APA WF 23-06B Transition to SoonerSelect
The proposed rule additions/revisions will outline and address state-sanctions and complementary non-compliance remedies required of the medical contracted entities (CEs) and dental benefit managers (DBMs) and will define terms, processes, and regulations that were outlined in the Oklahoma Senate Bill 1337 (SB1337) and the published RFP/Model Contract. Other rule additions will include, but are not limited to, managed care mandatory and voluntary populations (American Indian/Alaskan Native (AI/AN) members), processes for network adequacy, provider requirements, termination of contracts, transition of care policies, medical necessity, required notices and grievances and appeals. These changes comply with SB1337 and Oklahoma Senate Bill 1396 (SB 1396), which directs the Oklahoma Health Care Authority to transition to a new health care program, called SoonerSelect.
Please view the circulation document here: APA WF # 23-06B and submit feedback via the comment box below.
Circulation Date: 01/27/2023
Comment Due Date: 02/27/2023
Medical Advisory Committee (MAC) Meeting: 03/02/2023
Board Meeting: 03/22/2023
Comments
Rachel M Franklin:
Under definition of "primary care," please consider
1) adding language to specify exclusion of subspecialist pediatricians and OB/GYNs as was outlined for internal medicine
2) removing behavioral health providers from the definition of "primary care" - they need additional support from insurers
3) specifying that non-physicians (NPs and PAs) are covered only when practicing in a location otherwise defined as providing primary care, and specifically excluding those practicing in ERs or urgent care centers.
Philip R Palmer, MD:
Please consider modifying the definition proposed for primary care. The existing wording is good/valuable, but I feel that to qualify for the designation of a primary care provider (PCP), there needs to be an expectation that a significant/majority portion of that provider's practice be spent engaged in addressing and managing chronic disease care. This is the burden of health that affects so many Oklahomans and this is the "healthcare problem" that really prompts the need for improving reimbursement (spend) to benefit primary care providers.
I also feel that having "(G) behavioral health providers" identified/defined as a PCP doesn't achieve this goal. Although Oklahoma definitely needs to improve spending to address mental health in the state, I do not believe this is the best path.
Additionally, please consider modification to 317:55-3-14 (c)(2) to delete investments in EHR and recruitment/retention bonuses as being counted toward meeting the primary care spend. Most providers in the state already have an EHR. A third-party entity creating their own or offering add-ons will not benefit me or my patients in the slightest. Lots of money can be spent on recruitment but no guarantees of return on investment.
Anything counted towards the primary care spend should be money the benefits primary care providers and improves their ability to deliver high quality care to the citizens of our state. I do not believe the above two items move us toward achieving that goal.
