OK SPA 23-0006 Cost-Sharing Updates
The Oklahoma Health Care Authority (OHCA) will seek Center’s and Medicaid and Medicaid Services (CMS) approval to update the Agency’s cost-sharing within the Title XIX Medicaid state plan to ensure the copayment amounts are properly reflected for the following services:
- Administration of Advisory Committee on Immunization Practices (ACIP)-recommended vaccines (no copay)
- State Plan Personal Care Services ($4 copay per visit)
- PT/OT/ST ($4 copay per visit)
- Alternative Treatments for Pain Management ($4 copay per visit)
- Prosthetics and Orthotics ($4 copay per prescription)
Cost-sharing does not apply to exempted individuals or for services described in 42 CFR 447.56. The agency intends to submit this state plan amendment (SPA) to CMS on or after January 3, 2023 with a requested effective date of January 1, 2023.
Please view the draft SPA pages here: OK SPA 23-0006 and submit feedback via the comment box below.
The public notice can be found here.
Tribal Consultation: 11/01/22
60-day Tribal Consultation Period: 10/25/22 – 12/24/22
Circulation Date: 11/18/22
Comment Due Date: 12/18/22
Comments
Steven Goldman:
About the "Alternative Treatment for Pain Management ($4 copay per visit)":
If OHCA remains concerned about opioid (and other pain meds) overuse, a $0 copay would mean no financial barriers to alternative treatments. A $0 copay for this would be similar to the ongoing $0 copay for tobacco cessation products---to encourage healthier behaviors.
[This comment is as a private citizen, not related to any groups or employers--Thank you.]
