Archived Proposed Policy Changes
2013-2020
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.
APA WF# 20-04 Electronic Visit Verification (EVV)
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: 11/04/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-05 Continuation of Services Pending Appeals
The proposed new rule will describe under what conditions Medicaid benefits will continue or be reinstated pending an appeal to comply with Section 431.230 of Title 42 of the Code of Federal Regulations. 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: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-06A Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit
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. Finally, revisions will remove language that refers to the family planning program since the program will be terminated and that eligibility group will be eligible for full benefits as a part of the new adult group.
Please view the circulation document here: APA WF# 20-06A, and submit feedback via the comment box below.
Circulation Date: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-06B Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit
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: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-06C Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit
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: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-06D Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit
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: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-08A Medicaid Expansion
The proposed rule changes will expand Medicaid eligibility for individuals, age nineteen (19) or older and under age sixty-five (65), with incomes at or below 133% of the federal poverty level.
Please view the circulation document here: APA WF# 20-08A, and submit feedback via the comment box below.
Circulation Date: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-08B Medicaid Expansion
The proposed rule changes will expand Medicaid eligibility for individuals, age nineteen (19) or older and under age sixty-five (65), with incomes at or below 133% of the federal poverty level.
Please view the circulation document here: APA WF# 20-08B, and submit feedback via the comment box below.
Circulation Date: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-09 Patient Centered Medical Home (PCMH)
The proposed revisions are needed to with comply with the 1115 waiver that permits the Oklahoma Health Care Authority to waive compliance with the Medicaid program requirements and expand healthcare services to both providers and members who are nineteen (19) or older and under the age of sixty-five (65) through the PCMH service delivery model.
Please view the circulation document here: APA WF# 20-09, and submit feedback via the comment box below.
Circulation Date: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-10 Supplemental Hospital Offset Payment Program (SHOPP)
The proposed revisions will amend the Supplemental Hospital Offset Payment Program (SHOPP) assessment policy. According to current policy, the base year Medicare cost report, used to calculate the hospital assessment, is required to be updated every two years based on the hospital's fiscal year that ended two years prior. The proposed policy change would update the base year Medicare cost report, used to calculate the hospital assessment, to be every year based on the hospital's fiscal year that ended two years prior.
Please view the circulation document here: APA WF# 20-10, and submit feedback via the comment box below.
Circulation Date: 04/24/2020
Comment Due Date: 05/13/2020
Medical Advisory Committee: 05/14/2020
Board Meeting: 05/18/2020
____________________________________________________
APA WF# 20-11 Medicare Part C (Medicare Advantage)
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: 08/11/2020
Comment Due Date: 09/10/2020
Medical Advisory Committee: 09/10/2020
Board Meeting: 09/16/2020
____________________________________________________
APA WF# 20-13 Child Support Cooperation Exemption for Recipients of Indian Health Services
The proposed revisions update policy due to changes in federal regulations which state that a referral for medical support enforcement is not made from the state Medicaid agency to the state child support agency whenever the child is eligible for services through the Indian Health Service and the referral or the case is based solely on services provided through an Indian Health program. The revisions will add an additional instance when cooperation with the state child support agency is not required.
Please view the circulation document here: APA WF# 20-13, and submit feedback via the comment box below.
Circulation Date: 11/03/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-14 Therapy Assistants and Clinical Fellows
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: 11/04/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-15A Residential substance use disorder (SUD) treatment coverage
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: 10/16/2020
Comment Due Date: 11/09/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-15B Residential substance use disorder (SUD) treatment coverage
The proposed revisions will establish 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. Further revisions will outline provider requirements, medical necessity, service plan, and reimbursement policies as well as clarify language and remove the Medicaid institutions for mental disease (IMD) exclusion in certain policy sections.
Please view the circulation document here: APA WF# 20-15B, and submit feedback via the comment box below.
Circulation Date: 10/16/2020
Comment Due Date: 11/09/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-16 Opioid Treatment Program (OTP) and Medication-Assisted Treatment (MAT) Services
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: 10/09/2020
Comment Due Date: 11/09/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-17 Diabetes self-management education and support (DSMES) services
The proposed rule changes will clarify DSMES provider requirements for registered dieticians, registered nurses, and pharmacists. Revisions will also add other health care providers with certifications as Certified Diabetes Care and Education Specialist (CDCES) or as Board-Certified Advanced Diabetes Management (BC-ADM) as eligible DSMES providers. Other revisions will involve limited rewriting aimed at updating DSMES-related terminology.
Please view the circulation document here: APA WF# 20-17, and submit feedback via the comment box below.
Circulation Date: 11/03/2020
Comment Due Date: 12/03/2020
Medical Advisory Committee: 01/14/2021
Board Meeting: 01/20/2021
____________________________________________________
APA WF# 20-19A Appeals Language Cleanup
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. Finally, revisions will include minor cleanup to fix grammatical and formatting errors.
Please view the circulation document here: APA WF# 20-19A, and submit feedback via the comment box below.
Circulation Date: 11/03/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-19B Appeals and Incorrect References Cleanup
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 involve minor cleanup to fix grammatical and formatting errors.
Please view the circulation document here: APA WF# 20-19B, and submit feedback via the comment box below.
Circulation Date: 11/03/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-20 Pay-For-Performance Program
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: 11/04/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-21 Employment Services Offered through Developmental Disabilities Services
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: 11/04/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 20-27 Specialty Psychiatric Residential Treatment Facility (PRTF) Staffing and Admission Revisions
The proposed revisions will update the specialty Psychiatric Residential Treatment Facility (PRTF) staffing ratio from one (1) staff: three (3) members to one (1) staff: four (4) members. Revisions will also clarify inpatient psychiatric admission criteria for members under twenty-one (21) accessing specialty facilities. The proposed revisions will help support access to specialty providers for children with specialized treatment needs who are most in need of in-state specialty services.
Please view the circulation document here: APA WF# 20-27, and submit feedback via the comment box below.
Circulation Date: 11/03/2020
Comment Due Date: 11/11/2020
Medical Advisory Committee: 11/12/2020
Board Meeting: 11/12/2020
____________________________________________________
APA WF# 19-01 — Retroactive Eligibility
The proposed revisions to policy provide for a retroactive period of eligibility, in accordance with 42 C.F.R. § 435.915.
Please view the circulation document here: APA WF# 19-01, and submit feedback via the comment box below.
Circulation Date: 07/02/2019
Comment Due Date: 07/31/2019
Medical Advisory Committee: 07/18/2019
Board Meeting: 08/21/2019
____________________________________________________
APA WF# 19-02 — Certified Community Behavioral Health Clinics (CCBHC) Project
The proposed revisions will incorporate new rules to sustain the CCBHC project beyond its demonstration period in Oklahoma. The proposed revisions will outline CCBHC member eligibility, provider participation requirements, and program scope.
Please view the circulation document here: APA WF# 19-02, and submit feedback via the comment box below.
Circulation Date: 05/03/2019
Comment Due Date: 05/17/2019
Medical Advisory Committee: 05/16/2019
Board Meeting: 05/21/2019
____________________________________________________
APA WF# 19-02 Certified Community Behavioral Health Clinics (CCBHC) Project
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 incorporate new rules to sustain the CCBHC project beyond its demonstration period in Oklahoma. The proposed revisions will outline CCBHC member eligibility, provider participation requirements, and program scope.
Please view the circulation document here: APA WF# 19-02, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF # 19-03 Applied Behavior Analysis (ABA) services
The proposed rule changes will add new language establishing coverage and reimbursement for ABA services as an Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. The proposed language will define scope of service, provider criteria and credentialing requirements, medical necessity, prior authorization and extension requests for continued services. Other revisions will involve limited rewriting aimed at clarifying medical necessity criteria and updating outdated policy sections.
Please view the circulation document here: APA WF# 19-03, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/24/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-04 Eligibility Redetermination as Indicated by Returned Mail
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 comply with federal regulations regarding residency requirements and returned mail indicating a potential change in circumstances. Revisions allow a member's eligibility to be terminated if mail is returned to the agency with address unknown, and the Oklahoma Health Care Authority has made reasonable attempts to verify the member's current address.
Please view the circulation document here: APA WF# 19-04, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-05 Therapeutic Foster Care 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 rule changes will align therapeutic foster care policy with current practice. Revisions will add new language establishing a more intensive treatment program for children in the Oklahoma Department of Human Services (OKDHS) and Oklahoma Office of Juvenile Affairs (OJA) custody known as intensive treatment family care (ITFC). The proposed revisions will define ITFC, member criteria for the provision of ITFC services, provider participation and credentialing requirements, and program coverage and limitations. Lastly, the proposed revisions will establish reimbursement methodology and applicable rates for ITFC services.
Please view the circulation document here: APA WF# 19-05, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-06 Diabetes Self-Management Training (DSMT) 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 changes will establish diabetes self-management training (DSMT) as a new benefit in the SoonerCare program. DSMT is an educational disease management benefit designed to teach members how to successfully manage and control his/her diabetes.
Please view the circulation document here: APA WF# 19-06, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-08 Telehealth 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 changes to telehealth policies are in accordance with Oklahoma Senate Bill (SB) No. 575, which amended 25 Oklahoma Statutes (O.S.), Sections 2004 and 2005. Revisions outline and further define the following requirements for telehealth services: parental consent; confidentiality and security of protected health information; services provided or received outside of Oklahoma that may require prior authorization; and that services provided must be within the scope of the practitioner's license or certification. Revisions also define that program restrictions and coverage for telehealth services mirror those which exist for the same services when not provided through telehealth; however, the rule also outlines that only certain telehealth codes are reimbursable by SoonerCare.
Please view the circulation document here: APA WF# 19-08, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-09 Support Act
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 update SoonerCare eligibility policy to comply with recent changes to federal law.
Please view the circulation document here: APA WF# 19-09, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-10 American Indian/Alaska Native (AI/AN) Cost Sharing Exemptions
The proposed rule changes align Oklahoma's administrative rules regarding cost sharing exemptions for AI/AN members with Oklahoma's Medicaid State Plan language.
Please view the circulation document here: APA WF# 19-10, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-12 High Risk Obstetrical (HROB) 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 add "family practice physician - obstetrics" (FP/OB) as a new provider type under the Enhanced Services for Medically High Risk Pregnancies policy. This policy change will address and improve access to care for obstetrical related services in rural Oklahoma areas. Further revisions will update policy to reflect current business practices.
Please view the circulation document here: APA WF# 19-12, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-13A Long-Term Care Facilities
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 policy changes are necessary to comply with Senate Bill 280. Changes will add policy to outline the administrative appeals process regarding disputed long-term care facility cost reporting adjustments. Final changes will streamline the audit process.
Please view the circulation document here: APA WF# 19-13A, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-13B Long-Term Care Facilities
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 policy changes are necessary to comply with Senate Bill 280. The changes will increase rates and recalculate the Quality of Care fee for regular long-term care facilities and long-term care facilities serving residents with Acquired Immune Deficiency Syndrome (AIDS). Changes will establish new quality measures and criteria, as well as recalculate the incentive reimbursement rate plan for long-term care facilities participating in the Pay-for-Performance program. In addition, policy changes will direct certain redistribution of funds; update staffing ratios; establish an advisory group; and increase the personal needs allowance for residents of long-term care facilities and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs).
Please view the circulation document here: APA WF# 19-13B, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-15 Rural Health Clinic
The proposed policy changes will bring OHCA into compliance with the Benefits Improvement and Protection Act (BIPA) of 2000.
Please view the circulation document here: APA WF# 19-15, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-16 Behavioral Health Targeted Case Management (TCM) Updates
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 change, requested by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), increases the TCM monthly limits that are reimbursable by SoonerCare.
Please view the circulation document here: APA WF# 19-16, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-18 Opioid Standards and Drug Utilization Review (DUR) 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 rule changes will comply with Section 1396a(oo) of Title 42 of the United States Code (U.S.C.), which requires Medicaid agencies to build on current DUR activities to help combat the opioid crisis. Other revisions will align and reorganize DUR policy section with current practice.
Please view the circulation document here: APA WF# 19-18, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-19A Step Therapy Exception Process
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 Oklahoma Senate Bill (SB) 509, which was signed into law on April 16, 2019. SB 509 directed the OHCA to revise current step therapy protocols for medications approved by the Drug Utilization Review (DUR) Board and provide for exceptions to the drug step therapy protocol. Further, revisions will establish an appeals process for step therapy exception requests that have been denied. Other revisions are needed to correct outdated language.
Please view the circulation document here: APA WF# 19-19A, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-19B Step Therapy Exception Process
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 Oklahoma Senate Bill (SB) 509, which was signed into law on April 16, 2019. SB 509 directed the OHCA to revise current step therapy protocols for medications approved by the Drug Utilization Review (DUR) Board and provide for exceptions to the drug step therapy protocol. Further, revisions will establish an appeals process for step therapy exception requests that have been denied. Other revisions are needed to correct outdated language.
Please view the circulation document here: APA WF# 19-19B, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-20 Pharmacy Revisions And American Indians/Alaska Natives (AI/AN) Cost Sharing Exemptions
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 remove prescription limits on certain frequently monitored prescription drugs and medication-assisted treatment (MAT) drugs for opioid use disorder. The proposed rule changes will also remove co-payments for MAT drugs. Additional rule changes will amend prescription quantity limits when a product is on the maintenance drug list. Other revisions will align administrative rules regarding cost sharing exemptions for AI/AN members with Oklahoma's Medicaid State Plan language and federal regulation at Title 42 of the Code of Federal Regulations (C.F.R.) § 447.56(a)(x). Lastly, revisions will align policy with current practice and correct grammatical errors.
Please view the circulation document here: APA WF# 19-20, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-24 Urine Drug Screening and Laboratory Services Policy
The proposed rule changes update urine drug screening policy and laboratory services policy for clarification.
Please view the circulation document here: APA WF# 19-24, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-25 Polymerase Chain Reaction (PCR) Testing for Infectious Diseases
The proposed rule changes establish guidelines to assure medical necessity and consistency in the prior authorization process for PCR testing.
Please view the circulation document here: APA WF# 19-25, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-26 Countable Income and Resources for the Aged, Blind and Disabled (ABD) Eligibility Groups and Eligibility as a Qualified Medicare Beneficiary (QMB) Plus Member
The proposed rule changes update policy regarding the determination of countable income for the ABD population. Additional rule changes update policy regarding establishing the value of home and real property and update QMB policy to clarify the intent of the rule and align with other Medicare savings programs.
Please view the circulation document here: APA WF# 19-26, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 03/02/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-27 Ground Emergency Medical Transportation (GEMT) Supplemental Payment Program
The proposed rule changes establish rules consistent with the Oklahoma state plan which outlines the GEMT Supplemental Payment Program.
Please view the circulation document here: APA WF# 19-27, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-29 Reasonable Limits for Necessary Medical and Remedial Care not Covered under the Oklahoma Medicaid State Plan
The proposed rule changes update policy regarding the calculation of the SoonerCare members' monthly vendor payment for long-term care.
Please view the circulation document here: APA WF# 19-29, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-32 Inpatient Psychiatric Services and Service Quality Review (SQR) Revisions
The proposed rule changes will amend inpatient psychiatric services policy for members under twenty-one (21) to reflect current practice, update obsolete references, and reorganize sections for consistent application of policy. The proposed rule changes will also address SQR findings of deficiency regarding inpatient psychiatric facilities' compliance with federal regulations and OHCA administrative rules. Additionally, the proposed rule changes will create a general specialty add-on payment for children and adolescents with specialized treatment needs who are being served in a psychiatric residential treatment facility (PRTF), Acute II unit of a psychiatric hospital and general hospital with an Acute II psychiatric unit.
Please view the circulation document here: APA WF# 19-32, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-34 ADvantage Waiver Revisions
The proposed policy changes to the ADvantage Waiver policy will add new language addressing State Plan Personal Care provider eligibility exception criteria. Policy changes will clarify the criteria that an applicant must meet to receive ADvantage services and the type of living arrangements that are not eligible for ADvantage members.
Please view the circulation document here: APA WF# 19-34, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-35 Developmental Disabilities Services (DDS)
The proposed changes to the DDS policy amend the rules to implement changes recommended during the annual Oklahoma Department of Human Services (OKDHS) DDS rule review process. The proposed changes to the DDS policy will allow for self-directed services to now be an option under the Community waiver. Policy changes will also add language to note the daily hourly limits on services provided by the self-directed habilitation training specialist. Finally, changes will clean up grammatical mistakes and formatting.
Please view the circulation document here: APA WF# 19-35, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-37 Mobile and Portable Dental Treatment Facilities
The proposed revisions will add coverage and reimbursement for preventive dental services received through mobile and portable dental treatment facilities. Additionally, revisions will provider participation requirements pursuant to the Oklahoma State Dentistry Act and the Oklahoma Health Care Authority contracting requirements, while also defining coverage and limitations for preventive dental services, billing requirements, basic consent form requirements, and follow-up care requirements.
Please view the circulation document here: APA WF# 19-37, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-41A Patient-Centered Medical Homes (PCMH), Health Access Networks (HAN) and Health Management Program (HMP) Updates
The proposed changes update policy to reflect the SoonerCare Choice Patient-Centered Medical Homes (PCMH) redesign.
Please view the circulation document here: APA WF# 19-41A, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 03/17/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-41B Insure Oklahoma Individual Plan (IP) and Insure Oklahoma Employer Sponsored Insurance (ESI)
The proposed policy changes add language to the Insure Oklahoma IP and ESI policy regarding certification of newborns and removal of outdated language to reflect current business practices.
Please view the circulation document here: APA WF# 19-41B, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-42 Adult Inpatient Rehabilitation Days
The proposed rule changes will increase the number of covered inpatient rehabilitation hospital days for adult SoonerCare members from twenty-four (24) days per state fiscal year to ninety (90) days per state fiscal year.
Please view the circulation document here: APA WF# 19-42, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-43A Coverage Definitions for Children and Adults
The proposed rule changes will add definitions to clarify what the Oklahoma Health Care Authority (OHCA) views as a child and an adult, unless otherwise specified by federal and/or state law. Additional revisions will involve limited rewriting aimed at clarifying text; fixing any grammatical errors; and aligning rules with the current business practice.
Please view the circulation document here: APA WF# 19-43A, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-43B Coverage Definitions for Children and Adults
The proposed rule changes will add definitions to clarify what the Oklahoma Health Care Authority (OHCA) views as a child and an adult, unless otherwise specified by federal and/or state law. Additional revisions will involve limited rewriting aimed at clarifying text; fixing any grammatical errors; and aligning rules with the current business practice.
Please view the circulation document here: APA WF# 19-43B, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-44 Organ Transplant
The proposed rule changes will update organ transplant requirements and guidelines to reflect current practice.
Please view the circulation document here: APA WF# 19-44, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-45 Private Duty Nursing (PDN) Revisions
The proposed rule changes will update and strengthen PDN policy by defining the place of services PDN is allowed. Revisions will include adding language to allow for medically necessary PDN services outside of the home if certain requirements are met. Further revisions will clarify which PDN services will and will not be authorized. Finally, the proposed revisions will involve limited rewriting aimed at clarifying text; fixing any grammatical errors; and aligning rules with the current business practice.
Please view the circulation document here: APA WF# 19-45, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-46 School-Based/Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Revisions
The proposed rule changes will cleanup the school-based policy to separate and differentiate between services provided in a school setting under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit versus those school-based services that are pursuant to an Individual Education Plan (IEP). The proposed rule changes clarify that school based services are medically necessary health-related and rehabilitative services that are provided pursuant to an IEP. However, not all medically necessary services that the Oklahoma Health Care Authority will reimburse for and that are provided in a school setting are done pursuant to an IEP so those will be removed from Part 103, Qualified Schools as Providers of Health-Related Services, and referenced in Part 4, EPSDT.
Please view the circulation document here: APA WF# 19-46, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-47 Medically Necessary Extractions
The proposed revisions amend the rule that limits dental services for adults to “emergency” extractions only by changing it to “medically necessary” extractions. Additionally, the proposed rule revisions add definitions for medically necessary oral healthcare and medically necessary extractions. Finally, the proposed revisions will involve limited rewriting aimed at clarifying text; fixing any grammatical errors; and aligning rules with the current business practice.
Please view the circulation document here: APA WF# 19-47, and submit feedback via the comment box below.
Circulation Date: 01/16/2020
Comment Due Date: 02/18/2020
Public Hearing: 02/19/2020
Medical Advisory Committee (MAC): 03/12/2020
Board Meeting: 03/18/2020
____________________________________________________
APA WF# 19-08 Telehealth 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 bring the OHCA into compliance with recently enacted Senate Bill (SB) 575, which becomes effective on October 1, 2019. The rules will also establish and/or clarify requirements for the provision of telehealth services, including those services provided in a school setting.
Please view the circulation document here: APA WF# 19-08, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-11 Board Organization and Policy 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 comply with Senate Bill 456, which was signed into law on March 13, 2019, and directed the reorganization of the OHCA Board. The seven-member Board was replaced with a nine-member Board. Further revisions establish that the chair and vice-chair elections are held at the last regular meeting before January 1 of each year. Other revisions are needed to correct outdated language.
Please view the circulation document here: APA WF# 19-11, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-21 Claim Inquiry Procedures
The proposed rule changes amend claim inquiry procedures policy due to changes in the claim inquiry process.
Please view the circulation document here: APA WF# 19-21, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-22 Expedited Appeals
The proposed rule changes outline changes to the way an expedited appeal is requested.
Please view the circulation document here: APA WF# 19-22, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-23 Free-Standing Birthing Centers
The proposed rule changes will revoke policy regarding free-standing birthing centers as this type of provider no longer exists in Oklahoma.
Please view the circulation document here: APA WF# 19-23, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-30 The Oklahoma Office of Juvenile Affairs (OJA) Targeted Case Management (TCM) Services Revisions
The proposed revisions will increase the maximum eligible age for individuals who are involved in or at serious risk of involvement with the juvenile justice system and who are eligible for TCM services from eighteen (18) to under twenty-one (21). Additionally, the proposed revisions will align and reorganize TCM sections with current evidence-based practices.
Please view the circulation document here: APA WF# 19-30, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-31 Nursing Licensure Revisions
The proposed revisions will comply with 59 O.S. § 567.21, which allows Oklahoma to enter into the enhanced Nurse Licensure Compact (eNLC). The eNLC is an agreement between states that allows a nurse's licensure to be portable to other member-states of the Compact. These revisions amend references that narrowly tie a nurse's license to the Oklahoma Board of Nursing and align SoonerCare rules with the eNLC.
Please view the circulation document here: APA WF# 19-31, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-33 Indian Health Services, Tribal Programs, and Urban Indian Clinics (I/T/Us) Obstetrical (OB) Care
The proposed revisions will add language to clarify how I/T/Us should bill OB care.
Please view the circulation document here: APA WF# 19-33, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-36 Programs of All-Inclusive Care for the Elderly (PACE)
The proposed revisions provide PACE members clarification on the enrollment/disenrollment process. Revisions will also add language that permits a PACE organization to be a non-profit or for-profit entity.
Please view the circulation document here: APA WF# 19-36, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-38 Title XXI Parity Compliance
The proposed revisions will amend policy to remove the two visit limitation for the Unborn Child populations covered under the Title XXI State Plan. The revisions are needed to comply with Parity federal regulations which instruct the State to provide equivalent services to all children covered under the Plan.
Please view the circulation document here: APA WF# 19-38, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-39A Nursing Home Supplemental Payment Program Revocation
The proposed revocation of rules will remove rule sections that were created for the nursing home supplemental payment program, a program that was never implemented; the Centers for Medicare and Medicaid Services (CMS) did not ultimately approve the proposal.
Please view the circulation document here: APA WF# 19-39A, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-39B Nursing Home Supplemental Payment Program Revocation
The proposed revocation of rules will remove rule sections that were created for the nursing home supplemental payment program, a program that was never implemented; the Centers for Medicare and Medicaid Services (CMS) did not ultimately approve the proposal.
Please view the circulation document here: APA WF# 19-39B, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-40 Defunding Statutory Rape Cover-Up Act
The proposed new rule is needed to comply with House Bill (HB) 2591 which creates the Defunding Statutory Rape Cover-Up Act.
Please view the circulation document here: APA WF# 19-40, and submit feedback via the comment box below.
Circulation Date: 12/16/2019
Medical Advisory Committee: 01/09/2019
Comment Due Date: 01/15/2020
Public Hearing: 01/15/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-03 — Applied Behavior Analysis (ABA) Services
The proposed revisions will add new language establishing coverage and reimbursement for ABA services as an Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. The proposed language will define scope of service, provider criteria and credentialing requirements, medical necessity, intervention criteria, and extension requests for continued services. Other revisions will update outdated policy language.
Please view the circulation document here: APA WF# 19-03, and submit feedback via the comment box below.
Circulation Date: 05/03/2019
Comment Due Date: 05/17/2019
Medical Advisory Committee: 05/16/2019
Board Meeting:Please view all comments received here: APA WF# 19-03 Comment Document.
____________________________________________________
APA WF# 19-03 — Registered Behavior Technicians (RBTs)
The proposed revisions will add RBT as a new SoonerCare provider. Additionally, the proposed revisions will establish RBT provider requirements and reimbursement. The proposed revisions will allow RBTs to implement behavior-analytic treatment plans developed by a Board Certified Behavior Analyst (BCBA).
Please view the circulation document here: APA WF# 19-03, and submit feedback via the comment box below.
Circulation Date: 11/05/2019
Comment Due Date: 11/18/2019
Medical Advisory Committee: 11/07/2019
Board Meeting: 11/20/2019
____________________________________________________
APA WF# 19-06 — Diabetes Self-Management Training (DSMT) Services
The proposed rule changes will establish diabetes self-management training (DSMT) as a new benefit in the SoonerCare program. DSMT is an educational disease management benefit designed to teach members how to successfully manage and control his/her diabetes.
Please view the circulation document here: APA WF# 19-06, and submit feedback via the comment box below.
Circulation Date: 09/04/2019
Comment Due Date: 10/04/2019
Medical Advisory Committee: 09/05/2019
Board Meeting: 10/16/2019
APA WF# 19-06 Comment Spreadsheet
____________________________________________________
APA WF# 19-05 — Therapeutic Foster Care Revisions
The proposed revisions will align therapeutic foster care policy with current practice. Revisions will add new language establishing a more intensive treatment program for children in DHS and OJA custody known as Intensive Treatment Family Care (ITFC). The proposed revisions will define ITFC, member criteria for the provision of ITFC services, provider participation and credentialing requirements, and program coverage and limitations. Lastly, the proposed revisions will establish reimbursement methodology and applicable rates for ITFC services.
Please view the circulation document here: APA WF# 19-05, and submit feedback via the comment box below.
Circulation Date: 07/11/2019
Comment Due Date: 08/03/2019
Medical Advisory Committee: 07/18/2019
Board Meeting: 08/21/2019
____________________________________________________
APA WF# 19-08 — Telehealth Services
The proposed revisions bring OHCA policy into compliance with recently enacted Senate Bill 575, which becomes effective on July 1, 2019. The rules also establish and/or clarify requirements for the provision of telehealth services, including those services provided in a school setting.
Please view the circulation document here: APA WF# 19-08, and submit feedback via the comment box below.
Circulation Date: 06/24/2019
Comment Due Date: 07/27/2019
Medical Advisory Committee: 07/18/2019
Board Meeting: 08/21/2019
____________________________________________________
APA WF# 19-08 — Telehealth Services Revisions
The proposed revisions bring OAC 317:30-3-27 into compliance with recently enacted Senate Bill 575, which becomes effective on October 1, 2019. The rules also establish and/or clarify requirements for the provision of telehealth services, including those services provided in a school setting.
Please view the circulation document here: APA WF# 19-08, and submit feedback via the comment box below.
Circulation Date: 08/05/2019
Comment Due Date: 09/04/2019
Medical Advisory Committee: 09/05/2019
Board Meeting: 09/18/2019
____________________________________________________
APA WF# 19-09 — Support Act
The proposed revisions to SoonerCare eligibility policy are necessary to comply with new federal law.
Please view the circulation document here: APA WF# 19-09, and submit feedback via the comment box below.
Circulation Date: 10/21/2019
Comment Due Date: 11/19/2019
Medical Advisory Committee: 11/07/2019
Board Meeting: 11/20/2019
____________________________________________________
APA WF# 19-10 — American Indian/Alaska Native Cost Sharing Exemption
The proposed revisions make Oklahoma's administrative code language consistent with Oklahoma's State Plan language.
Please view the circulation document here: APA WF# 19-10, and submit feedback via the comment box below.
Circulation Date: 06/24/2019
Comment Due Date: 07/23/2019
Medical Advisory Committee: 07/18/2019
Board Meeting: 08/21/2019
____________________________________________________
APA WF# 19-11 — Board Organization and Policy Revisions
The proposed revisions will comply with Senate Bill 456, which was signed into law on March 13, 2019, and directed the reorganization of the OHCA Board. The seven-member Board was replaced with a nine-member Board. Further revisions will establish that the chair and vice-chair elections are held at the last regular meeting before January 1st of each year. Other revisions are needed to correct outdated language.
Please view the circulation document here: APA WF# 19-11, and submit feedback via the comment box below.
Circulation Date: 07/03/2019
Comment Due Date: 08/01/2019
Medical Advisory Committee: 07/18/2019
Board Meeting: 08/21/2019
____________________________________________________
APA WF# 19-12 — High Risk Obstetrical Services (HROB) Revisions
The proposed revisions will add "family practice physician - obstetrics" (FP/OB) as a new provider type under the enhanced services for medically high risk pregnancies policy. This policy change will address and improve access to care for obstetrical related services in rural Oklahoma areas. Further revisions will update policy to reflect current business practices.
Please view the circulation document here: APA WF# 19-12, and submit feedback via the comment box below.
Circulation Date: 07/17/2019
Comment Due Date: 08/16/2019
Medical Advisory Committee: 07/18/2019
Board Meeting: 08/21/2019
____________________________________________________
APA WF# 19-13A — Long-Term Care Facilities
The proposed revisions will bring the Oklahoma Health Care Authority (OHCA) into compliance with Senate Bill 280.
Please view the circulation document here: APA WF# 19-13A, and submit feedback via the comment box below.
Circulation Date: 08/29/2019
Comment Due Date: 09/17/2019
Medical Advisory Committee: 09/05/2019
Board Meeting: 09/18/2019
____________________________________________________
APA WF# 19-13B — Long-Term Care Facilities
The proposed revisions will bring the Oklahoma Health Care Authority (OHCA) into compliance with Senate Bill 280.
Please view the circulation document here: APA WF# 19-13B, and submit feedback via the comment box below.
Circulation Date: 08/29/2019
Comment Due Date: 09/17/2019
Medical Advisory Committee: 09/05/2019
Board Meeting: 09/18/2019
____________________________________________________
APA WF# 19-13A — Long-Term Care Facilities
This policy change had been previously posted for comments. It has since been updated.
The proposed revisions will bring the Oklahoma Health Care Authority (OHCA) into compliance with Senate Bill 280.
Please view the circulation document here: APA WF# 19-13A, and submit feedback via the comment box below.
Circulation Date: 09/05/2019
Comment Due Date: 09/17/2019
Medical Advisory Committee: 09/05/2019
Board Meeting: 09/18/2019
____________________________________________________
APA WF# 19-13B — Long-Term Care Facilities
This policy change had been previously posted for comments. It has since been updated.
The proposed revisions will bring the Oklahoma Health Care Authority (OHCA) into compliance with Senate Bill 280.
Please view the circulation document here: APA WF# 19-13B, and submit feedback via the comment box below.
Circulation Date: 09/05/2019
Comment Due Date: 09/17/2019
Medical Advisory Committee: 09/05/2019
Board Meeting: 09/18/2019
APA WF# 19-13B Comment Spreadsheet____________________________________________________
APA WF# 19-14 — Electronic Visit Verification (EVV)
The proposed revisions are necessary to come into compliance with the 21st Century Cures Act.
Please view the circulation document here: APA WF# 19-14, and submit feedback via the comment box below.
Circulation Date: 11/1/2019
Comment Due Date: 11/19/2019
Medical Advisory Committee: 11/07/2019
Board Meeting: 11/20/2019
____________________________________________________
APA WF# 19-16 — Behavioral Health Targeted Case Management (TCM) Updates
The proposed rule change, requested by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), increases the TCM monthly limits that are reimbursable by SoonerCare.
Please view the circulation document here: APA WF# 19-16, and submit feedback via the comment box below.
Circulation Date: 09/04/2019
Comment Due Date: 09/16/2019
Medical Advisory Committee: 09/05/2019
Board Meeting: 09/18/2019
____________________________________________________
APA WF# 19-17 — Treatment of Lottery or Gambling Winnings for Income Eligibility
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# 19-17, and submit feedback via the comment box below.
Circulation Date: 11/05/2019
Comment Due Date: 12/05/2019
Medical Advisory Committee: 01/09/2020
Board Meeting: 01/22/2020
____________________________________________________
APA WF# 19-18 — Opioid Standards and Drug Utilization Review (DUR) Program
The proposed rule changes will comply with Section 1396a(oo) of Title 42 of the United States Code, which requires Medicaid agencies to build on current DUR activities to help combat the opioid crisis. Other revisions will align and reorganize DUR policy section with current practice.
Please view the circulation document here: APA WF# 19-18, and submit feedback via the comment box below.
Circulation Date: 11/05/2019
Comment Due Date: 11/19/2019
Medical Advisory Committee: 11/07/2019
Board Meeting: 11/20/2019
____________________________________________________
APA WF# 19-19A — Step Therapy Exception Process
The proposed revisions will comply with Oklahoma Senate Bill (SB) 509, which was signed into law on April 16, 2019. SB 509 directed the OHCA to revise current step therapy protocols for medications approved by the Drug Utilization Review (DUR) Board and provide for exceptions to the drug step therapy protocol. Further, revisions will establish an appeals process for step therapy exception requests that have been denied. Other revisions are needed to correct outdated language.
Please view the circulation document here: APA WF# 19-19A, and submit feedback via the comment box below.
Circulation Date: 10/18/2019
Comment Due Date: 11/17/2019
Medical Advisory Committee: 11/07/2019
Board Meeting: 11/20/2019
____________________________________________________
APA WF# 19-19B — Step Therapy Exception Process
The proposed revisions will comply with Oklahoma Senate Bill (SB) 509, which was signed into law on April 16, 2019. SB 509 directed the OHCA to revise current step therapy protocols for medications approved by the Drug Utilization Review (DUR) Board and provide for exceptions to the drug step therapy protocol. Further, revisions will establish an appeals process for step therapy exception requests that have been denied. Other revisions are needed to correct outdated language.
Please view the circulation document here: APA WF# 19-19B, and submit feedback via the comment box below.
Circulation Date: 10/18/2019
Comment Due Date: 11/17/2019
Medical Advisory Committee: 11/07/2019
Board Meeting: 11/20/2019
____________________________________________________
APA WF# 19-20 — Pharmacy Revisions and Cost Sharing Exemptions
The proposed rule changes will remove prescription limits of certain frequently monitored prescription drugs and medication-assisted treatment (MAT) drugs for opioid use disorder. The proposed rule changes will also remove co-payments for MAT drugs. Additional rule changes will amend prescription quantity limits when a product is on the maintenance drug list. Further revisions will align administrative rules regarding cost sharing exemptions with the Oklahoma Medicaid State Plan. Other revisions will align policy with current practice and correct grammatical errors.
Please view the circulation document here: APA WF# 19-20, and submit feedback via the comment box below.
Circulation Date: 11/05/2019
Comment Due Date: 11/18/2019
Medical Advisory Committee: 11/07/2019
Board Meeting: 11/20/2019
____________________________________________________
APA WF# 18-02 — Work and Community Engagement Requirements as a Condition of SoonerCare Eligibility for Adults
The proposed policy will establish work and community engagement requirements as a condition of SoonerCare eligibility for adults who do not meet certain exemptions.
Please view the circulation document here: APA WF# 18-02, and submit feedback via the comment box below.
Circulation Date: 07/03/2018
Comment Due Date: 09/03/2018
Medical Advisory Committee Meeting: 07/19/2018
Board Meeting: TBD
____________________________________________________
APA WF# 18-01 — Laboratory Services Policy Update
The proposed revisions update laboratory services policy.
Please view the circulation document here: APA WF# 18-01, and submit feedback via the comment box below.
Circulation Date: 08/23/2018
Comment Due Date: 09/24/2018
Medical Advisory Committee Meeting: 09/20/2018
Board Meeting: 10/11/2018
APA WF# 18-01 Comment Document____________________________________________________
APA WF# 18-01 Laboratory Services Policy Update
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an Emergency Rule
The proposed revisions update laboratory services policy.
Please view the circulation document here: APA WF# 18-01, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
The following emergency rule was pulled and will instead go through the 2018 permanent rulemaking session.
____________________________________________________
APA WF# 18-05 — Exclusions of certain underpayments from resources
The proposed revisions amend policy to be consistent with federal law which excludes the unspent portion of Social Security Retirement, Survivors, and Disability Insurance (RSDI) or Supplemental Security Income (SSI) retroactive payments when determining the resources of an Aged, Blind, and Disabled (ABD) individual.
Please view the circulation document here: APA WF# 18-05, and submit feedback via the comment box below.
Circulation Date: 10/22/2018
Comment Due Date: 11/21/2018
Medical Advisory Committee Meeting: 11/15/2018
Board Meeting: 12/13/2018
____________________________________________________
APA WF# 18-05 — Exclusions of Certain Underpayments from Resources
The proposed revisions amend policy to be consistent with federal law which excludes the unspent portion of Social Security Retirement, Survivors, and Disability Insurance (RSDI) or Supplemental Security Income (SSI) retroactive payments when determining the resources of an Aged, Blind, and Disabled (ABD) individual.
Please view the circulation document here: APA WF# 18-05, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting: 02/14/2019
____________________________________________________
APA WF# 18-06 — Inpatient Psychiatric Services Revisions
The proposed revisions will establish a prior authorization requirement for inpatient psychiatric services for adults. Revisions will also align the time requirement of the first individual treatment by the physician to the requirement of completion of the psychiatric evaluation. Other revisions will involve limited rewriting aimed at clarifying text.
Please view the circulation document here: APA WF# 18-06, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting: 02/14/2019
____________________________________________________
APA WF# 18-10 — Oklahoma Electronic Health Records (EHR) Incentive Program Policy Revisions
The proposed revisions amend the Oklahoma EHR Incentive Program policy by changing policy regarding the required SoonerCare patient volume criteria and about documentation to support or correct the provider's EHR attestation.
Please view the circulation document here: APA WF# 18-10, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting: 02/14/2019
____________________________________________________
APA WF# 18-07A Preadmission Screening and Resident Review (PASRR) Revisions
The proposed revisions will incorporate new language to clarify that the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be used for diagnostic purposes in Medicaid-certified nursing facility admissions. Revisions will also involve limited rewriting aimed at clarifying text, eliminating redundancies, and updating outdated terminology.
Please view the circulation document here: APA WF# 18-07A, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-07B Preadmission Screening and Resident Review (PASRR) revisions
The proposed revisions will incorporate new language to clarify that the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) will be used for diagnostic purposes in Medicaid-certified nursing facility admissions. Revisions will also involve limited rewriting aimed at clarifying text, eliminating redundancies, and updating outdated terminology.
Please view the circulation document here: APA WF# 18-07B, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-09 Suspended Claims Review and/or Prepayment Review
The proposed revisions add new general provider policies to define various review mechanisms used by OHCA to help ensure that reimbursements are for medically necessary, correctly and/or appropriately billed medical supplies and services.
Please view the circulation document here: APA WF# 18-09, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
APA WF# 18-12 — Tax Equity and Fiscal Responsibility Act (TEFRA) Policy Revisions
The proposed revisions will amend Tax Equity and Fiscal Responsibility Act (TEFRA) policy by removing references to the Oklahoma Department of Human Services and replacing them with the Oklahoma Health Care Authority.
Please view the circulation document here: APA WF# 18-12, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting:____________________________________________________
APA WF# 18-13 Application Fees and Provider Screening
The proposed revisions to the general provider policies are added to establish provider enrollment application fees and other provider screening and enrollment requirements mandated by federal regulation.
Please view the circulation document here: APA WF# 18-13, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-14 Countable Income and Resources Policy Change
The proposed revisions amend countable income and resources policy, specifically the policy on resource disregards.
Please view the circulation document here: APA WF# 18-14, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-15A Change Timeframes for Appeals
The proposed revisions change all of the appeals rules to extend the length of time that appeals can be submitted from twenty days to thirty days of the date of an adverse agency action.
Please view the circulation document here: APA WF# 18-15A, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-15B Change Timeframes for Appeals
The proposed revisions change all of the agency's appeals rules, to extend the length of time that appeals can be submitted from twenty days to thirty days of the date of an adverse agency action.
Please view the circulation document here: APA WF# 18-15B, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-15C Change Timeframes for Appeals
The proposed revisions change all of the agency's appeals rules, to extend the length of time that appeals can be submitted from twenty days to thirty days of the date of an adverse agency action.
Please view the circulation document here: APA WF# 18-15C, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-16 Non-Emergency Transportation Parity Compliance
The proposed revisions will amend policy to provide non-emergency transportation (NET) to pregnant women covered under the Title XXI State Plan. The revisions are needed to comply with Parity federal regulations which instruct the State to provide equivalent services to all children covered under the Plan.
Please view the circulation document here: APA WF# 18-16, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-17 Maternal Depression Screening Policy Revisions
The proposed revisions will add coverage and reimbursement language for maternal depression screenings at Early and Periodic Screening Diagnostic and Treatment (EPSDT) at well-child visits. The policy will also reiterate how the Oklahoma Health Care Authority adopts and utilizes the American Academy of Pediatrics’ Bright Futures periodicity schedule including for the maternal depression screenings. Additionally, the proposed revisions will also update the child abuse section to provide a more thorough explanation of how to report child abuse including clarifying text, and updating outdated citations.
Please view the circulation document here: APA WF# 18-17, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-18 Mobile Dental ClinicsThis rule was pulled from the 2018-2019 Permanent Rulemaking Session.
The proposed revisions will add coverage and reimbursement for preventive dental services received through mobile dental clinics. Additionally, revisions will delineate mobile dental clinic provider participation requirements pursuant to the Oklahoma State Dentistry Act, while also defining coverage and limitations for preventive dental services, billing requirements, basic consent form requirements, and follow-up care requirements.
Please view the circulation document here: APA WF# 18-18, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-19 — Oklahoma Cares Breast and Cervical Cancer Treatment (BCC) Program Revisions
The proposed revisions to the BCC policy add reference to the American Society for Colposcopy and Cervical Pathology Consensus and National Comprehensive Cancer Network, which provides guidelines for "in need of treatment" determinations. In addition, the term "OKDHS worker" will be replaced with the term "eligibility coordinator" to make policy current; including clean-up and removal of outdated language.
Please view the circulation document here: APA WF# 18-19, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting: 02/14/2019
____________________________________________________
APA WF# 18-20 — Programs of All-Inclusive Care for the Elderly (PACE) Revisions
The proposed revisions to the PACE policy will update Uniform Comprehensive Assessment Tool requirements in order to reflect current business practices.
Please view the circulation document here: APA WF# 18-20, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting:____________________________________________________
APA WF# 18-21A — ADvantage Waiver Revisions
The proposed revisions to the ADvantage Waiver will add new language to outline requirements for personal care services and consumer directed personal assistance services and supports (CD-PASS) for case management services. Revisions will also remove and update outdated policy in order to align with current business practices and ensure rules are in accordance with state laws and regulations.
Please view the circulation document here: APA WF# 18-21A, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting:____________________________________________________
APA WF# 18-21B — ADvantage Waiver Revisions
The proposed revisions to the ADvantage Waiver will add new language to outline requirements for personal care services and consumer directed personal assistance services and supports (CD-PASS) for case management services. Revisions will also remove and update outdated policy in order to align with current business practices, and ensure rules are in accordance with state laws and regulations.
Please view the circulation document here: APA WF# 18-21B, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting:____________________________________________________
APA WF# 18-22A — Developmental Disabilities Division (DDS) Revisions
The proposed revisions to the DDS policy amend the rules to implement changes recommended during the annual Oklahoma Department of Human Services (DHS) DDS rule review process. Revisions will also eliminate and update outdated policy in order to better align with current business practices.
Please view the circulation document here: APA WF# 18-22A, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting:____________________________________________________
APA WF# 18-22B — Developmental Disabilities Division (DDS) Revisions
The proposed revisions to the DDS policy amend the rules to implement changes recommended during the annual Oklahoma Department of Human Services (DHS) DDS rule review process. Proposed revisions will reflect new service requirements for employment services through Home and Community-Based Services Waivers. Additional revisions will eliminate and update outdated policy in order to better align with current business practices.
Please view the circulation document here: APA WF# 18-22B, and submit feedback via the comment box below.
Circulation Date: 12/17/2018
Comment Due Date: 01/16/2019
Public Hearing: 01/16/2019
Medical Advisory Committee: 01/17/2019
Board Meeting:____________________________________________________
APA WF# 18-23 Psychiatric Services in Nursing Facilities Revisions
The proposed revisions will clarify provider types and reimbursement of psychiatric services as part of a direct physician service visit in a nursing facility. Revisions will also involve limited rewriting aimed at clarifying text, eliminating redundancies, and updating outdated terminology.
Please view the circulation document here: APA WF# 18-23, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-24 Out-of-State Services
The proposed revisions and additions will define and clarify coverage and reimbursement for services rendered by providers that are physically located outside of Oklahoma. Additionally, revisions will delineate out-of-state services, provider participation requirements, prior authorizations, and medical records requirements. Lastly, revisions will outline reimbursement criteria for out-of-state providers who do not accept the payment rate established through the State Plan.
Please view the circulation document here: APA WF# 18-24, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-25 General Policy Language Cleanup
The proposed policy revisions amend language to remove obsolete references and correct formatting errors for clarity and consistency.
Please view the circulation document here: APA WF# 18-25, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-26 Residential Behavioral Management Services (RBMS) Group Homes Revisions
The proposed revisions will streamline group home coverage and reimbursement policy language, and develop consistency with current practice. Revisions will involve limited rewriting aimed at updating outdated terminology.
Please view the circulation document here: APA WF# 18-26, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-27 Updates to Medicare Crossover Policy
The proposed revisions will streamline crossover payments for dual eligible individuals.
Please view the circulation document here: APA WF# 18-27, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-28 Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Services in Inpatient Psychiatric Settings
The proposed revisions will assure that members under twenty-one (21) years of age, residing in qualified inpatient psychiatric settings, have access to a full range of medically necessary EPSDT services. Revisions will also clarify that EPSDT services are accessible, regardless of whether such services are listed on the individual plan of care (IPC).
Please view the circulation document here: APA WF# 18-28, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
____________________________________________________
APA WF# 18-30 Federally Qualified Health Centers (FQHC) Encounter Limitations
The proposed revisions will amend the FQHC policy to reinstate administrative rules to allow and better define multiple encounters at FQHCs. Additional revisions will also define and establish guidelines for multiple encounters.
Please view the circulation document here: APA WF# 18-30, and submit feedback via the comment box below.
Circulation Date: 01/16/2019
Comment Due Date: 02/15/2019
Public Hearing: 02/20/2019
Medical Advisory Committee: 03/14/2019
Board Meeting: 03/21/2019
This policy change was previously posted for comments 11/08/2018 through 12/10/2018. The policy has since been updated.
____________________________________________________
APA WF# 18-08 (19-04) — Eligibility Termination as Indicated by Returned Mail (This APA WF# has been reassigned to APA WF# 19-04).
The proposed revisions expedite compliance with the Act to Restore Hope, Opportunity and Prosperity to Everyone (HOPE Act), by allowing a member's eligibility to be terminated if mail is returned to the agency with address unknown.
Please view the circulation document here: APA WF# 18-08 (19-04), and submit feedback via the comment box below.
Circulation Date: 11/08/2018
Comment Due Date: 12/27/2018
Medical Advisory Committee Meeting: 01/17/2019
Board Meeting: 02/14/2019
Please view all comments received here: APA WF# 18-08 (19-04) Comment Document.
The following emergency rule was pulled and will instead go through the 2018 permanent rulemaking session.
____________________________________________________
APA WF# 18-09 — Suspended claims review and/or prepayment review
The proposed revisions add new general provider policies to define various review mechanisms used by OHCA to help ensure that reimbursements are for medically necessary, correctly and/or appropriately billed medical supplies and services.
Please view the circulation document here: APA WF# 18-09, and submit feedback via the comment box below.
Circulation Date: 11/08/2018
Comment Due Date: 12/10/2018
Medical Advisory Committee Meeting: 01/17/2019
Board Meeting: 02/14/2019
____________________________________________________
APA WF# 17-01 — Policy Revision to Comply with Fairness in Medicaid Supplemental Needs Trusts Act
The proposed revisions are necessary to comply with federal regulation.
Please view the circulation document here: APA WF# 17-01, and submit feedback via the comment box below.
Circulation Date: 03/07/2017
Comment Due Date: 04/06/2017
Medical Advisory Committee Meeting: 05/18/2017
Board Meeting: 06/29/2017
____________________________________________________
APA WF# 17-01 — Fairness in Medicaid Supplemental Needs Trusts Act
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an Emergency Rule.
The proposed revisions are necessary to comply with federal regulation.
Please view the circulation document here: APA WF# 17-01, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-02 — Self-Employment Language in Insure Oklahoma Individual Plan Policy
The proposed revisions strengthen program integrity in the Insure Oklahoma Individual Plan for self-employed individuals.
Please view the circulation document here: APA WF# 17-02, and submit feedback via the comment box below.
Circulation Date: 03/07/2017
Comment Due Date: 04/06/2017
Medical Advisory Committee Meeting: 05/18/2017
Board Meeting: 09/27/2017
____________________________________________________
APA WF# 17-03 — Indian Health Services, Tribal Program and Urban Indian Clinics (I/T/U) Four Walls
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an Emergency Rule.
The proposed I/T/U revisions are to align policy with federal regulations and allow I/T/Us to be reimbursed at the OMB rate for services provided outside of the four walls of their facilities.
Please view the circulation document here: APA WF# 17-03, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-03 — Indian Health Services, Tribal Program and Urban Indian Clinics (I/T/U) Four Walls
The proposed I/T/U revisions are to align policy with federal regulations and allow I/T/Us to be reimbursed at the OMB rate for services provided outside of the four walls of their facilities.
Please view the circulation document here: APA WF# 17-03, and submit feedback via the comment box below.
Circulation Date: 08/14/2017
Comment Due Date: 09/13/2017
Medical Advisory Committee Meeting: 09/21/2017
Board Meeting:____________________________________________________
APA WF# 17-04A — MFP PRTF Wraparound Services Demonstration
Living Choice Rules are revised to add an additional population to be served in the Money Follows the Person demonstration. Living Choice is developing its implementation plan to transition eligible individuals from a Psychiatric Residential Treatment Facility back into the community.
Please view the circulation document here: APA WF# 17-04A, and submit feedback via the comment box below.
Circulation Date: 04/17/2017
Comment Due Date: 05/17/2017
Medical Advisory Committee Meeting: 05/18/2017
Board Meeting: 06/29/2017
____________________________________________________
APA WF# 17-04A — Money Follows the Person Demonstration for Psychiatric Residential Treatment Facility Wraparound Services
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an Emergency Rule.
Living Choice Rules are revised to add an additional population to be served in the Money Follows the Person demonstration. Living Choice is developing its implementation plan to transition eligible individuals from a Psychiatric Residential Treatment Facility back into the community.
Please view the circulation document here: APA WF# 17-04A, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-04B — MFP PRTF Wraparound Services Demonstration
Living Choice rules are amended to replace the term Intermediate Care Facility for Mentally Retarded ICF/MR with Intermediate Care Facility for Individuals with Intellectual Disabilities ICF/IID. Oklahoma's MFP Demonstration for Psychiatric Residential Treatment Facility (PRTF) is added to transition youth, ages 16 through 18, who have been in an inpatient PRTF for 90 or more days during an episode of care.
Please view the circulation document here: APA WF# 17-04B, and submit feedback via the comment box below.
Circulation Date: 04/17/2017
Comment Due Date: 05/17/2017
Medical Advisory Committee Meeting: 05/18/2017
Board Meeting: 06/29/2017
____________________________________________________
APA WF# 17-04B — Money Follows the Person Demonstration for Psychiatric Residential Treatment Facility Wraparound Services
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an Emergency Rule.
Living Choice rules are amended to replace the term Intermediate Care Facility for Mentally Retarded (ICF/MR) with Intermediate Care Facility for Individuals with Intellectual Disabilities (ICF/IID). Oklahoma's MFP Demonstration for Psychiatric Residential Treatment Facility (PRTF) is added to transition youth, ages 16 through 18, who have been in an inpatient PRTF for 90 or more days during an episode of care.
Please view the circulation document here: APA WF# 17-04B, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-05A — Medical Identification Card Policy Revisions
The proposed medical identification card revisions revoke the section that refers to member medical identification cards.
Please view the circulation document here: APA WF# 17-05A, and submit feedback via the comment box below.
Circulation Date: 06/15/2017
Comment Due Date: 07/19/2017
Medical Advisory Committee Meeting: 07/20/2017
Board Meeting: 08/24/2017
____________________________________________________
APA WF# 17-05A — Medical Identification Card Policy Revisions
Please note, sections of this rule were previously approved, as an Emergency Rule, by the OHCA Board of Directors and the Governor. Additional revisions have not yet been approved.
The proposed medical identification card revisions revoke the section that refers to member medical identification cards and amends up a sentence pertaining to SoonerCare insurance verification.
Please view the circulation document here: APA WF# 17-05A, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-05B — Medical Identification Card Policy Revisions
The proposed medical identification card revisions remove references that refer to the issuing of or mailing of member medical identification cards.
Please view the circulation document here: APA WF# 17-05B, and submit feedback via the comment box below.
Circulation Date: 06/15/2017
Comment Due Date: 07/19/2017
Medical Advisory Committee Meeting: 07/20/2017
Board Meeting: 08/24/2017
____________________________________________________
APA WF# 17-05B — Medical Identification Card Policy Revisions
Please note, sections of this rule were previously approved, as an Emergency Rule, by the OHCA Board of Directors and the Governor. Additional revisions have not yet been approved.
The proposed medical identification card revisions remove references that refer to the issuing of or mailing of member medical identification cards.
Please view the circulation document here: APA WF# 17-05B, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-06 — Pharmacy Revisions
The proposed pharmacy revisions will reduce brand name prescriptions from two (2) to one (1) per month per eligible non-institutionalized and non-wavier adult member. Revisions also remove coverage of optional non-prescription drugs for adults. (Insulin, nicotine replacement products for smoking cessation, and family planning products are not optional).
Please view the circulation document here: APA WF# 17-06, and submit feedback via the comment box below.
Circulation Date: 06/15/2017
Comment Due Date: 07/14/2017
Medical Advisory Committee Meeting: 07/20/2017
Board Meeting: 08/10/2017
____________________________________________________
APA WF# 17-06 — Pharmacy Revisions
Please note, sections of this rule were previously approved, as an Emergency Rule, by the OHCA Board of Directors and the Governor. Additional revisions have not yet been approved.
The proposed pharmacy revisions will amend coverage and prior authorization of non-prescription drugs and compounded prescriptions, discontinue coverage of over the counter antihistamines for adults, and exempt naloxone for use in opioid overdose from the prescription limit. The proposed changes will also clarify claim submission and reversals when not picked up by the member within 15 days of the date of service, and update pharmacy policy to align with current practice.
Please view the circulation document here: APA WF# 17-06, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-07 — School-Based Services Policy Revisions
The proposed revisions remove unintended barriers for medical services rendered in the school setting pursuant to an Individual Education Plan.
Please view the circulation document here: APA WF# 17-07, and submit feedback via the comment box below.
Circulation Date: 08/14/2017
Comment Due Date: 09/13/2017
Medical Advisory Committee Meeting: 09/21/2017
Board Meeting:____________________________________________________
APA WF# 17-07 — School-Based Services Policy Revisions
The proposed revisions remove unintended barriers for medical services rendered in the school setting pursuant to an Individual Education Plan.
Please view the circulation document here: APA WF# 17-07, and submit feedback via the comment box below.
Circulation Date: 08/14/2017
Comment Due Date: 09/21/2017
____________________________________________________
APA WF# 17-07 — School-Based Services Policy Revisions
The proposed revisions remove unintended barriers for medical services rendered in the school setting pursuant to an Individual Education Plan.
Please view the circulation document here: APA WF# 17-07, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
Please note that this rule is initiated by the Oklahoma Department of Mental Health and Substance Abuse Services.
____________________________________________________
APA WF# 17-09 — Behavioral Health Case Management Limits
The Oklahoma Department of Mental Health and Substance Abuse Services is proposing revisions to Behavioral Health Targeted Case Management (TCM) reduce the yearly limit on the amount of TCM from 25 units per member per month to 16 units per member per year. A process for authorizing up to 25 units per member per month will be used for individuals who meet established medical necessity criteria demonstrating the need for additional units.
Please view the circulation document here: APA WF# 17-09, and submit feedback via the comment box below.
Circulation Date: 06/26/2017
Comment Due Date: 07/28/2017
Medical Advisory Committee Meeting: 07/20/2017
Board Meeting: 08/24/2017
____________________________________________________
APA WF# 17-09 — Behavioral Health (BH) Assessment and Targeted Case Management Updates
Please note, sections of this rule were previously approved, as an Emergency Rule, by the OHCA Board of Directors and the Governor. Additional revisions have not yet been approved.
The proposed policy revisions will reduce the yearly limit on the amount of basic case management/resource coordination to 16 units per member per year. Policy revisions will clarify that intensive case management is only available to adults with Serious Mental Illness (SMI) in Programs of Assertive Community Treatment (PACT) and children with Serious Emotional Disturbance (SED) in a System of Care Network. Revisions will also clarify instances in which case management is not billable. Additionally, revisions will change requirements for BH assessments by allowing for diagnostic impressions on the assessment, while still requiring a diagnosis on the service plan. Other revisions will allow for one member signature page for both the assessment and treatment plan as well as allow a temporary change of service provider to be documented in a progress note for the service provided.
Please view the circulation document here: APA WF# 17-09, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-10A — Expedited Appeals
The proposed revisions to the appeals policy are necessary to comply with federal regulation requiring expedited appeals as well as to remove language referring to nursing home wage enhancement due to changes in state statute.
Please view the circulation document here: 17-10A Circulation Document, and submit feedback via the comment box below.
Circulation Date: 09/26/2017
Comment Due Date: 10/26/2017
Medical Advisory Committee Meeting: 11/16/2017
Board Meeting: 12/14/2017
____________________________________________________
APA WF# 17-10A — Expedited Appeals
The proposed revisions to the appeals policy are necessary to comply with federal regulation requiring expedited appeals.
Please view the circulation document here: APA WF# 17-10A, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-10B — Move Notification Sections to Correct Area of Policy
The proposed revisions to the notification sections of policy move sections to a more appropriate area of policy.
Please view the circulation document here: 17-10B Circulation Document, and submit feedback via the comment box below.
Circulation Date: 09/26/2017
Comment Due Date: 10/26/2017
Medical Advisory Committee Meeting: 11/16/2017
Board Meeting:____________________________________________________
APA WF# 17-10B — Notification Policy Revisions
The proposed revisions to notification policy move sections to the correct area of policy because they are applicable to all SoonerCare programs.
Please view the circulation document here: APA WF# 17-10B, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-12 — Wage Enhancement Policy Revisions
The proposed revisions remove wage enhancement language and requirements for specified employees in nursing facilities (NF) serving adults and intermediate care facilities for individual with intellectual disabilities (ICFs/IIDs). The revisions are necessary to comply with changes in Oklahoma state statute which repeal Title 63 section 5022 and 5022.1. The change in state statue became effective July 1, 2017. The federal minimum wage and the change in rate setting methodology increased the wages for employees of NFs serving and ICFs/IIDs, resulting in the policy being obsolete.
Please view the circulation document here: 17-12 Circulation Document, and submit feedback via the comment box below.
Circulation Date: 10/3/2017
Comment Due Date: 11/2/2017
Medical Advisory Committee Meeting: 11/16/2017
Board Meeting:____________________________________________________
APA WF# 17-12 — Wage Enhancement Policy Revisions
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an Emergency Rule.
The proposed revisions revoke policythat refers to wage enhancement.
Please view the circulation document here: APA WF# 17-12, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-13 — Signature Requirements Revisions
The proposed electronic records/electronic signatures and signature requirements policy revisions reverse the three (3) day signature language back to the policy that was in place from 2011 to September 1, 2017. The proposed revisions clarify that the authentication of medical records is expected on the day the record is completed. The revisions also clarify that the signature of the rendering provider and date entry is expected within three (3) business days from the day the record is completed if the record is being transcribed.
Please view the circulation document here: APA WF# 17-13, and submit feedback via the comment box below.
Circulation Date: 08/30/2017
Comment Due Date: 09/21/2017
Medical Advisory Committee Meeting: 09/21/2017
Board Meeting: 09/27/2017
____________________________________________________
APA WF# 17-13 — Signature Requirements Revisions
This rule has previously been approved by the OHCA Board of Directors and the Governor, as an Emergency Rule.
The proposed electronic records/electronic signatures and signature requirements policy revisions reverse the three (3) day signature language back to the policy that was in place from 2011 to September 1, 2017. The proposed revisions clarify that the authentication of medical records is expected on the day the record is completed. The revisions also clarify that the signature of the rendering provider and date entry is expected within three (3) business days from the day the record is completed if the record is being transcribed.
Please view the circulation document here: APA WF# 17-13, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-14 — Adult Dental Emergency ExtractionsThe proposed revision clarifies dental coverage for adults by amending the rule that limits dental services for adults to “emergency” extractions.
Please view the circulation document here: APA 17-14 — Dental Emergency Extractions, and submit feedback via the comment box below.
Circulation Date: 09/06/2017
Comment Due Date: 09/21/2017
Medical Advisory Committee Meeting: 09/21/2017
Board Meeting: 09/27/2017
____________________________________________________
APA WF# 17-14 — Adult Dental Emergency Extractions
Please note, sections of this rule were previously approved, as an Emergency Rule, by the OHCA Board of Directors and the Governor. Additional revisions have not yet been approved.
The proposed revision clarifies dental coverage for adults by amending the rule that limits dental services for adults to “emergency” extractions.
Please view the circulation document here: APA WF# 17-14, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF 17-15 — Student Earned Income Exclusion for Aged, Blind and Disabled (ABD) Applicants
The proposed ABD eligibility policy revisions remove specific amounts of a student's earned income that can be excluded because SSA revises the amounts on an annual basis. The revised policy refers to Oklahoma Department of Human Services (OKDHS) Appendix C-1.
Please view the circulation document here: APA WF# 17-15, and submit feedback via the comment box below.
Circulation Date: 12/18/2017
Comment Due Date: 01/17/2018
Medical Advisory Committee Date: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-15 — Student Earned Income Exclusion for Aged, Blind and Disabled (ABD) Applicants Revisions
The proposed ABD eligibility policy revisions remove specific amounts of a student's earned income that can be excluded because SSA revises the amounts on an annual basis. The revised policy refers to Oklahoma Department of Human Services (OKDHS) Appendix C-1.
Please view the circulation document here: APA WF# 17-15, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-16 — Accreditation Commission for Health Care (ACHC) accreditation option for Outpatient Behavioral Health Agencies
The proposed behavioral health revisions add the Accreditation Commission for Health Care (ACHC) as an additional accreditation option for outpatient behavioral health agencies. Revisions will also update policy terminology in order to align with current practice.
Please view the circulation document here: APA WF# 17-16, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting:____________________________________________________
APA WF# 17-17 — Indian Health Services, Tribal Program and Urban Indian Clinics (I/T/U) Current Procedural Terminology (CPT) Language Removal
The proposed I/T/U policy is amended to remove the restriction to billing with a CPT procedure code for outpatient behavioral health encounters.
Please view the circulation document here: APA WF# 17-17, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Medical Advisory Committee: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-18 — Therapeutic Leave Days Revisions
The proposed revisions eliminate therapeutic leave days for long-term care facilities, with the exception of Intermediate Care Facilities serving Individuals with Intellectual Disabilities, in an effort to meet the balanced budget requirements. Without the recommended revisions, the OHCA is at risk of exhausting its State appropriated dollars required to maintain the SoonerCare program.
Please view the circulation document here: 17-18 Circulation Document, and submit feedback via the comment box below.
Circulation Date: 10/17/2017
Comment Due Date: 11/16/2017
Medical Advisory Committee Meeting: 11/16/2017
Board Meeting:____________________________________________________
APA WF 17-19 — Inpatient Behavioral Health Revisions
The proposed inpatient behavioral health revisions will align policy with federal standards of restraint and seclusion for members under the age of 21. Rules will also be revised to update definitions.
Please view the circulation document here: APA WF# 17-19, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Medical Advisory Committee Date: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-19 — Inpatient Behavioral Health Revisions
Please note, sections of this rule were previously approved, as an Emergency Rule, by the OHCA Board of Directors and the Governor. Additional revisions have not yet been approved.
The proposed inpatient behavioral health revisions will be amended to align policy with federal standards of restraint and seclusion for members under the age of 21. Rules will also revise certification of need for care, plan of care, and utilization review plan requirements. Other revisions will include minor updates of policy terminology.
Please view the circulation document here: APA WF# 17-19, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-20 — Grandfathered CHIP children
The proposed revisions amend Qualifying Categorical Relationship policy by removing an eligibility group that no longer exists.
Please view the circulation document here: APA WF# 17-20, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Medical Advisory Committee: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-21 — Income Rounding for Non-disabled Adults and Children Eligibility
The proposed revisions amend rules to mirror current online eligibility system computations to income by rounding cents down at each step in the computations. Additionally, revisions also amend pre-MAGI and post-MAGI policy by removing pre-MAGI policy.
Please view the circulation document here: APA WF# 17-21, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-22A — Prior Authorization Policy Revisions
The proposed revisions amend prior authorization policy.
Please view the circulation document here: APA WF# 17-22A, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-22B — Prior Authorization Policy Revisions
The proposed revisions amend prior authorization policy.
Please view the circulation document here: APA WF# 17-22B, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting:____________________________________________________
APA WF# 17-23 — Breast and Cervical Cancer (BCC) Benefit Update
The proposed Breast and Cervical Cancer (BCC) Benefit policy is amended to comply with federal regulation, which addresses optional eligibility for individuals needing treatment for breast and cervical cancer. In order to align revisions with federal regulation requirements, the references to "women" will be replaced with the terms that are inclusive of both males and females for eligibility purposes.
Please view the circulation document here: APA WF# 17-23, and submit feedback via the comment box below.
Circulation Date: 11/20/2017
Comment Due Date: 12/19/2017
Medical Advisory Committee Meeting: 01/18/2018
Board Meeting:____________________________________________________
APA WF# 17-23 — Breast and Cervical Cancer (BCC) Benefit Update
The proposed Breast and Cervical Cancer (BCC) Benefit policy is amended to comply with federal regulation, which addresses optional eligibility for individuals needing treatment for breast and cervical cancer. In order to align revisions with federal regulation requirements the references to "women" will be replaced with the terms that are inclusive of both males and females for eligibility purposes.
Please view the circulation document here: APA WF# 17-23, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Medical Advisory Committee: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-24A — ADvantage Waiver Revisions
The proposed revisions to the ADvantage Waiver include cleanup to remove and update outdated policy in order to align with current business practices.
Please view the circulation document here: APA WF# 17-24A, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Medical Advisory Committee: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-24B — ADvantage Waiver Revisions
The proposed revisions to the ADvantage Waiver include clean-up to remove and update outdated policy in order to align with current business practices. In addition, proposed revisions add new language regarding the Ethics of Care Committee for the ADvantage and State Plan Personal Care program which outlines rules and processes. Proposed revisions clarify rules are in accordance with state laws and regulations.
Please view the circulation document here: APA WF# 17-24B, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Medical Advisory Committee: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-25A — Developmental Disabilities Division Revisions
The proposed revisions to the Developmental Disabilities Services policy amend the rules to implement changes recommended during the annual Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) rule review process.
Please view the circulation document here: APA WF# 17-25A, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Medical Advisory Committee: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-25B — Developmental Disabilities Division Revisions
The proposed revisions to the Developmental Disabilities Services policy amend the rules to implement changes recommended during the annual Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) rule review process.
Please view the circulation document here: APA WF# 17-25B, and submit feedback via the comment box below.
Circulation Date: 12/15/2017
Comment Due Date: 01/16/2018
Public Hearing: 01/16/2018
Medical Advisory Committee: 01/18/2018
Board Meeting: 02/08/2018
____________________________________________________
APA WF# 17-26 — Insure Oklahoma Policy Revisions
Please note, sections of this rule were previously approved, as an Emergency Rule, by the OHCA Board of Directors and the Governor. Additional revisions have not yet been approved.
The proposed revisions to the Insure Oklahoma policy is amended to strengthen program integrity in the Insure Oklahoma Individual Plan for self-employed individuals. In addition, proposed revisions will include minor language clean-up and removal of outdated language in order to reflect current business practices.
Please view the circulation document here: APA WF# 17-26, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-27 — Medically Fragile Waiver Revisions
The proposed policy revisions to the Medically Fragile Waiver is being requested to provide clean-up to the (Overview, Services and Annual Re-evaluation) sections of existing policy for general clarification and alignment with current waiver operation and language included in the approved waiver; including updating of some acronyms used in existing policy.
Please view the circulation document here: APA WF# 17-27, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Medical Advisory Committee Meeting: 03/15/2018
Board Meeting: 03/22/2018
____________________________________________________
APA WF# 17-28 — Federally Qualified Health Center Services (FQHC) Alternative Payment Methodology (APM)
The proposed policy revisions will introduce a new optional payment methodology for Federally Qualified Health Centers (FQHCs).
Please view the circulation document here: APA WF# 17-28, and submit feedback via the comment box below.
Circulation Date: 01/17/2018
Comment Due Date: 02/16/2018
Public Hearing: 02/20/2018
Board Meeting: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
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 Application for Extension of the Demonstration, 2016-2018. The comment period is open from now until Dec. 5, 2014. OHCA will respond in writing to any feedback received during the comment period.
Also, an overview of the feedback will be discussed in the public meetings mentioned below as received. Input from meeting participants will also be summarized and included in the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Application for Extension of the Demonstration, 2016-2018 to the Centers for Medicare and Medicaid Services.
Click here to offer feedback.
Click here to view the application for extension of SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver.
The public will have the opportunity to provide meaningful comment on the SoonerCare demonstration waiver September 9 through December 5, 2014.
1. September 16 at 5:30 p.m.
OHIP Children's Health Workgroup Meeting
OU Health Sciences Center Campus,
OU College of Medicine
Provost Conference Room (Room 223)
Bird Library
Oklahoma City, OK
Video conferencing is also available for this meeting:
-OU College of Medicine, Tulsa;
-Northwestern Oklahoma State University, Enid; and
-Eastern Oklahoma State University, Wilburton.
2. November 20 at 1 p.m.
Medical Advisory Committee Meeting
Charles Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N Lincoln Blvd.
Oklahoma City, OK
Modification to the Health Management Program within SoonerCare Choice
Circulated Date: 09/05/2012
OHCA Comment Due Date: 10/15/2012
1115(a) SoonerCare Research and Demonstration Waiver
Circulated Date: 04/25/2014
OHCA Comment Due Date: 05/25/2014
Proposed Submittal Date: 05/09/2014
Insure Oklahoma Sponsor's Choice Option
The 1115 demonstration waiver and corresponding agency rules will be amended to reflect a third Insure Oklahoma option. The Insure Oklahoma Choice program will establish coverage for sponsoring organizations, eligible populations including dependent spouses and children, qualifying benefit plans, cost sharing and expenditure authorities. The evaluation design will be modified to incorporate the Insure Oklahoma Choice program as well.
Circulation Date: 06/12/2015
OHCA Comment Due Date: 07/17/2015
Proposed Submittal Date: 07/31/2015
Home and Community-Based Services (HBCS) Waivers’ Amendments
Community Waiver Amendment
The participant direction option has been added to the waiver for members living in non-residential settings such as their own home or the home of a family member or friend. The participant direction service delivery method has been added as an option for Habilitation Training Specialist Services and a new service, Self-Directed Goods and Services (SD-GS), has been added.
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
The estimate of Factor D for waiver year 5 has been updated based on Form 372 for FY18. This includes an increase in the Respite Daily in Home rate from $38.00 to $57.04.
Please view the waiver amendment in its entirety here: Community Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
Homeward Bound Waiver Amendment
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
The estimate of Factor D for waiver year 5 has been updated based on Form 372 for FY18. This includes an increase in the Respite Daily in Home rate from $38.00 to $57.04.
Please view the waiver amendment in its entirety here: Homeward Bound Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Adults Amendment
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
A cost limit has been added for Prevocational and Supported Employment services which allows an additional $5500 per member above the $23,131.00 individual cost limit. This additional limit will allow members to access individual placement opportunities with a Job Coach, Employment Training Specialist and stabilization.
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
Estimate of Factor D for waiver years 4 and 5 has been updated based on Form 372 for FY18.
Please view the waiver amendment in its entirety here: In-Home Supports for Adults Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Children Amendment
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
The estimate of Factor D for waiver years 4 and 5 has been updated based on Form 372 for FY18.The above amendments will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: In-Home Supports for Children Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
Community Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: Community Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
Homeward Bound Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: Homeward Bound Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: In-Home Supports for Adults Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with Intellectual Disabilities age 3 through 17. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: In-Home Supports for Children Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
ADvantage Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the ADvantage waiver. The ADvantage waiver provides services and supports to assist older adults and adults with physical disabilities to live independently in their homes and communities. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please review the waiver amendment in its entirety here: ADvantage Waiver Amendment.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of a waiver, 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.
In-Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 3-5 has been made as well as an increase in the individual member cost limit. Currently, the cost limit amount is $22,235.00 per member, per plan of care year. This amount will be increased to $23,131.00. Other updates include further explanation related to the exclusion of room and board cost, clarification of provider rate methodology, the addition of Electronic Visit Verification procedure, clarification related to member safeguard procedure, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update and confirmation that Oklahoma’s Statewide Transition Plan was granted final approval.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with Intellectual Disabilities age 3 through 17. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 3-5 has been made as well as an increase in the individual member cost limit. Currently, the cost limit amount is $14,825.00 per member, per plan of care year. This amount will be increased to $15,426.00. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, the addition of Electronic Visit Verification procedure, clarification related to member safeguard procedure, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update and confirmation that Oklahoma’s Statewide Transition Plan was granted final approval.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Community Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made as well as an update of the number of unduplicated participants served through the waiver for year 5. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, clarification related to a waiver member’s medication management, critical incidents and safeguard procedure, the addition of Electronic Visit Verification procedure language, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update, confirmation that Oklahoma’s Statewide Transition Plan was granted final approval, level of care evaluation approval procedure change, Specialized Medical Supplies and Assistive Technology service definition and provider qualifications update, language clean-up to ensure reference to “mental retardation” has been changed to “intellectual disabilities”, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), confirmation that Extended Duty Nursing may be provided in a facility, Daily Living Supports and Intensive Personal Supports services may now be provided by a relative/legal guardian, Agency Companion provider qualification update and a change in the sampling approach described in the Quality Improvement Strategy for the Health and Welfare section of the waiver.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Homeward Bound Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, clarification related to a waiver member’s medication management, critical incidents and safeguard procedure, the addition of Electronic Visit Verification procedure language, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update, confirmation that Oklahoma’s Statewide Transition Plan was granted final approval, level of care evaluation approval procedure change, Specialized Medical Supplies and Assistive Technology service definition and provider qualifications update, language clean-up to ensure reference to “mental retardation” has been changed to “intellectual disabilities”, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), confirmation that Extended Duty Nursing may be provided in a facility, Daily Living Supports and Intensive Personal Supports services may now be provided by a relative/legal guardian and a change in Agency Companion provider qualifications.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Medically Fragile Waiver Amendment
Per CFR 441.304, a waiver amendment is required for substantive changes that include an increase in slot participation for unduplicated members, the Oklahoma Health Care Authority Medically Fragile Waiver is increasing slot participation in the waiver. During Fiscal Year 19, the Medically Fragile waiver met the awarded number of slots. Awarded slots cannot not be exceeded, therefore an amendment must be submitted.
The requested effective date of the slot increase will be July 1, 2019 upon Centers for Medicare and Medicaid Services (CMS) approval. Per the HCBS Technical Guide, “A retroactive effective date can be permitted for the purpose of increasing the unduplicated number of participants”.
The Medically Fragile Waiver serves adults 19 years of age and older who have been diagnosed with a medically fragile condition who require a Hospital/Skilled Nursing Facility level of care and whose needs could not otherwise be met through another Oklahoma Waiver. All Medically Fragile Waiver members receive services in a home and community setting.
The waiver amendment is available for review here. Please submit all comments by close of business, August 2, 2019. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: QA & Community Living Services: 1915(c) Waivers.
To request a free hard copy of a waiver, 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: QA & Community Living Services: 1915(c) Waivers.
Medically Fragile Waiver Amendment Rate Increase
Pursuant to 42 C.F.R. § 441.301, the Oklahoma Health Care Authority (OHCA) is required to give public notice and receive public input on any significant proposed changes to the 1915(c) Home and Community-Based Services (HCBS) waivers.
Revisions are needed to increase the current reimbursement rates for all SoonerCare-contracted provider types by five percent (5%), with the following exemptions: services financed through appropriations to other state agencies; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); non-emergency transportation capitated payments; services provided to Insure Oklahoma (IO) members; payments for drug ingredients/physician supplied drugs; Indian Health Services/Tribal/Urban Clinics (I/T/Us); Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs). The agency’s proposed revisions are in keeping with Sections 1 and 2 of the SB 1044, 57th Leg., 1st Sess. (Okla. 2019), except that reimbursement rates for PACE providers (Program for the All-inclusive Care for the Elderly) will also be increased by five percent (5%). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
The effective date of the 5% rate increase will be upon notification from the Centers for Medicare and Medicaid Services (CMS) or on 10/01/2019, whichever is first.
The Medically Fragile Waiver serves adults 19 years of age and older who have been diagnosed with a medically fragile condition who require a Hospital/Skilled Nursing Facility level of care and whose needs could not otherwise be met through another Oklahoma Waiver. All Medically Fragile Waiver members receive services in a home and community setting.
The waiver amendment is available for review here. Please submit all comments by close of business, August 3, 2019. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105.
Attention: QA& Community Living Services: 1915(c) Waivers.
To request a free hard copy of a waiver, 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: QA & Community Living Services: 1915(c) Waivers.
ADvantage Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the ADvantage Waiver. ADvantage provides services and supports to assist older adults and adults with physical disabilities to live independently in their homes and communities. The Oklahoma Legislature has mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 3, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Medically Fragile Waiver Amendment
Revisions are needed to increase the current reimbursement rates for the Medically Fragile Waiver services by three percent (3%) with the following exemptions: services financed through appropriations to other state agencies, Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS), non-emergency transportation capitated payments, services provided to Insure Oklahoma (IO) members, payments for drug ingredients/physicians supplied drugs, Indian Health Services/Tribal/Urban Clinics (I/T/U), Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
The waiver amendment is available for review using the following link here. Please submit all comments by close of business, October 14, 2018.
ADvantage Waiver Amendment
Pursuant to House Bill 3708, the Oklahoma Department of Human Services is increasing certain provider rates for the ADvantage program. These include a 7% rate increase for ADvantage direct care, case management and State Plan personal care effective upon CMS approval or October 1, 2018, whichever is earlier. The ADvantage waiver serves older adults and persons with disabilities who reside in a community setting.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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
In Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking an amendment to the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with intellectual disabilities age 18 and over. The specific changes being proposed include; an updated estimate of cost for waiver years 2-5, an updated number of unduplicated participants served through the waiver for years 2-5 as well as, an increase in the individual cost limit. Currently, the cost limit is $20,761.00 per member, per plan of care year. The cost limit being proposed will increase the amount to $22,235.00. The changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review using the following link here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking an amendment to the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with intellectual disabilities ages 3 through 17. The specific changes being proposed include an updated estimate cost for waiver years 2-5, an updated number of unduplicated participants served through the waiver for years 2-5 as well as, an increase in the individual cost limit. Currently, the cost limit is $13,844.00 per member, per plan of care year. The cost limit being proposed will increase the amount to $14,825.00. The changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.Community Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. The specific changes include an update of the estimated cost of the waiver for years 3-5 as well as an update of the number of unduplicated participants served through the waiver for years 3-5. The proposed changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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
Homeward Bound Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. The specific changes include an update of the estimated cost of the waiver for years 3-5 as well as an update of the number of unduplicated participants served through the waiver for years 3-5. The proposed changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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
Medically Fragile Waiver Renewal
The Oklahoma Health Care Authority is seeking a 5 year renewal of the Medically Fragile Waiver. The Medically Fragile program is a home and community-based alternative to placement in a hospital and/or skilled nursing unit of a nursing facility. The Medically Fragile waiver serves individuals 19 years of age and older who have a life-threatening condition, require frequent specialized treatment and have a dependency on medical technology. Specific changes to the renewal include, but are not limited to, (1) Modifying performance measures to adhere to CMS guidance from HCB setting regulations, (2) Adding language and performance measures to comply with Electronic Visit Verification regulations, (3) Adding language limiting conflict of interest for service plan development and monitoring with service delivery, and (4) Other changes include general clarification, alignment with state statute and cleanup.
Please view the renewal application here: Medically Fragile Waiver Renewal. Please submit all comments by close of business, March 25, 2018, 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, OK 73105. Attention: Health Policy 1915(c) Waivers.
To request a hard copy of waivers please call 1-888-287-2433 or send your request to the Oklahoma Health Care Authority, 4345 N Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
The Department of Human Services lost $69 million in state funding for the State Fiscal Year 2018 as a result of the Oklahoma Supreme Court ruling the cigarette fee unconstitutional. In October, DHS was required to submit a revised budget to the Oklahoma Office of Management and Enterprise Services (OMES) to fulfill Oklahoma’s constitutional requirements for a balanced budget. The revised budget resulted in additional reductions to DHS services. The ADvantage waiver serves the frail and elderly adults with physical disabilities age 21 and over who do not have intellectual disabilities or cognitive impairment. DHS is terminating the ADvantage Waiver effective December 1, 2017.
Please view the waiver amendment here: ADvantage Waiver. Please submit all comments by close of business, November 30, 2017, 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 waiver amendment 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© Waivers.In-Home Supports Waiver for Adults
In October, the Oklahoma Department of Human Services (DHS) was required to submit a revised budget to the Oklahoma Office of Management and Enterprise Services (OMES) to fulfill Oklahoma’s constitutional requirement to maintain a balanced budget for State Fiscal Year 2018 following the loss of $69 million from their operating budget. This is the amount of appropriations DHS would have received from the cigarette fee that was ruled unconstitutional by the Oklahoma Supreme Court. When the cigarette fee was struck down, additional reductions became necessary. As a result, DHS is terminating the In-Home Supports Waiver for Adults (IHSW-A) effective December 1, 2017. The IHSW-A serves individuals with intellectual disabilities age 18 and over. Upon termination of the waiver, current service recipient’s names will be added to the statewide waiver request list for Developmental Disability Service (DDS) waiver services with his or her original application date.
Please view the waiver amendment here: In-Home Supports Waiver for Adults. Please submit all comments by close of business, November 30, 2017, 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 waiver amendment 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© Waivers.
In-Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking waiver amendment approval for the In-Home Supports Waiver for Adults (IHSW-A) to meet the balanced budget requirements as mandated by state law. The IHSW-A serves individuals with Intellectual Disabilities ages 18 and over. Due to Oklahoma’s budget crisis, costs saving actions are necessary. In an effort to minimize that impact on members served, and in lieu of an elimination of service, the individual cost limit for adults has been reduced.
Please view the renewal application here: In-Home Supports Waiver for Adults. Please submit all comments by close of business, August 14, 2017, 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© 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© Waivers.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking waiver amendment approval for the In-Home Supports Waiver for Children (IHSW-C) to meet the budget requirements as mandated by State law. The IHSW-C serves individuals with Intellectual Disabilities ages 3 to 17. Due to Oklahoma’s budget crisis, costs saving actions are necessary. In an effort to minimize that impact on members served, and in lieu of an elimination of service, the individual cost limit for children has been reduced.
Please view the renewal application here: In-Home Supports Waiver for Children. Please submit all comments by close of business, August 14, 2017, 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.In-Home Supports for Adults Waiver Renewal Application
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Adults (IHSW-A) waiver. The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Specific changes include, but are not limited to, (1) Updating the rate determination methods section with details related to the fixed rate method associated with Prevocational and Supported Employment services; (2) Updating the Family Counseling service provider section; (3) Updating the Person Centered Planning and Service Delivery section; (4) Updating language regarding critical incidents and reporting, dental service providers, seclusion and restraints and supported employment services definition and limits; (5) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; (6) Updated unduplicated number of participants and reserved capacity number; and (7) Deleted Physician Services from Appendices C and J. Other changes include general clarification and cleanup.In-Home Supports for Adults Waiver Renewal Application – Extended Comment Period
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Adults (IHSW-A) waiver. The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Specific changes include, but are not limited to, (1) Updating the rate determination methods section with details related to the fixed rate method associated with Prevocational and Supported Employment services; (2) Updating the Family Counseling service provider section; (3) Updating the Person Centered Planning and Service Delivery section; (4) Updating language regarding critical incidents and reporting, dental service providers, seclusion and restraints and supported employment services definition and limits; (5) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; (6) Updated unduplicated number of participants and reserved capacity number; and (7) Deleted Physician Services from Appendices C and J. Other changes include general clarification and cleanup.
Please view the renewal application here: In-Home Supports for Adults Waiver Renewal Application. Please submit all comments by close of business, April 14, 2017, 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.
In-Home Supports for Children Waiver Renewal Application
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The IHSW-C serves individuals with Intellectual Disabilities age 3 to 17. Specific changes include, but are not limited to, (1) Updating Person Centered Planning and Service Delivery section; (2) Unduplicated number of participants and reserved capacity numbers; (3) Updating cost data/estimates updated throughout Appendix J; (4) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; and (5) Added Prevocational and Supported Employment services for members age 16 and above. Other changes include general clarification and cleanup.
Please view the renewal application here: In-Home Supports for Children Waiver Renewal Application. Please submit all comments by close of business, February 3, 2017, 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.
In-Home Supports for Children Waiver Renewal Application – Extended Comment Period
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The IHSW-C serves individuals with Intellectual Disabilities age 3 to 17. Specific changes include, but are not limited to, (1) Updating Person Centered Planning and Service Delivery section; (2) Unduplicated number of participants and reserved capacity numbers; (3) Updating cost data/estimates updated throughout Appendix J; (4) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; and (5) Added Prevocational and Supported Employment services for members age 16 and above. Other changes include general clarification and cleanup.
Please view the renewal application here: In-Home Supports for Children Waiver Renewal Application. Please submit all comments by close of business, April 14, 2017, 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.
Medically Fragile Waiver Amendment
The Medically Fragile waiver is amended to propose a reinstatement of the three percent provider rate reduction that was implemented April 1, 2016. The Oklahoma Health Care Authority is proposing to reinstate the above reduced rates to select programs and provider types that the agency has identified serve our most vulnerable populations and provide access to critical programs. Additionally, clean-up changes have been made to align the waiver with policy. The proposed effective date of the changes is December 1, 2016.
Please view the waiver amendment here: Medically Fragile Waiver Amendment. Please submit all comments by close of business, August 29, 2016, 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. A non-electronic version of this amendment can be requested by writing to the address above or calling 1-888-287-2443.
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 Application for Extension of the Demonstration, 2016-2018. The comment period is open from now until Dec. 5, 2014. OHCA will respond in writing to any feedback received during the comment period.
Also, an overview of the feedback will be discussed in the public meetings mentioned below as received. Input from meeting participants will also be summarized and included in the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Application for Extension of the Demonstration, 2016-2018 to the Centers for Medicare and Medicaid Services.
Click here to offer feedback.
Click here to view the application for extension of SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver.
The public will have the opportunity to provide meaningful comment on the SoonerCare demonstration waiver September 9 through December 5, 2014.
1. September 16 at 5:30 p.m.
OHIP Children's Health Workgroup Meeting
OU Health Sciences Center Campus,
OU College of Medicine
Provost Conference Room (Room 223)
Bird Library
Oklahoma City, OK
Video conferencing is also available for this meeting:
-OU College of Medicine, Tulsa;
-Northwestern Oklahoma State University, Enid; and
-Eastern Oklahoma State University, Wilburton.
2. November 20 at 1 p.m.
Medical Advisory Committee Meeting
Charles Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N Lincoln Blvd.
Oklahoma City, OK
Modification to the Health Management Program within SoonerCare Choice
Circulated Date: 09/05/2012
OHCA Comment Due Date: 10/15/2012
1115(a) SoonerCare Research and Demonstration Waiver
Circulated Date: 04/25/2014
OHCA Comment Due Date: 05/25/2014
Proposed Submittal Date: 05/09/2014
Insure Oklahoma Sponsor's Choice Option
The 1115 demonstration waiver and corresponding agency rules will be amended to reflect a third Insure Oklahoma option. The Insure Oklahoma Choice program will establish coverage for sponsoring organizations, eligible populations including dependent spouses and children, qualifying benefit plans, cost sharing and expenditure authorities. The evaluation design will be modified to incorporate the Insure Oklahoma Choice program as well.
Circulation Date: 06/12/2015
OHCA Comment Due Date: 07/17/2015
Proposed Submittal Date: 07/31/2015
Insure Oklahoma Phase-Out Plan
The OHCA will submit a phase-out plan to reflect changes to the Insure Oklahoma (IO) program, in accordance with the special terms and conditions of the 1115(a) waiver. The phase-out plan details the process by which affected stakeholders and members will be notified and the process in which changes will occur. Effective July 1, 2021, all IO Individual Plan (IP) members, and IO Employer-Sponsored Insurance (ESI) members with incomes at or below 133% of the federal poverty level (FPL), plus any applicable income disregards, will transition to and be provided services by the SoonerCare program under the expansion adult option. Additionally, revisions will clarify that IO ESI members’ FPL threshold is 134%-200%, plus any applicable income disregards.
Please view the draft waiver amendment here and submit feedback via the comment box below.
Effective Date: 07/01/2021
Tribal Consultation Date: 09/01/2020 – 10/31/2020
Comment Period: 10/01/2020 – 10/31/2020
Insure Oklahoma 1115(a) Demonstration Waiver Amendment
The OHCA will seek approval of an 1115(a) demonstration waiver to reflect changes to the Insure Oklahoma (IO) program. Effective July 1, 2021, all IO Individual Plan (IP) members, and IO Employer-Sponsored Insurance (ESI) members with incomes at or below 133% of the federal poverty level (FPL), plus any applicable income disregards, will transition to and be provided services by the SoonerCare program under the expansion adult option. Additionally, revisions will clarify that IO ESI members’ FPL threshold is 134%-200%, plus any applicable income disregards.
Please view the draft waiver amendment here and submit feedback via the comment box below.
Effective Date: 07/01/2021
Tribal Consultation Date: 09/01/2020 – 10/31/2020
Comment Period: 10/01/2020 – 10/31/2020
Adding the newly eligible adult group to PCMH and increasing care coordination rates for PCMH American Indian/Alaskan Native providers: July 1, 2020, 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 in effect through the end of the waiver demonstration on December 31, 2023:
The STCs will be amended to align the 1115(a) demonstration populations with the State Plan to include the adult group to:
- Improve access to high-quality, person-centered services that produce positive health outcomes for individuals who were previously under or uninsured.
- Encourage members to increase utilization of preventive, primary, urgent, and specialty care — accessing the appropriate type of care in the appropriate setting.
- Decrease reliance on emergency departments for services that would be better provided in lower levels of care settings.
- Through the use of HANs and HMP, the OHCA will help newly eligible members become more informed about their health condition and health care options, understand appropriate use of the ED, and learn best practices in self-management such that they are empowered to make better informed decisions about their care.
- Reduce the number of uninsured Oklahomans.
An additional amendment will be made to STC 40 to increase monthly patient-centered medical home (PCMH) care coordination payments to facilities operated by Indian Health Service, tribal facilities, and Urban Indian Clinics (ITUs) to $27.25 per member per month through December 2021, $28.50 per member per month for calendar year 2022, and $29.81 per member per month for calendar year 2023.
The OHCA anticipates the addition of a new Medicaid Eligibility Group (MEG) for the adult group expansion within the existing budget neutrality model. The proposed increase for I/T/U care coordination payments is estimated to equal $16.4 million annually, which is 100% federally funded.
OHCA will be holding a public hearing on this proposal as follows:
VIRTUAL MEETING
April 7, 2020 at 2 p.m.
Register for Zoom Meeting: (Expired Link)
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: Patient-Centered Medical Home Amendment. The public notice for the waiver amendment can 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 April 1, 2020 through May 1, 2020. On or after May 16, 2020, comments may also be made at https://www.medicaid.gov after the amendment has been submitted to CMS.
1115(a) Institution for Mental Disease (IMD) Waiver for Serious Mental Illness (SMI) and Substance Use Disorder (SUD)
The OHCA and Department of Mental Health and Substance Abuse Services are proposing to submit the 1115 IMD waiver for serious mental illness (SMI) and substance use disorder (SUD) to further provide access to mental health and substance use treatment by allowing Medicaid coverage and reimbursement for services provided to eligible adults with SMI/SUD, ages 21-64, within IMDs. Additionally, individuals under the age of 21 will be eligible to receive residential SUD services within an IMD and a new IMD provider type for qualified residential treatment programs (QRTP) will be established under the proposed waiver. The waiver will request coverage for medically necessary residential substance use disorder treatment, facility-based crisis stabilization, and inpatient treatment services within IMDs. The waiver will also seek to improve outcomes, quality, and accessibility of SMI/SUD treatment services in a cost-effective manner. Through this demonstration, Oklahoma seeks flexibility to improve access to quality behavioral health care to support the overall health of individuals diagnosed with SMI and/or SUD.
As of today, OHCA will be holding virtual public hearings on this proposal as follows:
Virtual Public Hearing
May 6, 2020, at 3 p.m.
Register for Zoom Public Hearing: (Expired Link)
Virtual Public Hearing
May 8, 2020, at 3 p.m.
Register for Zoom Public Hearing: (Expired Link)
Interested persons may view a copy of the proposed waiver, public notice(s), location and times of public hearings, here. Any public comments on the proposal, supplemental information, and updates may also be made here. Please view the waiver in its entirety here: Institutes for Mental Disease Waiver. 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 proposed waiver 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 proposed waiver will be accepted by contacting OHCA as indicated. Comments submitted through the OHCA policy blog will be available for review online at www.okhca.org/PolicyBlog. Other written comments are available upon request at federal.authorities@okhca.org. Comments will be accepted May 1-31, 2020.
Please view additional documents here:
1. OK 1115 Serious Mental Illness (SMI) Availability Assessment
2. OK 1115 Serious Mental Illness (SMI) Availability Assessment (Excel)
3. OK 1115 Substance Use Disorder (SUD) Availability Assessment
4. OK 1115 Substance Use Disorder (SUD) Availability Assessment (Excel)
5. Appendix B
6. Appendix B (Excel)
Health Access Networks (HAN) 1115(a) Demonstration Waiver Amendment, Effective: October 1, 2019
With this amendment request, the OHCA seeks approval of the following modifications to the 1115(a) demonstration for the current extension period that will be in effect through December 31, 2023:
Effective October 1, 2019, the waiver Special Terms and Conditions (STCs) will be updated for the Health Access Networks (HANs), contingent upon CMS approval. HANs are non-profit administrative entities that work with providers to coordinate and improve the quality of care for SoonerCare members.
The OHCA proposes to remove three paragraphs that are either duplicative or no longer applicable to HAN duties from STC 40. The paragraphs identified for removal are in relation to 1) ensuring access to all levels of care, 2) submitting a development plan, and 3) offering core components of electronic medical records, improved access to specialty care, telemedicine, and expanded quality improvement strategies.
OHCA proposes to continue the currently approved monitoring and evaluation components identified in the STCs. The hypotheses and measures provided in the current evaluation design remain applicable with the following corrections to STC 84, Evaluation of the HANs.
One correction will be to remove the word “pilot” from the reference to the program in the first paragraph. In addition, the subsequent paragraphs will be revised to reflect the evaluation design that the state has submitted to Centers for Medicare and Medicaid Services (CMS) including the following:
a. Impact on costs: The implementation and expansion of the HANs will reduce costs associated with the provision of health care services to SoonerCare beneficiaries served by the HANs;
b. Impact on access to care: The implementation and expansion of the HANs will improve access to and the availability of health care services to SoonerCare beneficiaries served by the HANs;
c. Impact on quality and coordination: The implementation and expansion of the HANs will improve the quality and coordination of health care services to SoonerCare beneficiaries served by the HANs, with specific focus on the populations at greatest risk, including those with multiple chronic illnesses; and
d. Impact on the patient-centered medical home (PCMH) program: The implementation and expansion of the HANs will enhance the State’s PCMH program through an evaluation of primary care physician (PCP) profiles that incorporates a review of utilization, disease guideline compliance, and cost.
Amending the language will not have any effect on budget neutrality for the 1115(a) demonstration waiver.
The proposed amendment was presented at the OHCA Medical Advisory Committee meeting and The Children’s Health Group (TCHG) meeting at the dates listed below:
OHCA Medical Advisory Committee Meeting
March 14, 2019
1:00 p.m.
Oklahoma Health Care Authority
Ed McFall Boardroom
4345 N. Lincoln Boulevard
Oklahoma City, Oklahoma 73105
The Children’s Health Group Quarterly Meeting
April 9, 2019
5:00 p.m.
OU Health Sciences Center Campus
Provost’s Conference Room
#233 Bird Library
1105 N. Stonewall Ave.
Oklahoma City, Oklahoma 73117
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: Health Access Network Waiver Amendment. The public notice for the waiver amendment can 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 March 11, 2019 through April 10, 2019.
Comments may also be made at https://www.medicaid.gov after the amendment has been submitted to CMS on or after April 11, 2019.
Please view additional documents here:
1. SoonerCare Choice Budget Neutrality
2. CMS Standard Funding Questions
3. 1115(a) Waiver Projects Currently Undergoing Application and Amendment
1115(a) Demonstration Health Management Program Waiver Amendment
Pursuant to 42 CFR § 431.408 and 42 CFR § 447.205, the Oklahoma Health Care Authority (OHCA) is providing public notice of a proposed amendment to the 1115(a) demonstration waiver. The proposed waiver amendment was presented at the September 4, 2018 and January 8, 2019 Tribal Consultations and two public meetings (refer to meeting information below). Additionally, the amendment was posted for a 30-day public review period from October 1, 2018, through October 30, 2018; however, the supplemental documentation for submission to Centers for Medicare and Medicaid Services (CMS) has since updated and the Agency is seeking an additional 30-day public review period.
The OHCA currently has an approved 1115(a) waiver for the 2018-2023 demonstration extension period. Effective July 1, 2019 and contingent upon CMS approval, the OHCA seeks approval of the following modifications to the demonstration for the current 2018-2023 extension period:
The waiver amendment requests a revision to the waiver special terms and conditions to reflect a more current description of the Health Management Program (HMP). The HMP was developed in response to a state mandate found at Oklahoma Statute §56-1011.6., and seeks to improve the quality of care and reduce cost of care for SoonerCare members with chronic conditions.
The “Health Management Program Defined” section will provide for more data analytic options than the current reference to HMP predictive modeling software. These are data sources that include but are not limited to claims, Health Information Exchange Information, provider referral, and other sources.
In addition, the HMP “Services” section is revised to focus more broadly on interventions used in HMP, removing limitations that refer to settings, and to allow for new approaches in practice facilitation to address emerging health trends.
The OHCA also proposes to add a sentence to the description regarding the length of time a member may be served in HMP, as follows: Maximum benefit is determined individually for each member served, and considers diagnoses, goals, and progress achieved.
The revised approach to the “Services” section will ask CMS to list HMP interventions along with brief descriptions and note that interventions include but are not limited to: health coaching, practice facilitation, health navigation, performance improvement projects, and assistance with transitions of care.
It is the intention of the OHCA to include the funding for HMP in its State Fiscal Year 2020 budget request. An HMP vendor is selected through a professional services contract procurement process that is open to the public and is implemented in accordance with state and federal purchasing requirements. The current budget request is not to exceed $15 million total dollars with an estimated state share of $5,220,000 for State Fiscal Year 2020.
The proposed amendment was presented at the OHCA Medical Advisory Committee and the Oklahoma Child Health Group at the dates listed below:
OHCA Medical Advisory Committee
September 20, 2018
1:00 p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Boulevard
Oklahoma City, Oklahoma
Oklahoma Child Health Group
October 9, 2018
5:00 p.m.
Oklahoma State Department of Health
1000 NE 10th Street
Oklahoma City, Oklahoma
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: Health Management Program Waiver Amendment. The amendment to the waiver will be posted online at www.okhca.org from January 23, 2019 through February 22, 2019.
Comments and questions may be submitted online through the Policy Change Blog or the Native American Consultation Page and by contacting the OHCA Federal Authorities Unit by telephone at 405-522-7270 or by written comment at 4345 N. Lincoln Blvd., Oklahoma City, OK 73105.
Comments may also be made at https://www.medicaid.gov after the amendment has been submitted to CMS on or after February 23, 2019.
Please view additional documents here:
1. SoonerCare Choice Budget Neutrality
2. CMS Standard Funding Questions
3. 1115(a) Waiver Projects Currently Undergoing Application and Amendment
1115(a) Demonstration Health Management Program Waiver Amendment
Pursuant to 42 CFR § 431.408 and 42 CFR § 447.205, the Oklahoma Health Care Authority (OHCA) is providing public notice of its plan to submit an amendment to the 1115(a) demonstration waiver. The OHCA currently has an approved 1115(a) waiver for the 2018-2023 demonstration period.
With this amendment request, the OHCA seeks approval of the following modifications to the demonstration for the 2018-2023 extension period:
Effective July 1, 2019, the waiver special terms and conditions will be updated for the Health Management Program (HMP), contingent upon CMS approval. The HMP was developed in response to a state mandate found at Oklahoma Statute §56-1011.6., and seeks to improve the quality of care and reduce cost of care for SoonerCare members with chronic conditions.
The “Health Management Program Defined” section will provide for more options for data analytics than the current reference to HMP predictive modeling software. These are data sources that include but are not limited to claims, Health Information Exchange Information, provider referral and other sources.
In addition, the HMP “Services” section will be revised to focus more broadly on interventions used in HMP and remove limitations that refer to settings, and to allow for new approaches in practice facilitation to address emerging health trends.
The OHCA also proposes to add a sentence to the description regarding the length of time a member may be served in HMP, as follows: Maximum benefit is determined individually for each member served, and considers diagnoses, goals and progress achieved.
The revised approach to the “Services” section will ask CMS to list HMP interventions along with brief descriptions and note that interventions include but are not limited to health coaching, practice facilitation, health navigation, performance improvement projects and assistance with transitions of care.
It is the intention of the OHCA to include the funding for HMP in its State Fiscal Year 2020 budget request. An HMP vendor is selected through a professional services contract procurement process that is open to the public and is implemented in accordance with state and federal purchasing requirements. The current budget request is not to exceed $15 million total dollars with an estimated state share of $5,220,000 for State Fiscal Year 2020.
The proposed amendment will be presented at the next scheduled Medical Advisory Committee and the Oklahoma Child Health Group pursuant to the below:
Medical Advisory Committee
September 20, 2018
1:00 p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Boulevard
Oklahoma City, Oklahoma
Oklahoma Child Health Group
October 9, 2018
5:00 p.m.
Oklahoma State Department of Health
1000 NE 10th Street
Oklahoma City, Oklahoma
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: Health Management Program Waiver Amendment Request Draft. The amendment to the waiver will be posted online at www.okhca.org from October 1, 2018, through October 30, 2018.
Comments and questions may be submitted online through the Policy Change Blog or the Native American Consultation Page and by contacting the OHCA Federal & State Reporting Division by telephone at 405-522-7914 or by written comment at 4345 N. Lincoln Blvd., Oklahoma City, OK 73105.
Comments may also be made at https://www.medicaid.gov after the amendment has been submitted to CMS on or after January 7, 2019.
Please view additional documents here:
1. SoonerCare Choice Budget Neutrality
2. 1115(a) Waiver Project Currently Undergoing Application and Amendment
3. CMS Standard Funding Questions
1115(a) Demonstration Waiver Community Engagement Amendment
Pursuant to 42 CFR § 431.408, the Oklahoma Health Care Authority (OHCA) is providing public notice of its plan to submit an amendment to the existing approved 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.
The proposed amendment will implement community engagement requirements as a condition of SoonerCare eligibility for certain adults not otherwise exempted.
It is the intent of the Oklahoma Health Care Authority to submit the amendment no later than October 1, 2018 with an effective date of February 1, 2019. The initial budget impact for system modifications is estimated at $700,000 total dollars with $70,000 of the total being state share. However, additional dollars are anticipated for the administration of the program but an exact amount is unknown at this time.
The OHCA expects to conduct several public meetings around the state during the months of July-September. As of this date, the agency has scheduled the below required public meetings. Information on additional meetings will be provided on the agency’s public website as future dates and times are determined.
July 11, 2018 at 11:00 a.m.
Tribal Consultation
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, Oklahoma
July 19, 2018 at 1:00 p.m.
Medical Advisory Committee
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, Oklahoma
August 10, 2018 at 11:30 a.m.
OU Sooner Health Access Network
OU - Tulsa Schusterman Center - Learning Center
4502 E. 41st Street, Tulsa, Oklahoma
August 16, 2018 at 3:00 p.m.
Comanche County Health Department
1010 SW Sheridan Road, Lawton, Oklahoma
August 17, 2018 at 3:00 p.m.
Norman Regional - Porter Campus
Education Center, Rooms ABC
901 N. Porter Avenue, Norman, Oklahoma
August 20, 2018 at 1:30 p.m.
Pawnee City Hall
510 Illinois Street, Pawnee, Oklahoma
August 21, 2018 at 1:30 p.m.
Variety Care - Lafayette Clinic
500 SW 44th Street, Oklahoma City, Oklahoma
August 23, 2018 at 3:00 p.m.
Northwestern Oklahoma State University
Room 131
2929 East Randolph Avenue, Enid, Oklahoma
August 24, 2018 at 10:00 a.m.
Eastern Oklahoma State College - McAlester Campus
1802 College Avenue, McAlester, Oklahoma
August 24, 2018 at 2:00 p.m.
Kiamichi Technology Center - Poteau Campus
1509 South McKenna Street, Poteau, Oklahoma
August 27, 2018 at 3:00 p.m.
James O. Goodwin Health Center
5051 South 129th East Avenue, Tulsa, Oklahoma
September 20, 2018 at 1:00 p.m.
Medical Advisory Committee
Charles Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, Oklahoma
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: Community Engagement Waiver Amendment Request Draft. Comments and questions may be submitted below, via email at OHCAcommunityengagement@okhca.org, or with the OHCA Federal & State Reporting Unit by telephone at 405-522-7914. Comments may be submitted from July 3, 2018 through September 30, 2018.
Please view additional documents here:
4. SoonerCare Choice Budget Neutrality
5. 1115(a) Waiver Projects Currently Undergoing Application and Amendment
6. CMS Standard Funding Questions
7. Continuous Comment Document
1115(a) Demonstration Waiver Supplemental Payment Amendment
Pursuant to 42 CFR § 431.408, the Oklahoma Health Care Authority (OHCA) is providing public notice of its plan to submit an amendment to the existing approved 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.
The proposed amendment would add supplemental payments to qualified entities for residency training and loan repayment programs in recognition of the higher cost associated with service delivery and physician recruitment and training to maintain sufficient access to quality preventive, primary and specialty healthcare for SoonerCare members.
It is the intent of the Oklahoma Health Care Authority to submit the amendment no later than January 19, 2018 with an effective date on or after March 1, 2018. The total estimated annual budget impact is one hundred and five million dollars ($105,000,000) of which the estimated state share is forty-three million, five hundred one thousand, five hundred dollars ($43,501,500) which is funded by participating entities.
A public meeting will be held at the following location:
January 18, 2018 at 1:00 p.m.
Medical Advisory Committee
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK.
Additionally, a special tribal consultation was held January 12, 2018 at 3:00 p.m. at the above location.
Please view the waiver amendment in its entirety here: 1115 Supplemental Payment Amendment.
The OHCA welcomes comments from the public regarding the amendment to the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver program. The application waiver will be posted online at the OHCA Public Webpage from January 15, 2018 through January 19, 2018.
Comments and questions may be submitted online at the Policy Change Blog and the Native American Consultation Page or by contacting Bill Garrison, OHCA Federal & State Reporting Coordinator by telephone at 405-522-7914.
Please view additional documents here:
1. Budget Neutrality for 1115 Waiver Amendment
2. Budget Neutrality for 1115 Waiver Amendment Worksheet
3. Waiver Projects Currently Undergoing Application or Amendment
Waiver Projects Currently Undergoing Application, Renewal, or Amendment
Purpose of this Webpage
In accordance with federal and state law, the Oklahoma Health Care Authority as a single state Medicaid agency, must notify the public of its intent to submit to the Centers for Medicare and Medicaid Services (CMS) any new 1115 demonstration waiver project or extension renewal or amendment to any previously approved demonstration waiver project and must make available at least a 30-day public comment period at minimum 30 days prior to submitting to CMS the new 1115 demonstration waiver project or extension renewal or amendment.
Public notices, including the description of the new 1115 Demonstration Waiver project or, extension renewal or amendment to an existing demonstration waiver project to be submitted to CMS, will be posted here along with links to the full public notice and the application/extension/amendment document to be submitted to CMS.
The full public notices will include:
· the address, telephone number and internet address where copies of the new demonstration waiver project or extension or amendment document is available for public review and comment;
· the postal address where written comments can be sent;
· the minimum 30-day time period in which comments will be accepted;
· the locations, dates and times of at least two public hearings convened by the State to seek input, (At least one of the two required public hearings will use telephonic and/or web conference capabilities to ensure statewide accessibility to the public hearing.);
· and a link to the CMS website to access comments received by CMS during their 30-day public comment period after the application/extension/amendment has been submitted to CMS.
Comments may be provided during scheduled public hearings or in writing during the public comment period. To submit comments, write to
Oklahoma Health Care Authority
Federal and State Policy Division
4345 N. Lincoln Blvd,
Oklahoma City, OK 73105
Locations, dates and times for public hearings will be published on the upcoming public hearings page of this website.
If you need this material in an alternative format, such as large print, please contact the Communications Division at 405-522-7300.
SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver Public Notice and Amended Application
Public Notice
Added 08/31/17
View or print public comments regarding SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver extension renewal request application
Added 08/31/17
View or print the SoonerCare Choice and Insure Oklahoma 1115 Demonstration Waiver and Post Award Forum Public Hearing Presentation
The Oklahoma Health Care Authority (OHCA) as the single state Medicaid agency is providing public notice of its intent to submit to the Centers of Medicare and Medicaid Services (CMS) a written request to amend the SoonerCare Choice and Insure Oklahoma 1115 Demonstration waiver and to hold public hearings to receive comments on the extension renewal request to the Demonstration.
The State will request an amendment to the SoonerCare Choice and Insure Oklahoma 1115 Demonstration waiver to remove the pilot status of the Health Access Networks (HAN) to allow the possibility of statewideness. Statewideness in accordance with Section 1902(a)(1) will also be removed from the waiver list.
The State does not request any additional waivers to implement the changes to the Demonstration:
The State will seek to eliminate the following waiver and expenditure authorities related to its Health Access Network statewideness:
· Statewideness/Uniformity Section
§ 1902(a)(1)
To enable the state to provide Health Access Networks (HANs) only in certain geographical areas of the State.
In addition, the second, of two public meetings described below, will also serve as the 2017 Post Award Forum to allow any discussion or feedback regarding the waiver.
Waiver List
· § 1902(a)(23)(A)
To enable the state to restrict beneficiaries’ freedom of choice of care management providers, and to use selective contracting that limits freedom of choice of certain provider groups to the extent that the selective contracting is consistent with beneficiary access to quality services. No waiver of freedom of choice is authorized for family planning providers.
· § 1902(a)(34)
To enable the state to waive retroactive eligibility for demonstration participants, with the exception of Tax Equity and Fiscal Responsibility Act (TEFRA) and Aged, Blind, and Disabled populations.
Expenditure Authorities
· Demonstration Population 5. Expenditures for health benefits coverage for individuals who are “Non-Disabled Low Income Workers” age 19–64 years who work for a qualifying employer and have no more than 200 percent of the federal poverty level (FPL), and their spouses.
· Demonstration Population 6. Expenditures for health benefits coverage for individuals who are “Working Disabled Adults” 19-64 years of age who work for a qualifying employer and have income up to 200 percent of the FPL.
· Demonstration Population 8. Expenditures for health benefits coverage for no more than 3,000 individuals at any one time who are full-time college students age 19 through age 22 and have income not to exceed 200 percent of the FPL, who have no creditable health insurance coverage, and work for a qualifying employer.
· Demonstration population 10. Expenditures for health benefits coverage for foster parents who work for an eligible employer and their spouses with household incomes no greater than 200 percent of the FPL.
· Demonstration Population 11. Expenditures for health benefits coverage for individuals who are employees and spouses of not-for-profit businesses with 500 or fewer employees, work for a qualifying employer, and with household incomes no greater than 200 percent of the FPL.
· Demonstration Population 12. Expenditures for health benefits coverage for individuals who are “Non-Disabled Low Income Workers” age 19–64 years whose employer elects not to participate in the Premium Assistance Employer Coverage Plan, who are self-employed, or unemployed, and have income up to 100 percent of the FPL, and their spouses.
· Demonstration Population 13. Expenditures for health benefits coverage for individuals who are “Working Disabled Adults” 19-64 years of age whose employer elects not to participate in the Premium Assistance Employer Coverage Plan, as well as those who are self-employed, or unemployed (and seeking work) and who have income up to 100 percent of the FPL.
· Demonstration Population 14. Expenditures for health benefits coverage for no more than 3,000 individuals at any one time who are full-time college students age 19 through age 22 and have income not to exceed 100 percent of the FPL, who have no creditable health insurance coverage, and do not have access to the Premium Assistance Employer Coverage Plan.
· Demonstration Population 15. Expenditures for health benefits coverage for individuals who are working foster parents, whose employer elects not to participate in Premium Assistance Employer Coverage Plan and their spouses with household incomes no greater than 100 percent of the FPL.
· Demonstration Population 16. Expenditures for health benefits coverage for individuals who are employees and spouses of not-for-profit businesses with 500 or fewer employees with household incomes no greater than 100 percent of the FPL, and do not have access to the Premium Assistance Employer Coverage Plan.
· Health Access Networks Expenditures. Expenditures for Per Member Per Month payments made to the Health Access Networks for case management activities.
· Premium Assistance Beneficiary Reimbursement. Expenditures for reimbursement of costs incurred by individuals enrolled in the Premium Assistance Employer Coverage Plan and in the Premium Assistance Individual Plan that are in excess of five percent of annual gross family income.
· Health Management Program. Expenditures for otherwise non-covered costs to provide health coaches and practice facilitation services through the Health Management Program.
· Work Force Development Supplemental Payments to State Teaching Universities.Expenditures for reimbursement to state teaching universities to grow and improve the healthcare workforce in Oklahoma.
The State continues to evaluate whether it will request other waivers or expenditure authorities.
The extension renewal to the Demonstration will further the objectives of Title XIX by providing a medical home and premium assistance insurance across the continuum of coverage. The removal of the pilot status of the Health Access Networks, this will allow for statewideness of the program.
This extension renewal will be statewide and will operate from calendar years 2019 through 2021. The State anticipates that this extension renewal will affect most of the approximately 545,858 SoonerCare Choice individuals covered under the Demonstration as of June 2017.
The Demonstration extension renewal, including the proposed amendment, will test hypotheses related to access to care, quality of care management, integration of Indian Health Services, and access to affordable health insurance. The State expects that, over the life of the Demonstration, covering SoonerCare Choice enrollees will be comparable to what the costs would have been for covering the same group of Oklahomans using traditional Medicaid. The State does not anticipate that the extension renewal to the Demonstration will affect its current waiver trend rate or per capita cost estimates, which can be found in the Demonstration Populations table below.
The information in the table below is provided by The Pacific Health Policy Group (PHPG) which has been retained by the OHCA as an independent contractor. The information is pulled from the Budget Neutrality exhibits which incorporate full-year enrollment and expenditure data through calendar year 2016 (demonstration year 21). Expenditures reflect C-Report amounts.
Projections for the remainder of the current extension period are based on Medicaid Eligibility Group (MEG) specific assumptions, as described in detail throughout the chapter. Updates to worksheets previously submitted are described in text boxes included at the top of each worksheet (where applicable). Traditional MEG projections for 2018 incorporate the CMS-mandated rebasing methodology, with 1) the budget neutrality PMPM set equal to the 2016 actual PMPM, trended to 2018 and 2) savings limited to a five-year look back period. Annual aggregate savings/ (deficit) projections for 2019 – 2021 are capped at 25 percent of actual prior to being added to cumulative savings/ (deficit) projections.
Demonstration Populations
Trend
DY 23 (2018) projection PMPM
DY 24 (2019) projection PMPM
DY 25 (2020) projection PMPM
DY 26 (2021) projection PMPM
TANF-Urban
4.40%
$256.79
$268.56
$280.43
$292.82
TANF-Rural
4.40%
$226.92
$238.32
$248.75
$259.64
ABD-Urban
4.20%
$1,121.61
$1,170.14
$1219.23
$1270.38
ABD-Rural
4.20%
$1,091.15
$1,138.39
$1,186.15
$1,235.91
Non-Disabled Working Adults (Employer Plan)
4.40%
$326.90
$341.28
$356.29
$371.97
Disabled Working Adults (Employer Plan)1
4.20%
$0
$0
$0
$0
TEFRA Children
4.20%
$777.48
$810.14
$844.16
$879.62
CHIP Medicaid Expansion Children2
$0
$0
$0
$0
Full-Time College Students (Employer Plan)
4.40%
$261.27
$272.76
$284.77
$297.30
Foster Parents (Employer Plan)3
$0
$0
$0
$0
Not-for-Profit Employees (Employer Plan)3
$0
$0
$0
$0
Non-Disabled Working Adults (Individual Plan)
$592.84
$618.93
$646.16
$674.59
Disabled Working Adults (Individual Plan)
$4,737.34
$4,936.31
$5,143.63
$5,359.66
Full-Time College Students (Individual Plan)
$197.21
$205.88
$214.94
$224.40
Foster Parents (Individual Plan)3
$0
$0
$0
$0
Not-for-Profit Employees (Individual Plan)3
$0
$0
$0
$0
· Demonstration Year (DY)
· Per Member Per Month (PMPM)
1All WDA enrollment has occurred within the IP component of the program.
2One additional population, CHIP Medicaid Expansion, is reported separately in the Budget Neutrality per PHPG.
3The OHCA is not projecting any enrollment for this MEG during the renewal period.
The Demonstration application may also be viewed from 8 AM – 4:00 PM Monday through Friday at:
Oklahoma Health Care Authority
Federal and State Policy Division
4345 N. Lincoln Blvd,
Oklahoma City, OK 73105
Contact: Sherris Harris-Ososanya
Public comments may be submitted until midnight on Friday, September 22, 2017. Comments may be submitted by agency blog to comments box or by regular mail to
Oklahoma Health Care Authority
Federal and State Policy Division
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
View comments that others have submitted.
Comments may also be viewed at the OHCA Public Webpage.
The State held two public hearings during the public comment period.
SoonerCare Choice and Insure Oklahoma Waiver Extension Renewal Public Hearing
July 11, 2017 at 5:00p.m.
The Child Health Workgroup,
OU Robert Bird Library
First Floor Conference Room
Oklahoma City, OK 73104.
Videoconferencing will be available for this meeting:
· OU College of Medicine, Tulsa;
· Northwestern Oklahoma State University, Enid;
· Eastern Oklahoma State University, Wilburton and
· Stillwater Medical Center
SoonerCare Choice and Insure Oklahoma Waiver Extension Renewal Public Hearing
September 21, 2017 at 1:00p.m.
Medical Advisory Committee Meeting
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK.
Videoconferencing will be available for this meeting.
Please submit comments via the comment box below.
2018 SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Extension Request
Pursuant to 42 CFR § 431.408, the Oklahoma Health Care Authority (OHCA) is providing public notice of its plan to submit an extension application for the SoonerCare Choice and Insure Oklahoma 1115(a) waiver to the Centers for Medicare and Medicaid Services (CMS) for the period January 1 2018, to December 31, 2018.
The waiver allows the state to offer managed care in a Primary Care Case Management (PCCM) model in which the OHCA contracts directly with providers throughout the state to provide SoonerCare Choice members a Patient-Centered Medical Home (PCMH) and also to operate the Insure Oklahoma program. The demonstration provides additional services such as the Health Management Program, Health Access Networks and Workforce Development for Teaching Universities. The extension application requires approval from our federal partners, CMS, to continue services provided under the waiver.
The State will apply no later than August 1, 2017 to extend the demonstration with one amendment to existing language. The amendment will provide payment methodology and metrics for supplemental payments to the state of Oklahoma teaching Universities.
Supplemental Payment Methodology
The OHCA proposes to make supplemental payments to state teaching universities to grow and improve the healthcare workforce in the state of Oklahoma. State universities can receive payments for programs that reach defined metrics such as primary care residents in training, percentage of graduating class entering primary care, retention rate for medical students within 5 years after completion of residency/fellowship training and percentage of nurses completing clinical rotation training in Medicaid contracted hospitals. This list of public meetings will be held at the following locations:
May 18, 2016 at 1:00p.m.
Medical Advisory Committee Meeting
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK.
Videoconferencing is also available for this meeting.
May 24, 2016 at 3:00p.m.
Child Health Workgroup
Cleveland County Health Department
50 12th Ave N.E. Norman, Oklahoma City, OK.
Please view the full 2018 SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Extension Request here: SoonerCare/Insure Oklahoma 1115 Waiver Extension.
The OHCA welcomes comments from the public regarding the extension SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver programs. The application will be posted from May 18, 2017 through June 30, 2017.
Comments can be submitted via the comment box below or by contacting Sherris Harris-Ososanya, OHCA Federal & State Reporting Coordinator, by telephone at 405-522-7507.
Please view the additional attachments for the 2018 SoonerCare Choice and Insure Oklahoma 1115 (a) Demonstration Waiver Extension Request below:
1. SoonerCare Budget Neutrality SCBN 2016-2018 Extension UPDATED May 2017
2. SoonerCare Budget Neutrality SCBN 2016-2018 Extension UPDATED May 2017
3. SoonerCare Evaluation Design 2015-2016
4. 2016 Child (CHIP) Medicaid Executive Summary - Oklahoma Health Care Authority
5. 2016 Adult Medicaid Executive Summary - Oklahoma Health Care Authority
6. SoonerCare HMP SFY2015 Evaluation Jul16
7. 1115 Demonstration Waiver Banner
8. OU SoonerHAN Annual Report FY2016
9. OU SoonerHAN Annual Report CY 2016 Jul-Dec 2016
10. PHCC Annual Report FY16
11. PHCC Annual Report AR 16 Jul-Dec
12. OSU HAN Annual Report Fiscal Year 2016
13. OSU HAN Annual Report July 2015-December 2016
14. Oklahoma 1115 Budget Neutrality Model Worksheet, December 2016
15. The Children's Health Group Quarterly Meeting April 2017
16. SoonerCare Choice Insure Oklahoma Post Award Forum PowerPoint April 2017
17. Post Award Forum Newspaper Publication Notice April 2017
18. Accessibility Report
19. Child Health Workgroup
20. Newspaper Publication Notice May 2017
2017-2018 SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Update
The Oklahoma Health Care Authority Reporting unit is seeking comments from the public regarding the current SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver on an update to the demonstration for an extension through 2017-2018.
Please view the full original SoonerCare Renewal application here: SoonerCare Renewal Application. Please submit all comments by close of business, June 3, 2016, via the comment box below. The OHCA will respond in writing to any feedback received during the comment period. Thank you for your participation in the process.
Also, an overview of the feedback received will be discussed in the public meetings mentioned below. Input from meeting participants will also be summarized and submitted to the Centers for Medicare and Medicaid Services.
April 19, 2016 5:00p.m.
OPQIC Oklahoma Perinatal Quality Improvement Collaborative Meeting,
Stephenson Cancer Center
Fifth Floor Conference Room
Oklahoma City, OK 73104.
Videoconferencing is also available for this meeting:
· OU College of Medicine, Tulsa;
· Northwestern Oklahoma State University, Enid;
· Eastern Oklahoma State University, Wilburton and
· Stillwater Medical Center.
May 19, 2016 at 1:00p.m.
Medical Advisory Committee Meeting
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK.
Home and Community-Based Services (HBCS) Waivers’ Amendments
Community Waiver Amendment
The participant direction option has been added to the waiver for members living in non-residential settings such as their own home or the home of a family member or friend. The participant direction service delivery method has been added as an option for Habilitation Training Specialist Services and a new service, Self-Directed Goods and Services (SD-GS), has been added.
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
The estimate of Factor D for waiver year 5 has been updated based on Form 372 for FY18. This includes an increase in the Respite Daily in Home rate from $38.00 to $57.04.
Please view the waiver amendment in its entirety here: Community Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
Homeward Bound Waiver Amendment
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
The estimate of Factor D for waiver year 5 has been updated based on Form 372 for FY18. This includes an increase in the Respite Daily in Home rate from $38.00 to $57.04.
Please view the waiver amendment in its entirety here: Homeward Bound Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Adults Amendment
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
A cost limit has been added for Prevocational and Supported Employment services which allows an additional $5500 per member above the $23,131.00 individual cost limit. This additional limit will allow members to access individual placement opportunities with a Job Coach, Employment Training Specialist and stabilization.
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
Estimate of Factor D for waiver years 4 and 5 has been updated based on Form 372 for FY18.
Please view the waiver amendment in its entirety here: In-Home Supports for Adults Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Children Amendment
The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.
The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.
Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.
The estimate of Factor D for waiver years 4 and 5 has been updated based on Form 372 for FY18.The above amendments will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: In-Home Supports for Children Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
Community Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: Community Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
Homeward Bound Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: Homeward Bound Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: In-Home Supports for Adults Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with Intellectual Disabilities age 3 through 17. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please view the waiver amendment in its entirety here: In-Home Supports for Children Waiver Amendment, and submit feedback via the comment box below.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free 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.
ADvantage Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the ADvantage waiver. The ADvantage waiver provides services and supports to assist older adults and adults with physical disabilities to live independently in their homes and communities. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.
The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.
Please review the waiver amendment in its entirety here: ADvantage Waiver Amendment.
Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of a waiver, 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.
In-Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 3-5 has been made as well as an increase in the individual member cost limit. Currently, the cost limit amount is $22,235.00 per member, per plan of care year. This amount will be increased to $23,131.00. Other updates include further explanation related to the exclusion of room and board cost, clarification of provider rate methodology, the addition of Electronic Visit Verification procedure, clarification related to member safeguard procedure, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update and confirmation that Oklahoma’s Statewide Transition Plan was granted final approval.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with Intellectual Disabilities age 3 through 17. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 3-5 has been made as well as an increase in the individual member cost limit. Currently, the cost limit amount is $14,825.00 per member, per plan of care year. This amount will be increased to $15,426.00. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, the addition of Electronic Visit Verification procedure, clarification related to member safeguard procedure, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update and confirmation that Oklahoma’s Statewide Transition Plan was granted final approval.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Community Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made as well as an update of the number of unduplicated participants served through the waiver for year 5. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, clarification related to a waiver member’s medication management, critical incidents and safeguard procedure, the addition of Electronic Visit Verification procedure language, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update, confirmation that Oklahoma’s Statewide Transition Plan was granted final approval, level of care evaluation approval procedure change, Specialized Medical Supplies and Assistive Technology service definition and provider qualifications update, language clean-up to ensure reference to “mental retardation” has been changed to “intellectual disabilities”, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), confirmation that Extended Duty Nursing may be provided in a facility, Daily Living Supports and Intensive Personal Supports services may now be provided by a relative/legal guardian, Agency Companion provider qualification update and a change in the sampling approach described in the Quality Improvement Strategy for the Health and Welfare section of the waiver.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Homeward Bound Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, clarification related to a waiver member’s medication management, critical incidents and safeguard procedure, the addition of Electronic Visit Verification procedure language, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update, confirmation that Oklahoma’s Statewide Transition Plan was granted final approval, level of care evaluation approval procedure change, Specialized Medical Supplies and Assistive Technology service definition and provider qualifications update, language clean-up to ensure reference to “mental retardation” has been changed to “intellectual disabilities”, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), confirmation that Extended Duty Nursing may be provided in a facility, Daily Living Supports and Intensive Personal Supports services may now be provided by a relative/legal guardian and a change in Agency Companion provider qualifications.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Medically Fragile Waiver Amendment
Per CFR 441.304, a waiver amendment is required for substantive changes that include an increase in slot participation for unduplicated members, the Oklahoma Health Care Authority Medically Fragile Waiver is increasing slot participation in the waiver. During Fiscal Year 19, the Medically Fragile waiver met the awarded number of slots. Awarded slots cannot not be exceeded, therefore an amendment must be submitted.
The requested effective date of the slot increase will be July 1, 2019 upon Centers for Medicare and Medicaid Services (CMS) approval. Per the HCBS Technical Guide, “A retroactive effective date can be permitted for the purpose of increasing the unduplicated number of participants”.
The Medically Fragile Waiver serves adults 19 years of age and older who have been diagnosed with a medically fragile condition who require a Hospital/Skilled Nursing Facility level of care and whose needs could not otherwise be met through another Oklahoma Waiver. All Medically Fragile Waiver members receive services in a home and community setting.
The waiver amendment is available for review here. Please submit all comments by close of business, August 2, 2019. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: QA & Community Living Services: 1915(c) Waivers.
To request a free hard copy of a waiver, 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: QA & Community Living Services: 1915(c) Waivers.
Medically Fragile Waiver Amendment Rate Increase
Pursuant to 42 C.F.R. § 441.301, the Oklahoma Health Care Authority (OHCA) is required to give public notice and receive public input on any significant proposed changes to the 1915(c) Home and Community-Based Services (HCBS) waivers.
Revisions are needed to increase the current reimbursement rates for all SoonerCare-contracted provider types by five percent (5%), with the following exemptions: services financed through appropriations to other state agencies; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); non-emergency transportation capitated payments; services provided to Insure Oklahoma (IO) members; payments for drug ingredients/physician supplied drugs; Indian Health Services/Tribal/Urban Clinics (I/T/Us); Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs). The agency’s proposed revisions are in keeping with Sections 1 and 2 of the SB 1044, 57th Leg., 1st Sess. (Okla. 2019), except that reimbursement rates for PACE providers (Program for the All-inclusive Care for the Elderly) will also be increased by five percent (5%). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
The effective date of the 5% rate increase will be upon notification from the Centers for Medicare and Medicaid Services (CMS) or on 10/01/2019, whichever is first.
The Medically Fragile Waiver serves adults 19 years of age and older who have been diagnosed with a medically fragile condition who require a Hospital/Skilled Nursing Facility level of care and whose needs could not otherwise be met through another Oklahoma Waiver. All Medically Fragile Waiver members receive services in a home and community setting.
The waiver amendment is available for review here. Please submit all comments by close of business, August 3, 2019. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105.
Attention: QA& Community Living Services: 1915(c) Waivers.
To request a free hard copy of a waiver, 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: QA & Community Living Services: 1915(c) Waivers.
ADvantage Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the ADvantage Waiver. ADvantage provides services and supports to assist older adults and adults with physical disabilities to live independently in their homes and communities. The Oklahoma Legislature has mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made.
The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 3, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
Medically Fragile Waiver Amendment
Revisions are needed to increase the current reimbursement rates for the Medically Fragile Waiver services by three percent (3%) with the following exemptions: services financed through appropriations to other state agencies, Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS), non-emergency transportation capitated payments, services provided to Insure Oklahoma (IO) members, payments for drug ingredients/physicians supplied drugs, Indian Health Services/Tribal/Urban Clinics (I/T/U), Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
The waiver amendment is available for review using the following link here. Please submit all comments by close of business, October 14, 2018.
ADvantage Waiver Amendment
Pursuant to House Bill 3708, the Oklahoma Department of Human Services is increasing certain provider rates for the ADvantage program. These include a 7% rate increase for ADvantage direct care, case management and State Plan personal care effective upon CMS approval or October 1, 2018, whichever is earlier. The ADvantage waiver serves older adults and persons with disabilities who reside in a community setting.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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
In Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking an amendment to the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with intellectual disabilities age 18 and over. The specific changes being proposed include; an updated estimate of cost for waiver years 2-5, an updated number of unduplicated participants served through the waiver for years 2-5 as well as, an increase in the individual cost limit. Currently, the cost limit is $20,761.00 per member, per plan of care year. The cost limit being proposed will increase the amount to $22,235.00. The changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review using the following link here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking an amendment to the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with intellectual disabilities ages 3 through 17. The specific changes being proposed include an updated estimate cost for waiver years 2-5, an updated number of unduplicated participants served through the waiver for years 2-5 as well as, an increase in the individual cost limit. Currently, the cost limit is $13,844.00 per member, per plan of care year. The cost limit being proposed will increase the amount to $14,825.00. The changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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.Community Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. The specific changes include an update of the estimated cost of the waiver for years 3-5 as well as an update of the number of unduplicated participants served through the waiver for years 3-5. The proposed changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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
Homeward Bound Waiver Amendment
The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. The specific changes include an update of the estimated cost of the waiver for years 3-5 as well as an update of the number of unduplicated participants served through the waiver for years 3-5. The proposed changes are effective upon CMS approval or October 1, 2018, whichever is earlier.
The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
To request a free hard copy of the waiver, 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
Medically Fragile Waiver Renewal
The Oklahoma Health Care Authority is seeking a 5 year renewal of the Medically Fragile Waiver. The Medically Fragile program is a home and community-based alternative to placement in a hospital and/or skilled nursing unit of a nursing facility. The Medically Fragile waiver serves individuals 19 years of age and older who have a life-threatening condition, require frequent specialized treatment and have a dependency on medical technology. Specific changes to the renewal include, but are not limited to, (1) Modifying performance measures to adhere to CMS guidance from HCB setting regulations, (2) Adding language and performance measures to comply with Electronic Visit Verification regulations, (3) Adding language limiting conflict of interest for service plan development and monitoring with service delivery, and (4) Other changes include general clarification, alignment with state statute and cleanup.
Please view the renewal application here: Medically Fragile Waiver Renewal. Please submit all comments by close of business, March 25, 2018, 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, OK 73105. Attention: Health Policy 1915(c) Waivers.
To request a hard copy of waivers please call 1-888-287-2433 or send your request to the Oklahoma Health Care Authority, 4345 N Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.
The Department of Human Services lost $69 million in state funding for the State Fiscal Year 2018 as a result of the Oklahoma Supreme Court ruling the cigarette fee unconstitutional. In October, DHS was required to submit a revised budget to the Oklahoma Office of Management and Enterprise Services (OMES) to fulfill Oklahoma’s constitutional requirements for a balanced budget. The revised budget resulted in additional reductions to DHS services. The ADvantage waiver serves the frail and elderly adults with physical disabilities age 21 and over who do not have intellectual disabilities or cognitive impairment. DHS is terminating the ADvantage Waiver effective December 1, 2017.
Please view the waiver amendment here: ADvantage Waiver. Please submit all comments by close of business, November 30, 2017, 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 waiver amendment 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© Waivers.In-Home Supports Waiver for Adults
In October, the Oklahoma Department of Human Services (DHS) was required to submit a revised budget to the Oklahoma Office of Management and Enterprise Services (OMES) to fulfill Oklahoma’s constitutional requirement to maintain a balanced budget for State Fiscal Year 2018 following the loss of $69 million from their operating budget. This is the amount of appropriations DHS would have received from the cigarette fee that was ruled unconstitutional by the Oklahoma Supreme Court. When the cigarette fee was struck down, additional reductions became necessary. As a result, DHS is terminating the In-Home Supports Waiver for Adults (IHSW-A) effective December 1, 2017. The IHSW-A serves individuals with intellectual disabilities age 18 and over. Upon termination of the waiver, current service recipient’s names will be added to the statewide waiver request list for Developmental Disability Service (DDS) waiver services with his or her original application date.
Please view the waiver amendment here: In-Home Supports Waiver for Adults. Please submit all comments by close of business, November 30, 2017, 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 waiver amendment 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© Waivers.
In-Home Supports Waiver for Adults Amendment
The Oklahoma Department of Human Services is seeking waiver amendment approval for the In-Home Supports Waiver for Adults (IHSW-A) to meet the balanced budget requirements as mandated by state law. The IHSW-A serves individuals with Intellectual Disabilities ages 18 and over. Due to Oklahoma’s budget crisis, costs saving actions are necessary. In an effort to minimize that impact on members served, and in lieu of an elimination of service, the individual cost limit for adults has been reduced.
Please view the renewal application here: In-Home Supports Waiver for Adults. Please submit all comments by close of business, August 14, 2017, 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© 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© Waivers.
In-Home Supports Waiver for Children Amendment
The Oklahoma Department of Human Services is seeking waiver amendment approval for the In-Home Supports Waiver for Children (IHSW-C) to meet the budget requirements as mandated by State law. The IHSW-C serves individuals with Intellectual Disabilities ages 3 to 17. Due to Oklahoma’s budget crisis, costs saving actions are necessary. In an effort to minimize that impact on members served, and in lieu of an elimination of service, the individual cost limit for children has been reduced.
Please view the renewal application here: In-Home Supports Waiver for Children. Please submit all comments by close of business, August 14, 2017, 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.In-Home Supports for Adults Waiver Renewal Application
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Adults (IHSW-A) waiver. The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Specific changes include, but are not limited to, (1) Updating the rate determination methods section with details related to the fixed rate method associated with Prevocational and Supported Employment services; (2) Updating the Family Counseling service provider section; (3) Updating the Person Centered Planning and Service Delivery section; (4) Updating language regarding critical incidents and reporting, dental service providers, seclusion and restraints and supported employment services definition and limits; (5) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; (6) Updated unduplicated number of participants and reserved capacity number; and (7) Deleted Physician Services from Appendices C and J. Other changes include general clarification and cleanup.In-Home Supports for Adults Waiver Renewal Application – Extended Comment Period
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Adults (IHSW-A) waiver. The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Specific changes include, but are not limited to, (1) Updating the rate determination methods section with details related to the fixed rate method associated with Prevocational and Supported Employment services; (2) Updating the Family Counseling service provider section; (3) Updating the Person Centered Planning and Service Delivery section; (4) Updating language regarding critical incidents and reporting, dental service providers, seclusion and restraints and supported employment services definition and limits; (5) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; (6) Updated unduplicated number of participants and reserved capacity number; and (7) Deleted Physician Services from Appendices C and J. Other changes include general clarification and cleanup.
Please view the renewal application here: In-Home Supports for Adults Waiver Renewal Application. Please submit all comments by close of business, April 14, 2017, 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.
In-Home Supports for Children Waiver Renewal Application
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The IHSW-C serves individuals with Intellectual Disabilities age 3 to 17. Specific changes include, but are not limited to, (1) Updating Person Centered Planning and Service Delivery section; (2) Unduplicated number of participants and reserved capacity numbers; (3) Updating cost data/estimates updated throughout Appendix J; (4) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; and (5) Added Prevocational and Supported Employment services for members age 16 and above. Other changes include general clarification and cleanup.
Please view the renewal application here: In-Home Supports for Children Waiver Renewal Application. Please submit all comments by close of business, February 3, 2017, 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.
In-Home Supports for Children Waiver Renewal Application – Extended Comment Period
The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The IHSW-C serves individuals with Intellectual Disabilities age 3 to 17. Specific changes include, but are not limited to, (1) Updating Person Centered Planning and Service Delivery section; (2) Unduplicated number of participants and reserved capacity numbers; (3) Updating cost data/estimates updated throughout Appendix J; (4) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; and (5) Added Prevocational and Supported Employment services for members age 16 and above. Other changes include general clarification and cleanup.
Please view the renewal application here: In-Home Supports for Children Waiver Renewal Application. Please submit all comments by close of business, April 14, 2017, 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.
Medically Fragile Waiver Amendment
The Medically Fragile waiver is amended to propose a reinstatement of the three percent provider rate reduction that was implemented April 1, 2016. The Oklahoma Health Care Authority is proposing to reinstate the above reduced rates to select programs and provider types that the agency has identified serve our most vulnerable populations and provide access to critical programs. Additionally, clean-up changes have been made to align the waiver with policy. The proposed effective date of the changes is December 1, 2016.
Please view the waiver amendment here: Medically Fragile Waiver Amendment. Please submit all comments by close of business, August 29, 2016, 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. A non-electronic version of this amendment can be requested by writing to the address above or calling 1-888-287-2443.
Effective July 1, 2021, and contingent upon the Centers for Medicare and Medicaid Services (CMS) approval, SoonerCare 2.0 will provide the coverage avenue for individuals made newly eligible for SoonerCare as of the state's July 1, 2020, expansion. This includes individuals with income up to 133% of the federal poverty level (FPL) and applicable income disregards who are not otherwise eligible for SoonerCare services provided by OHCA. SoonerCare 2.0 will implement policies to align with commercial market coverage and will:
- Introduce private insurance concepts like premiums and commercial-like benefit packages to prepare members to transition from SoonerCare into private coverage.
- Incentivize members to access services when and where appropriate and disincentivize inappropriate use of the emergency room with an $8 copay for non-emergency use of the ER.
- Encourage individuals to address additional facets of their health by requiring participation in activities that are positively correlated with good health, including work, volunteering, and educational/vocational activities.
- Encourage individuals to obtain and maintain health coverage before they are sick by eliminating retroactive coverage.
- Leverage care coordination and managed care strategies to improve health outcomes and member satisfaction through better coordinated services.
- Ensure appropriate coverage for eligible individuals by eliminating hospital presumptive eligibility.
The HAO Demonstration Waiver Application (SoonerCare 2.0) can be viewed in its entirety here: HAO Demonstration Waiver Application (SoonerCare 2.0).
The OHCA welcomes comments from the public regarding the HAO Demonstration Waiver Application (SoonerCare 2.0). Please submit comments via the comment box below. Persons wishing to obtain copies of the proposed waiver may do so at the following address: Oklahoma Health Care Authority, Federal Authorities Unit, 4345 N. Lincoln Blvd., Oklahoma City, Oklahoma 73105.
Written and/or oral comments or requests for copies of the proposed waiver will be accepted during regular business hours by contacting OHCA as indicated. Comments submitted will be available for review by the public Monday-Friday, 9 a.m.-4:30 p.m. at OHCA located at the above address, or viewed online at www.okhca.org/PolicyBlog . Comments will be accepted beginning March 16, 2020, through April 15, 2020.
Additionally, the OHCA will host two public hearings in which the public will be able to provide oral comments. The list of dates, times, and locations are below:
- VIRTUAL MEETING
March 18, 2020 at 3:00 p.m.
- VIRTUAL MEETING
March 20, 2020 at 3:00 p.m.
Register for Zoom Meeting: (Expired Link)
- VIRTUAL MEETING
March 24, 2020 at 1:30 p.m.
Register for Zoom Meeting: (Expired Link)
To find the most up to date list of meeting locations please visit www.okhca.org/SoonerCare2.
Prior to finalizing the proposed HAO waiver, the OHCA will consider all written and verbal public comments received. The comments will be summarized and addressed in the final version to be submitted to CMS.
State Plan Amendments
OK SPA 21-0004 SoonerPlan Termination
Oklahoma’s (OK) state plan amendment (SPA) 21-0004 will remove SoonerPlan eligibility as adults currently by SoonerPlan will transition to the new adult Medicaid expansion population on July 1, 2021 and will be eligible to receive more comprehensive services.
Please view the draft SPA pages here: OK SPA 21-0004, and submit feedback via the comment box below.
Tribal Consultation: 09/01/2020
60-day Tribal Consultation Period: 09/01/2020 – 10/31/2020
Circulation Date: 07/31/2020 – 08/30/2020
Requested Effective Date: 07/01/2021
OK SPA 21-0004 SoonerPlan Termination
Oklahoma’s (OK) state plan amendment (SPA) 21-0004 will remove SoonerPlan eligibility as adults currently being served by SoonerPlan will transition to the new adult Medicaid expansion population and will be eligible to receive more comprehensive services.
Please view the draft SPA pages here: OK SPA 21-0004, and submit feedback via the comment box below.
Tribal Consultation: 09/01/2020
60-day Tribal Consultation Period: 09/01/2020 – 10/31/2020
Circulation Date: 09/01/2020
Comment Due Date: 10/1/2020
Requested Effective Date: 07/01/2021
OK SPA 21-0008 Electronic Visit Verification (EVV)
The OHCA will seek revisions and subsequent approval of a State Plan Amendment (SPA) to bring Oklahoma into compliance with the 21st Century CURES Act which requires providers of personal care services (PCS) and home health services (HHCS) to utilize a system to electronically verify in-home visits. The Act requires that the type of service performed, the individual receiving the service, the date of service, the location of service delivery, the individual providing the service, and the time the service begins and ends be included In the verification process. The SPA proposal herein addresses compliance with the 21st Century CURES Act’s Electronic Visit Verification (EVV) requirements for personal care services only; a SPA to comply with EVV requirements for home health services is not required until January 1, 2023.
The Centers for Medicare and Medicaid Services (CMS) awarded the State a good faith effort (GFE) extension to comply with the Act until January 1, 2021.
Please view the draft SPA pages here: OK SPA 21-0008, and submit feedback via the comment box below.
Effective Date: 01/01/2021
Tribal Consultation Dates: 07/02/2019 – 08/31/2019 and 11/5/2019 – 01/04/2020
30-day Public Comment/Circulation Date: 10/07/2020 – 11/06/2020
Comment Due Date: 11/06/2020
OK SPA 21-0010 Diabetes Self-Management Education and Support (DSMES) Provider Types
The proposed state plan amendment (SPA) will clarify the provider types allowed to provide this service to include, based on national standards, registered dieticians, registered nurses, and pharmacists, as well as health care professionals holding certification of Certified Diabetes Care and Education Specialist (CDCES) or Board-Certified Advanced Diabetes Management (BC-ADM).
Please view the draft SPA pages here: OK SPA 21-0010, and submit feedback via the comment box below.
Tribal Consultation Dates: 11/03/2020
60-day Tribal Consultation Period: 11/03/2020 – 01/02/2021
Circulation Date: 12/03/2021 – 01/02/2021
Requested Effective Date: 03/01/2021
OK SPA 20-0002 Pharmacy Supplemental Rebate Agreement and Value-based Supplemental Rebate Agreement
Oklahoma’s (OK) state plan amendment (SPA) 20-0002 will revise language to reflect the new effective date for the Pharmacy Supplemental Rebate Agreement and Value-based Supplemental Rebate Agreement for Pharmaceuticals. The agreements will be effective on January 1, 2020 and after.
Please view the draft SPA pages here: OK SPA 20-0002, and submit feedback via the comment box below.
Tribal Consultation: 07/02/2019; 09/03/2019
60-day Tribal Consultation Period: 09/03/2019 – 11/02/2019
Circulation Date: 09/17/2019
Comment Due Date: 10/17/2019
Requested Effective Date: 01/01/2020
OK SPA 20-0003 Diabetes Self-Management Training (DSMT)
The proposed State Plan Amendment (SPA) will add new language establishing coverage and reimbursement for DSMT, an educational disease management benefit designed to teach individuals how to better manage and control their diabetes. The proposed revisions will define member eligibility for DSMT services, provider participation requirements, and program coverage and limitations. Lastly, the proposed amendment establishes the reimbursement methodology and applicable rates for DSMT services.
Please view the draft SPA pages here: OK SPA 20-0003, and submit feedback via the comment box below.
Effective Date: 01/01/2020
Tribal Consultation Dates: 01/08/2019; 09/03/2019
Circulation Date: 09/10/2019 – 10/10/2019
Please view all comments received here: OK SPA 20-0003 Comment Spreadsheet.
OK SPA 20-0004 Oklahoma Office of Juvenile Affairs (OJA) Targeted Case Management (TCM) Services
The proposed revisions will increase the maximum eligible age for individuals who are involved in or at serious risk of involvement with the juvenile justice system and who are eligible for TCM services from eighteen (18) to under twenty-one (21). Additionally, the proposed revisions will update reimbursement methodology language for TCM and align case management services with current evidence-based practice.
Please view the draft SPA pages here: OK SPA 20-0004, and submit feedback via the comment box below.
Effective Date: 09/01/2020
Tribal Consultation Date: 11/05/2019
60-day Tribal Consultation Date: 11/05/2019 – 01/04/2020
Circulation Date: 01/10/2020 – 02/09/2020
OK SPA 20-0009-A Prescription Drug Limit Exceptions & Maintenance Drug List Update & OK SPA 20-0009-B Removing Barriers for Medication Assisted Treatment (MAT)
The proposed revisions will amend the exception to the prescription drug limitation to include: certain drugs that require frequent monitoring, naloxone, contraceptives, prenatal vitamins, and tobacco cessation. Additional revisions will update language to allow more flexibility in the amount of drugs that members can receive per claim. Currently, prescription quantities are limited to a 34-day supply unless the prescription is on the maintenance drug list, then it allows for 100-dosage units. The proposed revisions seek to amend the limitation when the prescription is on the maintenance drug list and allow for a 90-day supply.
Further revisions will reduce barriers for Medication Assisted Treatment (MAT) by removing the copays as the Oklahoma Health Care Authority (OHCA) continues to engage in an effort to combat the prescription drug abuse epidemic in Oklahoma. MAT is the use of medications with counseling and behavioral therapies to treat substance use disorders and prevent opioid overdose. These revisions will exclude select products from the prescription limits and amend the cost sharing language to include prescriptions with $0 copay.
Please view the draft SPA pages here: OK SPA 20-0009-A and OK SPA 20-0009-B, and submit feedback via the comment box below.
Effective Date: 01/01/2020
Tribal Consultation Date: 06/18/2019& 11/05/2019
60-day Tribal Consultation Date (OK SPA 20-0009-B): 06/18/2019 – 08/17/2019
14-day Expedited Tribal Consultation Date (OK SPA 20-0009-A): 11/05/2019 – 11/19/2019
Circulation Date: 10/22/2019 – 11/21/2019
OK SPA 20-0011 Organ Transplant
The proposed revisions will extend covered organ and tissue transplant procedures to include pancreas and intestinal transplants. Organ transplant requirements and guidelines will be updated to include donor search and procurement services and ensure that the methods used for organ acquisition are consistent with the Medicare program. These amendments are necessary to reflect current practice.
Please view the draft SPA pages here: OK SPA 20-0011, and submit feedback via the comment box below.
Effective Date: 01/01/2020
Tribal Consultation Date: 09/03/2019
60-day Tribal Consultation Date: 09/03/2019 – 11/02/2019
Circulation Date: 10/30/2019 – 11/29/2019
OK SPA 20-0012 Inpatient Rehabilitation Hospital Days
The proposed State Plan amendment (SPA) seeks to increase the number of covered inpatient rehabilitation hospital days for adult SoonerCare members from 24 days per state fiscal year to 90 days per state fiscal year. Increasing access to stabilization services in an inpatient rehabilitation setting is necessary to meet the health care needs of SoonerCare members.
Please view the draft SPA pages here: OK SPA 20-0012, and submit feedback via the comment box below.
Effective Date: 09/01/2020
Tribal Consultation Date: 01/07/2020
60-day Tribal Consultation Date: 01/07/2020 – 03/07/2020
Circulation Date: 01/17/2020 – 02/16/2020
OK SPA 20-0013 Registered Behavior Technicians (RBTs)
The proposed State Plan Amendment (SPA) will establish RBTs as a new provider type to implement Board Certified Behavior Analyst's (BCBA) behavior treatment plans for Applied Behavior Analysis (ABA) services. Additionally, the proposed SPA will establish RBT provider requirements and reimbursement.
Please view the draft SPA pages here: OK SPA 20-0013, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 11/05/2019
14-day Tribal Consultation Date: 11/05/2019 – 11/19/2019
Circulation Date: 11/05/2019 – 11/19/2019
OK SPA 20-0017 Durable Medical Equipment (DME), Supplies and Appliances, Home Health, and Compliance with the 21st Century Cures Act
The proposed State Plan Amendment (SPA) seeks to align durable medical equipment (DME), supplies and appliances, as well as home health services with the 21st Century Cures Act (Cures Act). The SPA will define the coverage and reimbursement of DME, supplies and appliances, and home health services to comply with federal law.
Please review the draft SPA pages here: OK SPA 20-0017, and submit feedback via the comment box below.
Effective Date: 07/01/2020
Tribal Consultation Date: 03/06/2018, 05/16/2018, and 01/07/2020
60-day Tribal Consultation Date: 01/07/2020 – 03/07/2020
Public Comment Period: 01/24/2020 – 02/23/2020
OK SPA 20-0014 High-Investment Drug Carve-out
The proposed revisions will allow high-investment drugs to be “carved-out” of hospital inpatient and outpatient claims as a separate payment. Revisions will allow for reimbursement of high-investment drug therapies outside of the diagnosis-related group (DRG) payment to inpatient hospitals and outline outpatient hospital payment methodologies.
Please view the draft SPA pages here: OK SPA 20-0014, and submit feedback via the comment box below.
Tribal Consultation: 11/05/19
60-day Tribal Consultation Period: 11/05/19 – 01/04/2020
Circulation Date: 01/08/20
Comment Due Date: 02/07/20
Requested Effective Date: 04/01/2020
OK SPA 20-0019 Recovery Audit Contractor (RAC) Exception
The proposed State Plan Amendment (SPA) seeks an exemption from the federal RAC requirement. RAC programs execute audits for the purpose of identifying under/overpayments of Medicaid claims under the State Plan. The State currently has an exemption from the RAC program under the State Plan; however, the exemption expires March, 2020. The State has robust and effective program integrity procedures in place which perform the tasks of a RAC program; therefore, the Agency is seeking to extend the RAC program exemption, as it is duplicative of the auditing activities that the State already performs.
Please view the draft SPA pages here: OK SPA 20-0019, and submit feedback via the comment box below.
Tribal Consultation: 01/07/20
60-day Tribal Consultation Period: 01/07/20 – 03/07/2020
Circulation Date: 01/08/20
Comment Due Date: 02/07/20
Requested Effective Date: 04/01/2020
OK SPA 20-0018 Private Duty Nursing (PDN)
The proposed SPA defines PDN services and require these services be provided through an OHCA-contracted home health agency that meet certain requirements. Further revisions dictate that services are provided in the member’s primary residence unless it is medically necessary for a nurse to accompany the individual in the community. Finally, the proposed revisions will mandate that PDN services cannot be duplicative of services rendered by the member’s caregiver or be reimbursable by a third-party.
Please view the draft SPA pages here: OK SPA 20-0018, and submit feedback via the comment box below.
Effective Date: 09/01/2020
Tribal Consultation Date: 01/07/2020
60-day Tribal Consultation Date: 01/07/2020 – 03/07/2020
Circulation Date: 01/17/2020 – 02/16/2020
OK SPA 20-0020 Therapy Assistants
The OHCA will seek approval of a State Plan Amendment (SPA) to revise/add coverage and reimbursement methodologies for physical therapy assistants, occupational therapy assistants, speech language pathology assistants (SLPAs), and speech language pathology clinical fellows. The proposed revisions will outline provider qualifications and other requirements for provision of therapy services. Assistants will be paid 85% of the rate paid to fully licensed physical therapists, occupational therapists and speech-language pathologists.
Please view the draft SPA pages here: OK SPA 20-0020, and submit feedback via the comment box below.
Effective Date: 01/01/2021
Tribal Consultation Date: 03/03/2020
60-day Tribal Consultation Date: 03/03/2020 – 05/02/2020
Circulation Date: 06/26/2020 – 07/26/2020
OK SPA 20-0021 School-Based/EPSDT Changes
The proposed changes cleanup the school-based policy to separate and differentiate between services provided in a school setting under Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit versus those school-based services that are provided pursuant to an Individual Education Plan (IEP). Medically necessary services provided in a school setting but are not considered school-based (pursuant to an IEP) are removed.
Please view the draft SPA pages here: OK SPA 20-0021, and submit feedback via the comment box below.
Tribal Consultation: 01/07/20
60-day Tribal Consultation Period: 01/07/20 – 03/07/2020
Circulation Date: 01/31/20
Comment Due Date: 03/01/20
Requested Effective Date: 09/01/2020
OK SPA 20-0022 Medically Necessary Extractions
The proposed State Plan Amendment (SPA) seeks to improve dental access and coverage for adults, by amending the language that limits dental services for adults from “emergency” extractions only to “medically necessary” extractions.
Please view the draft SPA pages here: OK SPA 20-0022, and submit feedback via the comment box below.
Effective Date: 09/01/2020
Tribal Consultation Date: 01/07/2020
60-day Tribal Consultation Date: 01/07/2020 – 03/07/2020
Circulation Date: 02/25/2020 – 03/25/2020
OK SPA 19-0001 EPSDT Services for Children in Inpatient Psychiatric Settings
Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services for Children in Inpatient Psychiatric Settings — The proposed State Plan amendment (SPA) will implement language to comply with federal regulations and reflect that children under twenty-one (21) years of age, who are residing in an inpatient psychiatric facility must be provided all medically necessary services, regardless of whether such services are noted in the plan of care.
Please view the draft SPA pages here: OK SPA 19-0001, and submit feedback via the comment box below.
Effective Date: 01/01/2019
Tribal Consultation Date: 01/08/2019
60-day Expedited Tribal Consultation Date: 01/08/2019 – 03/09/2019
Circulation Date: 01/18/2019 – 02/17/2019
Medicaid Adult Expansion SPAs: Eligibility, Alternative Benefit Plan, & FMAP Claiming
The proposed Title XIX SPAs listed below were submitted to CMS to request the following:
- OK SPA 20-0024 adds adults 19-64 years of age, as per Section 435.119 of Title 42 of the Code of Federal Regulations, as a new eligibility group in the SoonerCare Program.
- OK SPA 20-0023 establishes alternative benefit plan (ABP) for individuals in the adult group.
- OK SPA 20-0025 establishes eligibility procedures for identification of the adult group for purposes of securing the Federal Medical Assistance Percentage (FMAP) rate for the adult group.
Please view the draft SPA pages here: OK SPA 20-0024, OK SPA 20-0023, and OK SPA 20-0025 and submit feedback via the comment box below.
Tribal Consultation: 02/21/20
14-day Tribal Consultation Period: 02/21/20 – 03/06/20
Circulation Date: 02/21/20
Requested Effective Date: 07/01/20
OK SPA 20-0033 - Certified Community Behavioral Health (CCBH) Services Reimbursement
The proposed state plan amendment (SPA) will replace the current process by which new rates for CCBH service providers are established. Currently, the rate for a new CCBH is based on the cost reporting year that ends June 30, using the facility’s most recent annual cost report data. Revisions clarify this process by adding a requirement for new CCBH service providers to submit an initial 12-month cost report to set the provider-specific rate and allowing for retroactive adjustment to claims based on the provider-specific rate.
Please view the draft SPA pages here: OK SPA 20-0033, and submit feedback via the comment box below.
Tribal Consultation: 05/05/2020
60-day Tribal Consultation Period: 05/05/2020 – 07/04/2020
Circulation Date: 06/04/2020
Comment Due Date: 07/04/2020
Requested Effective Date: 07/01/2020
OK SPA 20-0024 Adult Eligibility (Medicaid Expansion SPA)
The proposed Title XIX SPA will add adults 19-64 years of age, as per Section 435.119 of Title 42 of the Code of Federal Regulations, as a new eligibility group in the SoonerCare Program.
Please view the draft SPA pages here: OK SPA 20-0024, and submit feedback via the comment box below.
Tribal Consultation: 02/21/20
14-day Tribal Consultation Period: 02/21/20 – 03/06/20
Circulation Date: 02/21/20
Comment Due Date: 03/06/20
Requested Effective Date: 07/01/20
OK SPA 20-0026 Removal of Hospital Presumptive Eligibility (HPE) for Certain Individuals
Hospital presumptive eligibility (HPE) was erroneously chosen for adult expansion populations during the change in 2013 to comport with the Affordable Care Act (ACA), when the State did not seek authority to expand Medicaid. Oklahoma’s (OK) state plan amendment (SPA) 20-0026 will correct the error and remove HPE from individuals receiving family planning services as this eligibility group will be transitioned to the new adult eligibility group.
Please view the draft SPA pages here: OK SPA 20-0026, and submit feedback via the comment box below.
Tribal Consultation: 04/01/2020
30-day Tribal Consultation Period: 04/01/2020 – 05/01/2020
Circulation Date: 04/10/2020
Comment Due Date: 05/10/2020
Requested Effective Date: 07/01/2020
OK SPA 20-0028 Nursing Facility Rate Increases and Pay-for-Performance (PFP) Quality Metric Update
For the rate period beginning July 1, 2020, a proposed amendment to the state plan will recalculate the Quality of Care fee for regular nursing facilities, nursing facilities serving residents with Acquired Immune Deficiency Syndrome and Regular Intermediate Care Facilities for Individuals with an Intellectual Disability. The state will also make a one-time adjustment to the base rate to account for long-term care facility providers’ procurement of durable medical equipment, supplies, and appliances, including oxygen from the open market. Further revisions are proposed to enable the agency to update Pay-for-Performance quality measures as the metrics are modified by Medicare.
Please view the draft SPA pages here: OK SPA 20-0028, and submit feedback via the comment box below.
Effective Date: 07/01/2020
Tribal Consultation Date: 05/05/2020
60-day Tribal Consultation Date: 05/05/2020 – 07/04/2020
Circulation Date: 06/15/2020 – 07/15/2020
OK SPA 20-0029 SoonerPlan Termination
Oklahoma’s (OK) state plan amendment (SPA) 20-0029 will remove SoonerPlan eligibility as adults currently being served by SoonerPlan will transition to the new adult Medicaid expansion population and will be eligible to receive more comprehensive services.
Please view the draft SPA pages here: OK SPA 20-0029, and submit feedback via the comment box below.
Tribal Consultation: 04/01/2020
60-day Tribal Consultation Period: 04/01/2020 – 05/31/2020
Circulation Date: 04/10/2020
Comment Due Date: 05/10/2020
Requested Effective Date: 07/01/2020
OK SPA 20-0030 Compliance with SUPPORT Act
The proposed state plan amendment (SPA) will update policy to demonstrate compliance with the requirement of Section 5022 of the SUPPORT Act in areas related to coverage of developmental and behavioral health related screenings and applicable preventive services.
Please view the draft SPA pages here: OK SPA 20-0030, and submit feedback via the comment box below.
Tribal Consultation: 04/01/2020
60-day Tribal Consultation Period: 04/01/2020 – 05/31/2020
Circulation Date: 05/29/2020
Comment Due Date: 06/28/2020
Requested Effective Date: 10/24/2019
Requested Implementation Date: 07/01/2020
OK SPA 20-0035 Residential Substance Use Disorder (SUD) Services
The OHCA will seek approval of a State Plan Amendment (SPA) to add coverage and reimbursement of residential substance use disorder (SUD) services for individuals residing in a residential treatment facility with 16 beds or less. The proposed revisions will outline coverage of services utilizing the American Society of Addiction Medicine (ASAM) levels of care, describe provider requirements, and establish reimbursement methodologies, including performance-based bonus payments to promote the goals and outcomes of residential treatment.
Please view the draft SPA pages here: OK SPA 20-0035, and submit feedback via the comment box below.
Effective Date: 10/01/2020
Tribal Consultation Date: 09/01/2020
30-day expedited tribal consultation date: 09/01/2020 – 10/01/2020
Circulation Date: 09/16/2020 – 10/16/2020
OK SPA 20-0036 SUPPORT Act Medication-Assisted Treatment Compliance
The OHCA will seek approval of a State Plan Amendment (SPA) to establish coverage and reimbursement for medication-assisted treatment (MAT) through opioid treatment programs (OTPs) and office-based opioid treatment (OBOT) settings. Additionally, the SPA includes references to established State Plan reimbursement methodologies for complementary services offered within OTPs and OBOTs, including but not limited to behavioral health therapies and interventions and physician services.
Please view the draft SPA pages here: OK SPA 20-0036, and submit feedback via the comment box below.
Tribal Consultation: 07/07/2020
60-day Tribal Consultation Period: 07/07/2020 – 09/05/2020
Circulation Date: 09/25/2020
Comment Due Date: 10/25/2020
Requested Effective Date: 10/01/2020
OK SPA 20-0038 SUPPORT Act Compliance, Drug Utilization Review (DUR)
The proposed state plan amendment (SPA) will bring Oklahoma into compliance with Section 1004(b) of the SUPPORT Act, HR 6, which requires the State to include the standards of “excessive utilization” and “inappropriate or medically unnecessary care or prescribing or billing practices that indicate abuse or excessive utilization” within the State’s drug utilization review system.
Please view the draft SPA pages here: OK SPA 20-0038, and submit feedback via the comment box below.
Tribal Consultation Dates: 09/01/2020
60-day Tribal Consultation Period: 09/01/2020 – 10/31/2020
Circulation Date: 09/01/2020
Comment Due Date: 10/01/2020
Requested Effective Date: 10/01/2020
OK SPA 19-02 Deductible and Coinsurance for Medicare Claims
Oklahoma’s (OK) state plan amendment (SPA) 19-02, deductible and coinsurance for Medicare claims, proposes to update the reimbursement and percentage amount for the deductible and coinsurance on crossover claims to reflect current practice.
Please view the draft SPA pages here: OK SPA 19-02, and submit feedback via the comment box below.
Effective Date: 1/1/2019
Circulation Date: 12/27/2018
Tribal Consultation Date: 11/6/2018
60-day Tribal Consultation Period: 11/5/2019 – 01/05/2019
OK SPA 19-0003 — Provider Directory for Members
The proposed State Plan amendment establishes the development and use of a member-friendly provider directory. The directory will be available to members as well as providers and will include, but is not limited to, the following search options: provider’s name or NPI, provider type/specialty, PCP providers, behavioral health/substance abuse providers, providers by program (SoonerCare/Insure Oklahoma), zip code, physician gender, language of provider, and whether the physician or provider is accepting new patients. The directory will be updated every seven (7) days to ensure accurate, up-to-date information is provided, and will be accessible through mobile devices, tablets, etc. This change is pursuant to the 21st Century Cures Act (Cures Act).
Please view the draft SPA pages here: OK SPA 19-0003, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 01/08/2019
60-Day Tribal Consultation: 01/08/2019 – 03/09/2019
Circulation Date: 04/03/2019 – 05/04/2019
OK SPA 19-05 Limitation of Outpatient Laboratory, X-Ray, and Select Machine Testing Services for Adults
The proposed revisions will establish a benefit limitation of for outpatient laboratory, x-ray, and select machine testing services provided to adults on a fee-for-service basis. Revisions will include a $500 cap on services per member per year; however, certain diagnoses will be exempt from this restriction [in addition to some high cost diagnostic testing (i.e., MRI, MRA, etc.)]. Further exclusions will include services provided to individuals under twenty-one (21) as well as services received through federally qualified health centers (FQHCs) and Indian Health Service, tribal government(s), or urban Indian health program (ITU) facilities. A process for authorizing additional claims will be used for individuals who meet medical necessity criteria demonstrating the need for additional services. Changes are needed to limit inappropriate billing of wellness panels and other preventive tests in accordance with section 1902 of The Social Security Act.
Please view the draft SPA pages here: OK SPA 19-05, and submit feedback via the comment box below.
Effective Date: 04/01/2020
Tribal Consultation Date: 01/08/2019
60-day Tribal Consultation Date: 01/08/2019 – 03/09/2019
Circulation Date: 01/08/2019 – 03/10/2019
OK SPA 19-0006 — Residential Behavior Management Services (RBMS)
The Oklahoma Department of Human Services (DHS) and Oklahoma Office of Juvenile Affairs (OJA) propose revisions to coverage and reimbursement policy for Residential Behavior Management Services (RBMS) in group home settings. The proposed revisions will outline and clarify provider participation requirements, RBMS treatment components, establish new levels of care, and remove references to services provided in wilderness camps and Diagnostic and Evaluation (D&E) centers. Additional revisions will incorporate recent federal mandates, as applicable, related to licensure, accreditation, and nurse staffing requirements. Additionally, DHS and OJA propose replacing the existing payment structure for RBMS providers, established in March of 1998, by incorporating staffing, facility, and operational costs into a per diem/per recipient rate based on an established level of care.
Please view the draft SPA pages here: OK SPA 19-0006, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 01/08/2019
60-Day Tribal Consultation: 01/08/2019 – 03/09/2019
Circulation Date: 03/19/2019 – 04/18/2019
OK SPA 19-0007 Applied Behavioral Analysis (ABA) Services
The proposed Title XIX state plan amendment (SPA) establishes coverage and reimbursement for ABA services as an Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program benefit. The proposed language will define provider participation and credentialing requirements, medical necessity criteria, coverage and service limitation guidelines, and reimbursement methodology.
Please view the draft SPA pages here: OK SPA 19-0007, and submit feedback via the comment box below.
Effective Date: 07/01/2019
Tribal Consultation Date: 01/08/2019 & 05/07/2019
60-day Tribal Consultation Date: 01/08/2019 – 03/09/2019
Circulation Date: 06/07/2019 – 06/22/2019
Please view all comments received here: OK SPA 19-0007 Comment Spreadsheet.
OK SPA #19-08 Supplemental Hospital Offset Payment Program Cost-to-Charge Ratio Calculation Update for Critical Access Hospitals
OHCA recommends a change to the way cost is calculated for Critical Access Hospital (CAH) inpatient Supplemental Hospital Offset Payment Program (SHOPP) payments. Historically, an inpatient specific cost-to-charge ratio has not been used for calculating inpatient SHOPP payments. In lieu of the inpatient specific cost-to-charge ratio, OHCA utilized the generic hospital cost-to-charge ratio which is applied to DRG outlier payments. This current method is a blended (inpatient/outpatient) CCR that is an average of cost reports available from the most recent three-year period. OHCA currently uses an outpatient specific cost-to-charge ratio in calculations for SHOPP CAH payments. CMS has approved OHCA to implement the proposed CCR methodology for UPL demonstration purposes, but to implement the change for SHOPP CAH payments would require a State Plan amendment. This is proposed as a more appropriate method to calculate a hospitals inpatient cost-to-charge ratio and more accurately reimburse CAHs for inpatient services under SHOPP.
Please view the draft SPA pages here: OK SPA 19-08, and submit feedback via the comment box below.
Tribal Consultation: 11/06/2018
Circulation Date: 11/08/2018
Comment Due Date: 12/08/2018
Requested Effective Date: 01/01/2019
OK SPA 19-09 Out-of-State Services
Oklahoma’s (OK) state plan amendment (SPA) 19-09, out-of-state services, proposes to define and clarify coverage and reimbursement for services rendered by providers that are physically located outside of Oklahoma. Additionally, revisions will delineate out-of-state services, provider participation requirements, prior authorizations, and medical records requirements. Lastly, revisions will outline reimbursement criteria for out-of-state providers who do not accept the payment rate established through the Oklahoma State Plan.
Please view the draft SPA pages here: OK SPA 19-09, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Circulation Date: 01/16/2019
Tribal Consultation Date: 01/08/2019
60-day Tribal Consultation Period: 01/08/2019 – 03/09/2019
OK SPA 19-0010 CCBH Services
Certified Community Behavioral Health (CCBH) Services — The Department of Mental Health and Substance Abuse Services (ODMHSAS) will seek approval of a State Plan Amendment (SPA) to sustain CCBHs beyond their grant demonstration period in Oklahoma. Currently, there are three (3) CCBHs providing services to SoonerCare members. The services provided include nine (9) types of behavioral health treatment services, with an emphasis on the provision of 24-hour crisis care, utilization of evidence based practices, care coordination, and integration with physical health. The proposed SPA and new rules will outline CCBH member eligibility, provider participation requirements, program scope, and reimbursement methodology.
Please view the draft SPA pages here: OK SPA 19-0010, and submit feedback via the comment box below.
Effective Date: 04/01/2019
Tribal Consultation Date: 01/08/2019
14-day Expedited Tribal Consultation Date: 01/08/2019 – 1/22/2019
Circulation Date: 01/14/2019 – 01/29/2019
OK SPA 19-0011 Retroactive Eligibility
The proposed Title XIX state plan amendment (SPA) enables the State to grant retroactive eligibility to pregnant women and children under 19. Eligibility for Medicaid shall be effective no later than the third month before the date of application if the following conditions are met: (1) if the individual received covered Medicaid services at any time during the above period; and (2) if the individual would have been eligible for Medicaid at the time they received the services if they had applied or someone had applied for them. Previously, the Center for Medicaid and Medicare Services (CMS) had allowed Oklahoma to waive the requirement of retroactive eligibility for pregnant women and children under 19; however, in the latest approval of Oklahoma’s 1115(a) waiver, CMS removed this exception.
Please view the draft SPA pages here: OK SPA 19-0011, and submit feedback via the comment box below.
Effective Date: 04/01/2020
Tribal Consultation Date: 01/08/2019
60-day Tribal Consultation Date: 01/08/2019 – 03/09/2019
Circulation Date: 06/19/2019 – 07/31/2019
OK SPA 19-0013 Reimbursement Methodology for Partial Hospitalization Program (PHP) Services
This SPA has been updated to reflect a change in the reimbursement rate, as well as, a new effective date of 04/01/2019.
The proposed State Plan Amendment (SPA) allows the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) to request a change to the current reimbursement for PHP from a one hour unit of service to a single daily payment for all services provided in a day. This methodology is in line with the Healthcare Common Procedure Coding System (HCPCS) guidelines for the PHP Code, H0035, and will reduce the likelihood of a payment error finding.
Please view the draft SPA pages here: OK SPA 19-0013, and submit feedback via the comment box below.
Effective Date: 04/01/2019
Tribal Consultation Date: 11/06/2018
60-day Tribal Consultation: 11/06/2018 – 01/05/2019
Circulation Date: 01/28/2019 – 02/27/2019
OK SPA 19-0014 Increased Enhanced Payments for State University Affiliated Physicians
The proposed revisions will increase the enhanced payments made for services provided by physicians who are employed by or contracted with state universities. The current payments rates are set at 140 percent of the Medicare allowable and will be increased to 175 percent. The increase is based on the maximum percentage allowed by the Medicare Equivalent of the Average Commercial Rate calculation. The additional state share will be provided by the University of Oklahoma and Oklahoma State University.
Please view the draft SPA pages here: OK SPA 19-0014, and submit feedback via the comment box below.
Effective Date: 07/01/2019
Tribal Consultation Date: 03/05/2019
60-day Tribal Consultation Date: 03/05/2019 – 05/04/2019
Circulation Date: 04/10/2019 – 05/10/2019
OK SPA 19-0016 Federally Qualified Health Centers (FQHC) Limitation
The proposed State Plan amendment (SPA) will allow for adult members to receive multiple encounters at an FQHC within a 24-hour period.
Please view the draft SPA pages here: OK SPA 19-0016, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 01/08/2019
60-day Tribal Consultation Date: 01/08/2019 – 03/09/2019
Circulation Date: 04/10/2019 – 05/10/2019
OK SPA 19-0016 Federally Qualified Health Centers (FQHC) & Rural Health Clinics (RHC) Limitation
The proposed State Plan amendment (SPA) will reflect current rules and business practice of reimbursing for four (4) visits per adult member per month within FQHCs and RHCs. Further revisions will allow for adult members to receive more than one (1) medically necessary encounter at an FQHC within a 24-hour period when the appropriate modifier is applied.
Please view the draft SPA pages here: OK SPA 19-0016, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 09/03/2019
14-day Expedited Tribal Consultation Date: 09/03/2019 – 09/17/2019
Circulation Date: 09/10/2019 – 09/25/2019
OK SPA 19-0015 Administration Organization Update
An amendment to Oklahoma's State Plan is needed to update the organizational structure and functions within the Agency. The State Plan amendment is necessary to reflect current practice.
Please view the draft SPA pages here: OK SPA 19-0015, and submit feedback via the comment box below.
Effective Date: 01/01/2019
Circulation Date: 03/05/2019
Tribal Consultation Date: 01/08/2019
60-day Tribal Consultation Period: 01/08/2019 – 03/09/2019
OK SPA 19-0018 Qualified Behavioral Health Aide I & Qualified Behavioral Health Aide II Provider Qualifications and Rates
The Oklahoma Department of Human Services (DHS) seeks to increase the established rate for the Qualified Behavioral Health Aide (QBHA) / Treatment Parent Specialist (TPS) who provides services to children in Therapeutic Foster Care (TFC). Additionally, the Oklahoma DHS seeks to establish a rate for the QBHA II/TPS who provides services to children in Intensive Treatment Family Care (ITFC). The QBHA/TPS serves as an integral member of the TFC/ITFC team who provides high levels of care for the child, participates in the development and implementation of interventions, transports the child to therapy, documents interventions, and helps the child practice learned skills. The proposed rate will be higher for the QBHA II/TPS providing services to children in ITFC, as children served in ITFC often present with more complex behavioral health needs that require more frequent intervention by the QBHA II/TPS. Further, the State is proposing to increase the rate for QBHA I/TPS in an effort to increase access to services for eligible children, as medically necessary.
Please view the draft SPA pages here: OK SPA 19-0018, and submit feedback via the comment box below.
Effective Date: 09/01/2019 or upon CMS and Governor’s approval.
Tribal Consultation Date: 06/18/2019
60-Day Tribal Consultation: 06/18/2019 – 08/17/2019
Circulation Date: 07/12/2019 – 08/11/2019
OK SPA 19-0019 Outpatient Services Frontispiece
The proposed revisions clarify in the State Plan that an update to the Agency’s fee schedule for outpatient services occurs when the Medicare rates are updated pursuant to the specified reimbursement methodology in the Plan.
Please view the draft SPA pages here: OK SPA 19-0019, and submit feedback via the comment box below.
Circulation Date: 03/05/2019
Effective Date: 01/01/2019
Tribal Consultation Date: 03/05/2019
14-day Expedited Tribal Consultation Period: 03/05/2019 – 03/19/2019
OK SPA 19-0020 Inpatient Psychiatric Services (Under 21) Payment to State-owned PRTFs
The proposed Title XIX State Plan revision will allow for a cost-based reimbursement to state-owned psychiatric residential treatment facilities (PRTFs) rendering inpatient psychiatric services to individuals under the age of twenty-one (21). This amendment is necessary to align the State Plan with current practice.
Please view the draft SPA pages here: OK SPA 19-0020, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 01/08/2019
60-day Tribal Consultation Date: 05/07/2019 – 07/06/2019
Circulation Date: 06/20/2019 – 07/20/2019
OK SPA 19-0023 Rural Health Clinics Reimbursement Methodologies
The proposed SPA and policy changes will revise the payment methodology for Rural Health Clinics (RHCs) to increase access to care in rural areas. Additionally, a minor change was made to the proposed SPA language on 05/23/2019 to reflect the accurate frequency of rate notifications to hospital-based RHCs from CMS.
Please view the draft SPA pages here: OK SPA 19-0023, and submit feedback via the comment box below.
Effective Date: 07/01/2019
Tribal Consultation Date: 05/07/2019
60-day Tribal Consultation Date: 05/07/2019– 07/06/2019
Circulation Date: 05/07/2019 – 06/06/2019
Please view all comments received here: OK SPA 19-0023 Comment Spreadsheet.
OK SPA 19-0025 Nursing Facility Annual Rate Rebasing
The proposed SPA will increase the Quality of Care (QOC) Fee for Regular Nursing Facilities and Nursing Facilities serving patients with Acquired Immune Deficiency Syndrome (AIDS) per 56 O.S. § 2011, Section 2002. The change will match federal funds with QOC funds collected from providers to issue rate increases to these facilities.
Please view the draft SPA pages here: OK SPA 19-0025, and submit feedback via the comment box below.
Effective Date: 07/01/2019
Tribal Consultation Date: 06/18/2019
60-day Tribal Consultation Date: 06/18/2019– 08/17/2019
Circulation Date: 06/20/2019 – 07/22/2019
OK SPA 19-0026 — Telehealth Services
The proposed Title XIX State Plan amendment (SPA) will revise language regarding parental consent and primary care provider notification for telehealth services provided in school settings. Additional changes include revisions regarding confidentiality of protected health information and adding language that defines telehealth program coverage and limitations. The SPA is needed revisions are needed to comply with Senate Bill 575 (SB 575) which amended Oklahoma Statutes (O.S.) 25, Sections 2004 and 2005.
Please view the draft SPA pages here: OK SPA 19-0026, and submit feedback via the comment box below.
Effective Date: 07/01/2019
Tribal Consultation Date: 06/18/2019
60-Day Tribal Consultation: 06/18/2019 – 08/17/2019
Circulation Date: 06/21/2019 – 07/21/2019
OK SPA 19-0028 Inpatient Psychiatric Add-on Payment
The proposed revisions will create a general specialty add-on payment for children with specialized treatment needs who are being served in psychiatric hospitals, hospitals with a psychiatric wing, and psychiatric residential treatment facilities (PRTFs). Revisions will help offset the increased cost of serving children with specialized treatment needs.
Please view the draft SPA pages here: OK SPA 19-0028, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 07/02/2019
60-day Tribal Consultation Date: 07/02/2019 – 08/31/2019
Circulation Date: 07/16/2019 – 08/15/2019
OK SPA 19-0031-A Personal Needs Allowance Increase and OK SPA 19-0031-B Rate Increase for Regular Nursing Facilities and Nursing Facilities Serving Patients with AIDS and Focus on Excellence Program Updates
This SPA has been updated to reflect a change in the language. This SPA will be posted for an additional 15 day comment period.
The OHCA is proposing revisions to bring the agency into compliance with Oklahoma Senate Bill 1044 and Senate Bill 280. These revisions will increase the personal needs allowance for residents of nursing homes as well as increase rates and recalculate the Quality of Care fee for regular nursing facilities and nursing facilities serving residents with Acquired Immune Deficiency Syndrome (AIDS). Further revisions will establish new quality measures and criteria as well as recalculate the incentive reimbursement rate plan for nursing facilities participating in the Focus on Excellence (FOE) program. Revisions to the state’s FOE incentive program include the potential for participating nursing facilities to earn up to $5.00 per Medicaid patient day if the four metrics outlined in the state plan are met or exceeded. The FOE program update also includes a provision that redistributes funds remaining from payments not earned to those who achieve the metrics.
Please view the draft SPA pages here: OK SPA 19-0031-A and OK SPA 19-0031-B, and submit feedback via the comment box below.
Effective Date: 10/01/2019
Tribal Consultation Date: 07/02/2019
60-day Tribal Consultation Date: 07/02/2019 – 08/31/2019
Circulation Date: 08/02/2019 – 09/01/2019; 09/05/2019 – 09/20/2019
Please note, this SPA has been updated on the following dates:
- August 2, 2019;
- August 6, 2019;
- August 9, 2019 (split into two separate SPAs 19-0031A and 19-0031B); and
- September 5, 2019
Please view all comments received here: OK SPA 19-0031A&B Comment Spreadsheet.
OK SPA 19-0034 Outpatient Services Rate Increase
In keeping with Sections 1 and 2 of SB 1044, 57th Leg., 1st Sess. (Okla. 2019), revisions are needed to increase the current reimbursement rates for all outpatient SoonerCare-contracted provider types by five percent (5%), with the following exemptions: services financed through appropriations to other state agencies; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); non-emergency transportation capitated payments; services provided to Insure Oklahoma (IO) members; payments for drug ingredients/physician supplied drugs; Indian Health Services/Tribal/Urban Clinics (I/T/Us); Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
Please view the draft SPA pages here: OK SPA 19-0034, and submit feedback via the comment box below.
Effective Date: 10/01/2019
Tribal Consultation Date: 07/02/2019
60-day Tribal Consultation Date: 07/02/2019 – 08/31/2019
Circulation Date: 08/02/2019 – 09/01/2019
OK SPA 19-0035 Inpatient Services Rate Increase
In keeping with Sections 1 and 2 of SB 1044, 57th Leg., 1st Sess. (Okla. 2019), revisions are needed to increase the current reimbursement rates for all inpatient SoonerCare-contracted provider types by five percent (5%), with the following exemptions: services financed through appropriations to other state agencies; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); non-emergency transportation capitated payments; services provided to Insure Oklahoma (IO) members; payments for drug ingredients/physician supplied drugs; Indian Health Services/Tribal/Urban Clinics (I/T/Us); Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
Please view the draft SPA pages here: OK SPA 19-0035, and submit feedback via the comment box below.
Effective Date: 10/01/2019
Tribal Consultation Date: 07/02/2019
60-day Tribal Consultation Date: 07/02/2019 – 08/31/2019
Circulation Date: 08/02/2019 – 09/01/2019
OK SPA 19-0036 State Plan Personal Care Services Rate Increase
In keeping with the First Regular Session of the Fifty Seventh Oklahoma Legislature, the proposed Title XIX state plan amendment (SPA) is needed to increase the current reimbursement for State Plan personal care direct care services by four percent (4%).
Please view the draft SPA pages here: OK SPA 19-0036, and submit feedback via the comment box below.
Effective Date: 10/01/2019
Tribal Consultation Date: 06/18/2019
60-day Tribal Consultation Date: 06/18/2019 – 08/17/2019
Circulation Date: 08/02/2019 – 09/01/2019
OK SPA 19-0037 Pharmacy Dispensing Fee Rate Increase
In keeping with Sections 1 and 2 of SB 1044, 57th Leg., 1st Sess. (Okla. 2019), revisions are needed to increase the current reimbursement rate for the professional dispensing fee of SoonerCare-contracted pharmacies. The state plan amendment (SPA) proposes to update the reimbursement rate for the professional dispensing fee by five percent (5%). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
Please view the draft SPA pages here: OK SPA 19-0037, and submit feedback via the comment box below.
Effective Date: 10/01/2019
Tribal Consultation Date: 07/02/2019
60-day Tribal Consultation Date: 07/02/2019 – 08/31/2019
Circulation Date: 08/02/2019 – 09/01/2019
Please view all comments received here: OK SPA 19-0037 Comment Spreadsheet.
OK SPA 19-0038 Behavioral Health Targeted Case Management (TCM)
The proposed State Plan Amendment (SPA) will remove language limiting the amount of TCM that is reimbursable by SoonerCare. The TCM limit per member month will increase from 16 units per member per year to 12 units per member per month.
Please view the draft SPA pages here: OK SPA 19-0038, and submit feedback via the comment box below.
Effective Date: 7/01/2019
Tribal Consultation Date: 09/03/2019
14-day Expedited Tribal Consultation Date: 09/03/2019 – 09/17/2019
Circulation Date: 09/10/2019 – 09/25/2019
OK SPA 19-0040 Opioid Standards and Drug Utilization Review (DUR) Program
The proposed Title XIX State Plan amendment will comply with the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act that was signed into federal law on October 24th, 2018. Title I, Section 1004 of the SUPPORT Act requires Medicaid agencies to build on current state Medicaid drug utilization review activities to help combat the opioid crisis. The proposed SPA will outline the following assurances that the OHCA will:
- Have safety edits, as specified by the State, for subsequent opioid fills and maximum daily morphine equivalent that exceed State-defined limitations.
- Have an automated process that monitors when an individual is concurrently prescribed opioids and benzodiazepines or antipsychotics;
- Monitor antipsychotic prescribing for members aged 18 and younger; and
- Have a process that identifies potential fraud or abuse by enrolled individuals and pharmacies.
Please view the draft SPA pages here: OK SPA 19-0040, and submit feedback via the comment box below.
Effective Date: 09/01/2019
Tribal Consultation Date: 07/02/2019
60-day Tribal Consultation Date: 07/02/2019 – 08/31/2019
Circulation Date: 11/05/2019 – 12/05/2019
OK SPA 20-0001 — Provider Directory for Members
The proposed State Plan amendment establishes the development and use of a member-friendly provider directory. The directory will be available to members as well as providers and will include, but is not limited to, the following search options: provider’s name or NPI, provider type/specialty, PCP providers, behavioral health/substance abuse providers, providers by program (SoonerCare/Insure Oklahoma), zip code, physician gender, language of provider, and whether the physician or provider is accepting new patients. The directory will be updated every seven (7) days to ensure accurate, up-to-date information is provided, and will be accessible through mobile devices, tablets, etc. This change is pursuant to the 21st Century Cures Act (Cures Act).
Please view the draft SPA pages here: OK SPA 20-0001, and submit feedback via the comment box below.
Effective Date: 01/01/2020
Tribal Consultation Date: 01/08/2019
60-Day Tribal Consultation: 01/08/2019 – 03/09/2019
Circulation Date: 08/20/2019 – 09/19/2019
OK SPA 20-0006 Nursing Licensure Revisions
The proposed State Plan Amendment (SPA) will comply with Oklahoma House Bill (HB) 2351, which allows Oklahoma to enter into the enhanced Nurse Licensure Compact (eNLC). The eNLC is an agreement between states that allows a nurse's licensure to be portable to other member-states of the Compact. These revisions amend references that narrowly tie a nurse's license to the Oklahoma Board of Nursing and align SoonerCare rules and the State Plan with the eNLC.
Please view the draft SPA pages here: OK SPA 20-0006, and submit feedback via the comment box below.
Effective Date: 09/01/2020
Tribal Consultation Date: 11/05/2019
60-Day Tribal Consultation: 11/05/2019 – 01/04/2020
Circulation Date: 11/05/2019 – 12/05/2019
OK SPA 20-0008 Reasonable Limits on Amounts for Necessary Medical or Remedial Care Not Covered under Medicaid
The proposed State Plan Amendment (SPA) will establish exclusions of and/or requirements on the amount of medical expenses that can be deducted from the post-eligibility income of individuals who are institutionalized in nursing facilities or receiving home or community-based services under a 1915 waiver, pursuant to federal regulation.
Please view the draft SPA pages here: OK SPA 20-0008, and submit feedback via the comment box below.
Effective Date: 09/01/2020
Tribal Consultation Date: 11/05/2019
60-Day Tribal Consultation: 11/05/2019 – 01/04/2020
Circulation Date: 11/05/2019 – 12/05/2019
OK SPA 18-01 Breast and Cervical Cancer Benefit Update
Oklahoma’s (OK) state plan amendment (SPA) 18-01, Breast and Cervical Cancer (BCC) benefit update, proposes to amend the Title XIX state plan in order to comply with federal regulation which addresses optional eligibility for individuals needing treatment for breast and cervical cancer. In order to align policy with federal regulation requirements the term "women" will be replaced with the term "individuals".
Please view the draft OK SPA 18-01 here: OK SPA 18-01 BCC Benefit Update Redlined SPA, and submit feedback via the comment box below.
Effective Date: 2/1/2018
Circulation Date: 1/3/2018
Tribal Consultation Date: 9/5/2017
60-day Tribal Consultation Period: 9/5/2017 – 11/4/2017
OK SPA 18-02 Inpatient Psychiatric Services for Individuals under Age 21
Oklahoma’s (OK) state plan amendment (SPA) 18-02, inpatient psychiatric services for individuals under age 21, will align settings and reimbursement methodology for inpatient psychiatric services for individuals under age 21 with federal regulation and guidance. The proposed SPA will revise and expand the identification of settings where inpatient psychiatric services for individuals under age 21 are provided and delineate requirements for reimbursement within each setting. Additionally, the SPA will update the list of accrediting bodies for psychiatric facilities to meet federal regulations. Other revisions include page format and grammatical changes.
Please view the draft OK SPA 18-02 here: OK SPA 18-02 Inpatient Psych Services for Individuals under Age 21, and submit feedback via the comment box below.
Tribal Consultation: 11/07/2017
60-day Tribal Consultation Period: 10/24/17 - 12/23/17
Circulation Date: 1/30/2018
Comment Due Date: 03/01/2018
Requested Effective Date: 01/01/2018
This SPA was previously posted for a 30-day comment period from 01/12/2018 through 02/11/2018 and was re-posted for an additional 30-day comment period due to a subsequent change in the language which further clarifies that the IEP includes all relevant supporting documentation.
OK SPA 18-03 School-based Health Services
The proposed school-based health services (SBS) revisions clarifies the definition of school-based services. Language is added to outline notification requirements for schools regarding parental/legal guardian consent. Other revisions will remove specific references that are no longer applicable. Changes are needed to align with current practice and federal regulation.
Please view the draft SPA pages here: OK SPA 18-03, and submit feedback via the comment box below.
Tribal Consultation: 11/07/2017 & 01/02/2018
Comment Due Date: 03/17/2018
Requested Effective Date: 01/01/2018
OK SPA 18-06 EPSDT Periodicity Schedule Update
The proposed revisions will update the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Periodicity Schedule recommended for physicians and other practitioners who provide screening services to children. The proposed periodicity schedule will reflect recommendations by the American Academy of Pediatrics (AAP) and the American Academy of Pediatric Dentistry (AAPD).
Please view the draft SPA pages here: OK SPA 18-06, and submit feedback via the comment box below.
Tribal Consultation: 01/02/2018
Comment Due Date: 02/16/2018
Requested Effective Date: 09/01/2018
OK SPA 18-07 Accreditation Commission for Health Care (ACHC) Accreditation Option for Outpatient Behavioral Health Organizations
The proposed behavioral health revisions will add the ACHC as an additional accreditation option for outpatient behavioral health organizations.
Please view the draft SPA pages here: OK SPA 18-07, and submit feedback via the comment box below.
Tribal Consultation: 11/07/2017
Comment Due Date: 02/16/2018
Requested Effective Date: 09/01/2018
OK SPA 18-08 Value-based Contract for Pharmaceuticals
Oklahoma’s (OK) state plan amendment (SPA) 18-08, Value-based Contract for Pharmaceuticals, will incorporate value-based purchasing contract language to policy. Value-based purchasing contracts provide an opportunity to increase supplemental drug rebates, help clarify the complicated drug purchasing landscape for the SoonerCare program, and help improve patient access to evidence-based therapies while helping the program predict and manage prescription drug costs.
Please view the draft OK SPA 18-08 here: OK SPA 18-08 Value-based Contract for Pharmaceuticals, and submit feedback via the comment box below.
Tribal Consultation: 01/02/2018
60-day Tribal Consultation Period: 12/17/18 - 2/16/18
Circulation Date: 1/30/2018
Comment Due Date: 03/01/2018
Requested Effective Date: 01/01/2018
18-09 Outpatient Hospital Dental and ENT Rates
The proposed revisions will provide a new methodology for increasing the reimbursement rate for dental services in an outpatient hospital. The new method uses the cost of dental services and the cost of services in the Ambulatory Patient Classification group 5164 to calculate the rate for all outpatient hospitals.
Please view the draft SPA pages here: OK SPA 18-09; submit feedback via the comment box below.
As part of the federal requirements for documentation of access to care and service payment rates found at 42 CFR 447.203, the State must submit an access to care analysis for any service within a state plan amendment that proposes to reduce or restructure provider payment rates.
Please view the draft Access to Care Analysis pages here for OK SPA 18-09; submit feedback via the comment box below.
Tribal Consultation: 11/07/17
Comment Due Date: 03/30/2018
Recovery Audit Contractor (RAC) Exception
The proposed revision seeks an exemption from the recovery audit contract (RAC) requirement. Federal RAC programs execute audits for the purpose of identifying under/overpayments of Medicaid claims under the state plan. The state has developed an internal audit process, which performs the tasks of a RAC program. Therefore, the Agency is seeking an exemption to the RAC requirement, as it is duplicative of the auditing activities that the State already performs.
Please view the draft SPA pages here: OK SPA 18-11, and submit feedback via the comment box below.
Tribal Consultation: 03/06/18
Comment Due Date: 05/20/18
Requested Effective Date: 04/01/18
OK SPA # 18-23 Provider Rate Reduction Exemption for Indian Health Services, Tribal Program and Urban Indian Clinic (I/T/U) Services Provided Outside of the Office of Management and Budget (OMB) Rate
Oklahoma's (OK) state plan amendment (SPA) 18-23 will allow the Oklahoma Health Care Authority (OHCA) to exempt I/T/U services provided outside of the Office of Management and Budget (OMB) rate and reimbursed at 100 percent Federal Medical Assistance Percentage (FMAP) from proposed provider rate reductions.
Please view the draft SPA pages here: OK SPA 18-23, and submit feedback via the comment box below.
Tribal Consultation: 11/07/2017
60-day Tribal Consultation Period: 11/07/2017-01/06/2018
Circulation Date: 08/23/2018
Comment Due Date: 09/22/2018
Requested Effective Date: 10/01/2018
Please view all comments received here: OK SPA 18-23 Comment Document.
OK SPA 18-24 Parity Compliance
A proposed Title XXI State Plan Amendment (SPA) will add language to comply with the Mental Health Parity and Additional Act and CHIP final rule at 42 CFR 457.496. The OHCA is requesting deemed compliance with Parity through EPSDT.
Please view the draft SPA pages here: OK SPA 18-24 Parity Compliance, and submit feedback via the comment box below.
Tribal Consultation: 05/16/2018
Comment Due Date: 06/29/2018
Requested Effective Date: 10/02/2017
OK SPA # 18-17 Nursing Facility Rate Changes
For the rate period beginning July 1, 2018, the Quality of Care fee will be recalculated for regular nursing facilities, nursing facilities serving residents with Acquired Immune Deficiency Syndrome, regular (greater than 16 beds) intermediate care facilities for individuals with intellectual disabilities (ICF/IID), and acute (16 beds or less) ICF/IID. A proposed amendment to the state plan will propose a new rate for regular nursing facilities and nursing facilities serving residents with Acquired Immune Deficiency Syndrome based on the recalculation of the Quality of Care fee.
Please view the draft SPA pages here: OK SPA 18-17, and submit feedback via the comment box below.
Tribal Consultation: 05/16/2018
Comment Due Date: 06/29/2018
Requested Effective Date: 07/01/2018
OK SPA 18-18 Acute Level 1 Psychiatric Hospitals Rate Increase
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is proposing to increase the reimbursement rate by 3% for SoonerCare services provided by Acute Level 1 Inpatient Psychiatric Hospitals beginning July 1, 2018, subject to CMS approval.
Please view the draft SPA pages here: OK SPA 18-18 Acute Level 1 Psych Hospitals Rate Increase, and submit feedback via the comment box below.
Tribal Consultation: 05/16/2018
Comment Due Date: 07/15/2018
Requested Effective Date: 07/01/2018
OK SPA 18-19 Licensure Candidates Rate Increase
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is proposing to increase the reimbursement rate by 3% for SoonerCare services provided by Licensure Candidates beginning July 1, 2018, subject to CMS approval.
Please view the draft SPA pages here: OK SPA 18-19 Licensure Candidates Rate Increase, and submit feedback via the comment box below.
Tribal Consultation: 05/16/2018
Comment Due Date: 07/15/2018
Requested Effective Date: 07/01/2018
OK SPA 18-20 Level 1 LBHPs (Psychologists) Rate Increase
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is proposing to increase the reimbursement rate by 3% for SoonerCare services provided by Level 1 LBHPs (psychologists) in independent practice beginning July 1, 2018, subject to CMS approval.
Please view the draft SPA pages here: OK SPA 18-20 Level 1 LBHPs (Psychologists) Rate Increase, and submit feedback via the comment box below.
Tribal Consultation: 05/18/2018
Comment Due Date: 07/15/2018
Requested Effective Date: 07/01/2018
OK SPA 18-21 Vaccine Rate Methodology
A proposed State Plan Amendment (SPA) will add language to establish that the rate methodology used for vaccines is the equivalent to Medicare Part B, ASP + 6%. When ASP is not available, an equivalent price is calculated using Wholesale Acquisition Cost (WAC). If no Medicare, ASP, or WAC pricing is available, then the price will be calculated based on invoice cost.
Please view the draft SPA pages here: OK SPA 18-21 Vaccine Rate Methodology, and submit feedback via the comment box below.
Tribal Consultation: 05/16/2018
Comment Due Date: 06/29/2018
Requested Effective Date: 07/01/2018
OK SPA 18-22 Nursing Home Supplemental Payment Program
This SPA was previously posted with an effective date of 04/01/2018; the new effective date is 05/01/2018.
The proposed revisions will add a nursing home supplemental payment program for nursing facilities and will change the methodology for computing the Upper Payment Limit.
Please view the draft OK SPA 18-22 here: OK SPA 18-22 NF Supplemental Payment SPA, and submit feedback via the comment box below.
Tribal Consultation: 11/07/2017
60-day Tribal Consultation Period: 11/07/2017 - 01/06/2018
Circulation Date: 04/09/2018
Comment Due Date: 04/20/2018
Requested Effective Date: 05/01/2018
OK SPA # 18-25 — Pharmacy State Plan Revision
The proposed pharmacy revisions will remove language regarding cosmetic or hair growth medications and sexual or erectile dysfunction medications from the State Plan. Currently, the State Plan has language noting that the aforementioned medications are not a covered benefit; however, the language is being removed all together to comply with federal guidance.
Please view the draft SPA pages here: OK SPA 18-25, and submit feedback via the comment box below.
Tribal Consultation: 01/02/2018
Comment Due Date: 02/09/2018
Requested Effective Date: 01/01/2018
OK SPA 18-26 Outpatient Services Rate Increase Update
Revisions are needed to increase the current reimbursement rates for all SoonerCare-contracted provider types by three percent (3%) with the following exemptions: services financed through appropriations to other state agencies, Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS), non-emergency transportation capitated payments, services provided to Insure Oklahoma (IO) members, payments for drug ingredients/physicians supplied drugs, Indian Health Services/Tribal/Urban Clinics (I/T/U), Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs). The is SPA proposed to update the fee-for-service (FFS) fee schedule rates to include a three percent (3%) increase to reimbursement for outpatient services including but not limited to the following services/providers: vaccine administration, outpatient hospital, clinical laboratory, physician, physician assistants, home health, freestanding ambulatory surgery center (ASC), dental, renal dialysis facilities, anesthesiologists, hospice, ambulance transportation providers, and eyeglasses. All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
Please view the draft SPA pages here: OK SPA 18-26, and submit feedback via the comment box below.
Tribal Consultation: 09/04/2018
14-day Expedited Tribal Consultation Period: 09/04/2018-09/18/2018
Comment Due Date: 09/12/2018
Requested Effective Date: 10/01/2018
OK SPA 18-27 Inpatient Services Rate Increase
Revisions are needed to increase the current reimbursement rates for all SoonerCare-contracted provider types by three percent (3%) with the following exemptions: services financed through appropriations to other state agencies, Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS), non-emergency transportation capitated payments, services provided to Insure Oklahoma (IO) members, payments for drug ingredients/physicians supplied drugs, Indian Health Services/Tribal/Urban Clinics (I/T/U), Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs). The state plan amendment (SPA) proposes to update the reimbursement rates for inpatient hospital services to include a three percent (3%) increase. All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
Please view the draft SPA pages here: OK SPA 18-27, and submit feedback via the comment box below.
Tribal Consultation: 09/04/2018
14-day Expedited Tribal Consultation Period: 09/04/2018-09/18/2018
Comment Due Date: 09/12/2018
Requested Effective Date: 10/01/2018
OK SPA 18-28 Long-term Care Facilities Rate Increase
Revisions are needed to increase the current reimbursement rates for SoonerCare-contracted long-term care facilities by four percent (4%). The four percent (4%) increase for long-term facilities is calculated only on the portion of the rate funded by state appropriations, resulting in an increase on the total rate of 3.2 percent (3.2%) for regular nursing facilities and 3.5 percent (3.5%) for regular and acute Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IIDs). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
Please view the draft SPA pages here: OK SPA 18-28, and submit feedback via the comment box below.
Tribal Consultation: 09/04/2018
14-day Expedited Tribal Consultation Period: 09/04/2018-09/18/2018
Comment Due Date: 09/12/2018
Requested Effective Date: 10/01/2018
OK SPA 18-29 Outpatient BH Rehab and Clinic
Pursuant to Oklahoma HB3707, the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is proposing a three percent (3%) rate increase for licensed behavioral health professionals and licensure candidates for psychotherapy services provided in outpatient behavioral health clinics.
Please view the draft SPA pages here: OK SPA 18-29 Outpatient BH Rehab and Clinic, and submit feedback via the comment box below.
Tribal Consultation: 05/16/2018
Comment Due Date: 09/27/2018
Requested Effective Date: 07/01/2018
Please view all comments received here: OK SPA 18-29 Comment Document.
OK SPA 18-30 Pharmacy Dispensing Fee Rate Increase
Revisions are needed to increase the current reimbursement rate for the professional dispensing fee of SoonerCare-contracted pharmacies. The state plan amendment (SPA) proposes to update the reimbursement rate for the professional dispensing fee by three percent (3%). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.
Please view the draft SPA pages here: OK SPA 18-30, and submit feedback via the comment box below.
Tribal Consultation: 09/04/2018
14-day Expedited Tribal Consultation Period: 09/04/2018-09/18/2018
Comment Due Date: 09/12/2018
Requested Effective Date: 10/01/2018
OK SPA # 18-39 Supplemental Reimbursement for Ground Ambulance Transportation Providers
Oklahoma's (OK) state plan amendment (SPA) 18-39 proposes to implement a supplemental reimbursement program for SoonerCare contracted ground ambulance transportation providers, in addition to their current rate of payment, effective October 1, 2018. Additional federal dollars will be leveraged through Certified Public Expenditure (CPE) to reduce the gap between Medicaid payments and the actual cost of providing ground ambulance transportation services. The state plan amendment defines the scope, payment methodology, cost reporting requirements, and payment frequency for supplemental payments.
Please view the draft SPA pages here: OK SPA 18-39, and submit feedback via the comment box below.
Tribal Consultation: 07/11/2018
60-day Tribal Consultation Period: 7/11/2018 – 9/9/2018
Circulation Date: 09/28/2018
Comment Due Date: 10/28/2018
Requested Effective Date: 10/01/2018Please view all comments received here: OK SPA # 18-39 Comment Document.
OK TXXI SPA 18-0001 Health Service Initiatives - Sickle Cell Disease Care Kits, Safe Sleep, and Long-Acting Reversible Contraceptive Devices
Health service initiatives (HSIs) protect public health and/or the health of individuals, improves or promotes a state’s capacity to deliver public health services, strengthen the human and material resources necessary to accomplish public health goals to improve children’s health, and targets low-income children under 19. Due to an increase in the Children's Health Insurance Program (CHIP) Federal Medical Assistance Percentages (FMAP) for FY19 to fund HSIs, the Oklahoma Health Care Authority (OHCA) is amending the Title XXI State Plan to propose three new initiatives including: Sickle Cell Disease (SCD) Care Kits; Safe Sleep, and Long-Acting Revisable Contraceptive (LARC) Devices.
As partnership with the Supporters of Families with Sickle Cell Disease, Inc., the proposed SCD Care Kits HSI will create and distribute care kits to mothers of diagnosed children, ages newborn to 5 years old. A second care kit will be provided to children, ages 6 to 18 years old, and their parents(s)/caregiver(s) who are currently living with the disease and associated diagnosis. The state match will be provided by the OHCA.
As an existing partnership between the Oklahoma State Health Department and various birthing hospitals, the proposed Safe Sleep HSI will provide safe sleeps cribs and infant safe sleep education to parents of newborns. In an effort to reduce the number of infant deaths related to Sudden Infant Death Syndrome (SIDS) and Sudden Unexpected Infant Death (SUID), this HSI seeks to increase access to the use of infant safe sleep environments and improvements in safe sleep practices. The state match will be provided by the Oklahoma State Health Department.
The proposed LARC Devices HSI will seek to purchase long-acting reversible contraceptive devices for the Oklahoma State Health Department. It will serve to supply various Health Department locations across the state with these contraceptive devices in an effort to increase access to the devices and accomplish public health goals to improve children's health. The state match will be provided by the Oklahoma State Health Department.
Please view the draft OK TXXI SPA 18-0001 here: OK TXXI SPA 18-0001 HSIs (SCD Care Kits, Safe Sleep, LARC) Redlined SPA, and submit feedback via the comment box below.
HSI Request #6 (SCD Care Kits) Tribal Consultation Date: 07/11/17
HSI Request #7 (Safe Sleep) Tribal Consultation Date: 03/07/17
HSI Request #8 (LARC Devices) Tribal Consultation Date: 07/11/17
Circulation Date: 04/13/18
Comment Due Date: 04/20/18
Requested Effective Date: 10/01/18
OK SPA # 18-0013 Revise and Update CHIP Goals and Objectives
The proposed changes will revise and update the current Title XXI State Plan’s Strategic Objectives and Performance Goals. These changes are being proposed because current measures and goals are obsolete, and it will allow the OHCA to effectively report on the Children’s Health Insurance Program (CHIP) through the CHIP annual report. The revisions will update Section 9, of the Title XXI state plan, and establish new targets for performance to ensure the agency is in compliance with applicable federal regulations.
The Title XXI state plan will also be revised to update language to reflect current practices regarding tribal consultation and public notice processes, renumber sections, remove obsolete processes, and correct grammatical errors in order to comport with the new Title XXI state plan template format.
Please view the draft SPA pages here: OK SPA 18-0013, and submit feedback via the comment box below.
Tribal Consultation: 05/16/18
Comment Due Date: 08/29/18
Requested Effective Date: 09/01/2018
OK TXXI SPA 18-0016 Health Service Initiative - Reach Out and Read
Health service initiatives (HSIs) protect public health and/or the health of individuals, improves or promotes a state’s capacity to deliver public health services, strengthen the human and material resources necessary to accomplish public health goals to improve children’s health, and targets low-income children under 19. Due to an increase in the Children's Health Insurance Program (CHIP) Federal Medical Assistance Percentages (FMAP) for FFY19 to fund HSIs, the Oklahoma Health Care Authority (OHCA) is amending the Title XXI State Plan to propose a new HSI.
In partnership with the University of Oklahoma, the Reach Out and Read HSI will provide training to pediatric and primary care providers in order to integrate the evidence-based ROR model into their practice. Providers will be trained to incorporate the use of an age appropriate, culturally sensitive, new book to be given to the child during the exam and used by the provider as a tool for assessment and anticipatory guidance. The book will be used to survey the child’s gross and fine motor skills, cognitive and speech milestones, and to observe parent/child interactions. The provider models reading the book aloud to the child, helps the parent understand the importance of language and development skills, and gives a prescription for reading aloud. Providers will also be provided with standardized developmental screening tools, i.e., Ages& Stages Questionnaires, and trained on their use. The state match will be provided by the University of Oklahoma.
Please view the draft OK TXXI SPA 18-0016 here: OK TXXI SPA 18-0016 ROR SPA Redlined, and submit feedback via the comment box below.
HSI Request #9 (Reach Out and Read) Tribal Consultation Date: 09/05/17
Circulation Date: 07/02/18
Comment Due Date: 08/01/18
Requested Effective Date: 11/01/18
OK SPA # 17-05 — Tribal, IHS, and Urban Indian Health Program Facilities Designated as FQHCs
Tribal, IHS, and Urban Indian Health Program Facilities Designated as FQHCs — The proposed revisions allow I/T/Us who choose to contract and are designated as Federally Qualified Health Centers to be reimbursed at the Federal Office of Management and Budget (OMB) rate for services provided outside of the four walls of their facilities. These revisions are necessary in order to come into compliance with federal regulations.
Please view the draft SPA pages here: OK SPA 17-05, and submit feedback via the comment box below.
Tribal Consultation: 03/07/2017
Comment Due Date: 12/20/2017
Requested Effective Date: 01/01/2018
OK SPA # 17-06 — Hospice Care Concurrent Treatment for Children
A proposed state plan amendment (SPA) will align Medicaid hospice services with current program operations and federal regulations. The proposed SPA will allow children to receive hospice services without forgoing other medical/curative services which children are entitled to under Medicaid. Additional revisions to the hospice state plan pages are made to make the benefit more descriptive.
Please view the draft state plan amendment (SPA) pages here: Hospice Care Concurrent Treatment for Children, and submit feedback via the comment box below.
Requested Effective Date: 07/01/2017
Tribal Consultation Date: 05/23/2017
Comment Due Date: 06/22/2017
OK SPA # 17-07 — Long acting reversible contraceptives (LARC) Devices
This proposed state plan amendment (SPA) will revise coverage language to increase access and utilization of LARC devices. The proposed SPA will expand access to these devices by removing unnecessary restrictions. Changes within the proposed SPA will support appropriate birth spacing, which can reduce infant and maternal mortality.
Please view the draft SPA pages here: OK SPA # 17-07 — Long acting reversible contraceptives (LARC) Devices, and submit feedback via the comment box below.
Requested Effective Date: 07/01/2017
Tribal Consultation Date: 05/23/2017
Comment Due Date: 06/23/2017
OK SPA # 17-08 — Long-Term Care Facilities Rebasing Rates
A proposed state plan amendment (SPA) will revise the Quality of Care fee for regular nursing facilities, nursing facilities serving residents with Acquired Immune Deficiency Syndrome (AIDS), regular (greater than 16 beds) intermediate care facilities for individuals with intellectual disabilities (ICF/IID), and acute (16 beds or less) intermediate care facilities for individuals with intellectual disabilities (ICF/IID).
Please view the draft SPA pages here: OK SPA 17-08, and submit feedback via the comment box below.
Tribal Consultation: 05/23/17
Comment Due Date: 07/22/2017
Requested Effective Date: 07/01/2017
OK SPA # 17-09 — Pharmacy Brand Name Reduction and Elimination of Over-The-Counter for Adults
The proposed state plan amendment (SPA) will reduce brand name prescriptions from two (2) to one (1) per month per eligible non-institutionalized and non-wavier adult member. Revisions also remove coverage of optional non-prescription drugs for adults. (Insulin, nicotine replacement products for smoking cessation, and family planning products are not optional.)
Please view the draft SPA pages here: OK SPA 17-09, and submit feedback via the comment box below.
Tribal Consultation: 05/23/2017
Comment Due Date: 08/16/2017
Requested Effective Date: 10/01/2017
OK SPA # 17-12 — Outpatient Hospital Dental and ENT Rates
The proposed revisions will provide a new methodology for increasing the reimbursement rate for dental services in an outpatient hospital. The new method uses the cost of dental services and the cost of services in the Ambulatory Patient Classification group 5164 to calculate the rate for all outpatient hospitals.
Please view the draft SPA pages here: OK SPA 17-12, and submit feedback via the comment box below.
Tribal Consultation: 11/07/17
Comment Due Date: 01/05/2018
Requested Effective Date: 01/01/2018
OK SPA # 17-13 — Behavioral Health Targeted Case Management Units Limitation
A state plan amendment (SPA) is proposed in order to coincide with the Oklahoma Department of Mental Health and substance Abuse Services’ (ODMHSAS) proposed rule changes within APA WF # 17-09, Behavioral Health Case Management Limit, that were posted to OHCA’s public website for a 30-day comment period of June 26, 2017- July 28, 2017. The SPA limits the number of Behavioral Health Targeted Case Management (TCM) units to 16 units per member per year. A process for authorizing up to 25 units per member per month will be used for individuals who meet established medical necessity criteria demonstrating the need for additional units.
Please view the draft SPA pages here: OK SPA 17-13 BH TCM Units Limitation, and submit feedback via the comment box below.
Requested Effective Date: 09/01/2017
Tribal Consultation Date: 07/11/2017
Comment Due Date: 09/21/2017
OK SPA # 17-15 — Federally Qualified Health Center Services (FQHC) Alternative Payment Methodology (APM)
The proposed revisions will introduce a new optional payment methodology for Federally Qualified Health Centers (FQHCs). FQHCs are currently reimbursed through a Prospective Payment System (PPS) methodology; the proposed revision will add the Alternative Payment Methodology (APM) as an optional reimbursement method for FQHCs.
Please view the draft SPA pages here: OK SPA 17-15, and submit feedback via the comment box below.
Tribal Consultation: 11/07/17
Comment Due Date: 01/03/2018
Requested Effective Date: 04/01/2018
OK SPA # 17-16 — Private Duty Nursing (PDN)
PDN Rate Increase - OHCA proposes to increase the rate paid for private duty nursing (PDN) from $6.30 per 15 minute unit ($25.20/hour) to $7.55 per 15 minute unit ($30.20/hour). The adjustment attempts to better align the rates with the current economic situation experienced by this industry in Oklahoma as well as recruit and retain nurses in the field. The proposed rate increase will necessitate a state plan amendment.
Please view the draft SPA pages here: OK SPA 17-16, and submit feedback via the comment box below.
Tribal Consultation: 09/05/17
Comment Due Date: 10/08/2017
Requested Effective Date: 10/01/2017
OK SPA # 17-17 — Nursing Facilities' Wage Enhancement Payments Redaction
A proposed state plan amendment (SPA) removes wage enhancement language and requirements for specified employees in nursing facilities (NF) serving adults and intermediate care facilities for individual with intellectual disabilities (ICFs/IIDs). The revisions are necessary to comply with changes in Oklahoma state statute, which became effective July 1, 2017. The federal minimum wage and the change in rate setting methodology increased the wages for employees of NFs serving adults and ICFs/IIDs, resulting in the policy being obsolete.
Please view the draft state plan amendment (SPA) pages here: OK 17-17 NFs' Wage Enhancement Payments Redaction Draft SPA, and submit feedback via the comment box below.
Requested Effective Date: 01/01/2018
Tribal Consultation Date: 09/05/0217
Comment Due Date: 11/01/2017
Genetic Counseling
The proposed amendment to the State Plan will allow members to access genetic counseling after genetic testing has found that a member displays clinical features of a suspected genetic condition, is at direct risk of inheriting the genetic condition in question, or has been diagnosed with a condition where identification of specific genetic changes will impact treatment or management. Currently, the State Plan limits this service to women with a high-risk pregnancy.
Please view the draft state plan amendment (SPA) here: Genetic Counseling SPA Draft, and submit feedback via the comment box below.
Effective Date: 04/01/2017
Tribal Consultation Date: 03/07/2017
Circulation Date: 03/07/2017
60-day Tribal Consultation Period: 03/07/2017 - 05/06/2017
Pharmacy State Plan Amendment
The proposed amendment to the State Plan will revise language to reflect OHCA’s participation in the Sovereign States Drug Consortium for supplemental rebate negotiation. The amendment will also update the pharmacy coverage to specify that investigational drugs are not covered; even if they have been FDA approved but are part of a post marketing study or trial. Changes to reflect new federal regulations and the Affordable Care Act (ACA) guidelines regarding covered outpatient drugs and reimbursement were previously submitted to CMS for these pages.
Please view the draft state plan amendment (SPA) here: Pharmacy SPA Draft, and submit feedback via the comment box below.
Effective Date: 01/01/2017
Tribal Consultation Date: 03/07/2017
Circulation Date: 03/07/2017
14-day Expedited Tribal Consultation Peroid: 03/07/2017 - 03/20/2017
Title XXI Health Service Initiative (HSI)
Due to an increase in the CHIP FMAP for FY16 and FY17 to fund health service initiatives, the OHCA is exploring two projects including one targeting blood lead screening test awareness and utilization and one that would provide safe sleeps cribs to hospitals to distribute to families in need as part of an existing partnership between the State Health Department and various birthing hospitals. State match will be provided by either partner agencies or by the Oklahoma Health Care Authority. HSIs protect public health and/or the health of individuals, improves or promotes a state’s capacity to deliver public health services, strengthen the human and material resources necessary to accomplish public health goals to improve children’s health, and targets low-income children under 19.
Please view the draft state plan amendment (SPA) here: HSI SPA Draft, and submit feedback via the comment box below.
Effective Date: 07/01/2017
Tribal Consultation Date: 03/07/2017
Circulation Date: 03/07/2017
Comment Due Date: 03/20/2017
Access Monitoring Review Plan
OHCA is proposing the final draft of the Access Monitoring Review Plan for comment from interested parties. Comments will be considered until September 9, 2016.
Rate Reduction for Licensed Behavioral Health Professionals in Independent Practice
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for Licensed Behavioral Health Professionals in Independent Practice. A methodology change is requested to establish Independent Practice LBHP reimbursement rates for Common Procedure Terminology (CPT) codes which equate to 70% of the rates paid to LBHPs in an outpatient behavioral health clinic setting. Changes are necessary to reduce the Agency's spending to balance the state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated.
Please view the full rate reduction proposal here: Licensed Behavioral Health Professionals in Independent Practice. Please submit all comments by close of business, April 25, 2016 via the comment box below. Thank you for your participation in the process.
The following meetings are open to the public:
State Plan Amendment Rate Committee (SPARC) Meeting
April 25th, 2016 at 10:00a.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Board Meeting
April 28th, 2016 at 1:00p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Rate Reduction for Residential Psychiatric Services
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for Private, in-state Psychiatric Residential Treatment Facilities (PRTF), Private Psychiatric Hospitals (Institutions for Mental Disease) and General Hospitals with Psychiatric Units. A prospective per diem payment is made based on facility peer group for a comprehensive package of services and room and board; the proposed rates are 15% less than the current rates in effect. Changes are necessary to reduce the Agency's spending to balance the state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated.
Please view the full rate reduction proposal here: Residential Psychiatric Services. Please submit all comments by close of business, April 25, 2016 via the comment box below. Thank you for your participation in the process.
The following meetings are open to the public:
State Plan Amendment Rate Committee (SPARC) Meeting
April 25th, 2016 at 10:00a.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Board Meeting
April 28th, 2016 at 1:00p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Rate Reduction for Behavioral Health Licensure Candidates
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for Behavioral Health Licensure Candidates. The reimbursement rates for services provided by Licensure Candidates in outpatient behavioral health clinics will be reduced by 10%. This reduction will create new payment rates for outpatient behavioral health agencies which in the aggregate equal 67.4% of the 2007 Medicare Physician Fee Schedule. Changes are necessary to reduce the Agency's spending to balance the state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated.
Please view the full rate reduction proposal here: Behavioral Health Licensure Candidates. Please submit all comments by close of business, April 25, 2016, via the comment box below. Thank you for your participation in the process.
The following meetings are open to the public:
State Plan Amendment Rate Committee (SPARC) Meeting
April 25th, 2016 at 10:00a.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Board Meeting
April 28th, 2016 at 1:00p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Rate Reduction for Psychologists in Independent Practice
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for Psychologists in Independent Practice. The new rates will be 87.07% of the CY2013 Medicare Physician Fee Schedule. Changes are necessary to reduce the Agency's spending to balance the state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated.
Please view the full rate reduction proposal here: Psychologists in Independent Practice. Please submit all comments by close of business, April 25, 2016 via the comment box below. Thank you for your participation in the process.
The following meetings are open to the public:
State Plan Amendment Rate Committee (SPARC) Meeting
April 25th, 2016 at 10:00a.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Board Meeting
April 28th, 2016 at 1:00p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Rate Reduction for Freestanding Psychiatric Hospitals
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for freestanding psychiatric hospitals. Rates for freestanding psychiatric hospitals in effect as of 4-30-2016 will be decreased by 3 percent. Changes are necessary to reduce the Agency's spending to balance the state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated.
Additionally, the State provides clarification that the inpatient hospital provider rate cut of 7.75 percent promulgated in 2014 with an effective of July 1, 2014, was applicable to inpatient DRG and freestanding rehabilitation hospitals only; the 2014 inpatient hospital provider rate cut of 7.75 percent did not affect freestanding psychiatric hospitals.
Please view the full rate reduction proposal here: Freestanding Psychiatric Hospitals. Please submit all comments by close of business, April 25, 2016 via the comment box below. Thank you for your participation in the process.
The following meetings are open to the public:
State Plan Amendment Rate Committee (SPARC) Meeting
April 25th, 2016 at 10:00a.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Board Meeting
April 28th, 2016 at 1:00p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Access to Care Analysis RE: OK SPA 16-19 Freestanding Psychiatric Hospitals Rate Reduction
As part of the documentation of access to care and service payment rates federal requirements found at 42 CFR 447.203, the State must conduct an access to care analysis for any service within a state plan amendment that proposes to reduce or restructure provider payment rates in circumstances when the changes could result in diminished access.
OK SPA 16-19, Freestanding Psychiatric Hospitals Rate Reduction, was submitted June 22, 2016, with an effective date of May 1, 2016, and approved on February 10, 2017. This is the first annual update to the access to care analysis for the reduced payment rate within OK SPA 16-19.
Please view the draft access to care analysis here: OK SPA 16-19 Freestanding Psych Hospitals Rate Reduction 2017 Annual Access to Care Analysis, and submit feedback via the comment box below.
Circulation Date: 08/03/2017
Comment Due Date: 09/02/2017
Access to Care Analysis RE: OK SPA 16-20 Independent Practice LBHP & Psychologist Rate Reduction
As part of the documentation of access to care and service payment rates federal requirements found at 42 CFR 447.203, the State must conduct an access to care analysis for any service within a state plan amendment that proposes to reduce or restructure provider payment rates in circumstances when the changes could result in diminished access.
OK SPA 16-20, Freestanding Psychiatric Hospitals Rate Reduction, was submitted June 24, 2016, with an effective date of May 1, 2016, and approved on April 5, 2017. This is the first annual update to the access to care analysis for the reduced payment rate within OK SPA 16-20.
Please view the draft access to care analysis here: OK SPA 16-20 Independent Practice LBHP & Psychologist Rate Reduction 2017 Access to Care Analysis, and submit feedback via the comment box below.
Circulation Date: 08/03/2017
Comment Due Date: 09/02/2017
Access to Care Analysis RE: OK SPA 16-21 Psychiatric Residential Treatment Facilities (PRTF) Rate Reduction
As part of the documentation of access to care and service payment rates federal requirements found at 42 CFR 447.203, the State must conduct an access to care analysis for any service within a state plan amendment that proposes to reduce or restructure provider payment rates in circumstances when the changes could result in diminished access.
OK SPA 16-21, Freestanding Psychiatric Hospitals Rate Reduction, was submitted June 24, 2016, with an effective date of May 1, 2016, and approved on February 14, 2017. This is the first annual update to the access to care analysis for the reduced payment rate within OK SPA 16-21.
Please view the draft access to care analysis here: OK SPA 16-21 PRTF Rate Reduction 2017 Annual Access to Care Analysis, and submit feedback via the comment box below.
Circulation Date: 08/03/2017
Comment Due Date: 09/02/2017
Access to Care Analysis RE: OK SPA 16-26 Licensure Candidate Rate Reduction
As part of the documentation of access to care and service payment rates federal requirements found at 42 CFR 447.203, the State must conduct an access to care analysis for any service within a state plan amendment that proposes to reduce or restructure provider payment rates in circumstances when the changes could result in diminished access.
OK SPA 16-26, Licensure Candidate Rate Reduction, was submitted June 24, 2016, with an effective date of May 1, 2016, and approved on February 13, 2017. This is the first annual update to the access to care analysis for the reduced payment rates within OK SPA 16-26.
Please view the draft access to care analysis here: OK SPA 16-26 Licensure Candidate Rate Reduction 2017 Annual Access to Care Analysis, and submit feedback via the comment box below.
Circulation Date: 08/03/2017
Comment Due Date: 09/02/2017
Proposed amendment to the State Plan, reduction of payments for coinsurance and deductibles on all crossover claims
Due to further anticipated decreases in state appropriated funding, OHCA will propose a State Plan Amendment (SPA) to reduce payments for coinsurance and deductibles on all Medicare crossover claims. The proposed methodology is to consider the Medicare paid amount payment in full for all crossover claims, excluding ITU provided services and physician supplied drugs. Total payments from all sources will not be less than the Medicaid established rate of payment per claim. No payment will be made when the sum of payments from all other sources is greater than the Medicaid rate. The new payment methodology for crossover claims will take effect for services rendered on or after June 1, 2016.
Please submit all comments by close of business May 1, 2016, via the comment box below. Thank you for your participation in the process.
The following meetings about the proposed changes are open to the public:
State Plan Amendment Rate Committee (SPARC) Meeting
May 10, 2016 at 10 a.m.
Charles Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Board Meeting
May 12, 2016 at 1 p.m.
Charles Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Rate Revision for Behavioral Health Assessments performed in Outpatient Behavioral Health Agencies
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for Behavioral Health Assessments provided by outpatient behavioral health agencies. The current rates are based on a percentage of the 2007 Medicare Physician Fee Schedule and vary based on the length of the assessment. The proposed methodology would create a single reimbursement rate per assessment session regardless of time spent and would equate to 80% of the CY2016 MPFS for CPT code 90791 for fully licensed behavioral health professionals and 70% of the CY2016 MPFS for CPT code 90791 for licensure candidates.
Please submit all comments by close of business, August 5, 2016, via the comment box below. Thank you for your participation in the process.
Nursing Facility Rate Changes
For the rate period beginning July 1, 2016, a proposed amendment to the Title XIX State Plan will amend the reimbursement rates as follows for long-term care facilities:
- Regular Nursing Facilities. A revision will be made, establishing the pool amount for other and direct care components of the rate at $158,741,836. This will make the base rate $107.57 per patient day.
- Nursing Facilities serving residents with Acquired Immune Deficiency Syndrome (AIDS). A revision will be made to set the base rate at $199.19 per patient day.
- Regular (greater than 16 beds) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). A revision will be made to set the base rate at $122.32 per patient day.
- Acute (16 beds or less) Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). A revision will be made to set the base rate at $156.51 per patient day.
Please submit all comments by close of business, August 5, 2016, via the comment box below. Thank you for your participation in the process.
Change in Upper Payment Limit (UPL) Methodology & Supplemental Payments
The Oklahoma Health Care Authority proposes to change the Upper Payment Limit methodology and establish a Supplemental Payment for nursing facilities.
Please submit all comments by close of business, August 10, 2016, via the comment box below. Thank you for your participation in the process.
Access Monitoring Review Plan
CMS recently issued a final rule directing State Medicaid programs to analyze and monitor access to care for Medicaid fee-for-service programs. Through an access monitoring review plan, the State will demonstrate access to care by measuring the following: enrollee needs; the availability of care and providers; utilization of services; characteristics of the enrolled members, and estimated levels of provider payment from other payers. The plan must be created in consultation with the Medical Advisory Committee and be published and made available to the public for a period of no less than 30 days prior to being submitted to CMS. The State will submit the initial access monitoring review plan to CMS on July 1, 2016; the State will have to provide CMS a renewed plan noting any access issues and how the State resolved the issues every 5 years. Further, the state must conduct and submit an access monitoring review plan when promulgating a State Plan Amendment that affects payment methodology and/or rates.
Please view the plan document here: Access Monitoring Review Plan, and submit feedback via the comment box below by close of business May 19, 2016. Thank you for your participation in the process.
Medical Advisory Committee (MAC) Meeting:
May 19, 2016 at 1:00p.m.
Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N. Lincoln Blvd, Oklahoma City, OK 73105
Diagnosis-Related Group (DRG) Transfer Outlier Payments Method Change
The OHCA will change transfer methodology policy to reflect current practice as follows:
Transfers pay the lesser of transfer fee or Diagnosis-Related Group (DRG). In the case of a transfer, the Transfer Allowable Fee for the Transferring Facility shall be calculated as follows: Transfer Allowable Fee = (MS-DRG Allowable Fee/Mean Length of Stay) X (Length of Stay + 1 day). The total Transfer Allowable Fee paid to the transferring facility shall be capped at the amount of the MS-DRG Allowable Fee for a non-transfer case. Outlier payments will be paid to the transferring hospital, if applicable. Payment to the receiving facility, if it is also the discharging facility, will be at the DRG allowable plus outlier if applicable. No budget impact will result from this change in methodology as the action simply aligns the policy with the current practice.
Please view the full transfer methodology policy change here: DRG Transfer Outlier Payments. Please submit all comments by close of business, May 28, 2016 via the comment box below. Thank you for your participation in the process.
SPARC: 03/22/16
BOARD: 03/24/16
Title XXI Health Service Initiative (HSI) - MAGI
Due to an increase in the CHIP FMAP for FY16 and FY17 to fund health service initiatives, the OHCA is exploring a project designed to offer direct MAGI methodology instruction for agency enrollment partners. State match will be provided by a partner agency. HSIs protect public health and/or the health of individuals, improves or promotes a state’s capacity to deliver public health services, strengthen the human and material resources necessary to accomplish public health goals to improve children’s health, and targets low-income children under 19.
Please submit all comments by close of business, February 20, 2016 via the comment box below. Thank you for your participation in the process.
Title XXI Health Service Initiative (HSI)
Due to an increase in the CHIP FMAP for FY16 and FY17 to fund health service initiatives, the OHCA is exploring various projects including two projects targeting long acting reversible contraceptives (LARC); a foster child behavior health coordination and passport upgrade project; a naloxone rescue kits project; an outpatient donor breast milk project; and an academic detailing program targeting attention deficit hyperactivity disorder (ADHD) medications and atypical antipsychotic medications. State match will be provided by partner agencies and/or organizations. HSIs protect public health and/or the health of individuals, improve or promote a state’s capacity to deliver public health services, strengthen the human and material resources necessary to accomplish public health goals to improve children’s health, and target low-income children under 19.
Please submit all comments by close of business, February 3, 2016 via the comment box below. Thank you for your participation in the process.
Supplemental Hospital Offset Payment Program (SHOPP)
The Supplemental Hospital Offset Payment Program (SHOPP) was created and implemented in 2011 for the purpose of assuring access to quality care for Oklahoma Medicaid members. The program is designed to assess Oklahoma hospitals, unless exempt, a supplemental hospital offset payment program fee. Hospitals that are owned or operated by a federally recognized Indian Tribe or the Indian Health Service are among the exempt providers.
The OHCA is seeking to amend a State Plan page regarding SHOPP in order to address Centers for Medicare & Medicaid Services (CMS) concerns related to cost-to-charge ratio (CCR) and trending. CMS changed cost report formats in 2011 which changes the lines, specified in the State Plan, used to calculate the inpatient CCR. Also, CMS advises that we mention trending of costs in the State Plan.
Circulated Date: 09/25/2015
OHCA Comment Due Date: 10/07/2015
Proposed Submittal Date: 10/12/2015
Pursuant to House Bill 1566 passed by the Oklahoma Legislature in 2015, it is the intent of the Oklahoma Health Care Authority (OHCA) to issue a Request for Proposal (RFP) for care coordination model(s) for the Aged, Blind and Disabled (ABD) populations. To comply with the direction of the bill, the OHCA is soliciting information and input from a wide variety of stakeholders including but not limited to SoonerCare members, advocates, providers, health care systems, and the general public through a Request for Information (RFI) process, for the development and requirements of the RFP. Please submit all comments by the close of business July 24, 2015. Thank you for your participation in the process.
Circulated Date: 06/24/2015
OHCA Comment Due Date: 07/24/2015
Hospitals Deemed Disproportionate Share
Due to reductions in Agency budgets for SFY 2016, ODMHSAS is seeking to amend a State Plan page related to the deemed disproportionate share payment for hospitals to have the denominator include days attributable to Medicaid patients between 21 and 65 years of age in an Institution for Mental Diseases (IMD). The change is necessary in order to increase revenues to Griffin Memorial Hospital to balance ODMHSAS' state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated.
Circulated Date: 07/17/2015
OHCA Comment Due Date: 09/16/2015
Proposed Submittal Date: 09/30/2015
Developmental Disabilities Services Providers
Reimbursement for services will be changed to the following rates: Homemaker (State Fund)/Homemaker Respite, $3.20; Habilitation Training Specialist (State Fund), $3.78; Self-Directed Habilitation Training Specialist, $3.78; Intensive Personal Supports (State Fund), $3.78; Daily Living Supports (Therapeutic Leave), $143.97. Also, Group Home Respite Six Bed, $67.79; Seven Bed, $57.90; Eight Bed, $50.66; Nine Bed, $ 46.32; 10 Bed, $42.70; 11 Bed, $40.05; and 12-Bed, $37.63. Also, Group Home Community Living/Respite Six Bed, $125.45; Seven Bed, $121.35; Eight Bed, $111.46; Nine Bed, $103.74; 10 Bed, $97.46; 11 Bed, $92.16; 12 Bed, $87.09; Group Home Alternative – Four Bed, $272.85; Agency Companion-Close (Therapeutic Leave)/Respite, $90.23; Agency Companion-Enhanced (Therapeutic Leave)/Respite, $117.49; Agency Companion-Pervasive (Therapeutic Leave)/Respite, $1128.34; and Agency Companion-Intermittent (Therapeutic Leave)/Respite, $62.97. Additionally, Center Based Prevocational Services (State Fund), $4.67; Community Based Prevocational Services (State Fund), $9.34; Pre-vocational HTS-SUPP Supports (State Fund), $11.77; Enhanced Community Based Prevocational (State Fund), $12.47; Community Based Individual Services (State Fund) $15.13; Job Stabilization/Extended Services, $1.29; Job Coaching Service, $3.12; Enhanced Job Coaching Service, $3.63; Job Coaching Individual Services (State Fund), $4.15; Employment Specialist, $5.66; Transportation – Mileage Indirect, $.47; and Transportation-Adapted-Non-emergency Van, $1.21.
Circulated Date: 07/15/2015
OHCA Comment Due Date: 08/11/2015
DRG Hospital Readmissions
The OHCA proposes to reduce payment for hospital readmissions occurring within 30 days since the last hospital discharge date. OHCA will set the target to 102% for CY 2015, decreasing 1% per year until the target is 100%. A target of 102% means we would allow a hospital to have 102% of the potentially-preventable admissions that we would expect based on statewide data before we assess a penalty.
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
DRG Hospital Outlier Payment
The OHCA proposes to reduce DRG outlier payments by increasing DRG threshold to $50,000. Currently the DRG threshold is $27,000.
State Plan Amendment & Rate Change
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
DRG Hospital Lesser of Transfer Fee or DRG
The OHCA proposes to pay lesser of transfer fee or DRG. Payment to the receiving Facility, if it is also the final discharging Facility, will be at the DRG allowable. Currently, both are paid at the DRG allowable. No outlier payments will be allowed for transfers.
State Plan Amendment & Rate Change
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
Physician Services in Facility Setting
The OHCA proposes to pay like Medicare for physician services performed in a facility setting.
State Plan Amendment & Rate Change
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
Mid-level Practitioner Reimbursement
The OHCA proposes to reduce payments to mid-level practitioners to 85% of the appropriate OHCA physician fee schedule.
State Plan Amendment & Rate Change
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
Mid-level Practitioner Reimbursement
The OHCA proposes to reduce payments to mid-level practitioners to 85% of the appropriate OHCA physician fee schedule.
State Plan Amendment & Rate Change
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
Nursing Facility Crossovers
The OHCA proposes to reduce payments for coinsurance and deductibles from 100% to 75%.
State Plan Amendment & Rate Change
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
Durable Medical Equipment
The OHCA proposes to reimburse for stationary oxygen using the Medicare competitive bid rate. In addition, the agency proposes to eliminate coverage for sterile water and gloves.
State Plan Amendment & Rate Change
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
Polycarbonate Lenses
The OHCA proposes to reduce payments for polycarbonate lenses to $10 per lens.
Circulation Date: 05/06/2015
Comment Due Date: 06/07/2015
Medical Advisory Committee (MAC): 05/21/2015
State Plan Amendment Rate Committee (SPARC) Meeting: 06/18/2015
Board: 06/25/2015
Mental Health Substance Use Screening
Rules were revised during 2015 permanent rulemaking to add coverage of Mental Health/Substance Use Disorder (MH/SUD) screens provided in outpatient behavioral health agencies. ODMHSAS proposes to reimburse for screens provided by qualified providers using approved evidence based tools at a rate of $25.32 per event.
Circulated Date: 07/15/2015
OHCA Comment Due Date: 08/11/2015
Independent Practitioners Rate Equalization
The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for independent Licensed Behavioral Health Practitioners (LBHPs) in order to equalize payment for their services with the payments made for services provided by the same level of provider in an outpatient behavioral health agency setting. This change is being proposed due to the agency budget shortfall of SFY2016. This change does not affect the methodology for Physicians, Psychiatrists or Psychologists.
Circulated Date: 07/15/2015
OHCA Comment Due Date: 08/11/2015
Severe Combined Immunodeficiency Disorder (SCID) Newborn Screen
The Oklahoma State Department of Health (OSDH) has recently (February 2015) added a new test to the existing state-mandated panel for newborn screening (NBS). This test, which screens for Severe Combined Immunodeficiency Disorder (SCID), was approved as part of the national Recommended Uniform Screening Panel (RUSP) for newborn testing, which includes 31 core disorders and 26 secondary disorders, in May 2010. The OSDH NBS Program has systematically adopted all testing reflected in the nationally-recognized RUSP. SCID includes more than 10 genetic disorders characterized by profound defects in both cellular immunity and specific antibody production, and is estimated to occur in about 1/33,000 births. Early identification of the asymptomatic SCID infant during the first few weeks of life is essential for successful treatment, which generally involves allogeneic hematopoietic stem cell transplantation. SCID infants who are treated early have almost 10-fold lower total clinical care costs compared with those treated later. If undiagnosed, SCID infants usually die from severe infections with the first year of life. Unfortunately, while SCID is potentially treatable, it is infrequently recognized prior to the onset of devastating infections.
This test will also detect clinically important, non-SCID T-cell-related lymphocyte deficiencies in newborns, which can also be associated with serious morbidities in early childhood. Currently more than half of the babies born in the US are screened for SCID. SCID testing in newborns involves real-time PCR – a technology that is currently not part of other NBS testing – to amplify T-cell receptor excision circles (TRECs). The OSDH Public Health Laboratory (PHL) secured funding from the CDC in 2013 to develop the capacity to offer SCID screening of newborns in Oklahoma; these funds were used to purchase equipment, reagents and consumables for test validation and to hire testing personnel. Following comprehensive test validation, the OSDH PHL implemented routine, population-based SCID screening of newborns in February 2015. The CDC funds were not intended, and are insufficient, to sustain any long term testing; therefore, OSDH is requesting a charge of $6 to be added to the current fee in order to offset the added costs incurred in performing SCID screening. These costs included those associated with laboratory analysis of dried blood spot specimens and follow-up triage of presumptive cases by Screening and Special Services.
Circulated Date: 07/15/2015
OHCA Comment Due Date: 08/11/2015
The Oklahoma Health Care Authority (OHCA) recommends adding a rate for a new code (81415) for exome sequence analysis.
Circulated Date: 07/15/2015
OHCA Comment Due Date: 08/11/2015
Addition of Health Home services - Adults
The Oklahoma State Plan will be amended to include the addition of Health Home services as authorized in federal law. Two new service delivery models will be created as a result of the State Plan Amendment. One health home will provide an integrated system of services to assist children with serious emotional disturbance. The adult health home will serve qualifying individuals with serious mental illness. Health home providers will coordinate all primary, acute and behavioral health and long-term care services and supports to treat the whole person.
Circulated Date: 07/10/2014
OHCA Comment Due Date: 08/09/2014
Proposed Submittal Date: 10/01/2014
Addition of Health Home services - Children
The Oklahoma State Plan will be amended to include the addition of Health Home services as authorized in federal law. Two new service delivery models will be created as a result of the State Plan Amendment. One health home will provide an integrated system of services to assist children with serious emotional disturbance. The adult health home will serve qualifying individuals with serious mental illness. Health home providers will coordinate all primary, acute and behavioral health and long-term care services and supports to treat the whole person.
Circulated Date: 07/10/2014
OHCA Comment Due Date: 08/09/2014
Proposed Submittal Date: 10/01/2014
State Plan Amendment to allow for additional Program for All-Inclusive Care for the Elderly (PACE) providers to contract with OHCA.
Circulated Date: 04/17/2014
OHCA Comment Due Date: 05/19/2014
Proposed Submittal Date: 07/01/2014
State Plan Change for Reimbursement of certain Outpatient Drugs
Circulated Date: 03/22/2013
OHCA Comment Due Date: 04/04/2013
Federal regulation at 42 CFR 447.203, documentation of access to care and services payments, directs State Medicaid programs to analyze and monitor access to care for Medicaid fee-for-service programs through the Access Monitoring Review Plan (AMRP). Through the AMRP, the State demonstrates access to care by measuring the following: enrollee needs; the availability of care and providers; utilization of services; characteristics of the enrolled members; and estimated levels of provider payment from other payers. The AMRP must be taken through consultation with the State's Medical Advisory Committee (MAC) and be published and made available to the public for a period of no less than 30 days prior to being submitted to the Centers for Medicare & Medicaid Services (CMS). The State submitted the initial access monitoring review plan on September 28, 2016 and must submit a revised plan every three years. The AMRP will note any access issues identified during the prior three years and if any issues were identified, the plan will include a corrective action plan. Further, the AMRP includes the State’s access to care analyses conducted for State Plan amendments that reduced and/or restructured payment rates that could diminish access to care which were promulgated and approved within the previous three years.
Please view the draft SPA pages here: 2019 Access Monitoring Review Plan, and submit feedback via the comment box below.
MAC Date: 09/05/2019
Circulation Date: 08/27/2019 – 09/26/2019
Submittal to CMS Date: 09/30/2019
Statewide Transition Plan
Pursuant to 42 C.F.R. § 441.301, the Oklahoma Health Care Authority (OHCA) is required to give public notice and receive public input on any significant proposed changes to the 1915(c) Home and Community-Based Services (HCBS) waivers.
Oklahoma Transition Plan for Home and Community-Based Services (HCBS) Settings
The purpose of this Transition Plan is to ensure the individuals receiving Home and Community-Based Services (HCBS) are integrated in and have access to supports in the community, including opportunities to seek employment, work in competitive integrated settings, engage in community life, and control personal resources. The State has prepared a revised transition plan in order to comply with federal regulations for community-based settings. Overall, the Transition Plan provides assurance that the individuals receiving HCBS have the same degree of access as individuals not receiving Medicaid HCBS. This updated Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements.
All HCBS settings have to be in compliance by March 2019. The State must continue to submit Statewide Transition Plans to CMS until both an initial and final approval of the plan is received. The following is an outline of the CMS Statewide Transition Plan submission and approval process:
- Initial Proposed Plan
- Clarifications and/or Modifications required for Initial Approval (CMIA): The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, but CMS has identified issues that must be resolved in the STP prior to initial approval.
- Initial Approval with Milestones and a Resubmission Date: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP is sufficient, but systemic and/or site-specific assessments are not yet completed. The response to the state will vary dependent on whether the state has or has not identified settings that are presumed to have institutional characteristics and any information the state may wish CMS to consider under the heightened scrutiny process.
- Final Approval: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP has provided all necessary information including but not limited to; systemic assessment, site specific assessment, settings presumed to have institutional characteristics, information regarding heightened scrutiny or the state’s decision to let the presumption stand, and clear remedial steps with milestones are delineated.
- Approved Plan: The CMS approved STP.
Please view the Statewide Transition Plan in its entirety here: Statewide Transition Plan. The plan will be posted for public comments from December 22, 2016 - January 22, 2017. The Amended Statewide Transition Plan was submitted to CMS on December 22, 2016.
For more information regarding the Statewide Transition Plan, please see the training webinar video.
Previous Submissions and CMS Feedback, concerning the Statewide Transition Plan, can be viewed here:
- Initial Statewide Transition Plan - Submitted May 2015
- CMS Response Letter to Initial Submission
- Amended Statewide Transition Plan - Submitted January 2016
- CMS Response to Amended Submission
- Amended Statewide Transition Plan - Submitted November 2016
- CMS Final Approval Letter - August 2017
- Statewide Transition Plan - Approved August 2017
Please submit your comments 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. A non-electronic version of this Statewide Transition Plan can be requested by writing to the address above or calling 1-888-287-2443.
Disclaimer: Oklahoma Health Care Authority (OHCA) policy comment section will be reviewed and considered under the current policy rule change. Personal information should not be shared/or submitted in the comment section. This comment section is reserved for proposed policy rule changes.
