for Provision of Vocational and/or Day Services (APA WF 23-12) -
Audio-Only Health Service Delivery (APA WF 23-14 & OK SPA 23-0025) -
1915(c) HCBS In-Home Supports Waiver for Children -
1915(c) HCBS In-Home Supports Waiver for Adults -
1915(c) HCBS Homeward Bound Waiver Amendment -
1915(c) HCBS Community Waiver Amendment -
OK SPA 23-0018 Pharmacist Administered Vaccines -
OK SPA 23-0020 Enhanced payment for Vocational and Day Services Provided in Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICFs/IID) -
OK SPA 23-0019 Private Duty Nursing Rate Increase -
OK SPA 23-0015 Independent Clinical Psychologist Services -
OK SPA 23-0014 Doula Services -
APA WF 22-16 Statewide HIE -
APA WF 23-11 Private Duty Nursing Reimbursement and Overtime -
APA WF 23-10 Doula Services -
APA WF 23-09 Copayment Exemption for Expansion Adults -
APA 23-02 Insure Oklahoma Self-Funded/Self-Insured Plans -
APA WF 22-24B Developmental Disabilities Services (DDS) Policy Revisions -
APA WF 22-05 Ambulance Service Provider Access Payment Program -
1915(c) HCBS Medically Fragile Waiver Renewal -
APA WF 22-31 Elimination of the Certificate of Medical Necessity (CMN) Form Requirement for Most Medical Supplies, Equipment, and Appliances -
APA WF 22-30 Outdated/Obsolete Policy Language Cleanup -
APA WF 22-29 Laboratory Services Policy Cleanup -
APA WF 22-28 Opioid Treatment Program (OTP) Rule Changes -
APA WF 22-27 Physician Assistant Rule Revisions -
APA WF 22-26 Crisis Intervention Rule Revisions -
APA WF 22-25 Behavioral Health Rules Cleanup -
APA WF 22-24A Developmental Disabilities Services (DDS) Policy Revisions -
APA WF 22-23B OKDHS ADvantage Waiver Revisions -
APA WF 22-23A OKDHS ADvantage Waiver Revisions -
APA WF 22-22 Ukrainian Humanitarian Parolees -
APA WF 22-21B Increase Income Standard for Pregnant Women and Extend Postpartum Coverage -
APA WF 22-21A Increase Income Standard for Pregnant Women and Extend Postpartum Coverage -
APA WF 22-18 Mobile Dental Services -
APA WF 22-17 Covering Former Foster Care Youth from Another State -
APA WF 22-15 Removing Provider Panel Limits in the Patient Centered Medical Home (PCMH) -
APA WF 22-14 Coverage for Donor Human Breast Milk -
APA WF 22-13 Allowing Advanced Practice Registered Nurses (APRNs) and Physician Assistants (PAs) to Render Physician-Required Psychiatric Services -
APA WF 22-12 Staff Ratios and Staff Licensing Requirements for Out-of-State Psychiatric Providers -
APA WF 22-11 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Visit and Sick Visit on the Same Day -
APA WF 22-10 Pay-for-Performance (PFP) Program -
APA WF 22-08 Hospice Benefit for Expanded Population -
APA WF 22-07 Tribal Residential Substance Use Disorder (SUD) Policy Updates -
APA WF 22-03 Clinical Trials Routine Service and Dental Out-of-State Services -
APA WF 22-02 Independent Clinical Psychologist Services for Adults -
APA WF 22-01 Non-Emergency Transportation (NEMT) Driver Compliance -
1115(a) SoonerCare Research and Demonstration Waiver Amendment Request -
APA WF 23-06B Transition to SoonerSelect -
APA WF 23-06A Transition to SoonerSelect -
1915(c) HCBS In-Home Supports Waiver for Children -
1915(c) HCBS In-Home Supports Waiver for Adults -
1915(c) HCBS Homeward Bound Waiver Amendment -
1915(c) HCBS Community Waiver Amendment -
APA 23-05 Notification of Date of Service (NODOS) Timeframe Change -
APA 23-01 State Plan Personal Care Services for Expansion Adults, TEFRA Eligible Children and Certain MAGI Populations -
APA WF 22-21B Increase Income Standard for Pregnant Women and Extend Postpartum Coverage -
APA WF 22-21A Increase Income Standard for Pregnant Women and Extend Postpartum Coverage -
OK SPA 22-0042 Pregnancy-Related Federal Poverty Limit Increase, Postpartum Coverage Extension, and Proxy Methodology -
OK SPA 23-0006 Cost-Sharing Updates -
1115(a) SoonerCare Choice Demonstration Waiver Renewal -
Institutions for Mental Diseases (IMD) Waiver for Serious Mental Illness/Substance Use Disorder Post Award Forum -
APA WF 22-22 Ukrainian Humanitarian Parolees -
APA WF 22-11 Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Visit and Sick Visit on the Same Day -
SoonerCare Choice Post Award Forum -
OK SPA 22-0040 Dental Services Reimbursement Methodology -
APA WF 22-16 Statewide HIE -
APA WF 22-13 Allowing APRNs and PAs to Render Physician-Required Psychiatric Services -
APA WF 22-18 Mobile Dental Services -
APA WF 22-17 Covering Former Foster Care Youth from Another State -
APA WF 22-14 Coverage for Donor Human Breast Milk -
APA WF 22-12 Staff Ratios and Staff Licensing Requirements for Out-of-State Psychiatric Providers -
APA WF 22-05 Ambulance Service Provider Access Payment Program -
OK SPA 22-0031 Former Foster Care Youth -
1915(c) HCBS Medically Fragile Waiver Amendment -
APA WF 22-15 Removing Provider Panel Limits in the Patient Centered Medical Home (PCMH) -
OK SPA 22-0017 Nursing Facility Rebasing and Pay-for-Performance Update -
OK SPA 22-0032 Outpatient BH Rate Increases -
1915(c) HCBS Homeward Bound Waiver Amendment -
1915(c) HCBS ADvantage Waiver Amendment -
1915(c) HCBS In-Home Supports Waiver for Adults -
1915(c) HCBS In-Home Supports Waiver for Children -
1915(c) HCBS Community Waiver Amendment -
APA WF # 22-09 Termination of SoonerPlan Family Planning Program -
APA WF # 22-10 Pay-for-Performance (PFP) Program -
APA WF # 22-08 Hospice Benefit for Expanded Population -
OK SPA 22-0027 SoonerPlan Termination -
APA WF # 22-07 Updating Tribal Residential Substance Use Disorder Policy -
APA WF # 22-03 Clinical Trials and Dental Out-of-State Services -
OK SPA 22-0011 Independently Licensed Psychologist Services -
OK SPA 22-0024 Recovery Audit Contractor Date Revision -
OK SPA 22-0021 Clinical Trials Patient Costs -
OK SPA 22-0016 Partial Hospitalization Benefit -
OK SPA 22-0004 Adult Expansion Alternative Benefit Plan (ABP) Update -
APA WF# 21-17 Dental Revisions -
OK SPA 22-0020 Dental Prophylaxis Revisions -
APA WF# 21-45 Referrals for Specialty Services Revisions -
APA WF# 21-43 Opioid Treatment Provider (OTP) Policy Changes -
APA WF# 21-42 Rural Health Centers (RHC) and Federally Qualified Health Centers (FQHC) Visit Limitation Revisions -
APA WF# 21-41B Outdated/Obsolete Policy Language Cleanup -
APA WF# 21-41A Outdated/Obsolete Policy Language Cleanup -
APA WF# 21-40 Pregnant Women Copayment Language Cleanup -
APA WF# 21-39 Laboratory Services Policy Cleanup -
APA WF# 21-38B Developmental Disabilities Services (DDS) Updates for Specialized Foster Care, Agency Companion, Employment Services and Self-Directed Services -
APA WF# 21-38A Developmental Disabilities Services (DDS) Updates for Specialized Foster Care, Agency Companion, Employment Services and Self-Directed Services -
APA WF# 21-37 Private Duty Nursing (PDN) Revisions -
APA WF# 21-35 Lodging and Meals Revisions -
APA WF# 21-32 Obstetric (OB) Emergency Room Ultrasound Coverage -
APA WF# 21-29 Partial Hospitalization Program (PHP) Services for Adults -
APA WF# 21-28 Qualified Medicare Beneficiary Plus (QMBP) Policy Clarification -
APA WF# 21-26 COFA Migrant Medicaid Extension and Afghan Refugees Eligibility Determinations -
APA WF# 21-22 Title XXI Dental Revisions for Pregnant Women -
APA WF# 21-20 Alternative Treatments for Pain Management -
APA WF# 21-19 Appeals to the Chief Executive Officer (CEO)/Administrative Law Judge (ALJ) -
APA WF# 21-16 Hospital Presumptive Eligibility (HPE) for Expansion Adults -
APA WF# 21-15 Ensuring Access to Medicaid Act -
APA WF# 21-13 Grievance Procedures and Process Rules Revisions -
APA WF# 21-11 Indian Health Service, Tribal and Urban Indian (I/T/U) Shared Savings Program -
APA WF# 21-10 Transitioning Developmental Disabilities Services Division (DDSD) Members back into the Money Follows the Person (MFP) Program -
APA WF# 21-08 Statewide HIE (OKSHINE) -
APA WF# 21-07 Payments from Trusts for Clothing Expenses Not Counted as Income -
APA WF# 21-05B Medicaid Expansion -
APA WF# 21-05A Medicaid Expansion and Durable Medicaid Equipment -
APA WF# 21-04 Diabetes Self-Management Education and Support (DSMES) Services -
APA WF 21-01 Reimbursing Federally Qualified Health Centers (FQHCs) for Long- Acting Reversible Contraceptives (LARCs) Outside of the Encounter Rate -
APA WF# 21-34 Reimbursement Methodology for Providers of Certified Community Behavioral Health (CCBH) Services -
APA WF# 21-33 Improve 340B Shared Savings Methodology -
APA WF# 21-31 Applied Behavior Analysis (ABA) Revisions -
APA WF# 21-30 Eliminate Community Based Extended (CBE) and Community Based Transitional (CBT) Levels of Care -
1915(c) HCBS In Home Supports Waiver for Children Renewal -
1915(c) HCBS In Home Supports Waiver for Adults Renewal -
1915(c) HCBS Homeward Bound Waiver Amendment -
1915(c) HCBS Community Waiver Amendment -
OK SPA 22-0010 Supplemental Drug Rebate Updates -
APA WF 22-01 (formerly APA WF 21-25) Non-Emergency Transportation (NEMT) Provider-Driver Requirements -
APA WF# 21-44 Independent Clinical Psychologist Services for Adults -
APA WF# 21-27 Cleanup Policy Reference about Timely Filing -
APA WF# 21-14 Expansion Adults into SoonerCare Choice -
APA WF# 21-12 Purchasing Rules Revisions -
APA WF# 21-09 Supplemental Hospital Offset Payment Program (SHOPP) -
APA WF# 21-06 Insure Oklahoma Individual Plan and Timely Filing -
APA WF# 21-02B OHS ADvantage Waiver Services and State Plan Personal Care Services -
APA WF# 21-02A OHS ADvantage Waiver Services and State Plan Personal Care Services -
OK SPA 22-0007 Ambulance Service Provider Access Payment Program (ASPAPP) -
OK SPA 22-0019 Eliminate Community Based Extended (CBE) and Community Based Transitional (CBT) Levels of Care -
OK SPA 21-0043 Non-Emergency Transportation (NEMT) Provider-Driver Requirements -
OK SPA 21-0047 Program of All-inclusive Care for the Elderly (PACE) Capitation Payment Rate Methodology -
SoonerCare Choice Post Award Forum -
OK SPA 21-0041 Certified Community Behavioral Health (CCBH) Reimbursement -
OK SPA 21-0042 Intensive Residential Substance Use Disorder (SUD) Treatment for Adolescents -
APA WF 21-22 Title XXI Dental Revisions for Pregnant Women -
OK SPA 21-0039 Appeals to the Administrative Law Judge (ALJ) -
OK SPA 21-0035 Alternative Non-Pharmacological Treatments for Pain Management (UPDATED) -
APA WF 21-11 Indian Health Service, Tribal and Urban Indian (I/T/U) Shared Savings Program -
APA WF 21-10 Transitioning Developmental Disabilities Services Division (DDSD) Members back into the Money Follows the Person (MFP) Program -
APA WF 21-01 Reimbursing Federally Qualified Health Centers (FQHCs) for Long Acting Reversible Contraceptives (LARCs) -
APA WF 21-21 Hospice Benefit for Expanded Population -
APA WF 21-20 Alternative Treatments for Pain Management -
APA WF 21-19 Appeals to the Chief Executive Officer (CEO)/Administrative Law Judge (ALJ) -
APA WF 21-18 Compact of Free Association (COFA) Migrant Medicaid Extension -
APA WF 21-17 Adult Dental Limited Benefits Revisions -
APA WF 21-16 Hospital Presumptive Eligibility (HPE) for Expansion Adults -
OK SPA 21-0038 Hospital Presumptive Eligibility (HPE) and Expansion Adults -
OK SPA 21-0018 Alternative Benefit Plan (ABP) Benefit Updates -
APA WF 21-14 Expansion Adults into SoonerCare Choice -
APA WF 21-15 Ensuring Access to Medicaid Act -
APA WF 21-13 Grievance Procedures and Process Rules Revisions -
APA WF 21-12 Purchasing Rules Revisions -
OK SPA 21-0027 Nursing Facility Annual Rebasing of Rates (UPDATED) -
OK SPA 21-0031 Adult Expansion Alternative Benefit Plan (ABP) Service Delivery System Update -
OK SPA 21-0033 Adult Dental Copays -
APA WF 21-09 Supplemental Hospital Offset Payment Program (SHOPP) -
APA WF 21-08 Statewide HIE (OKSHINE) -
OK SPA 21-0029 Dental Services for Adults -
OK SPA 21-0014 Alternative Benefit Plan (ABP) Benefits Updates -
OK SPA 21-0022 Terminate Health Homes -
OK SPA 21-0025 Third Party Liability Payment of Claims -
1915(c) HCBS Medically Fragile Waiver Amendment -
APA WF 21-07 Payments from Trusts for Clothing Expenses Not Counted as Income -
OK SPA 21-0026 Ordering Providers for Home Health Services -
APA WF 21-02 State Plan Personal Care Services -
APA WF 21-06 Insure Oklahoma Individual Plan and Timely Filing -
APA WF 21-05B Medicaid Expansion -
APA WF 21-05A Medicaid Expansion and Durable Medical Equipment -
OK SPA 21-0007 Reimbursement of Long-Acting Reversible Contraceptive (LARC) Devices in a Federally Qualified Health Center (FQHC) -
APA WF 21-01 Reimbursing Federally Qualified Health Centers (FQHCs) for Long-Acting Reversible Contraceptives (LARCs) -
OK SPA 21-0020 Supplemental Rebate Agreement for Prescription Drugs Update -
OK SPA 21-0015 Adult Expansion ABP Service Delivery System Update -
APA WF# 21-03 Remove Reasonable Limits on Amounts for Necessary Medical and Remedial Care not covered under the Oklahoma Medicaid State Plan -
SoonerCare Choice Post Award Forum
APA WF# 20-01 High-Investment Drugs Carve-Out
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will allow for reimbursement of high-investment drug therapies outside of the inpatient and outpatient hospital payment methodologies. Revisions will also align policy with current practice and correct grammatical errors.
Please view the circulation document here: APA WF# 20-01, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Board Meeting: 01/20/2021
APA WF# 20-02 Retroactive Eligibility
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed rule changes provide for a retroactive period of eligibility, in accordance with 42 Code of Federal Regulations § 435.915.
Please view the circulation document here: APA WF# 20-02, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Board Meeting: 01/20/2021
APA WF# 20-03 Treatment of Lottery or Gambling Winnings for Income Eligibility
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions amend how lottery or gambling winnings of $80,000 and above, which are paid out in a single payout, and not in installments over a period of time, are counted for SoonerCare income eligibility.
Please view the circulation document here: APA WF# 20-03, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Board Meeting: 01/20/2021
APA WF# 20-04 Electronic Visit Verification (EVV)
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed new rules are needed in order to comply with the 21st Century Cures Act which requires providers of personal care services to utilize an EVV system where visit details are documented.
Please view the circulation document here: APA WF# 20-04, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-05 Continuation of Services Pending Appeals
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed new rule will comply with Section 431.230 of Title 42 of the Code of Federal Regulations by describing the conditions in which Medicaid benefits will continue or be reinstated pending an appeal. Additionally, the proposed new rule will describe the application, obligations, and implications for the appellant when Medicaid benefits are continued or reinstated pending an appeal.
Please view the circulation document here: APA WF# 20-05, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Board Meeting: 01/20/2021
APA WF# 20-06B Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit. Prosthetics and orthotics are under a separate regulation and remain an optional benefit.
Please view the circulation document here: APA WF# 20-06B, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Board Meeting: 01/20/2021
APA WF# 20-06C Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit. Prosthetics and orthotics are under a separate regulation and remain an optional benefit.
Please view the circulation document here: APA WF# 20-06C, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 02/22/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-06D Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit. Prosthetics and orthotics are under a separate regulation and remain an optional benefit.
Please view the circulation document here: APA WF# 20-06D, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Board Meeting: 01/20/2021
APA WF# 20-11 Medicare Part C (Medicare Advantage)
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will standardize the language in policy between Medicare Part A, Part B, and Part C.
Please view the circulation document here: APA WF# 20-11, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Board Meeting: 01/20/2021
APA WF# 20-13 Child Support Cooperation Exemption for Recipients of Indian Health Services
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will reflect changes in federal regulations regarding a Medicaid agency's process for medical child support referrals.
Please view the circulation document here: APA WF# 20-13, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-14 Therapy Assistants and Clinical Fellows
These rule changes were previously approved by the OHCA Board of Directors and the Governor and are currently in effect as emergency rules. Due to Oklahoma Statutes, these rules must be taken through the permanent rulemaking process.
The proposed revisions will add physical therapy assistants, occupational therapy assistants, speech-language pathology assistants (SLPAs), and speech-language pathology clinical fellows as eligible providers that can render therapy services to SoonerCare members. Additionally, the proposed revisions will outline provider qualifications and other requirements for provision of these therapy services. Finally, revisions will be made to clarify that these providers will be reimbursed at the rate established per the Oklahoma Medicaid State Plan.
Please view the circulation document here: APA WF# 20-14, and submit feedback via the comment box below.
Circulation Date: 02/01/2021
Comment Due Date: 03/03/2021
Public Hearing: 03/03/2021
Board Meeting: 03/17/2021
APA WF# 20-15A Residential Substance Use Disorder (SUD) Treatment Coverage
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will support WF 20-15B, which proposes to establish coverage of residential substance use disorder (SUD) treatment for Medicaid-eligible individuals and removes the eligibility exclusion of members in an institution for mental disease (IMD) under the SoonerCare Choice program. Lastly, the proposed revisions will also remove "family planning" references as the program is terminating due to Medicaid expansion.
Please view the circulation document here: APA WF# 20-15A, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-15B Residential Substance Use Disorder (SUD) Treatment Coverage
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
Emergency rule revisions established residential SUD treatment coverage for Medicaid-eligible adults, ages twenty-one (21) to sixty-four (64), and members under the age of twenty-one (21) in residential SUD treatment facilities with seventeen (17) beds or more and/or residential SUD treatment facilities with sixteen (16) beds or less. Permanent rule revisions will remove references to non-Medicaid compensable services and align covered services with the Oklahoma Medicaid State Plan. Further revisions will revise assessment and service plan timeframes and certain treatment hour requirements. Other revisions will involve limited rewriting aimed at clarifying policy language.
Please view the circulation document here: APA WF# 20-15B, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-16 Opioid Treatment Program (OTP) and Medication-Assisted Treatment (MAT) Services
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will comply with the SUPPORT Act, HR 6, and establish coverage and reimbursement of medically necessary medication-assisted treatment (MAT) services and/or medications for SoonerCare members with opioid use disorder (OUD) in opioid treatment programs (OTPs) and within office-based opioid treatment (OBOT) settings.
Please view the circulation document here: APA WF# 20-16, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-19A Appeals Language Cleanup
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed rule changes will replace incorrect rule section references with the appropriate references. Additionally, revisions will remove appeals language for programs that no longer exist and will identify the appropriate appeal form to fill out when filing an appeal.
Please view the circulation document here: APA WF# 20-19A, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-19B Appeals and Incorrect References Language Cleanup
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will revise certain sections of policy that have references to incorrect or outdated sections.
Please view the circulation document here: APA WF# 20-19B, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-20 Pay-For-Performance Program
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will update the Pay-for-Performance (PFP) program quality measures to align with the most recent metrics modified by the Centers for Medicare and Medicaid. Additional revisions will specify the timeline in which a nursing facility can submit its quality of care documentation to be eligible for reimbursement.
Please view the circulation document here: APA WF# 20-20, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-21 Employment Services Offered through Developmental Disabilities Services
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed rule revisions will describe group job placements. Additional changes will authorize remote supports for individual placements and remove the specific limit that the cost of the member's employment services, excluding transportation and state-funded services, cannot exceed limits specified in OKDHS Appendix D-26. Furthermore, changes will clarify that adult members receiving In-Home Supports Waiver (IHSW) services can access individual placement in job coaching, stabilization, and employment training specialist services; however, not to exceed limits specified in OKDHS Appendix D-26 per Plan of Care year. Additional revisions will include updates to standard policy language including cleanup of formatting and grammatical errors plus clarify and update terminology used to reflect current business practices.
Please view the circulation document here: APA WF# 20-21, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Board Meeting: 03/17/2021
APA WF# 20-22 Programs of All Inclusive-Care for the Elderly (PACE) Revisions
The proposed revisions will update policy regarding enrollment denials for PACE to reflect current business practices. Additional policy changes will add language to clarify and establish OHCA's role in reviewing justifications for expedited appeals from PACE organizations. These proposed rule changes will align policy with Section 460.122 of Title 42 of the Code of the Federal Regulations.
Please view the circulation document here: APA WF# 20-22, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-23 Developmental Disabilities Services (DDS) Revisions
The proposed revisions will change the timeframe for the physical health examinations and medical evaluations that are required when applying for the DDS Home and Community-Based Services waiver from ninety (90) to one (1) calendar year. Additionally, revisions will add language for remote services that are provided in the member's home, family home, or employment site. Revisions will also address the new agency companion household criteria and new agency champion provider requirements, as well as modify the procedures for the DDS home profile process. Finally, revisions will establish new criteria on how the member is to obtain assistive technology devices and will clarify instructions to staff whom are providing Stabilization Services authorized through remote supports.
Please view the circulation document here: APA WF# 20-23, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-24A ADvantage Waiver
The proposed revisions will align waiver policy with the Oklahoma Health Care Authority's overarching Electronic Visit Verification rules. Additional revisions will involve eliminating or updating outdated policy and correcting grammatical errors.
Please view the circulation document here: APA WF# 20-24A, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-24B ADvantage Waiver
The proposed revisions will align waiver policy with the Oklahoma Health Care Authority's overarching Electronic Visit Verification rules. Additional revisions will involve eliminating or updating outdated policy and correcting grammatical errors.
Please view the circulation document here: APA WF# 20-24B, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-25 Peer Recovery Support Specialist (PRSS) Services in Indian Health Services, Tribal Programs and Urban Indian Clinics (I/T/Us)
The proposed revisions will add coverage and reimbursement of PRSS services. The proposed revisions will also support WF 20-15A&B in adding coverage and reimbursement of residential substance use disorder (SUD) treatment services. Other revisions will reorganize policy for clarity and correct grammatical errors.
Please view the circulation document here: APA WF# 20-25, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-26 Applied Behavior Analysis (ABA) Services Revisions
The proposed revisions will clarify individualized treatment plan requirements, common ABA-based techniques, medical necessity criteria, and required documentation for ABA treatment extension requests. The proposed revisions will also allow licensed psychologists to render ABA services without additional ABA-related certification requirements. Other revisions will involve limited rewriting aimed at clarifying policy language.
Please view the circulation document here: APA WF# 20-26, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-27 Specialty Psychiatric Residential Treatment Facility (PRTF) Staffing and Admission Revisions
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.
The proposed revisions will make changes to the specialty Acute II and PRTF staffing ratio and criteria for admission.
Please view the circulation document here: APA WF# 20-27, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-29 Provider Refund to Member when Copayment is Over-Collected
The proposed revisions will state the provider's requirement to refund any copayment collected from the member in error.
Please view the circulation document here: APA WF# 20-29, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-31 State Treasurer’s Achieving a Better Life Experience (STABLE) Accounts
The proposed revisions further define Aged, Blind, and Disabled (ABD) resource exclusion rules regarding contributions to STABLE accounts.
Please view the circulation document here: APA WF# 20-31, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-33 Bariatric Surgery Revisions
The proposed revisions will update bariatric surgery requirements and guidelines to reflect current business practice. Additional revisions will involve fixing grammatical and/or formatting errors, as well as, revoking obsolete sections.
Please view the circulation document here: APA WF# 20-33, and submit feedback via the comment box below.
Circulation Date: 12/15/2020
Comment Due Date: 01/15/2021
Public Hearing: 01/19/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-34 Dental Revisions
The proposed rule changes will add "scaling in the presence of a generalized moderate or severe gingival inflammation" as a new procedure to dental policy. Additional revisions will specify that a caries risk assessment form must be documented when submitting a prior authorization for crowns. Further revisions will explain that written consent from a parent or court appointed legal guardian must be provided for any services that are rendered to a minor child. Finally, revisions will clarify billing language for administering nitrous oxide and involve cleanup of formatting and grammatical errors.
Please view the circulation document here: APA WF# 20-34, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-36A Lodging, Meals, and SoonerRide
The proposed revisions will update the lodging and meals policy by changing the allowed mileage radius from one hundred miles or more to fifty miles or more. This change improves access to the lodging and meals benefit and to medically necessary care. Additional changes will reformat and organize the existing policy in order to provide better clarity on how the approval process works for the lodging and meals benefit. Furthermore, the proposed revisions will update and reformat the SoonerRide Non-Emergency Transportation (NEMT) policy to provide more clarity to providers and members. The proposed revisions will outline the specific services that SoonerRide NEMT offers and how members and long-term care facilities can request transportation assistance through SoonerRide NEMT. The proposed revisions to lodging and meals, as well as SoonerRide, will align policy with current business practices.
Please view the circulation document here: APA WF# 20-36A, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-36B Lodging, Meals, and SoonerRide
The proposed revisions will remove duplicate policy regarding lodging, meals, and SoonerRide non-emergency transportation. The policies regarding these services are already outlined in the Oklahoma Health Care Authority's Chapter 30.
Please view the circulation document here: APA WF# 20-36B, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-37 Obstetrical (OB) Ultrasound
The proposed revisions will update the OB Ultrasound policy to allow for both an abdominal and vaginal ultrasound to be performed in the first trimester when clinically appropriate and medically necessary. Policy currently only allows for either an abdominal or vaginal ultra sound.
Please view the circulation document here: APA WF# 20-37, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-38 Clinical Trials
The proposed revisions will add guidelines for coverage of clinical trials medical necessity criteria for coverage of routine care services during a clinical trial, and clarifying that experimental and investigational treatment is not covered.
Please view the circulation document here: APA WF# 20-38, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-39 Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Policy Revisions
The proposed revisions will align RHC/FQHC policy language with the Oklahoma Medicaid State Plan, federal regulations and OHCA's current business practices.
Please view the circulation document here: APA WF# 20-39, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-40 Medicaid-Funded Abortion Certification Requirements
The proposed revisions will align with 63 Oklahoma Statutes § 1-741.1 and require the Certification for Medicaid Funded Abortion form to be completed by the physician and the patient.
Please view the circulation document here: APA WF# 20-40, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-41 Sunsetting of Behavioral Health Homes
The Health Homes benefit will be phased out effective September 30, 2021; thereby, rendering the associated rule language obsolete. However, other care coordination models will still be in place to still serve this population.
Please view the circulation document here: APA WF# 20-41, and submit feedback via the comment box below.
Circulation Date: 01/19/2021
Comment Due Date: 02/18/2021
Public Hearing: 02/23/2021
Medical Advisory Committee Meeting: 03/11/2021
Board Meeting: 03/17/2021
APA WF# 20-01 High-Investment Drugs Carve-Out
The proposed revisions will allow for reimbursement of high-investment drug therapies outside of the inpatient and outpatient hospital payment methodologies. Revisions will also align policy with current practice and correct grammatical errors.
Please view the circulation document here: APA WF# 20-01, and submit feedback via the comment box below.
Circulation Date: 01/15/2020
Comment Due Date: 02/14/2020
Medical Advisory Committee: 03/12/2020
Board Meeting: 03/18/2020
OK SPA 21-0009 Rate Revisions for the Specialty, Standard, and Extended Psychiatric Residential Treatment Facilities (PRTFs)
The Oklahoma Mental Health & Substance Abuse (OMHSA) will seek approval of a State Plan Amendment (SPA) to revise rates for PRTFs. The established per diem base rate for standard populations will be restored from $286.08 to $336.57 (the rate prior to the 2016 budget reduction). The established per diem base rate for standard populations will be restored from $271.61 to $319.54 (the rate prior to the 2016 budget reduction). The established per diem base rate for specialty populations will increase from $340.04 to $550.00.
Please view the draft SPA pages here: OK SPA 21-0009, and submit feedback via the comment box below.
Tribal Consultation: 01/05/2021
30-day Tribal Consultation Period: 01/05/2021 – 02/04/2021
Circulation Date: 12/28/2020
Comment Due Date: 1/27/2021
OK SPA 21-0013 OMB Rate for Tribal Providers of Residential Substance Use Disorder Services (SUD) in a Non-IMD
The OHCA originally presented policy changes and a state plan amendment request to establish coverage and reimbursement of residential substance use disorder (SUD) treatment services for individuals under the age of 21 and individuals age 21-64 residing in facilities with 16 beds or less in September 2020. At the time of the submission, the State requested reimbursement for all providers at a State-defined per diem rate. However, since submission of OK SPA 20-0035, Residential SUD Services, the State has received further guidance from CMS of options for reimbursement methodologies of residential services to tribal providers. Therefore, the State will seek to reimburse tribal providers an outpatient OMB rate for residential substance use disorder services.
Please view the draft SPA pages here: OK SPA 21-0013, and submit feedback via the comment box below.
Tribal Consultation Dates: 01/05/2021
30-day Expedited Tribal Consultation Period: 01/05/2021 – 02/04/2021
Circulation Date: 01/25/2021– 02/04/2021
Requested Effective Date: 01/01/2021
OK SPA 21-0016 Adult Inpatient Physician & Surgical Physician Visit Limitation
Oklahoma’s (OK) state plan amendment (SPA) 21-0016 will remove the 24-day per state fiscal year limit for covered inpatient physician and surgical services provided to adult SoonerCare members. The limitation is removed to align with current practice and for the purposes of the alternative benefit plan for adults in the expansion group.
Please view the draft SPA pages here: OK SPA 21-0016, and submit feedback via the comment box below.
Tribal Consultation: 01/05/2021
60-day Tribal Consultation Period: 01/05/2021 – 03/06/2021
Circulation Date: 01/05/2021
Comment Due Date: 02/04/2021
OK SPA 21-0019 Applied Behavior Analysis (ABA) Psychologist Requirements
The proposed revision will allow licensed psychologists to render ABA services without additional ABA-related certification requirements.
Please view the draft SPA pages here: OK SPA 21-0019, and submit feedback via the comment box below.
Tribal Consultation: 01/05/2021
60-day Tribal Consultation Period: 01/05/2021 – 03/06/2021
Circulation Date: 01/21/2021
Comment Due Date: 02/20/2021
Enrollment of Certain Medicaid Members under the Demonstration and Implementation of SoonerSelect Managed Care Model, effective: October 1, 2021, contingent upon CMS approval
With this amendment request, the OHCA seeks approval of the following modifications to the 1115(a) demonstration Special Terms and Conditions (STCs) for the current extension period that will be effect through the end of the waiver demonstration on December 31, 2023:
- Add the Expansion Adult Group under the Demonstration for the purposes of waiving retroactive eligibility and enrolling the Expansion Adult Group in SoonerSelect, the State’s comprehensive Medicaid managed care model;
- Add the Former Foster Care Group under the Demonstration for the purpose of enrolling this Group in SoonerSelect; and
- Enroll qualified individuals in SoonerSelect, with a targeted effective enrollment date of October 1, 2021.
The requested amendment does not change the budget neutrality model for current Demonstration populations.
The OHCA welcomes comments from the public regarding the amendment to the SoonerCare Choice and Insure Oklahoma 1115(a) demonstration waiver program. Please view the waiver amendment in its entirety here: OK Waiver Amendment, Managed Care Organizations(MCO), and submit feedback via the comment box below.
The public notice for the waiver may be viewed on the Agency’s Policy change and Native American Consultation webpages. The amendment will be available for a 30-day public comment period from January 4, 2021 through February 5, 2021.
Tribal Consultation Dates: 07/07/2020
60-day Tribal Consultation Period: 07/07/2020 – 09/05/2020
30-day Circulation Date: 01/04/2021 – 02/05/2021
Requested Effective Date: 10/01/2021
OHCA Comment Response: Oklahoma joins 40 other states in engaging with managed care organizations to assist them in administering certain Medicaid benefits. This is one of the largest contracts procured in the state’s history. The contracts were competitively bid and were selected after a technical evaluation and oral presentations. The four chosen partners will allow the State to improve health outcomes for Oklahomans; move toward value-based payment and away from payment based on volume; improve SoonerCare beneficiary satisfaction; improve access to prevention and treatment services through better care coordination; and increase cost predictability in the State.
SoonerCare Choice Post Award Forum - The annual Post Award Forum is held to report the progress of Oklahoma’s SoonerCare Choice section 1115(a) Medicaid demonstration project and solicit feedback from the public. Any comments received will be included in the waiver’s semi-annual and annual reports to CMS.
Please view the most recent annual report here: 2019 SoonerCare Choice Annual Report, and submit feedback via the comment box below. A presentation on the demonstration’s progress will be held at the Medical Advisory Committee (MAC) meeting on March 11, 2021, at 1 PM in the OHCA boardroom at the OHCA offices located at 4345 N. Lincoln Blvd., Oklahoma City, OK 73105.
Due to the current public health emergency and the associated social distancing guidelines, persons wishing to present their views in writing or obtain copies of the SoonerCare Choice annual report may do so via mail by writing to: Oklahoma Health Care Authority, Federal Authorities Unit, 4345 N. Lincoln Blvd., Oklahoma City, Oklahoma 73105, or by email at federal.authorities@okhca.org. Written comments or requests for copies of the annual report will be accepted by contacting OHCA as indicated. Comments submitted through the OHCA policy blog will be available for review online on the Policy Blog. Other written comments are available upon request at federal.authorities@okhca.org.
Circulation Date: 12/11/2020 – 03/11/2021
1915(c) HCBS ADvantage Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval
The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the ADvantage Waiver. The goal of the program is to provide services for members ages 21-64 with a physical disability and/or members age 65 and older who are Medicaid eligible and who meet nursing facility level of care to remain at home or in the residential setting of their choosing while receiving the necessary care.
The waiver renewal updates the unduplicated number of participants and the State's financial estimates for waiver years 1-5. The waiver renewal also allows the contracted Financial Management Services provider (FMS) the option to provide self-directed services via the Electronic Visit Verification system (EVV) in order to comply with federal regulation. Additional service updates include: adding the option to complete medical eligibility assessments through an electronic format (phone, video conference, etc.); updating services and supports provided by a legally responsible individual to reflect current OHCA policy; and removing the self-evaluation tool as means to evaluate the Case Managers Interdisciplinary Team meeting (IDT) facilitation performance. Further updates include escalated issues processes and timelines; how to notify Adult Protective Services of abuse, neglect, and exploitation (a/n/e); OHS fair hearing notification language; references to Oklahoma Administrative Code policies; and revising rates for waiver services to match OHCA rate methodologies. Other changes include general clarification, alignment with state statute, and clean-up throughout the waiver document.
Please view the renewal application here: 1915(c) HCBS ADvantage Waiver Renewal.
Please submit all comments by close of business, March 2, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
1915(c) HCBS In-Home Supports Waiver for Children Amendment effective: upon CMS approval or July 1, 2021, whichever is earlier
The Oklahoma Department of Human Services (OHS) is seeking to amend the In-Home Supports Waiver for Children serving individuals ages 3-17 through a combination of community resources, SoonerCare services such as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, and waiver services. OHS/DDS case managers help identify concerns and coordinate, locate, and secure needed services. OHS/DDS case managers also help families recognize natural supports that may already be available.
The waiver amendment proposes to decrease the unduplicated number of participants for waiver year 5. The amendment adds a telehealth delivery option for Family Training services and the option for electronic signature for service plan developments. Further updates allow for OHS/DDS case management and quality assurance staff the option of monitoring members in their own home via phone calls or video conferencing. Critical event or incident reporting requirements are also updated.
Please view the waiver amendment here: 1915(c) HCBS In-Home Supports Waiver for Children Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
1915(c) HCBS In-Home Supports Waiver for Adults Amendment effective: upon CMS approval or July 1, 2021, whichever is earlier
The Oklahoma Department of Human Services (OHS) is seeking to amend the In-Home Supports Waiver for Adults. The purpose of the In-Home Supports Waiver for Adults (IHSW-A) is to assist members in their goal to lead healthy, independent, and productive lives to the fullest extent possible; promote the full exercise of their rights as citizens of their community, state, and country; and promote the integrity and well-being of their families.
The waiver amendment increases the unduplicated number of participants and updates the participant-directed and quality payment sub-components to the supported employment services for waiver year 5. The amendment adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as for OHS/DDS case management and quality assurance staff the option of monitoring members in their own home via phone calls or video conferencing. Critical event or incident reporting requirements are also updated.
Please view the waiver amendment here: 1915(c) HCBS In-Home Supports Waiver for Adults Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
1915(c) HCBS Homeward Bound Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval
The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the Homeward Bound Waiver. The Homeward Bound waiver is intended to better meet the needs of members representing the Plaintiff Class in Homeward Bound et al v. The Hissom Memorial Center et al, United States District Court, Northern District of Oklahoma, Case No. 85-C-437-e. The Homeward Bound waiver is a self-determined waiver which services include residential and comprehensive supports for class members.
The waiver renewal will decrease the number of participants served and update the unduplicated number of participants, the State's financial estimates, and add the supported employment service quality payment sub-component for waiver years 1-5. The 12-month period amount for all prevocational services and supported employment services combined will increase. The renewal adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as the option of monitoring members in their own home via phone calls or video conferencing for OHS/DDS case management and quality assurance staff. Critical event or incident reporting requirements are also updated.
Please view the renewal application here: 1915(c) HCBS Homeward Bound Waiver Renewal, and submit feedback via the comment box below.
Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
1915(c) HCBS Community Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval
The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the Community Waiver which serves individuals with intellectual disabilities beginning at age three. Services are provided with the goal of promoting independence through the strengthening of the member’s capacity for self-care and self-sufficiency.
The waiver renewal will decrease the unduplicated number of participants, reserved capacity, and the State's financial estimates for waiver years 1-5 and increases the 12-month period amount for all prevocational services and supported employment services combined. The renewal adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as the option of monitoring members in their own home via phone calls or video conferencing for OHS/DDS case management and quality assurance staff. Critical event or incident reporting requirements are also updated.
Please view the renewal application here: 1915(c) HCBS Community Waiver Renewal, and submit feedback via the comment box below.
Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
2017-2018 SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Update
The Oklahoma Health Care Authority Waiver Development and Reporting unit is seeking comments from the public regarding the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver update to the extension of the Demonstration, 2017-2018. The application requests approval of the waiver in its present form, with the addition of language to specify Medical Residents must be licensed in the State in which they practice.
Please view the full 2017-2018 SoonerCare Renewal Application here: SoonerCare Renewal Application. Please note, that to view the document attachments please select the paperclip in the renewal document.
The comment period is open from August 26, 2016 until September 26, 2016. Please submit all comments by close of business, September 26, 2016, via the comment box below. The OHCA will respond in writing to any feedback received during the comment period.
The public meetings have been conducted for this waver at the locations mentioned below. Input from meeting participants was summarized and included in proposed extension submission to the Centers for Medicare and Medicaid Services.
1.April 19, 2016 5:00p.m.OPQIC Oklahoma Perinatal Quality Improvement Collaborative Meeting