OK SPA 21-0014 Alternative Benefit Plan (ABP) Benefits Updates

OK SPA 21-0014, Alternative Benefit Plan (ABP) Benefits Updates - Effective July 1, 2021

ABP updates include revisions to the original content submitted to CMS. The State will note that infusion therapy is a covered service, appropriately rename the skilled nursing service, and remove long-term care services from the ABP. Additionally, the OHCA seeks to make changes to its ABP by removing the 24-day limitation for inpatient physician services, adding medication assisted treatment (MAT) services, and adding residential substance use disorder (SUD) treatment services. The ABP provides benefits to Expansion Adults, as described in 42 CFR 435.119. The proposed service changes were recently amended or added to the Oklahoma State Plan; the benefit package within the Adult Expansion ABP is being revised to reflect the approved State Plan.

Further, per legislative directive from the 58th Oklahoma Legislature, the OHCA will expand dental benefits within the Oklahoma State Plan. Dental examinations, X-rays, dental cleanings, fluoride, dental fillings, scaling and root planning, as well as, dentures and partial dentures will be added as covered services, subject to prior authorization, for adult SoonerCare members. Adult members, including Expansion Adults, will have access to the aforementioned dental benefits effective July 1, 2021. The newly added dental services will be reimbursed pursuant to the current established methodology for dental services within the Oklahoma State Plan. Coverage of newly added dental services, as described, will also be added to the ABP SPA.

Please view the draft SPA pages here: OK SPA 21-0014, and submit feedback via the comment box below.

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