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Archived Proposed Policy Changes

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

For Quick Reference Search; please click the applicable archive Proposed Policy Changes  


APA WF# 20-01 High-Investment Drugs Carve-Out

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will allow for reimbursement of high-investment drug therapies outside of the inpatient and outpatient hospital payment methodologies. Revisions will also align policy with current practice and correct grammatical errors. 

Please view the circulation document here: APA WF# 20-01, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021


APA WF# 20-02 Retroactive Eligibility

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed rule changes provide for a retroactive period of eligibility, in accordance with 42 Code of Federal Regulations § 435.915. 

Please view the circulation document here: APA WF# 20-02, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021


APA WF# 20-03 Treatment of Lottery or Gambling Winnings for Income Eligibility

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions amend how lottery or gambling winnings of $80,000 and above, which are paid out in a single payout, and not in installments over a period of time, are counted for SoonerCare income eligibility. 

Please view the circulation document here: APA WF# 20-03, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021


APA WF# 20-04 Electronic Visit Verification (EVV)

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed new rules are needed in order to comply with the 21st Century Cures Act which requires providers of personal care services to utilize an EVV system where visit details are documented. 

Please view the circulation document here: APA WF# 20-04, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 


APA WF# 20-05 Continuation of Services Pending Appeals

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed new rule will comply with Section 431.230 of Title 42 of the Code of Federal Regulations by describing the conditions in which Medicaid benefits will continue or be reinstated pending an appeal. Additionally, the proposed new rule will describe the application, obligations, and implications for the appellant when Medicaid benefits are continued or reinstated pending an appeal. 

Please view the circulation document here: APA WF# 20-05, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021


APA WF# 20-06B Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit.  Prosthetics and orthotics are under a separate regulation and remain an optional benefit.  

Please view the circulation document here: APA WF# 20-06B, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021


APA WF# 20-06C Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit.  Prosthetics and orthotics are under a separate regulation and remain an optional benefit.  

Please view the circulation document here: APA WF# 20-06C, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 02/22/2021

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021


APA WF# 20-06D Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit.  Prosthetics and orthotics are under a separate regulation and remain an optional benefit.  

Please view the circulation document here: APA WF# 20-06D, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021


APA WF# 20-11 Medicare Part C (Medicare Advantage)

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will standardize the language in policy between Medicare Part A, Part B, and Part C.

Please view the circulation document here: APA WF# 20-11, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021


APA WF# 20-13 Child Support Cooperation Exemption for Recipients of Indian Health Services

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will reflect changes in federal regulations regarding a Medicaid agency's process for medical child support referrals.

Please view the circulation document here: APA WF# 20-13, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021


APA WF# 20-15A Residential Substance Use Disorder (SUD) Treatment Coverage

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will support WF 20-15B, which proposes to establish coverage of residential substance use disorder (SUD) treatment for Medicaid-eligible individuals and removes the eligibility exclusion of members in an institution for mental disease (IMD) under the SoonerCare Choice program. Lastly, the proposed revisions will also remove "family planning" references as the program is terminating due to Medicaid expansion. 

Please view the circulation document here: APA WF# 20-15A, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 


APA WF# 20-15B Residential Substance Use Disorder (SUD) Treatment Coverage

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

Emergency rule revisions established residential SUD treatment coverage for Medicaid-eligible adults, ages twenty-one (21) to sixty-four (64), and members under the age of twenty-one (21) in residential SUD treatment facilities with seventeen (17) beds or more and/or residential SUD treatment facilities with sixteen (16) beds or less. Permanent rule revisions will remove references to non-Medicaid compensable services and align covered services with the Oklahoma Medicaid State Plan. Further revisions will revise assessment and service plan timeframes and certain treatment hour requirements. Other revisions will involve limited rewriting aimed at clarifying policy language.

Please view the circulation document here: APA WF# 20-15B, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-16 Opioid Treatment Program (OTP) and Medication-Assisted Treatment (MAT) Services

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will comply with the SUPPORT Act, HR 6, and establish coverage and reimbursement of medically necessary medication-assisted treatment (MAT) services and/or medications for SoonerCare members with opioid use disorder (OUD) in opioid treatment programs (OTPs) and within office-based opioid treatment (OBOT) settings. 

Please view the circulation document here: APA WF# 20-16, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 


APA WF# 20-19A Appeals Language Cleanup

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed rule changes will replace incorrect rule section references with the appropriate references. Additionally, revisions will remove appeals language for programs that no longer exist and will identify the appropriate appeal form to fill out when filing an appeal.

Please view the circulation document here: APA WF# 20-19A, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021


APA WF# 20-19B Appeals and Incorrect References Language Cleanup

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will revise certain sections of policy that have references to incorrect or outdated sections.    

Please view the circulation document here: APA WF# 20-19B, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 


APA WF# 20-20 Pay-For-Performance Program

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will update the Pay-for-Performance (PFP) program quality measures to align with the most recent metrics modified by the Centers for Medicare and Medicaid. Additional revisions will specify the timeline in which a nursing facility can submit its quality of care documentation to be eligible for reimbursement.   

Please view the circulation document here: APA WF# 20-20, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021


APA WF# 20-21 Employment Services Offered through Developmental Disabilities Services

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed rule revisions will describe group job placements. Additional changes will authorize remote supports for individual placements and remove the specific limit that the cost of the member's employment services, excluding transportation and state-funded services, cannot exceed limits specified in OKDHS Appendix D-26. Furthermore, changes will clarify that adult members receiving In-Home Supports Waiver (IHSW) services can access individual placement in job coaching, stabilization, and employment training specialist services; however, not to exceed limits specified in OKDHS Appendix D-26 per Plan of Care year. Additional revisions will include updates to standard policy language including cleanup of formatting and grammatical errors plus clarify and update terminology used to reflect current business practices. 

Please view the circulation document here: APA WF# 20-21, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 


APA WF# 20-22 Programs of All Inclusive-Care for the Elderly (PACE) Revisions

The proposed revisions will update policy regarding enrollment denials for PACE to reflect current business practices. Additional policy changes will add language to clarify and establish OHCA's role in reviewing justifications for expedited appeals from PACE organizations. These proposed rule changes will align policy with Section 460.122 of Title 42 of the Code of the Federal Regulations.   

Please view the circulation document here: APA WF# 20-22, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-23 Developmental Disabilities Services (DDS) Revisions

The proposed revisions will change the timeframe for the physical health examinations and medical evaluations that are required when applying for the DDS Home and Community-Based Services waiver from ninety (90) to one (1) calendar year. Additionally, revisions will add language for remote services that are provided in the member's home, family home, or employment site. Revisions will also address the new agency companion household criteria and new agency champion provider requirements, as well as modify the procedures for the DDS home profile process. Finally, revisions will establish new criteria on how the member is to obtain assistive technology devices and will clarify instructions to staff whom are providing Stabilization Services authorized through remote supports.

Please view the circulation document here: APA WF# 20-23, and submit feedback via the comment box below.

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-24A ADvantage Waiver

The proposed revisions will align waiver policy with the Oklahoma Health Care Authority's overarching Electronic Visit Verification rules. Additional revisions will involve eliminating or updating outdated policy and correcting grammatical errors.

Please view the circulation document here: APA WF# 20-24A, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-24B ADvantage Waiver

The proposed revisions will align waiver policy with the Oklahoma Health Care Authority's overarching Electronic Visit Verification rules. Additional revisions will involve eliminating or updating outdated policy and correcting grammatical errors. 

Please view the circulation document here: APA WF# 20-24B, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 


APA WF# 20-25 Peer Recovery Support Specialist (PRSS) Services in Indian Health Services, Tribal Programs and Urban Indian Clinics (I/T/Us)

The proposed revisions will add coverage and reimbursement of PRSS services. The proposed revisions will also support WF 20-15A&B in adding coverage and reimbursement of residential substance use disorder (SUD) treatment services. Other revisions will reorganize policy for clarity and correct grammatical errors.

Please view the circulation document here: APA WF# 20-25, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-26 Applied Behavior Analysis (ABA) Services Revisions

The proposed revisions will clarify individualized treatment plan requirements, common ABA-based techniques, medical necessity criteria, and required documentation for ABA treatment extension requests. The proposed revisions will also allow licensed psychologists to render ABA services without additional ABA-related certification requirements. Other revisions will involve limited rewriting aimed at clarifying policy language. 

Please view the circulation document here: APA WF# 20-26, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 


APA WF# 20-27 Specialty Psychiatric Residential Treatment Facility (PRTF) Staffing and Admission Revisions

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will make changes to the specialty Acute II and PRTF staffing ratio and criteria for admission.

Please view the circulation document here: APA WF# 20-27, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-29 Provider Refund to Member when Copayment is Over-Collected

The proposed revisions will state the provider's requirement to refund any copayment collected from the member in error. 

Please view the circulation document here: APA WF# 20-29, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-31 State Treasurer’s Achieving a Better Life Experience (STABLE) Accounts

The proposed revisions further define Aged, Blind, and Disabled (ABD) resource exclusion rules regarding contributions to STABLE accounts.  

Please view the circulation document here: APA WF# 20-31, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-33 Bariatric Surgery Revisions

The proposed revisions will update bariatric surgery requirements and guidelines to reflect current business practice. Additional revisions will involve fixing grammatical and/or formatting errors, as well as, revoking obsolete sections.

Please view the circulation document here: APA WF# 20-33, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-34 Dental Revisions

The proposed rule changes will add "scaling in the presence of a generalized moderate or severe gingival inflammation" as a new procedure to dental policy. Additional revisions will specify that a caries risk assessment form must be documented when submitting a prior authorization for crowns. Further revisions will explain that written consent from a parent or court appointed legal guardian must be provided for any services that are rendered to a minor child. Finally, revisions will clarify billing language for administering nitrous oxide and involve cleanup of formatting and grammatical errors. 

Please view the circulation document here: APA WF# 20-34, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 


APA WF# 20-36A Lodging, Meals, and SoonerRide

The proposed revisions will update the lodging and meals policy by changing the allowed mileage radius from one hundred miles or more to fifty miles or more. This change improves access to the lodging and meals benefit and to medically necessary care. Additional changes will reformat and organize the existing policy in order to provide better clarity on how the approval process works for the lodging and meals benefit. Furthermore, the proposed revisions will update and reformat the SoonerRide Non-Emergency Transportation (NEMT) policy to provide more clarity to providers and members. The proposed revisions will outline the specific services that SoonerRide NEMT offers and how members and long-term care facilities can request transportation assistance through SoonerRide NEMT. The proposed revisions to lodging and meals, as well as SoonerRide, will align policy with current business practices.

Please view the circulation document here: APA WF# 20-36A, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-36B Lodging, Meals, and SoonerRide

The proposed revisions will remove duplicate policy regarding lodging, meals, and SoonerRide non-emergency transportation. The policies regarding these services are already outlined in the Oklahoma Health Care Authority's Chapter 30. 

Please view the circulation document here: APA WF# 20-36B, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 


APA WF# 20-37 Obstetrical (OB) Ultrasound

The proposed revisions will update the OB Ultrasound policy to allow for both an abdominal and vaginal ultrasound to be performed in the first trimester when clinically appropriate and medically necessary.  Policy currently only allows for either an abdominal or vaginal ultra sound.

Please view the circulation document here: APA WF# 20-37, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-38 Clinical Trials

The proposed revisions will add guidelines for coverage of clinical trials medical necessity criteria for coverage of routine care services during a clinical trial, and clarifying that experimental and investigational treatment is not covered. 

Please view the circulation document here: APA WF# 20-38, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 


APA WF# 20-39 Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Policy Revisions

The proposed revisions will align RHC/FQHC policy language with the Oklahoma Medicaid State Plan, federal regulations and OHCA's current business practices. 

Please view the circulation document here: APA WF# 20-39, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 


APA WF# 20-40 Medicaid-Funded Abortion Certification Requirements

The proposed revisions will align with 63 Oklahoma Statutes § 1-741.1 and require the Certification for Medicaid Funded Abortion form to be completed by the physician and the patient.

Please view the circulation document here: APA WF# 20-40, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


APA WF# 20-41 Sunsetting of Behavioral Health Homes

The Health Homes benefit will be phased out effective September 30, 2021; thereby, rendering the associated rule language obsolete. However, other care coordination models will still be in place to still serve this population.

Please view the circulation document here: APA WF# 20-41, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021


    APA WF# 20-01 High-Investment Drugs Carve-Out

    The proposed revisions will allow for reimbursement of high-investment drug therapies outside of the inpatient and outpatient hospital payment methodologies. Revisions will also align policy with current practice and correct grammatical errors.

    Please view the circulation document here: APA WF# 20-01, and submit feedback via the comment box below.

    Circulation Date: 01/15/2020

    Comment Due Date: 02/14/2020

    Medical Advisory Committee: 03/12/2020

    Board Meeting: 03/18/2020


OK SPA 21-0009 Rate Revisions for the Specialty, Standard, and Extended Psychiatric Residential Treatment Facilities (PRTFs)

The Oklahoma Mental Health & Substance Abuse (OMHSA) will seek approval of a State Plan Amendment (SPA) to revise rates for PRTFs. The established per diem base rate for standard populations will be restored from $286.08 to $336.57 (the rate prior to the 2016 budget reduction). The established per diem base rate for standard populations will be restored from $271.61 to $319.54 (the rate prior to the 2016 budget reduction). The established per diem base rate for specialty populations will increase from $340.04 to $550.00.  

Please view the draft SPA pages here: OK SPA 21-0009, and submit feedback via the comment box below.  

Tribal Consultation: 01/05/2021 

30-day Tribal Consultation Period: 01/05/2021 – 02/04/2021 

Circulation Date: 12/28/2020  

Comment Due Date: 1/27/2021


OK SPA 21-0013 OMB Rate for Tribal Providers of Residential Substance Use Disorder Services (SUD) in a Non-IMD

The OHCA originally presented policy changes and a state plan amendment request to establish coverage and reimbursement of residential substance use disorder (SUD) treatment services for individuals under the age of 21 and individuals age 21-64 residing in facilities with 16 beds or less in September 2020. At the time of the submission, the State requested reimbursement for all providers at a State-defined per diem rate. However, since submission of OK SPA 20-0035, Residential SUD Services, the State has received further guidance from CMS of options for reimbursement methodologies of residential services to tribal providers. Therefore, the State will seek to reimburse tribal providers an outpatient OMB rate for residential substance use disorder services.

Please view the draft SPA pages here: OK SPA 21-0013, and submit feedback via the comment box below. 

Tribal Consultation Dates: 01/05/2021

30-day Expedited Tribal Consultation Period: 01/05/2021 – 02/04/2021 

Circulation Date: 01/25/2021– 02/04/2021 

Requested Effective Date: 01/01/2021 


OK SPA 21-0016 Adult Inpatient Physician & Surgical Physician Visit Limitation

Oklahoma’s (OK) state plan amendment (SPA) 21-0016 will remove the 24-day per state fiscal year limit for covered inpatient physician and surgical services provided to adult SoonerCare members. The limitation is removed to align with current practice and for the purposes of the alternative benefit plan for adults in the expansion group. 

Please view the draft SPA pages here: OK SPA 21-0016, and submit feedback via the comment box below.  

Tribal Consultation: 01/05/2021  

60-day Tribal Consultation Period: 01/05/2021 – 03/06/2021  

Circulation Date: 01/05/2021   

Comment Due Date: 02/04/2021  


OK SPA 21-0019 Applied Behavior Analysis (ABA) Psychologist Requirements

The proposed revision will allow licensed psychologists to render ABA services without additional ABA-related certification requirements.  

Please view the draft SPA pages here: OK SPA 21-0019, and submit feedback via the comment box below.   

Tribal Consultation: 01/05/2021 

60-day Tribal Consultation Period: 01/05/2021 – 03/06/2021  

Circulation Date: 01/21/2021 

Comment Due Date: 02/20/2021 


Enrollment of Certain Medicaid Members under the Demonstration and Implementation of SoonerSelect Managed Care Model, effective: October 1, 2021, contingent upon CMS approval

With this amendment request, the OHCA seeks approval of the following modifications to the 1115(a) demonstration Special Terms and Conditions (STCs) for the current extension period that will be effect through the end of the waiver demonstration on December 31, 2023: 

  • Add the Expansion Adult Group under the Demonstration for the purposes of waiving retroactive eligibility and enrolling the Expansion Adult Group in SoonerSelect, the State’s comprehensive Medicaid managed care model; 
  • Add the Former Foster Care Group under the Demonstration for the purpose of enrolling this Group in SoonerSelect; and
  • Enroll qualified individuals in SoonerSelect, with a targeted effective enrollment date of October 1, 2021.

The requested amendment does not change the budget neutrality model for current Demonstration populations. 

The OHCA welcomes comments from the public regarding the amendment to the SoonerCare Choice and Insure Oklahoma 1115(a) demonstration waiver program. Please view the waiver amendment in its entirety here: OK Waiver Amendment, Managed Care Organizations(MCO), and submit feedback via the comment box below.  

The public notice for the waiver may be viewed on the Agency’s Policy change and Native American Consultation webpages. The amendment will be available for a 30-day public comment period from January 4, 2021 through February 5, 2021.  

Tribal Consultation Dates: 07/07/2020 

60-day Tribal Consultation Period: 07/07/2020 – 09/05/2020

30-day Circulation Date: 01/04/2021 – 02/05/2021

Requested Effective Date: 10/01/2021

OHCA Comment Response: Oklahoma joins 40 other states in engaging with managed care organizations to assist them in administering certain Medicaid benefits. This is one of the largest contracts procured in the state’s history. The contracts were competitively bid and were selected after a technical evaluation and oral presentations. The four chosen partners will allow the State to improve health outcomes for Oklahomans; move toward value-based payment and away from payment based on volume; improve SoonerCare beneficiary satisfaction; improve access to prevention and treatment services through better care coordination; and increase cost predictability in the State. 


1915(c) HCBS In-Home Supports Waiver for Children Amendment effective:  upon CMS approval or July 1, 2021, whichever is earlier

The Oklahoma Department of Human Services (OHS) is seeking to amend the In-Home Supports Waiver for Children serving individuals ages 3-17 through a combination of community resources, SoonerCare services such as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, and waiver services. OHS/DDS case managers help identify concerns and coordinate, locate, and secure needed services. OHS/DDS case managers also help families recognize natural supports that may already be available.  

The waiver amendment proposes to decrease the unduplicated number of participants for waiver year 5. The amendment adds a telehealth delivery option for Family Training services and the option for electronic signature for service plan developments. Further updates allow for OHS/DDS case management and quality assurance staff the option of monitoring members in their own home via phone calls or video conferencing. Critical event or incident reporting requirements are also updated. 

Please view the waiver amendment here: 1915(c) HCBS In-Home Supports Waiver for Children Amendment, and submit feedback via the comment box below.  

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 


1915(c) HCBS In-Home Supports Waiver for Adults Amendment effective: upon CMS approval or July 1, 2021, whichever is earlier

The Oklahoma Department of Human Services (OHS) is seeking to amend the In-Home Supports Waiver for Adults. The purpose of the In-Home Supports Waiver for Adults (IHSW-A) is to assist members in their goal to lead healthy, independent, and productive lives to the fullest extent possible; promote the full exercise of their rights as citizens of their community, state, and country; and promote the integrity and well-being of their families.  

The waiver amendment increases the unduplicated number of participants and updates the participant-directed and quality payment sub-components to the supported employment services for waiver year 5.  The amendment adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as for OHS/DDS case management and quality assurance staff the option of monitoring members in their own home via phone calls or video conferencing. Critical event or incident reporting requirements are also updated. 

Please view the waiver amendment here: 1915(c) HCBS In-Home Supports Waiver for Adults Amendment, and submit feedback via the comment box below. 

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 


1915(c) HCBS Homeward Bound Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval

The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the Homeward Bound Waiver. The Homeward Bound waiver is intended to better meet the needs of members representing the Plaintiff Class in Homeward Bound et al v. The Hissom Memorial Center et al, United States District Court, Northern District of Oklahoma, Case No. 85-C-437-e. The Homeward Bound waiver is a self-determined waiver which services include residential and comprehensive supports for class members.  

The waiver renewal will decrease the number of participants served and update the unduplicated number of participants, the State's financial estimates, and add the supported employment service quality payment sub-component for waiver years 1-5. The 12-month period amount for all prevocational services and supported employment services combined will increase. The renewal adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as the option of monitoring members in their own home via phone calls or video conferencing for OHS/DDS case management and quality assurance staff. Critical event or incident reporting requirements are also updated. 

Please view the renewal application here: 1915(c) HCBS Homeward Bound Waiver Renewal, and submit feedback via the comment box below. 

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 


1915(c) HCBS Community Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval

The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the Community Waiver which serves individuals with intellectual disabilities beginning at age three. Services are provided with the goal of promoting independence through the strengthening of the member’s capacity for self-care and self-sufficiency.  

The waiver renewal will decrease the unduplicated number of participants, reserved capacity, and the State's financial estimates for waiver years 1-5 and increases the 12-month period amount for all prevocational services and supported employment services combined. The renewal adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as the option of monitoring members in their own home via phone calls or video conferencing for OHS/DDS case management and quality assurance staff. Critical event or incident reporting requirements are also updated. 

Please view the renewal application here: 1915(c) HCBS Community Waiver Renewal, and submit feedback via the comment box below. 

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

    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 Clinics

    This 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 Extractions

    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 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

2.May 19, 2016 at 1:00p.m. Medical Advisory Committee Meeting

    1115 Waiver Demonstration Feedback

    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


    SC Waiver 12-01

    Modification to the Health Management Program within SoonerCare Choice 

    Circulated Date: 09/05/2012 

    OHCA Comment Due Date: 10/15/2012  


     

    Amendment Request

    1115(a) SoonerCare Research and Demonstration Waiver   

    05/06/2014 Tribal Agenda

    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.

         

     
     ADvantage Waiver 

    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.
     
    Please view the renewal application here: In-Home Supports for Adults 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.
     
    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 – 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.

    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 – 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.