OK SPA 21-0035 Alternative Non-Pharmacological Treatments for Pain Management (UPDATED)
The proposed state plan amendment adds coverage and reimbursement for chiropractor services and physical therapy services for the treatment of pain management in an effort to reduce or prevent the use of opioid medications for SoonerCare adult members. The proposal will define provider participation and credentialing requirements, medical necessity, coverage and service limitation guidelines, and reimbursement methodology. Reimbursement for chiropractic and physical therapy services will follow the Agency’s existing rate methodology that is used for physician services which are updated annually, per the current State Plan.
Please view the draft SPA pages here: OK SPA 21-0035 and submit feedback via the comment box below.
Tribal Consultation: 07/06/2021
30-Day Tribal Consultation Period: 07/06/2021 – 08/05/2021
Circulation Date: 07/06/2021
Comment Due Date: 08/05/2021
Comments
Jimmy Leopard:
My understanding is that this SPA will only allow for payment for physical therapy services to non-hospital based physical therapy providers. Our hospital-based physical therapy department is the only service available in our town/county that currently accepts Medicaid/SoonerCare. Our independent competitor DOES NOT accept Medicaid/SoonerCare. Please allow exceptions for hospitals like us so we can meet the needs of these patients. We serve a large client base of Medicaid (25% of our total business).
Thank you for your consideration.
OHCA Response:
Thank you for your comments/questions. The OHCA takes every comment under advisement.
The OHCA will also continue current coverage of PT, OT, and Speech Therapy for children and adults in the outpatient hospital setting. All covered Adults are allowed 15 visits of each discipline (PT, OT, and Speech therapy) per year without a PA for rehabilitation services in an outpatient hospital facility. In addition, Expansion Adults are allowed an additional 15 visits of each discipline (PT, OT, and Speech Therapy) per year without a PA for habilitation services in an outpatient hospital facility.
