Kerry:

This should not apply to every licensed PT contracted with OK Medicaid. As a pediatric outpatient clinic with no hospital affiliations, mandating that our clinic participate will be an unnecessary cost. We are a small privately owned clinic, providing therapy services in rural Ok. We do not have excess funds for unnecessary costs.

OHCA Response:

If you feel this will cause a financial burden, you may apply for an exemption from the mandate. The exemption process is being developed at this time and will be added to our website (okshine.oklahoma.gov) once completed. 

Samantha Musumeci:

We are an EHR looking for connection information for the HIE requirements.

Nick:

Will patient still be able to opt out? If yes, if you have already opted out of MyHealth Access Network will a new opt out form need to be submitted with OKSHINE?

OHCA Response:

Yes, patients still have the ability to opt out. My Health Access Network is the State Designated Entity; therefore, if the patient currently has opted out through them then they will not need to submit a new request.

Sue Marolf:

Occupational Therapists and Speech-Language Pathologists are not listed in the proposal but in the two Zoom meetings I have attended Mr. Miller and Dr. Kendrick were unable to specifically say whether OT and ST's have to do this since we are licensed in Oklahoma. We are a small pediatric practice and the start up cost not to mention monthly fee per provider will be undoable. We already send our clients' evaluations and progress reports to their primary physician. I doubt our EMR is already integrated and this will also be an unreasonable burden. We see most of our clients weekly; I doubt the hospitals and doctors really want to see all of our notes cluttering up the system. Do pediatric OT and ST have to do this?

Carlee:

Please do not require private practice SLPs to engage in this. This would be an undue financial burden.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Stephanie:

I have major concerns about the HIE system. Firstly, I do not want ALL my medical records, or my daughter's medical records accessible to any Joe Schmo off the street. I understand the benefit that this COULD have, but I think there are too many tricky situations for this to be beneficial. My daughter is autistic, but that does not mean I want her records to be available to anyone who takes an interest. I feel that her records are for OUR FAMILY to establish a plan for her going forward, so I would opt out for her and for myself until there were permissions in place where I could control who sees what information. The client (or their parent) needs to have control over their information and who they share it with. I am all for teamwork and communication amongst practitioners who are part of our village, but as a mother protecting her child, I need to be in control of who has access to private records. 

Megan:

I am concerned about the $5,000 startup cost for a small private clinic just getting their footing. There is no guarantee that this cost/program will benefit our company, and that our clients will be willing to share private information with other practitioners. We have many concerns about HIPAA violations, and the fact that anybody can access ALL information, regardless of intention with the information available to them. It would be great for the client to be asked permission via text or email/approve who can view their personal documents prior to sharing. I understand people can opt in or opt out, but with the available access to private information, it may decrease the desire for clients' participation in the HIE system. I have a concern that if a doctor uploads their diagnosis/professional opinion to the HIE system, the option for a "second opinion" is diluted. Making the $5,000 startup fee mandatory for a small business is detrimental to our growth, especially if clients are not interested in participating. 

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Aileen Sadler:

What documentation will be required by pediatric OT/PT/ST clinics? In other words, what part of the clinic EMR is going to need to interface with the HIE? What type of metrics and benchmarks are going to be requested from this type of provider?  Is connection information available for the HIE requirements so that clinic EMRs can be contacted?

OHCA Response:

Once you have completed the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), a representative from MyHealth Access Network will reach out to you to discuss the next steps in getting your EHR connected to the HIE and the necessary data elements needed to be submitted. We are still in the process of developing metrics around the utilization of the HIE but will at a minimum expect all new patients’ health information to be looked up in the HIE.

Abigail Ballard:

As a solo practitioner in rural Oklahoma, participating in a HIE is an unnecessary cost. If this is a requirement for Medicaid. I will no longer accept Medicaid as a form of payment.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The mandate applies to all licensed health care providers not just Medicaid providers. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Kim Kysar:

I am a school based Speech Language Pathologist.  This would create a huge financial hardship to just about every SLP I know.  I fully support a permanent exemption.  I can't imagine how there would be any SLPs that could afford to stay and work in the public schools if this was required.  Many are already having to leave due to the low pay and inflation being at a high.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Nicole Hill:

I am a school based SLP and provide private after school speech therapy to families in the evening through my business My Ability Speech Therapy LLC. This requirement would bankrupt my small business since it makes less than $10,000 per year right now. As a school based SLP this is an impossible requirement. If SLPs have to register and pay individually then there will be no school based SLPs. We are in the middle of the highest inflation in 40 years and wages are are stagnant. This requirement will affect families that need care and are unable to get speech therapy services due to a lack of providers that can’t afford to sign up and be part of the HIE.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Nicole Power:

I think it is important to consider that not all providers work in an office/clinic.  Many SLPs provide services in their homes to just a few students. Other SLPs only provide services to a few kids during the summers. The registration fee is out of reach for many sole proprietors who are part-time/private pay only and reduces care options for families as many mini/micro practices stop providing services because of the undue burden this mandate creates.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Ashley Erickson:

I work for Speech and Beyond in Jenks, Ok. We are a pediatric therapy clinic providing services like Speech, Occupational Therapy, Physical therapy etc. After reviewing the HIE information, it does not appear that it would be beneficial to have these types of providers/clinic-a small outpatient clinic to be required to participate. There is insufficiency and a lack of clarity on the requirements and the rules. The cost would be prohibitive to a small facility that does not operate like a hospital or large facility. We do not show any type of viable business plan to help small facilities sustain the HIE. I do not support the HIE in small business/clinics.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Karrie Hayes:

I am owner of small private practice pediatric OT and ST clinic with 9 therapist.  The services we provide are important and make changes in children and their families' lives. The evaluations and notes are of no true benefit for the HIE, and our therapist will have no need for use of the HIE. This clinic is still struggling to come back after the  COVID-19 Pandemic and a fee for a program such as this could be detrimental to us.  There also appears to be many unknown factors about this program including the cost, and possibility of who can be exempt from the program. This program isn't appropriate for clinics such as us that provide pediatric OT and ST. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Clayton:

I have serious concerns that this bill severely impacts the privacy of both clients and providers. The required fees associated with the adoption of the changes to the HIE are onerous and burdensome to small businesses and individual providers.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Shelly Geddes:

I have significant concerns regarding the statewide transition to HIE. I have already verified that our practice (and many others utilized by Allied Health Professions in the state) software will not support HIE.

Our business, and many other small businesses, will be put through extreme financial and personnel hardship in order to make this change (for no apparent reason, other than this proposed rule which is supposed to streamline information...). It will in fact, do just the opposite. It will put many businesses out of business and therefore members out of the services they desperately need.

I strongly oppose the APA WF 22-16 Statewide HIE.

Thank you for considering my comments.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Please complete the application at (https://www.surveymonkey.com/r/MyHealthAccessNetwork) and someone will reach out to you to discuss your options with reporting data to the HIE. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Katie:

Does this apply to all small private dental offices? Or only providers that take Medicaid or Soonercare? This seems excessive and I feel uncomfortable having that much unregulated access to my patients health records. The cost is also substantial for a small office like us. Not to mention we do not even know if our software will bridge easily and could require substantial employee time to keep this running- it is already hard enough to keep our office fully staffed without adding more busy work.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The mandate applies to all licensed health care providers not just Medicaid providers. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Martha Bean:

Fresenius Kidney Care (FKC) shares Oklahoma's goal of exchanging information across healthcare settings to improve patient safety and continuity of care. To achieve this goal, FKC (through Oracle Cerner) joined national Health Information Exchanges (HIEs) in 2019, namely CommonWell and eHealth Exchange. Today, over 900 Oklahoma healthcare organizations participate in the national HIEs, allowing thousands of providers across Oklahoma to access critical patient data from FKC clinics across the country as well as allowing such providers to access information shared by each other.

Submitting these same data points to a single state HIE is redundant, creating a separate interoperability platform. Additionally, connecting to the Oklahoma State Health Information Exchange (OKSHINE) is expensive and impacts clinical workflow; accessing a separate portal and tracking user access would be burdensome to clinicians who have national HIE access already. In today’s healthcare climate, and the lesson from COVID-19, it is critical that FKC and other Oklahoma healthcare organizations minimize workforce burden to our clinical care teams and allocate funding responsibly.

We respectfully ask to be permitted to continue sharing records with Oklahoma organizations and providers via the existing connections rather than through the duplicative, expensive, and burdensome transmission of data to OKSHINE. This could be done by inserting the following language in O.A.C. § 317:30-3-35 at the end of section (d) for Required participation:

(5) A health care provider will be considered to have met the reporting and utilization requirement of O.A.C. § 317:30-3-35(d)(1) if such health care provider has executed an agreement with a “Qualified Health Information Organization (Qualified HIO).”  A Qualified HIO shall mean a national health information exchange, such as eHealth Exchange or other multi-state health information exchange, that facilitates the exchange of health and social services information with participants of the SDE.

OHCA Response:

We appreciate your concern. At this time CommonWell does not proactively feed data into MyHealth Access Network therefore, does not meet the 'report data to' requirements of the mandate. The Participants in MyHealth Access Network have considered this type of connection but the concerns about the hand off and consent structure lead to the current Participants voting against this connection. However, the network is governed by its Participants and if the members were to determine to add CommonWell as an additional connection, then that could be done.

Joanna:

This will cause undo financial burden at my worksite.  

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Barbara Moreira:

Many private pediatric therapy clinics (PT, OT, Speech) have EMRs that have indicated they are unable to or do not participate in state HIEs. These revisions, as they stand, will be an immense capital expense for private practice owners to initiate compliance as well as the ongoing monthly fees to stay compliant (costs have not been shared but alluded to). Ultimately, these revisions will put small private practice therapy clinics out of business as this will bring about a significant financial burden many will be unable to overcome.

There needs to be a permanent exemption for pediatric PT, OT, and Speech providers.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Please complete the application at (https://www.surveymonkey.com/r/MyHealthAccessNetwork) and someone will reach out to you to discuss your options with reporting data to the HIE. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Kellye:

I am very concerned about the financial and time impact this will have on my individual therapy practice.  I see clients part time and the reported $5000 start up fee is not realistic and I don't have support staff to manage the increase in workload required to maintain this system. Please consider the current lack of availability of therapists and consider the impact of reducing that further. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Shauna:

The rules are confusing. Is this a requirement of all providers, or only providers who accept Medicaid or state funded treatment reimbursement? This would be a hardship on the majority of small business owners I know who provide mental health therapy. They are single person entities. This cost could likely put them and myself out of business, further exasperating the mental health crisis in this state.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The mandate applies to all licensed health care providers not just Medicaid providers. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Laura Jacobs:

This bill and website need far more clarification. When it says "all providers" where does OHCA have the authority to require private providers to comply with this? Has this been signed into state law?

Why are small and solo providers being charged the exact same startup fees as large entities? This will only further contribute to the provider shortage happening across the board.

A small mental health agency or private provider should not be assessed the same fee as Integris or a large agency such as NorthCare. The exemption language does not say how long exemptions are good for, or how many times a provider can be given an exemption.

I am opposed to this as it's currently written and planned. It needs clarification on how OHCA can demand compliance from providers who are not contracted with them and the start up costs need to be addressed immediately. They are prohibitive for a lot of providers and not being assessed equitably. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The overall authority for these rules comes from Title 63 of the Oklahoma Statutes Section 1-133 for which specifies all health care providers licensed by and located in the state and relies on the OHCA board to define health care providers for which we did via OAC 317:30-3-35. Please note that the startup costs are technology based and not based on the size of your practice as are the monthly subscription costs. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Jennifer:

Let me be absolutely clear- the financial burden would be devastating to my small business. A $5000 startup means my business will either close or cease providing services to OHCA clients.

And that’s before we even start addressing HIPPA and other privacy issues for our clients.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Amanda Sprigg:

I am a LPC and LADC in solo private practice. I have serious concerns that this bill severely impacts the privacy of both clients and providers. Additionally, the $5000 startup fees as well as monthly costs are an undo financial burden to a small private practice.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Elizabeth Fletcher:

The proposed rule as it currently stands will require all healthcare providers, including mental health providers who are in business as sole practitioners, to pay $5,000 to onboard to the HIE and thereafter to pay whatever MyHealth charges, including any rate increases, with no option to opt out.

Requiring small businesses, especially masters-level clinicians, to pay the same rates as large physician practices to onboard to a system we had no role in choosing and cannot opt out of is unjust and will lead to mental health clinicians leaving the field or closing their practice doors.

We are already facing a worsening crisis of mental health provider shortage and insufficient mental health resources to meet demand and urgent need in our state. Part of this shortage is due to low reimbursement rates and high costs of being in private practice, as well as the long and arduous educational requirements that yield relatively low wages even to established clinicians.

This rule as it is currently written will worsen those conditions and ultimately worsen the crisis of accessible mental health services for Oklahomans. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Clyde wafford:

OrionNet Systems with its EHR, ThinkHealth for Mental Health and Substance Abuse agencies, started working with SMRTNet in 2013 on HIE, later that moved over to MyHealth Access Network. Our system was sending data at that time and integrated in for our customers, but the process went through various changes, right up to some of our recent talks with MyHealth.  For our current agencies we are ready to turn that feature back on and continue our work with MyHealth at no additional cost to our members, unless there is some additional cost OHCA or MyHealth imposes.  Our normal startup fee is very low.  However, I do have a question on the point in the document, "APA WF # 22-16", where it says: "secure connection to the state designated entity for HIE and submit data in the form and format as defined on the Office of the State Coordinator for HIE website.", who do we talk to about testing our system for the secure connection?  If there has been changes since our last work with MyHealth then we would like to know.  We would like to have the process simple like it was before were our customers have to do little other than authorize the process and opt the patient in or out. 

OHCA Response:

If you are already connected, reporting data to and utilizing MyHealth Access Network then there is nothing more for you to do. If you are not, please complete the application form (https://www.surveymonkey.com/r/MyHealthAccessNetwork) and a representative with MyHealth will reach out to you regarding next steps including what is needed to establish and test your connection to them.

Luke Small:

I am a private practice mental health therapist in business with one other therapist. I am curious as to what the requirements will be to mental health providers who accept Soonercare/Medicaid.

So few providers already accept Soonercare and many mental health therapists are going to private pay entirely. Extra cost barriers for agencies and private practice therapists will greatly diminish our ability to serve an already underserved population. I agree that sharing info can be helpful for practitioners and patients, but startup costs and ongoing monthly costs will make it virtually impossible for us to serve our most vulnerable population.

Thank you for this opportunity to share my thoughts.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The mandate applies to all licensed health care providers not just Medicaid providers. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Marnee:

As a single owner business for pediatrics, this cost would greatly effect my business and possibly cause me to close. I service 35 children in home and office. Most clinics have a very long wait for speech services which would mean these children and families would be without speech services. Financially we haven’t had a raise in over 3 years, in fact we took a pay cut. This would end many small practices. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Brenda Kinnison:

This new requirement is not cost effective and allows all providers access to provider records. Please do not allow this to come to fruition.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Angela Dunlevy:

Please examine the unintended consequences of bad legislation like this! It is heartbreakingly hard for my clients to find therapists today. This would force out so many providers and make the shortage even worse! We absolutely need good legislation to improve services, but not extra and unduly burdensome rules that drive small businesses out of business! This idea should've never seen the light of day!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Lynnette West:

I have many concerns.  How much information will be shared? We are a small mental health agency and I’m sure most of our clients will chose to opt out.  How does this comply with our code of ethics regarding confidentiality.  Most people receiving mental health services prefer that to be private.  Also the price seems outrageous, especially for small rural agencies.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.  

Kelly:

I am the Director of a small outpatient pediatric PT-OT-ST clinic in Tulsa. We see our patients multiple times a week and already send documentation to the referring provider. The start up cost and per monthly provider fee is cost prohibitive to small clinics and will funnel money away from patient care when inflation is already at an all time high. I strongly oppose the APA WF 22-16 Statewide HIE. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Cindy:

My small pediatric therapy practice provides Occupational Therapy services for children with special needs in the home and community setting.  The providers who work with us are all independent contractors.  Our EMR is not enabled to participate with the states HIE.  We cannot afford participating in this with such a small clinic following over 20% revenue cuts that the state has implemented over the last couple of years with more on the horizon for the next fiscal year.  Our services are essential for early intervention and supporting families that are trying to work while also caring for children with special needs.  Many children will go without services if they cannot receive them as they are now in their daycares, pre-schools, public schools and homes.  If we are required to change EMRs, this will cost our team a signifiant about of expense and administrative burden which will continue to impact our ability to provide as many services to children and families.  Please consider eliminating the fees and required participation for small therapy business that are providing essential services that are not being covered by the large hospital systems.

In addition, for affordability we share our EMR membership with 2 other small practices and are curious how the data would be able to be separated without requiring new memberships for each of us.  We also serve children in public schools under the department of Education, this data would be difficult to identify and separate out of our EMR.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. Once you have completed the application a representative from MyHealth Access Network will reach out to you to discuss next steps and the options available to connect your EHR to the HIE. At this time there are no funds available to offset the cost of connection. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Regan Gray:

I run a private practice on my own. The cost of this is prohibitive, seems like a huge overstep, and it is unclear to me what the benefit is to me or my clients in being required to participate.

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application 

Anje Newnam:

As an independent provider with a small practice this HIE ruling with the requirement to register, at a cost of $5,000, with MyHealth, is catastrophic to my practice. I do not have $5,000 dollars to lend toward this issue. I do not even know if my current EMR will work with MyHealth, and the thought of changing EMR providers makes me honestly think about just throwing in the towel. Privacy also becomes a major issue as other providers should not be granted access to my clients records simply because they want to have them. This is outrageous and a huge overstep on all sides. I strongly urge the State to look hard at this requirement and consider those of use who already struggle simply to get paid because we are private providers and not a large agency. The state is already in short supply of mental health providers and this implementation and requirement is certainly not going to help this matter at all. 

OHCA Response:

We hear your concern. Once you have completed the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), a representative will reach out to you regarding next steps and will be able to discuss with you your options in getting your EHR connected to the HIE. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Abby:

We are concerned about the $5,000 startup cost for a small private clinic with OT and ST.  We also have many concerns about the potential for HIPAA violations. The mandatory startup fee and monthly fees for a small business will be detrimental to our growth. 

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Stephannie Bethel:

This is a very confusing situation for allied health providers such as occupational therapy, since it appears that there is little knowledge about how we are expected to participate or the extent that our participation will be helpful to us, our clients, or other healthcare professionals. I understand that things take time, but it would also be nice to know if this would at least automate the situation with medicaid. We are hearing from EMR system companies that they do not plan on connecting to the HIE, which puts us all in an impossible situation. It's also absolutely ridiculous that the providers are the ones stuck footing a bill like this when it is going to be legally required of us. It's not just single providers that are incapable of paying the kind of money it takes to connect, so I don't think requesting an exemption is going to cut it for many of us. On top of that, how do we deal with EMR systems we paid thousands of dollars for refusing to connect? We cannot afford to ditch what we have to pay out for a different EMR system willing to connect to the HIE. I don't understand all the logistics behind it, but I believe these aspects to be a huge and problematic oversight.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Please reach out to us at okshine@okhca.org to discuss the situation with Medicaid that you are referring to and to discuss more of what you are hearing regarding the EHR vendor refusing to connect to the HIE. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. Once you have completed the application a representative from MyHealth Access Network will reach out to you to discuss next steps and the options available to connect your EHR to the HIE. At this time there are no funds available to offset the cost of connection. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Melissa Thurman:

There are already pathways for behavioral health providers to share information.  a. as clinically indicated b. With permission from the client/guardian. HIE will create an undo financial burden as well as expose patients private mental health information to scrutiny by users of the HIE who do not need this sensitive information to care for the patient. A dentist doesn’t need to know their patient is having marital problems. This is an invasion of privacy and a barrier to mental health care. We already have patients who are afraid of what can be learned through insurance billing practices. 

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Lacey Reikowsky:

As a counselor practicing solo in private practice the start up cost would be exorbitant & a huge financial hardship for me. I also have concerns regarding confidentiality & I feel certain some of my clients will as well. I understand this being a positive thing for some providers & patients but not outpatient mental health providers or their clients. 

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Leslie:

This is an undue financial hardship for mental health providers and frankly for all private practice practitioners (LMFTs, LPCs, LCSWs, Speech language pathologists, occupational therapists). None of us have $5000 for the start up fee and this expectation is unfair and will harm our businesses; which will impact patient care.

Furthermore, as practitioners we have laws and ethics that govern our licensures that I believe those who drafted this bill failed to consider. As mental health care providers we have even more technicalities that we have to be careful about. For one, mental health care is privileged. And due to the sensitivity of mental health care and substance use patients should not be required to have their personal health information in this public system. Furthermore, as mental health practitioners I don’t know if we can even comply with this bill legally and/or ethically. So in addition to the extremely high burdensome fees associated with this bill, mental health providers will also have to pay attorney fees to make sure we aren’t breaking the laws and ethics governing our licenses.

This bill raises serious concerns. And as on top of legislation as we all try to be, most of us are just now hearing about this bill that apparently passed last year. Had we known about it you can guarantee we would’ve said something.

And where can we find information about the fees? We all keep hearing about them and yet no one can find where these fees are listed.

Lastly, mental health care providers (and OTs and SLPs etc.) should have been consulted in the drafting of this bill and other bills that are currently being proposed that affect our professions. We are already in a mental health crisis. What the State actually needs to focus on is holding insurance companies accountable to paying mental health practitioners a fair wage, so that more patients will have access to services.

This bill feels like its intent is to penalize and fine providers. Another person commented that there should be a permanent exception for private practice OTs and SPLs. I agree and this permanent exception should extend to all mental health private practice practitioners as well (LMFTs, LPCs, LCSWs, etc.). And I stand behind all of the EHR compatibility issues that have also been brought up in the comments.

If the State is set on implementing this then the State needs to pay for it and not place undue burden on small business owners that are out here trying to provide care for the citizens of OK.

It seems that this bill is trying to streamline information for providers? I’m still not clear on its objective. And if this is the objective this is a great ideal to strive for; however, this bill failed to consider the very real complexities of our healthcare system. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. Once you have completed the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), a representative from MyHealth Access Network will reach out to you and discuss next steps as well as the specific fees for your practice. At this time there are no funds available to offset the cost of connection. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Melissa Winkler:

Charge us $5000 to be forced to send our mental health records to a centralized system, break confidentiality and possibly go out of business due to the cost. No thank you.

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Cyndi Wilson:

I work for two different school systems that bill Medicaid.  Will they have to pay a $5000.00 fee for each provider?

OHCA Response:

No, the $5000 fee is based on connecting the EHR system to the HIE and will be a one-time fee. The monthly subscription fees will be calculated based on the number of providers using the HIE.

Racheal Edwards:

This rule will put me out of business. I am a solo practice provider. I cannot afford $5000. Requiring me to spend $5000 to do the business I'm already doing. I am already functioning legally and ethically in my practice. This requirement will not change that, it will simply create a hardship that I cannot keep up with. In a world where we are at a shortage of mental health providers, creating more difficult financial and logistic tasks for them to engage in to practice seems senseless. I enjoy my job, but I also need to be able to support my family with my job. If I am already HIPAA compliant and obeying all laws, what purpose does this serve? Especially if I'm not serving the Medicaid community?

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. Please note this mandate applies to all health care providers and not just Medicaid providers. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Jared Whitmire:

It appears that many have already made the argument about the financial hardship on individual clinicians. As well as the privacy concerns. I share these concerns. However, another way to think about this is why give one entity the power to regulate our mental health/medical information. I know this may be done in the name of Quality Care, but that appears to be a euphonism that also conceals the obvious privacy concerns. Privacy is also very important to the patients I treat. Also, choice if this bill goes into effect, you are taking that choice away. This also make no sense to me why the cost of signing up for this is put onto the individual provider or even large health care providers. Where on gods green earth does it cost 5000 to sign up for a EHR connected platform that's integrated to others. If we are going to be strong armed into paying this fee, I think we deserve to understand the thinking behind such a cost. 

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Karin Price:

Who will pay for this?

OHCA Response:

It is the responsibility of the practice to pay for the connection to the HIE along with the monthly subscription fees.

Lindsay Hanna:

On behalf of a hearing healthcare organization that serves 20,000 pediatric patients a year, mandated participation in this program would prove costly to our non-profit organization in a number of ways including the following: unbudgeted, exorbitant costs for interface of our current EMR system, set-up for 40+ providers, and administrative time for initiation and maintenance of the program. Additionally, the benefit of participation as an organization is unclear. Recent participation in a nationwide repository proved to be time-consuming and the data was unable to be queried. I strongly urge the OHCA and OKSHINE to consider an exclusion from this policy for our speech pathology, audiology, and behavioral health providers. 

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. Please note this mandate applies to all health care providers and not just Medicaid providers. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Darcy Stowe:

On behalf of a hearing healthcare organization that serves 20,000 pediatric patients a year, mandated participation in this program would prove costly to our non-profit organization in a number of ways including the following: unbudgeted, exorbitant costs for interface of our current EMR system, set-up for 40+ providers, and administrative time for initiation and maintenance of the program. Additionally, the benefit of participation as an organization is unclear. Recent participation in a nationwide repository proved to be time-consuming and the data was unable to be queried. I strongly urge the OHCA and OKSHINE to consider an exclusion from this policy for our speech pathology, audiology, and behavioral health providers.  

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. Please note this mandate applies to all health care providers and not just Medicaid providers. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Randel:

On behalf of a hearing healthcare organization that serves 20,000 pediatric patients a year, mandated participation in this program would prove costly to our non-profit organization in a number of ways including the following: unbudgeted, exorbitant costs for interface of our current EMR system, set-up for 40+ providers, and administrative time for initiation and maintenance of the program. Additionally, the benefit of participation as an organization is unclear. Recent participation in a nationwide repository proved to be time-consuming and the data was unable to be queried. I strongly urge the OHCA and OKSHINE to consider an exclusion from this policy for our speech pathology, audiology, and behavioral health providers.  

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. Please note this mandate applies to all health care providers and not just Medicaid providers. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Danielle:

First, as a resident of Oklahoma I'm disturbed by the fact that my medical information will be apart of this HIE. The medical decisions I make for myself and my family should be between us and our providers. There is no need for the state to have access to this information. If I want another provider to have access to our medical charts - I want the power to make that request myself. I can see how this information can be potentially used to restrict access and care and be used to target specific populations. 

Secondly, as a sole provider this system is cost prohibited. As a therapist, information I obtain is highly sensitive and I doubt many of my clients would feel comfortable with the information being stored in a statewide HIE. I believe this is a gross violation of HIPAA. As a business owner, I don't think the state has any right to dedicate what sort of EHR/EMR I use for MY business. I strongly oppose the APA WF 22-16 Statewide HIE and hope the state listens to the concerns of the providers commenting below. 

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Caitlin:

This is an extreme start of fee for private practice individuals. As an LPC with a caseload of maybe 30 clients, this is not at ASD cost effective. It is also extremely concerning to have psychotherapy notes available on such a large database. Small practices should be excluded from this ruling. 

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Alexie Foster:

From what I understand, it seems that many of us in private or solo practice would likely need to shut down and no longer provide services to our clients/patients due to the egregious cost to participate, leaving Oklahomans without the services they need. As a mental health professional, there's already a shortage of therapists and many of my colleagues and I have long waiting lists. I fail to understand how this benefits the people of Oklahoma whatsoever. Why has this been approved by the OHCA Board of Directors and the Governor and already in effect as emergency rules? What is the purpose of this bill?

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Erin:

Not only will this HIE be a financial burden for small private clinics, but the use of the information will not be beneficial for others within the HIE. It is between the parent, doctor, and therapist to determine the child’s treatment plan. We have close relationships with our doctors and are able to provide them with the information that they need to be able to refer for services and insurance companies only need the information necessary to determine authorization. Additionally, the Electronic Medical Record systems that we work with have communicated with us that they are unsure of how this will be realistically implemented. It is far too much of a burden to change EMRs from the one we have utilized for years, so that is not an option. Overall, for pediatric therapy practitioners, not only is this unnecessary, it is costly, and it will not benefit the outcomes of our clients in any way. 

OHCA Response:

We hear your concern. Please review our Why OKSHINE flyer to see ways the HIE can benefit your practice. Please know that we are not asking you to change your EMR system rather to send data to and incorporate the use of a HIE into your workflow. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

April Starr:

I'm a marriage and family therapist in Oklahoma, and this requirement will put me and many others like me out of business completely.  Additionally, I have HUGE concerns about discrimination in other healthcare areas if mental health records are freely available to all providers.  People with serious mental illness history are often feared by healthcare providers and prevented from getting appropriate care.  You will alienate thousands of people from mental healthcare and other forms of healthcare by requiring compliance with this system.

OHCA Response:

We hear your concern. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Reyna Romero:

On behalf of a hearing healthcare organization that serves 20,000 pediatric patients a year, mandated participation in this program would prove costly to our non-profit organization in a number of ways including the following: unbudgeted, exorbitant costs for interface of our current EMR system, set-up for 40+ providers, and administrative time for initiation and maintenance of the program. Additionally, the benefit of participation as an organization is unclear. Recent participation in a nationwide repository proved to be time-consuming and the data was unable to be queried. I strongly urge the OHCA and OKSHINE to consider an exclusion from this policy for our speech pathology, audiology, and behavioral health providers.  

Lori Black, RHIA, CHPS, CHDA:

Individual responsibility to report utilization of HIE services is unclear when the individual qualifies as a "health care provider" by policy definition but is employed by a "health care facility", such as a hospital, and is not practicing independently. In this circumstance, requiring any and all licensed providers to individually meet a utilization metric and submit utilization reports would significantly increase administrative burden and interfere with the activities of patient care. Please consider further defining a "health care provider" and individual vs. organizational utilization and reporting requirements.

Dianna Persun:

The mandate for therapy practices to be compliant with HIE by July 1.  I have been in practice since 2008 and have use the same EMR for OT, Speech and ABA since 2013.  I have reach out to Clinic Source and they currently do not interface with nor have the plans to be able to interface with HIE.  I have been involved over the last years as we have been discussing these upcoming changes and not one time do I recall a   need for the current EMR to be able to do a different function.  I do recall the need for a cleaning house to ease the transition of not having a provider to log into three or more different platforms.   I have reviewed the video that was posted over the last two weeks that strongly encourages us to log on and join.  Following the application where one can ask for an extension, no other information is being provided as what this looks like for the merging of current EMR to be able to access the HIE. As a small woman own company, I do not have it in my budget to switch companies or to incur a huge expense to do so.

What are some plans or foreseen changes that could be made so that we (myself and other small clinics)   could submit our information to a portal that would not jeopardize what we are currently using?

Bonnie:

On behalf of a hearing healthcare organization that serves 20,000 pediatric patients a year, mandated participation in this program would prove costly to our non-profit organization in a number of ways including the following: unbudgeted, exorbitant costs for interface of our current EMR system, set-up for 40+ providers, and administrative time for initiation and maintenance of the program. Additionally, the benefit of participation as an organization is unclear. Recent participation in a nationwide repository proved to be time-consuming and the data was unable to be queried. I strongly urge the OHCA and OKSHINE to consider an exclusion from this policy for our speech pathology, audiology, and behavioral health providers.

Additionally, countless children in our state rely on services from independent contractors or small clinics who could not afford the financial burden. There appears to be a very likely consequence of putting these colleagues out of business, and ultimately further reducing access to necessary services. 

Joanna Smith:

On behalf of a hearing healthcare organization that serves 20,000 pediatric patients a year, mandated participation in this program would prove costly to our non-profit organization in a number of ways including the following: unbudgeted, exorbitant costs for interface of our current EMR system, set-up for 40+ providers, and administrative time for initiation and maintenance of the program. Additionally, the benefit of participation as an organization is unclear. Recent participation in a nationwide repository proved to be time-consuming and the data was unable to be queried. I strongly urge the OHCA and OKSHINE to consider an exclusion from this policy for our speech pathology, audiology, and behavioral health providers.   

Albert Rios:

As a therapist we take an oath of do no harm, this hear goes against that completely. My clients are having to live in a state that has the most bills that are actively trying to erase their rights and intervene in their private healthcare. Many of them have been abused, discriminated and shamed by these systems based on their orientation, expression, mental health diagnoses and several other factors. Giving others access to their records does not seem to keep confidentiality and safety in mind.

This seems illegal and if it is not, please help me understand how this aligns with 42CFR Part 2 and how the clients are guaranteed protection with their information being exposed?

How do you expect us providers to afford this change it is not going to be cheap nor do we have the funds to do so. Especially when we wholeheartedly disagree with this violation of rights. This is dangerous for our patients and does not make sense. Where did this come from and what is the "benefit" 

As an individual seeking therapy or any service with my providers, how would I feel safe sharing personal information. This will push out several people seeking help and providers who can help. When we don't have those support services, we will see this is a ripple effect that will cause harm to many. 

Leah Holland LPC:

Please do not allow this bill to pass. The start up costs and additional monthly fees will place a financial burden on Oklahoma providers. We are already struggling to maintain quality medical providers and this could cause many to leave the field or move to another state. The $5000 start up fee will impact not only providers but the individuals who are receiving care.

Jessica Butcher:

Not only will this change be a financial burden for small businesses, it also creates difficulty for the current EMR in place as they are unsure of how this can be realistically implemented. It would be an additional burden to change from the EMR that we have used for years to one that would be compatible with HIE.

Lisa:

You are effectively ensuring my child will no longer receive health care in this state. It is NO ONES business and violates all privacy and ethical standards. Shame on you all. 

NaKisia McDaniel:

What is the financial burden?

NaKisia Chenevert:

Are there any other options outside of MyHealth?  

This feels close to extortion. Feels like bullying.  Do we as providers not have a right to chose an HIE company?  Why was MyHealth chosen over other companies who have been in business longer?  Were other companies taken into consideration?   

Helen Allred:

Does this impact non medicaid providers?

The proposed cost per practitioner is obscene. I can't possibly work enough to pay the proposed cost and still earn a living. 

Deanna James:

As an LPC and private practice owner I am very concerned about this mandate to participate in the HIE. We were not made aware of this during the last legislative session and I am just now learning about it. This would create undo cost and hardship on all small businesses and business owners. I also have serious concerns about my clients mental  health information being shared with all healthcare providers due to stigma and physicians ignoring medical issues when they know of mental health issues. The wording of these new requirements is vague and unhelpful. Most of our EMR’s for therapists do not work with the states system and it feels like a huge overstep to require us to buy into state mandated system under the guise of better patient care. I would encourage an exemption for small agencies and allied health services. 

Amanda Brandon:

As a private  practice mental health provider I have serious concerns that this bill severely impacts the privacy of both clients and providers. The required fees associated to make the changes to the HIE are onerous and burdensome to small businesses and individual providers, potentially causing many to shut their practices. There is already a significant mental health services shortage and we are at capacity. Even one therapist shutting down could leave 50-60+ people seeking services elsewhere, with little to no availability.

This proposed bill would cause significant hardship on providers and raises serious privacy concerns. It would severely impact an already fragile, overwhelmed, underpaid mental health system. 

Ovia Foreman:

This will destroy our healthcare system in Oklahoma. 

Jackie Horton:

I disagree with this decision due to its financial impact on small outpatient mental health agencies that are not hospital affiliated, mandating that our clinic participate will be an unnecessary cost. With already low reimbursement rates, inquiring more operating cost will be detrimental to us.

T. Susan Bachmann:

How does the legislature think this will have no effect on small business?  It will put me out of business. I am a Licensed Professional Counselor in private practice with no employees, no administrative staff and no IT professional.  This cost of connecting to the HIE and the administrative burden of having to change from an EMR system that work well for me to one that is compliant with Oklahoma's HIE is an unreasonable and unnecessary burden.  Then there is the issue of client privacy/confidentiality. Does the legislature not understand mental heal confidentiality or not care? This is in conflict with our code of ethics, and deprives clients of the right to choose when and with whom to share their mental health information. In case the legislators are unaware, clients' identity as a client is confidential information. If these rules remain in place without an exclusion for mental health providers, I will close my practice. Need you be reminded there is already a shortage of mental healthcare providers? I get calls daily from potential clients who are struggling to find practitioners who are accepting new clients, and I also have limited openings for them. This is an unnecessary and burdensome requirement that will further restrict access to mental health care.

Angie:

First off, I am disappointed at the lack of information and communication that was made available to providers and the public. Nobody I have spoke to has a clue about it. Second, the financial cost being the same for a small rural clinic like my own and large companies like Mercy is ludicrous. Half of us are going to have to find a new EMR company because the one we are currently using has not been made aware of this proposal much less prepared.  My third concern is how can it be beneficial for an optometrist to know a patients full mental health history?  I have yet to find any persuading benefits and reasons for this change. 

Lack of communication and help leading to frustration as usual!

Brandy Peoples:

There are many concerns that I feel are not answered.  There needs to be more clarification and work on this legislation before moving forward.  Working at a small agency in rural Oklahoma where there is constantly a wait list to get clients a therapist - and where the cost alone would be devastating.  Our EHR is not ready or aware of the changes.  Our clients are not aware or ready for the changes.  We have many clients who do not wish for their information to be openly shared - I understand their will be an opt out option, however, having to again help clients through the process that we ourselves may not fully understand and help decrease their fears and anxieties in this change is a set back to what they originally came to therapy for.  

Christine Wayman:

What is time is the public hearing on 3/7/23? What location is the public hearing?

OHCA Reponse:

Thank you for your comment. The public hearing will be held at the Oklahoma Health Care Authority's main office location. It will start at 1PM. If you wish to make a comment, for the record, you will need to be signed in before the start of the meeting

Angie Wright:

Reasons I am opposed to the HIE proposal:

1. Lack of information. The providers and well as the public have been kept in the dark about these changes, changes that will impact all of us. I read all of my OHCA notifications and do my best to stay on top of what is going on, however, I found out through FACEBOOK 4 days ago. This is unacceptable. The general population who this will effect has no idea that this is in the works. Oklahomans should have been given written notification and an opportunity to also comment on these proposed changes.

2. Concerns of privacy, I do not feel an optometrist needs information from mental health records. Patients are not even going to know this is happening and when they find out they will already be opted in and have to navigate how to opt out. In the past the states opt of options are confusing and not all patients will be able to do so.

3. Financial devastation, small agencies should not be paying the same fees as large companies such as Mercy, Integris, etc. Also the details on the expemtions are vague and unhelpful. Those providers who are not currently using a compatible EHR service are basically forced to endure another expense and major inconvenience of changing EHR’s. As of right now it sounds like we have one compatible option (Think Health).

4. Stress on providers, this change is coming right in the middle of the whole managed care change. The small agencies that serve Oklahoma’s rural communities do not have the resources to implement these huge changes in the short timeline we are expected. I feel like we will lose many providers and most of them will be the ones who serve low income areas in rural communities, We are already short on providers in these areas.

Please consider the impact on the providers that are working to serve Oklahomans the best we can. 

Amy:

As a long time pediatric occupational therapist, I would like to share my concerns with the requirements of joining the proposed HIE program in Oklahoma.  As a small, part-time provider, my concerns are both financial and data exchange compliance for our current documentation systems. 

As it has been explained to me, all providers would be required to individually sign up for the program and be required to pay a substantial fee to interface.  This will likely pose a financial hardship for many therapists with small individual practices or who do not see a substantial number of patients.  I foresee that this will likely cause providers to leave the profession and cause and even greater shortage of therapists than there currently is. 

Also of concern, is the ability to interface current documentation systems with the HIE.  Will this require me to use a different documentation system, what are the financial implications for this. 

While I completely understand the reasons behind the HIE and the need for such a program, I would also like to make sure that it is practical and reasonable for all healthcare providers who will be required to subscribe to it. 

Thank you for your time and attention to this matter.  

Bradley Horn:

This system of care will likely increase marginalized populations not feeling safe enough to seek out care for fear of their information being shared with other providers. The cost of this system is also restrictive for small practices that are serving these communities and the state overall.   

Samantha Fisher:

The proposed rule as it currently stands will require all healthcare providers, including mental health providers who are in business as sole practitioners, to pay $5,000 to onboard to the HIE and thereafter to pay whatever MyHealth charges, including any rate increases, with no option to opt out.

Requiring small businesses, especially masters-level clinicians, to pay the same rates as large physician practices to onboard to a system we had no role in choosing and cannot opt out of is unjust and will lead to mental health clinicians leaving the field or closing their practice doors.

This rule as it is currently written will worsen those conditions and ultimately worsen the crisis of accessible mental health services for Oklahomans. "

I'm just re-posting this comment because I think it is very well said, and as a small counseling center, this would definitely negatively affect our business as well.

Caleb Tanck:

This financial burden would be hard to take for a private optometry company. My company is also concerned that any patient information would be able to be viewed by any other organization participating. This seems completely unnecessary for us to continue seeing SoonerCare patients. This also causes an issue if our EHR is not already integrated into this program.

Misty:

I have concerns about the lack of definition of who this applies too, the lack of notice to plan ahead to implement these changes, the upstart costs to implement this, how to keep the confidentiality of my mental health clients that I am mandated to protect, and the impacts this will have on the mental health, speech therapy, and occupational therapy fields. I foresee many practices such as mine being priced out of our fields and closing. This will leave thousands of Oklahomans left without services, especially in rural areas.

As a master level clinician I simply do not make enough in a solo practice to justify this $5000 fee to onboard. I refuse to work for agencies that under pay and over work their clinicians. I currently have a full case load and a waitlist. All of these clients would be left to find another clinician trained in EMDR therapy. 

Heidi Kamm:

This is a gigantic government over-reach and apparently it's being done last minute, "emergency" (?), under cover of confusion and silence. Offering of contract to a bidder who placed a higher bid than another is unethical, and our governor has a track record of poor judgment in this regard. Expect a further exodus of health care providers and mental health providers if you insist on pushing this through. I'm a psychologist in private practice treating trauma and PTSD. I've been working with veterans and others in Norman since 2010. I doubt I will stay in practice here if this is pushed through in such an underhanded way. I will also make sure the news stations know why it's *EVEN HARDER* to find therapists in general, but especially one trained, knowledgeable, and experienced with combat vets. 

Frank Couch:

I have been a clinician in large and small agencies. I have been in practice for 13ish years, most of which have been in rural settings. The rural agency is vital for many adults and children who are on the lower functioning and lower socioeconomic platform. Although there are some valid reasons for a HIE, it should be noted that there are always unintended consequences. What I have observed is that the larger agencies can handle the consequences better than small agencies in rural settings, especially with a disadvantaged clientele. Asking a small agency to effectively communicate the benefits and risks of a HIE or giving informed consent to such is asking too much. A mental health clinician should not be unduly burdened with the responsibility of helping clients with all the possibilities of what it means to give their information to an HIE. HIPPA is hard enough. The primary responsibility of a mental health provider is to help clients navigate a proper relationship with themselves and with others. Adding to that list the informed consent to whether CPS/DHS, ophthalmologist, or any other practitioner can see mental health records borders on being harmful to a person is struggling to make it through a week. What happens if someone with more nefarious motives uses mental health information against the person who provided it? 

I am deeply concerned that although sharing information may help in some ways, what happens  if there is a breech or someone with poor/harmful motives is involved. There are fines to help keep mental health providers accountable, but what about an HIE? Just because we CAN does not mean we SHOULD. Please give caution to the idea of an HIE.

Also, I was not able to find anything regarding the fee schedules. In fact, I was not able to find much about these proposed changes. The fact that I had to find out through Facebook is shameful and gives occasion for me (and many others) to be skeptical about HIE. The fees I was informed of are one-time fee of 5k with monthly or year maintenance fees. Again, I was not able to substantiate this by Facebook, google, OHCA, or by other LPC supervisors. These fees will deeply harm most small rural agencies and negatively impact services for at risk populations. I am speaking from the mental health field perspective only. 

Kendra Smith:

As a provider at a small non-profit agency I am concerned about the enrollment fee as well as other fees that are expected. OHCA already pays significantly less than private insurance agencies and other re-imbursements.  Why is there now a fee for providers?

Nannette Bowers LADC-MH:

I am truly concerned about 42CFR part A. How are you going to protect the MH and SA records when federal law prohibits us from even acknowledging a client is a client without a release from the client. I do not think it is fair to ask them to sign blind releases.  I am ethically bound to not disclose any information about a consumer without their consent. How are you going to not break federal law?

Dr Kristen Clouse:

The burden of this on providers is unnecessary. When I have a patient referred to psychiatric services, I would request the last note from a PCP, which I receive free of charge with the clients knowledge. I only release client notes which include personal information that is helpful to no one but me and my client and irresponsible to be released to any provider other than a counselor. If a doctor needs a med list or diagnosis list I’ll send them one, again, for free. There is no burden on my staff as well. I have no patients that have even taken advantage of the patient portal I pay for monthly. I live in a rural area and most clients don’t have the data on their phone that is paid for by the state to access it. My concern is that they would not even be able to opt out of this program! Is OHCA increasing how much they will pay me to see their clients? Where will my clients or I see a benefit financially or otherwise? I have weekly and monthly notes on every one of my thousand + clients over the life of my practice. Who is contacting all of them regarding this? Why would every medical provider in the state or with a state license need to see all of it? I don’t even have a lunch break because I see so many clients a day and have so many waiting. I can guarantee this won’t make me want to work harder or longer or better. I have not seen any evidence that this improves patient care or made my practice easier. National clearinghouses exist for a reason and this is unnecessary for the state to participate in other that making money for someone that’s not even practicing medicine.

Rebekah Taylor:

I have many concerns about this bill, the implementation of the bill and the subsequent ramifications on providers. I am a LPC in private practice. The cost of this program for sole practitioners of all health care fields or small facilities that are serving underserved populations is  extreme. Once again it seems our legislature jumped the gun and created a policy without thinking through the implantation of it or educating/informing those of us that it will effect.

We are out here doing the work to support and aid Oklahomas on a daily basis. We need support from our elected officials not additional burdens or hardship. Please consider how this bill affects all of us, not just the large medical facilities. 

Kris Kygar:

I have several concerns with this. First and foremost as someone who is trying to get started as a private practitioner, I can tell you that there is no way I can afford this fee. Additionally, I have no plans to utilize Medicaid and I am wondering about the legality regarding OHCA attempting to require everyone to participate in this even if they are not contracted with OHCA. And finally, I feel like this measure will be rendered completely moot with the number of people who are going to have to file for exemptions due to the ridiculously expensive cost and the number of clients who are going to opt out because they do not want their information potentially compromised.

Bryanna Howard:

If this goes through, it violates hipaa. Whatever is said to providers is to stay with that provider. Many of the OT, SLP, and therapist won’t be able to afford the 5000. As my son is autistic if he loses his Speech teacher and OT, I will not be able to care for him the way he needs. Please don’t pass this. 

Megan Secrest:

I am a Licensed Mental Health Provider in a solo private practice. Many of my clients are private pay and do not wish for their mental health records to be available to any provider they see. They may be afraid of stigma and poor treatment from other providers as a result of their mental health diagnoses and treatment. I firmly oppose this HIE being required for all providers and am sorely disappointed in the state for passing the cost of integration along to the providers. This is simply not feasible to me financially and will make it difficult for many providers to cooperate. My EHR will not integrate and in order to participate I will have to potentially switch that as well. This violates patient confidentiality and will not be helpful in my treatment of my clients. 

Jessica Wilson:

Thank you for considering my comment.  This bill is problematic and should have never been voted in with the language that was finalized. 

1.This is a gross oversight of legislation overreach to mandate all healthcare providers to comply.  OHCA has no authority over non-contracted agencies and solo providers.    The language should have never been changed from only contracted providers under OHCA to all providers in the state. 

2. This bill also grossly violates HIPAA and 42 CFR part 2.  Most of our clients already struggle to reach out for services due to systematic discriminations.  This HIE rule would stigmatize treatment even more.  HIPAA and 42 CFR part 2 are protective of mental health and substance abuse services for those reasons.  Requiring behavioral health providers to comply sets back behavioral health treatment to decades where it was easier to lock individuals up or deny treatment than treating.  Oklahoma is already one of the worst states for behavioral health services and imprisons the most individuals per capita. We need more access to treatment not more distrust in our services.

3.  Even if this this rule was legal, the processes are atrocious in requiring providers who do not want to be a part of this system to then pay for the system.  If this is something that non-medical lawmakers want to in force, then the state should find the money in the budget to provide the system.  However, that is the problem.  The Oklahoma budge doesn't allow for that but that is not the problem of the providers.  If there is any cost, it should be on a sliding scale based on the size taking into considerations such as size, financial, and services provided.  As a solo provider, I do not have the same funds as larger organizations such as Mercy, Integris, NorthCare, Red Rock, etc.  The additional cost of getting an EHR/EMR that complies or paying additional costs that my current system may charge.  Then there are the additional work hours as a solo provider of learning a new system and creating my electronic forms.  There is also the possibility of losing clients who won’t want to weather the changes and new system not providing same notification systems as my current system provides to ensure attendance of sessions, fear of the potential access to their information regardless of the opt out option, and inability to afford cost of services that I would need to increase to cover the exuberant cost.  The hardships this rule creates goes beyond the cost of an unwanted system.

4. It appears predatory towards are marginalize populations for BIPOC, LGBTQIA2+, and women.  Access to healthcare for our marginalize populations is atrocious at best.  Creating a system that tracks their care is invasive and unlawful.  Most of us had no voice in this matter which is something that happens every day for marginalize populations where cis-white males make up laws that have gross oversight without consideration of the implication.  I would say that this surprises me but not here in Oklahoma where the goal is to strip people of their rights to privacy and choice.

I adamantly oppose these changes and appalled that this law was even allowed to be voted into the legislation without proper vetting of the legal and financial ramifications for the Oklahoma citizens and medical professionals.

Fay O'Neill:

This is going to be catastrophic for a lot of practices. You say that "I. A determination of the effect of the proposed rule on the public health, safety and environment and, if the proposed rule is designed to reduce significant risks to the public health, safety and environment, an explanation of the nature of the risk and to what extent the proposed rule will reduce the risk: The proposed rule should have no adverse effect on the public health, safety or environment. "

That is so wrong! How are businesses going to be able to afford this cost? It is going to put people out of business, raise fees to clients/patients, and lower salaries in order to make up for the cost if they are even able to stay in business. It is hard enough to find services these days with the crisis we are in, not enough clinicians, an overflow of people seeking their services, high burnout rates, etc and now you want to add ANOTHER barrier to them being able to access services? Shame on you!

"J. A determination of any detrimental effect on the public health, safety and environment if the proposed rule is not implemented: The agency does not anticipate any detrimental effect on the public health and safety if the proposed rule is not passed."

THEN LEAVE IT ALONE!!!!! It makes NO GOOD SENSE to implement something that is CLEARLY going to cause a lot of people more harm than good, when by NOT implementing it, it would cause NO MORE HARM!

You are going to see people leaving the helping professions in droves. You can take that to the bank!

Jeffery Wilson:

I'm greatly concerned about any potential cost as I'm a private practice, mental health provider. And whenever a review of the laws and texts, it only has to do with Medicaid providers. I do not understand why this would include private insurance as Medicaid in Oklahoma does not pay very much and there are many, many Medicaid mental health providers that are stopping taking Medicaid.

K. Jones:

I am a mental health worker with a small practice in rural OK.  My predominate concern is the outrageous risk this brings. Mental Health providers constantly fight the stigma and work to help people trust this field.  Yet this is essentially proposing that my eye doctor could know if I’ve had an abortion or my speech pathologist would know if I take erectile dysfunction meds or someone treating me for poison ivy would know I’ve been treated for bipolar issues related to childhood trauma.  This is wrong, unacceptable and ,at the very least, overreaching violations of personal information on every level.  This has the ability to derail mental health services. The financial burden this will cause so many providers will cripple the field even more.  My hope is that someone with enough authority will read these comments and HEAR US! 

Rachel Kirk:

I do not agree with this bill, nor do I want to be forced as a LPC, or small business to pay for a platform that I don’t need to properly treat my clients. As a provider my job is to build rapport and do an assessment that provides most of the information your rep told me I would benefit from this service. Clients could loose providers that they are comfortable working with which is not health for Any patients in any aspect of the medical field. I also believe the price is to much 5000.00 And a monthly fee is crazy for me as a small business. HIE is a nonprofit gettin rich off these forced fees. While we can loose our Livelihood. $5000 could be 3 to 4 + months of our income in addition to that waiver form that in the video stated we would eventually have to pay, so is it an extension or a waiver? This impacts our ability as providers to take care of home. Self care is important and medical providers see and hear thing’s daily that impact us for a lifetime . We heal, comfort, teach, protect educate, and you all are helping suck every bit of our dreams down the drain by creating opticals for Oklahoma providers to NOT excel. We all need to focus on what truly matters and that the people of the community healing and having a healthy life style , and not how to pick out pockets .  And I fell HIPAA is being violated if not on a state level Maybe federal . 

Sarah Whitewater:

In response to: APA WF 22-16 Statewide HIE

The current proposed rule change presents a lot more questions than answers. I would like additional information about what specific problems/situations that warrant this particular rule to be proposed. The purpose of the rule is unclear in the document provided and the long term implications should be explored more thoroughly before making it a permanent rule. However, it is clear that "there will be a cost for providers to connect to the statewide HIE", as it was stated five times throughout the document. The financial implications of this are straight forward, more money out of providers pockets, greater likelihood that providers/small businesses will not be able to keep the doors open, therefore less access to healthcare services (specifically mental health). Personally, I received 135 requests for my services last year and was only able to serve about 40 of those. We are in a mental health crisis post COVID pandemic and Oklahoman's need as many resources to support them through this time. This rule would significantly impact all healthcare access and restrict the already limited services available. It's disheartening to see that this has not been considered as it wasn't address once in the proposed rule document.

I am opposed to the proposed rule change as it lacks clarity and viability. Additionally, I request further explanation of what prompted this proposed rule change and I strongly encourage exploring more cost effective ways to resolve issues with information exchange. 

Brandy Guidry:

I strongly oppose the APA WF 22-16 Statewide HIE.

Ashley Whitmire:

As a solo private  practice mental health provider, I have serious concerns that this bill severely impacts the privacy of both clients and providers. It also conflicts with the code of ethics my license has established. The required fees associated to make the changes to the HIE are devastating and burdensome to small businesses and individual providers, potentially causing many to shut their practices. This will be catastrophic to mental health services here in Oklahoma. There is already a significant mental health services shortage. The demand for mental health care since COVID-19 has increased significantly and the public outcry for treatment is louder than ever before. Even one therapist shutting down could impact the lives of Oklahomans greatly. The established relationships and trust built with clients from their provider is necessary to work on their most difficult traumas, addictions, suicidal ideations, and anxieties following the last several years of disruption. It  is vital to improving overall health and wellness. Causing many of us to go out of business leaves these most vulnerable Oklahomans isolated and alone. This will continue to cause Oklahoma to fall more and more nationwide in measurements.

This proposed bill would cause significant hardship on providers and raises serious privacy concerns. It would severely impact an already fragile, overwhelmed, underpaid mental health system. 

Angela Fultz:

I am very concerned about what information will be shared and who will have access to the records. Clear information regarding what information will be accessible by other providers and who will have access to records would be helpful, please.  Additionally, the cost is outrageous and will cause multiple small businesses to close. 

Brittany:

The HIE system would cause an undue hardship on my agency and many others who I know. $5k per provider is an insurmountably unimaginable impossible cost to pay for so many.  This will take a great majority of us off the map in the first year if mandated. I’m also concerned that even if there are financial hardship exemptions, that eventually it’ll just be a requirement so it’ll only create office closure and reduced mental health and medical services in a state which is already suffering from a deficit in care.

Also, I do not want my medical and mental health records in such a system without it being crystal clear who all has access to this information and what the limitations of usage of my information are. And the majority of patients will likely feel the same as confidentiality is a primary concern of many who seek care and fear of violation hinders many from seeking services enough already.

Also there needs to be spelled out what the usage permissions are, and heavy consequences of misuse, otherwise it won’t matter about the rules.

Lastly, there are already systems in place to share necessary information to provide care for patients. There are also Release of Information (ROI) forms for patients (or their legal guardians) to sign if they so desire their info to be shared for their benefit and continuity of care.

The HIE system is an unnecessary cost, for an unnecessary activity, with an underwhelming lack of insight and understanding of how very little health organizations profit and how very fatal this system implementation will be to the vast majority of services and how very big the barriers to accessing quality healthcare already are in the state of Oklahoma, especially for certain populations (such as the poor, people of color, new clinicians, start up practices, youth, young adults, the elderly, the disabled, legal immigrants, etc). And services which are able to survive will have an incredible blow to the quality of care and administrative support they can offer because the largest cost and priority will then forcefully be HIE membership instead of treatment and ethical care of patients.

Quintrell Johnson:

I believe passing this would be invasive to the clients we serve health care information, while also pushing out small private sectors to compete. As a mental health provider I don't believe this system would benefit providers and our services. I think alot of small businesses would be effected by having to pay $5000 and a monthly fee. I believe this only benefits big businesses and is a detriment to small businesses and their clients.

OHCA Response: 

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Debbie Decker:

I have a small business and these large costs may put me out of business. I am just going through the CARF recertification process now and this cost a lot and I can't afford $5000 more. Please do not do this to us small business owners. Thank you.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Esther:

I have concerns that this is going to put solo mental health practitioners out of business. The  financial cost of  connecting to the HIE may not impact large agencies, groups, clinics, or hospital/ inpatient facilities, but is a very high price for an individual practitioner.  This bill seems to increase a solo practitioners yearly expenses by a minimum of $5660 a year. Increasing buisness expenses this much in a solo practice leaves less money for the practitioner to improve their buisness in ways that could benefit clients/patients,  leaves less money in a budget to obtain quality training that would better client outcomes, and impacts overall take home pay for the hard working provider. This bill would also impact choice of EHR systems. I have contacted 3 EHR companies ( my current one and 2 others I have used in the past) and all 3 reported they will not be making changes to accommodate connection to the Oklahoma HIE. This would impact work flow and finances for the solo practitioner.

I appreciate you taking the time to review the comments related to OK Senate Bill 1369.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. Please note the $5000 connection fee is a one-time fee. Most EHR should already be capable of connecting to a HIE; however, once you have completed the application (https://myhealthaccess.net/apply) a representative from MyHealth will be able to begin working with you to determining whether your EHR is capable of connecting to the HIE. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Apryl Boyd-Stephens:

I am a private practice LPC. Requiring participation in the network will cause undo hardship ob my solo practice. This rule will result in the closing of solo practices and further exacerbate the shortage of providers in this state.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Christi:

This legislation is an egregious overreach and abuse of power/force by the state. As a psychotherapist, this will not benefit me or my clients at all. I wonder what the conservative citizens of this state would think about their government leaders forcing small business owners to purchase an expensive product they don't want or need, to be forced to participate in a program that goes against our personal/professional ethics and values, and to know that the state wants to data mine from citizens private health information? And we should not have to apply for an exemption. This law should not apply to us at all. This is a poorly written and thought-out piece of legislation. It's a scam. It is unnecessary and inappropriate government regulation on small business.  The law should not include psychotherapists, psychiatrists (there is already such a shortage of them), or the "allied health" professions at minimum. But, please enlighten us all on how this law benefits us and our clients? It seems to me the only one's benefiting are the corporate entity who will enjoy a nice profit off our backs and the politicians who are without a doubt, receiving some form of financial incentive to support this racket. Oklahoma ranks as one of the worst states for mental health and the state now wants to place more burdens on mental health providers? With telehealth, we can get licensed in other states and then choose not see Oklahoma residents. I see this also as a deterrent for anyone considering moving to Oklahoma and opening a healthcare business. So much for small government...and I am saying that as someone who is generally more liberal. Our state leaders are making it clear, they do not support small local business and they do not respect the rights of the citizens of Oklahoma. Those on the frontlines in healthcare know that most anything administrators force in the name of patient care, is never about patient care.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Please note that all of the fees to be paid are paid to the non-profit entity providing the HIE services. None of the fees paid will be provided to the state. As you pointed out, Oklahoma not only ranks low with mental health, but ranks low in overall health as well. Therefore, by gaining access to the patient’s complete medical record at the time of care will enable you and other healthcare providers to provide the most appropriate level of care at the time of the encounter. However, in order to create this “complete” record it is necessary to get as many health care providers connected to the HIE. If you still find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Terri:

This should not apply to small nonprofit agencies providing free outpatient services in rural Oklahoma. Mandating that our agency participate will be an unnecessary cost. We do not have excess funds for unnecessary costs.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Leah Holland:

I am concerned about this bill and the limited information within.

What will the cost be to individual providers?

Will the cost go towards agencies or each person with an NPI?

What would qualify a provider for the hardship exception?

Will the hardship exception eliminate the cost completely, lower the cost or cause the cost to be payable in smaller amounts over time? 

OHCA Response:

Please complete the application (https://myhealthaccess.net/apply) and someone from MyHealth Access Network will reach out to you to discuss the fees associated with the type and size of your organization. The initial cost will be a one-time fee to connect your EHR to the HIE and will be for the whole organization. The monthly subscription fees will be based on the number of providers within your organization. Hardship exemption will be based on technological or financial burdens and may be requested by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption. The exemption will only delay the time frame for which you must comply with the mandate.

Amy Graves:

This should not apply to small nonprofit agencies that are providing free outpatient services to rural Oklahoma. Mandating that our agencies participate will be an unnecessary cost. 

We do not have excess funds for unnecessary costs causing our agency a financial burden. You could be putting a lot of small agencies out of business by mandating HIE.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. At this time the mandate applies to all health care providers licensed in the state of Oklahoma. However, if you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Cassandra:

I am strongly opposed to this bill due to the privacy/control that is being taken away from myself and my clients. As a small solo mental health provider it seems Oklahoma doesn't care or respect this field as other medical providers do not need access to my clients files. I've worked hard on setting up my private business in a way that works best for myself in order to provide for my family. Requiring me to change my whole business to be compliant and force my business into using a record system that will cause myself a great deal of stress and struggle performing record keeping, which will take away time I use to provide for clients is harmful. This is a financial burden to Oklahom's people as I am a therapist and live in Oklahoma and don't have the funds. The hardship still requires the payment, as there is no permanent exemption. Oklahoma will lose more providers and we are already short handed. This will take away my rights on how I chose to run my business. I hope someone takes notice the massive negative impact this will cause to small businesses and it's people.

OHCA Reponse:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://www.surveymonkey.com/r/MyHealthAccessNetwork), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Chris W.:

1) Why $5,000? 

I understand setting up a system like this would be expensive. But is $5k/each the cost to build the system? What is the total cost to create this system. Why is the number of providers not independent of the final cost?  It should be $500,000 of tax-funded money to build it. Then an appropriate fee to apply (~$100), then $x/month to stay. The $5,000 seems so arbitrary and a certain burden for most providers.

What is the average income of a provider? What is the expected impact of $5,000 to a provider? (has this research been done before the amount was chosen?) I am personally a good about saving money. But I think everyone can acknowledge that many Americans making $50,000/year have trouble coming up with $5,000 in their budget.  I don't think many self-billers are able to afford this.

What are some guidelines as to what is considered hardship for affording $5,000?

If you apply for, and are approved for hardship exception - will you ever need to pay the $5,000?

In the comments it is said by OHCA that you much re-apply for hardship exception. If you are not approved after a certain time frame - would only you start paying the monthly amount, or would you need to afford the $5,000 plus the monthly amount?

2) Can we get examples of the definition of "health care provider".

In the Rule Impact Statement (A) it was noted that the definition changed. It is still not clear. Can we get a list of examples of who may be affected?

(Persons see clients and who bill directly will be required...) (Person who bill through an agency will not be required...)

These are the two basic examples - and honestly there is a lot of confusion about even these two base cases.

$5,000 is too much to ask when there is this ambiguity/confusion amongst those affected.

3) Why are answers being given privately and after applying?

In response to at least one comment with questions, the answer was given that after applying someone would reach out to answer questions.

This has a public hearing in 4 days - the community must have answers to their questions before that time.

4) What if it is underfunded?

From the replies it seems many solo providers will have trouble affording the $5,000.  If this happens to a large portion of the affected people will the system be underfunded?

We just don't understand what the $5,000 does or what it funds. We don't understand the implications of hardship because of this. We don't understand the impact to us or to the state because of this.

5) What is the purpose of the public hearing?

Is it only to air frustrations? Is it to answer questions? Is it to modify the bill?

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. We understand the cost to connect to the HIE can be burdensome for some providers. These costs are technology costs that are necessary in connecting the EHR to the HIE to properly submit health care information electronically. If you are a health care facility or person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of business or practice of a profession then you are bound by the mandate. Some responses will be specific to a particular type or size of the practice so the intent is to provide accurate information per individual provider or organization rather than allow for information to be misinterpreted. The HIE has been in operations for several years with several providers and organizations already participating. As mentioned previously, the major costs identified are based on connecting technology and not used to sustain the platform. As you have done through this public comment, your voice is heard and all information provided is considered for future policies and program development. We encourage everyone to use these platforms to express their opinions, concerns or applauses to ensure we are moving in the right direction. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Marla:

Is the onboarding cost deferment indefinite?  If not, it will be useless. 

OHCA Response:

No, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Rhonda:

At a time when America is facing the biggest mental health crisis ever, all this will do is close the door for small agencies and single providers making it even harder for Oklahoma's children to receive mental health services.  The initial cost and monthly fee not to mention the cost to upgrade and maintenance that will be required, it not doable.  You say everyone can request a hardship exemption, but I'm betting those are hard to come by and temporary, only putting off the inevitable cost.  The children in rural Oklahoma will pay the price while the large agencies reap the benefits.  What a shame!!!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Ken Bournival:

This rule has so many issues, I'm not sure there's enough characters allowed in this comment space to go through them all.

We can start here, with the likely falling under "void for vagueness". If an average citizen can't figure it out what it means and how it applies, then chances are the rule would be struck down in court. There will be lawsuits regarding this rule, costing OK taxpayers money we already don't seem to have.

Next, we can look at the financial conflict of interest that exists. My wife is a LMFT, and currently uses TherapyNotes (EHR) for tracking all of her notes and billing claims to insurances. When this rule goes into effect, the ONLY software (EHR) that will be available for her to use is going to be ThinkHealth, which is owned by Orion. Orion is the company that is the SDE for MyHealth, as chosen by the state of OK. My wife has spoken to 5 other companies, including TherapyNotes. The multi-state companies are choosing to drop all OK clientele (ie Healthcare Providers) so as not to have to deal with OK's mandates of the HIE, and the smaller companies are literally going to close their doors and go out of business. So not only does this present a huge conflict of interest financially, but how is it the government can mandate a private business use a specific software to run their business? I thought this state stood for individual freedom? By the way, FYI, many therapists don't use ThinkHealth because it's designed to work with the requirements of OHCA, which makes it much more time consuming for the individual therapist. The proposed 15 minutes that the Agency says providers will save will be more than washed away by the requirement to use a much more complicated EHR. Therapists in private practice don't get paid for the time outside of actual therapy sessions, so this is just more overhead (financial loss) and time away from family. I'm sure the emotional impact of all this wasn't even a thought. There are also ADA concerns for therapists that I won't get into for privacy reasons, but suffice to say the state  might be violating ADA law with this rule.

Second big issue is the financial liability this is going to put on therapists (and other providers), and how it's going to hurt the citizens of this state. OK is already woefully short of mental health providers; this $5,000 start up cost, additional monthly fee, the process of having to change to and learn a totally new EHR (which is more expensive than my wife's current EHR by $30/mo) is going to cause so many therapists to go out of business and pursue other forms of employment. My wife is already looking to see where she could transition to easiest, and I can see by the other comments left here that many others are going to follow suit. Instead of waiting 3 months to get into therapy, people will be waiting 6 plus months. Also, therapists will stop working with OHCA (which underpays therapists by a lot compared to private insurances), so good luck getting any services at all if you or your children are on SoonerCare.

Another question I have, is how is it that we (the People of state of OK) are automatically opted into this HIE? Courts have ruled that private businesses must by default opt customers OUT of things, and they must give their express permission to be opted IN to anything. I'm pretty sure the same would apply to a government agency.

I'm a disabled veteran, and I get 99% of my healthcare at a VA facility. Guess who can't see my medical records unless I sign a specific release? ANY of my other healthcare providers. So how exactly is this HIE going to benefit me.

Where the fees associated with this are involved, how is the same startup fee going to be levied on a large corporation like Integris Health going to be leveraged on a sole proprietor or other small business? It's comical how the proposed rule states that "A determination of whether implementation of the proposed rule will have an economic impact on any political subdivisions or require their cooperation in implementing or enforcing the rule: The proposed rule changes will not have an economic impact on any political subdivision or require their cooperation in implementing or enforcing the rule changes; however, there will be a cost for providers to connect to the statewide HIE." Guess what? A $5,000 fee for forced participation IS an impact on a political subdivision; and in the case of couples like my wife and I, these additional fees represent at least 10% of her annual income. For many therapists the work exclusively with OHCA, I can guarantee that $5,000 is far greater than just 10% of their annual income. So, sections C, D, E , F and G are all lies, and therefore this rule should be stopped because it DOESN'T meet it's own legal requirements.

Other considerations, especially where mental health is concerned, is that ALL providers will be able to see ALL of a patient's health records. What if my wife happens to provide therapy services to someone who is trans? If that information has to entered into the HIE through my wife's EHR (her notes required by insurances), then other providers could choose to stop providing services to that person based strictly on the fact that they are trans. A stillbirth that is medically removed is coded by insurance as an abortion. If a mental healthcare provider provides counseling for such, and is put into the client's notes, what's to stop the state from trying to charge the person with a crime under our abortion laws (aside from the fact that is would be a gross violation of HIPAA laws as that isn't a legitimate business purpose). What if a client is Schizophrenic and doesn't want that shared with other medical providers, or if a child is diagnosed with Oppositional Defiance Disorder? That child could lose services from other medical providers simply because children with ODD can be notoriously difficult to deal with, and providers will choose to drop them. There are a great many other issues regarding people's mental health that could be issues, probably too numerous to list here.

In summary, this rule: is vague to the point my wife and many other providers can't tell how drastically it's going to affect their practice (livelihood), is likely to REDUCE the amount of providers for mental health, occupational and speech therapy (amongst others), creates a financial conflict of interest for the State's contracted SDE, outright lies in proposed Rule regarding economic impact on political subdivisions and citizens, brings up MANY HIPAA-related concerns, and has NO benefit to providers in the mental health (and similar) field(s). All in all, this rule is extremely tone deaf and detrimental to many people both financially and personally. Unfortunately, our political leaders likely don't care enough about us to actually pull this back and rethink about how to enact the provisions of Senate Bill 1369, or to actually amend the bill so that it actually benefits the citizens that voted them into office. I'm expecting my extremely long comment will probably just get the same canned response everyone else's has gotten, because no one at the State level truly cares.

P.S. The changes that were just made to the proposed final rule actually make the rule HARDER to understand for therapists than the version that was proposed last week. Good job!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. We apologize for any confusion there may be regarding the organizations involved in providing HIE services. The company (OrionNet) that provides the ThinkHealth software has absolutely no affiliation with any of the vendors provider HIE services. We are not requiring any provider to switch their EHR system. We would ask that you complete your application (https://myhealthaccess.net/apply), so a representative with MyHealth Access Network may work with you and your EHR vendor to determine connection options before you attempt to change EHR systems. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Rocmnd Youth Services:

The cost to small agencies will be detrimental and more than likely cause businesses to close, making it harder for children in rural areas to access mental health services.  The request for hardship exemption is temporary.  The cost for small businesses to implement this and maintain it will shut down many agencies that children in rural areas so desperately need.  This change is confusing and will require an extra unnecessary workload for small businesses.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Cassi:

I am PT at a small, privately owned pediatric clinic.  HIE is a costly and burdensome requirement, which is a disservice to patients, their families, and the providers.  We already have close relationships with our doctors and provide them with the information they need to be able to refer for services.  Insurance companies only need the information necessary to determine authorization.  This is an unnecessary burden, which will take away resources for quality patient care. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Heather Hammons:

This should not apply to small nonprofit agencies that are providing free outpatient services to rural Oklahoma. Mandating that our agencies participate will be an unnecessary cost.

We do not have excess funds for unnecessary costs causing our agency a financial burden. You could be putting a lot of small agencies out of business by mandating HIE.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Tara Fritsch, MA, LMFT:

As a mental health provider, I have deep concerns about how this rule impacts the privacy of my clients. Requiring me to report any information on all clients appears to be a violation of the ethical codes of my profession.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies.

Ursula Bowling:

This will be a disaster for my practice.  I’m a small (only me) psychologist  who currently sees 12 clients, several on a sliding scale.  This cost would be more than 10% of my gross income.  In addition, I have huge privacy concerns regarding the record/not component of this.  Oklahoma already has a giant shortage of mental health providers and this odious requirement will make that worse.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Casey Green:

This is not the best interest of those of us who are in private practice. The expense alone will be a hardship for so many. I understand the intent but this isn’t the way to get better collaborative care. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Thomas Riffey:

I'm terribly frustrated and concerned about what this will do for care. The $5,000 cost to any provider will be a burden on a number of providers who cannot afford that kind of hit. Not every health provider makes the same level of income, and $5,000 is a lot of money to some providers.

And sure, you can fill out a hardship form, but if I am understanding the hardship correctly, this will only draw out the time period of how long the $5,000 is paid. It does not defer any costs and so the issue remains.

The cost of this will likely be passed on to patients in the form of additional admin fees, which can adversely impact care as well. Either penalizing lower cost care providers with an additional startup cost, or penalizing patients to cover the overhead cost of this will do as much harm as good to patient care. It will also keep good providers from expanding access if they have to front the cost before their practice is established.

If OHCA needed this hub so badly maybe they should have budgeted for the system better instead of pushing the sticker shock onto providers. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Please note that the $5000 cost is a one-time fee to establish the connection between your EHR and the HIE. The HIE mandate is not an OHCA requirement, but is a state-wide legislative mandate that the Office of the State Coordinator for HIE was created within OHCA to implement and oversee.

Victoria Scoville:

I am concerned with the startup cost for mental health providers in private practice.  This will detrimentally impact my own private practice as well as many other clinicians I work alongside in private practice.  The mental health field is currently facing a great demand with not enough providers to support the need and this will likely lead to many providers being unable to continue their work.  Additionally, I am concerned about the impact of privacy for my clients, many of whom would not want their information shared so freely.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Stephanie Winfrey:

I am not sure I understand the purpose of this bill. I am a skilled psychotherapist that offers flexible schedule to treat anxiety, depression and trauma. I am certified in EMDR, the leading treatment for trauma. I am currently working towards certification specializing in OCD treatment. As a licensed clinical social worker, I am already reporting to a state board that regulates my license. If it is passed where therapists in private practice have to pay $5k to the state, it will put me out of business. I will be forced to move out of state which would be an immediate detriment to people in Oklahoma. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Please note that the $5000 cost is a one-time fee to establish the connection between your EHR and the HIE. The fee is paid directly to the non-profit organization providing the HIE services. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Jerred Scotland:

This seems like a pad idea to require of all health care providers. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Cara McCarty:

Forcing mental health professionals to participate in the HIE will keep us from building trust and rapport with our clients, goes against confidentiality, and is a financial burden for those of us in private practice. We already are struggling with insurance rates being all over the place, having to pay into this system will cause many qualified professionals to change course. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Andrew Bentley:

As a solo private practice therapist I will never be able to afford this. On top of not being able to afford it, I have significant concerns about mental health records being this accessible and it being required by the state. Some people specifically cash pay so that no one other than the therapist knows their personal mental health struggles, by passing using insurance. I also have a client in ND that has had a difficult time getting appropriate and good medical care since his mental health and substance abuse records have become known to medical staff. They have had a very poor experience and now avoid medical care and often end up in the emergency room.

I am licensed in several jurisdictions and see clients in other states and this reality was definitely not considered when this bill was passed. I am not comfortable sharing any of my client file, but especially those from out of state clients.

I also, as a clinical social worker, have the ethical right to deny my clients to see their own medical records to protect their mental health, why would I share it with a network that would allow random providers to access it, especially in this time when this state is weaponizing medical care. And this is just issues I see from a cursery glance at this policy.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. This mandate only applies to data on which your Oklahoma license authorizes you to provide care. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Stacie Maze:

This will put extreme financial burden on Behavioral Health Providers (Psychotherapists) and decrease access to care for mental health.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Christopher Lopez:

I do not understand this overreach in power to disrupt services that are needed. What is the real goal and requiring all providers to do this? Money? Confidential information? 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. By participating in the HIE you will be doing your part in improving the health outcomes of Oklahomans. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Lindsey:

I keep seeing OCHA standard reply stating 'we hear your concerns' go here anddo this BUT you are still responsible to pay the fee.

Then you are NOT HEARING US. It's not ONLY about the 5k...so HEAR everything!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Elizabeth Hemme:

I will loose my small counseling business thanks to this rule and the extreme cost.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Deanna:

As a private practice clinician in mental health I strongly oppose being forced into this. You say we can file for an exemption for a period of time-what happens when it is not granted? I am forced out of business or have to raise my rates and pass the cost on to the consumer? Forcing this upon any private practitioner is wrong. Additionally, it brings up great concerns regarding individuals not obtaining the actual care they need if they have a history of mental health issues. This sets up an environment for the most vulnerable to be dismissed and passed off. While this may make sense for medical records, for private practice mental health records, it is a horrible idea. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. 

Sarah Allbright:

I am writing as a Licensed Professional Counselor (LPC) in OK state. I am very concerned about the implementation of this law. Requiring mental health professionals to comply with the terms of the law as it is currently written would present ethical conflicts relating to privacy concerns. It would also impose logistical hardship. This would be due to the requirement of the $5,000 start up fee, monthly fee, and necessity of using an EHR other than the ones most therapists in private practice use. Unless changes and revisions are made, this will place undue hardship on therapists already struggling in pandemic/ post pandemic conditions. Oklahoma is currently facing a mental health crisis, and cannot afford to loose competent therapists due to this new law. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Alison Squire-Anderson:

This bill is far too vague as to who it applies to.  It lacks consideration for small businesses.  It does not take into consideration all of the costs involved for individual providers including changing EHRs.  Because this bill impacts providers, it will in turn also negatively impact patients.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you are a health care facility or person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of business or practice of a profession then you are bound by the mandate. We would ask that you complete your application (https://myhealthaccess.net/apply), so a representative with MyHealth Access Network may work with you and your EHR vendor to determine connection options before you attempt to change EHR systems. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.  

Christina Walker:

This is will make my small private practice go out of business. I find it truly important to serve Oklahomans with mental health needs, and I love communicating to other professionals as I do today. Please remember us small private practice owners have limited funds.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Nichole Ruiz, LCSW, PMH-C:

This is a complete violation of our rights as business owners to determine our fee schedule, and be able to opt out of working with insurance companies who pay us less than half of our billable hour.  As a small business person and a social worker I try to maintain rates that work for me, as well as my clients well, not having insurance companies dictate how I run my practice, what modalities I use, and the length of my sessions. Furthermore, this is a violation of client privilege, and requiring me as a provider to change my EMR, if my current system does not coordinate with the state system. There is no reason the state of Oklahoma needs access to my client records as they are confidential and protected.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. There is no requirement for you to change your EMR. If your EMR is not capable to transmitting data to the HIE, which will be determined once you have submitted your application (https://myhealthaccess.net/apply), and have spoken with a MyHealth Access Network representative. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Amber Walter, LPC:

Please do not implement this! This will just be another huge barrier to people getting the mental health care that they need! I just opened a private practice and will not be able to afford the aftermath of this bill, and would therefore lose my caseload of about 40 people. This will be absolutely crushing for providers and clients!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Lauren Garder:

I do not contract with soonercare and ohca has no business telling me what EHR to use. I am in private practice part time. $5,000 for a start up cost is insane! 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The HIE mandate is not an OHCA requirement, but is a state-wide legislative mandate that the Office of the State Coordinator for HIE was created within OHCA to implement and oversee. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Vicky Hampton:

This will greatly impact the work we do and potentially violate the confidentiality of those we serve. Most of us cannot afford the ridiculous fees your suggesting. And, this us a great way to deter future therapists from coming on board. This is not a good thing! My clients have said they will not participate. We need more therapists today! You are making an incredible mistake by lumping all of us into this!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Marcia Leys:

I am opposed to this!  Our work is taxing enough. We want our focus to be on our clients, not on more paperwork.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Caleb Scoville:

As a therapist of over 12 years I am directly opposed to this move by OHCA and the state.  I know 12 years is nothing compared to many other commenters but I can honestly say things have gotten worse not better in mental healthcare overall.  This is not a solution, this bill and move by OHCA and the state will drastically impact the work myself and other mental health care providers do- let alone the financial burden of $5,000 per provider. Oklahoma needs more mental health providers and this will definitely discourage people from that path in my opinion.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The HIE mandate is not an OHCA requirement, but is a state-wide legislative mandate that the Office of the State Coordinator for HIE was created within OHCA to implement and oversee. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Machaelie Souza:

As a solo private practice LPC, I absolutely cannot afford this unnecessary cost and will have to change fields. This is a detriment to an already incredibly strained mental health field. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Kristen Callaway:

This bill is a massive overreach of OHCAs power and imposes undue financial burdens on mental health providers. This bill should not include mental health providers and will discourage others from joining the field. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The HIE mandate is not an OHCA requirement, but is a state-wide legislative mandate that the Office of the State Coordinator for HIE was created within OHCA to implement and oversee. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Ranada Sims:

I do not believe this is fair to force this on us. We should have a choice with other affordable options. These last minute mandates are not fair I do not agree to this! Very unhappy and disappointed about this.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Lou Moore:

I am an LPC  and own my private practice without any employees. I am not a government agency. Over the years, as a provider for children in the Soonercare mental health services, I have watched proposals approved that have limited the number of sessions a child can receive from eight to four and the reimbursement rate cut in half. As I read this new proposal, once again, you are placing another financial burden on licensed professional counselors, who have their own practice. The standard response to other comments has been to apply for an exemption. However, if I read the last change correctly, an exemption, does not remove you from having to comply with the policy it just gives you additional time. This is not acceptable.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.    

Brandon Schmidt:

Vote no. OHCA and other governing bodies have already ransacked mental health in this State. And they are hoping that more power and more control will solve the problem. When has that ever solved the problem? We need less regulation and less of the government getting in between us and our clients/patients. If the problem is too many clients and not enough providers, then do something to incentives providers. Most have gone to cash pay fees because we can’t stand government continuing to come between us and our care for our clients. I say no to more regulation!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. 

Kacey Brewer:

Please examine the unintended consequences of bad legislation like this! It is heartbreakingly hard for my clients to find therapists today. This would force out so many providers and make the shortage even worse! We absolutely need good legislation to improve services, but not extra and unduly burdensome rules that drive small businesses out of business! This idea should've never seen the light of day!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Michael:

I am not ok with this. This does not seem to have the best interest of protecting clients or patients, especially in the mental and behavioral health arena and it appears to be in violation of HIPPA. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Cari:

I guess I’ll get my education here and then move to a pro-business state. This will close many businesses and make services harder to o rain for everyone in Oklahoma. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation.

Cynthia Sherbon:

Why is this announced 5 months before the deadline for implementation.  As a psychotherapist I am concerned about confidentiality and my records being placed in a website that may or may not be secure.  These rules are ambiguous and not transparent.  What is the cost to a single provider?  Why am I just finding out on a Facebook group about this "emergency" legislation and that there is a Public Hearing in just 4 days from me learning about it.  I guarantee there are thousands of psychotherapists, especially in private practice that don't have a clue about this legislation.  I suspect there will be many leaving the profession at a time when Mental Health services are critically needed.  My experience has been that these websites aren't easily navigated.  Will be mailing a notice to all Mental Health therapist's about this legislation.  It seems to me it hasn't been thought through very well.  I'm wondering where I might find specific information about the cost of joining and what happens if we don't?

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. Once you submit your application (https://myhealthaccess.net/apply), a representative with MyHealth Access Network will contact you to discuss next steps and provide you with the costs associated with your organization. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Linda Russell:

How would implementing such a burdensome process be a benefit to clients when it will likely element many providers? There is such a great need for mental health care providers now,  this type of legislation does not appear to be in anyone's best interest with the possible exception of those who are requiring this burdensome rules.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Paula Edwards-Gayfield:

I strongly oppose the APA WF 22-16 Statewide HIE. Participation in the HIE has the potential to be financially detrimental to many private practitioners. As others have stated, to require a small business to pay the same fees as a larger organization is indicative of what is wrong with our society. I DO NOT WANT my healthcare information shared with anyone and realize I can opt out. But as your response encourages individuals to review the flier, it uses language that may be intimidating to some (and I paraphrase) that if they were in an accident, hospitals may not have access to their records. This feels like bullying tactics! I am seriously concerned about my clients information being shared as there is not only mental health stigma, but provider bias amongst healthcare professionals. Maybe you should consider why many individuals prefer to pay privately for services versus utilizing their insurance benefits. The wording of these new requirements is vague and unhelpful. Requiring providers to participate in a state-mandated system is not collaborative, it is a huge overstep under the guise of better patient care, it removes patient and provider choice. I would encourage an exemption for small agencies and allied health services.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Kelly Morgan:

I am a mental health clinician working in a rural area. I am concerned about how my clients’ records could be accessed by other providers in such a small community. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE.

Amber M. Prather:

As an LPC in private practice I am outraged and alarmed by the overreach of this bill! Were there no licensed mental health professionals consulted in the drafting of this bill? This bill violates privacy and ethics and severely interferes with the mental health professional’s ability to protect these vital components that make therapy work. I am alarmed as both a provider and a patient. This needs to be reevaluated in its extension to mental health at a time that mental health care is at an all time high and providers are overburdened. This is egregious and outrageous to require providers to pay for a subscription to a platform that violates the very premise that makes mental health therapy safe-confidentiality. The $5000 is laughable to already underpaid mental health providers. I am very concerned about the negative impact of this extension to the mental health field, providers and patients! Please hear these many voices of concern and make needed adjustments.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Mackenzie Brewer:

What you all mean by the active participation? How often would be active? What would the fee be for private practices? What is that based on how many clients?

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. We are still in the process of defining what “active participation” will look like. At a minimum we would expect health care providers to look up all new patients within the HIE. Please complete your application at https://myhealthaccess.net/apply and a representative from MyHealth Access Network will contact you to discuss the costs associated with your organization.

Betsy Brelsford:

I own a small private practice for therapy and this bill appears to only add stress and financial burdens to my job and many others in my field.  I am surprised and disappointed that it is being considered. Federal taxes as well as state taxes already take a major chunk of our income. We are already heavily burdened with paperwork. I do not want to have to pay for something that I do not want. This seems like a major overreach of power. Why would you all try to crush small businesses like mine? I work part time and have 3 small children at home. My husband and I work very hard. I cannot imagine having to pay for something that I will not even benefit from, nor will my clients. Rarely do medical doctors want or even concern themselves with mental health. This is completely unnecessary and I truly hope someone advocates for small practices like mine that cannot afford more financial burdens, however small, and more paperwork and data to keep track of. Mental health workers have been drowning in paperwork for decades. Just stop it. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Chad McCoy, LPC-S:

If I am to understand this bill with the intention that it is written, I understand that OHCA contacted entities will need to adhere to these rules promulgated through 1369 as they choose to work with the OHCA through Soonercare.

If I am to understand this bill with regards to the surface, face valid language of the law, ALL providers will be mandated to adhere to those rules promulgated by 1369 even if choosing not to contract with OHCA; coercing practitioners into a monopoly system of how they interact with their clients and their clients PHI.

My concern, as a private entity practicing counseling in the state of Oklahoma, is that my client’s information, will be required to be submitted without their expressed consent.  This act, if allowed, may have unintended consequences for those who hope to seek out private, confidential counseling to which they do not wish any other entity, insurance or state agency, privy to.  This egregious overreach will encourage individuals to not seek out counseling services due to the continued stigma that surrounds our counseling field and the inability for our clients to have a choice and control over their PHI. 

I am not in support of 1369 in any way overreaching into the private business, or their client’s, ability to provide, and seek out, private and confidential care regarding mental health needs.  

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. The mandate applies to all health care providers in the state not only Medicaid contracted providers. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. Additionally, patients have the option to opt out of the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Stacy Ensminger:

This was too costly a burden on those in private practice who provide an immeasurable service to our Oklahoma citizens with mental health issues. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Kelley Brister:

This bill should not be passed. It is too hard for small business owners!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Kayla Reid:

DO NOT PASS!!! This is going to crush small businesses with this 5k database! Insane!!!

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Scott Brelsford:

I am against this bill. Adding more paperwork and expense to an already overburdened sector will now help the current state of mental health in OK. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. By participating in the HIE, you will be able to reduce the amount of paperwork from your workflow. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Vanessa Funk:

I am a licensed professional counselor in  solo private practice since 2018. While on the surface this sounds quite helpful  in a higher level of care setting, I do not think this is appropriate for outpatient mental health counseling. The wording is extremely vague and leaves many areas up to different interpretations. Additionally, I do not feel it is fair to place the burden of the $5,000 cost on small businesses such as mine, or smaller agencies. There is no way I have this kind of money lying around in savings to be able to afford this. Especially for only one provider! Not to mention the additional time and effort,  unpaid, it would take to compile  a plan outlying intended steps to compliance. Many clients who choose not to use their insurance do so for the sake of privacy. It is not the government’s business to be part of my, and others, healthcare. I implore you to consider the significant burden this places on a small business. Organizations like mine do not prescribe medication and deal with extremely private and protected personal health information. Respectfully, please consider the many updates needed including specific wording clarifications, and overall more thought and detail needed to make this appropriate and helpful for the community. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Kristin Holland-Pitts:

As an independent provider in private practice I am appalled that we are expected to foot a bill for $5000.  I do not want access to my client's medical records in a private setting.  I have utilized the HIE when working in community mental health when it was necessary to determine if clients were shopping for pain medication.  I have no use for this system now, as I don't have clients with intense mental health needs.  Our state is at an all time high need for mental health after Covid.  Our LGBTQIA+ community is greatly struggling and women have had their ability to determine if we want to give birth no longer an option.  Adding just one more requirement is inhumane.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Jeannine H:

As a Mental Health Provider in Private Practice I am not only concerned about the mandatory cost of this but also about being required to enter information about my clients into a system like this.  In my opinion there is no reason a Mental Health Therapist should be required to enter client information into this type of data base that is open to every healthcare provider in the state. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.  

Gina Campbell:

Please don’t pass this bill.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. 

Lois Bryan-Williams:

I am an LPC in private practice in Norman, Oklahoma. I work with clients on a daily basis and this rule will impact their privacy in ways that are not appropriate, ethical or helpful to their treatment. Please reconsider your position. This will also impact providers negativity in terms of financial impacts. Please reconsider. Thanks for your time. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Rachel Hudson:

These rules would be a disastrous privacy violation for the mental health field as well as the practice of medicine. As a healthcare professional and patient, I am vehemently opposed to the sharing of patient information, my own information or my clients' information. Doctors, dentists, therapists, and the state do not need access to the private information of any individual, but their own patient, and what information the patient chooses to share. This is a massive overreach and will result in medical professionals fleeing the state to protect their patients. This would be the final straw for moving to a state that values its education, mental health field, and citizens as more than a disposable commodity. Please heed caution and do not further intrude on citizen freedom, nor the private, individual care between provider and patient.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Courtney Dickensheet:

As a licensed therapist in the state of Oklahoma, these types of rules prohibit us from being able to provide the type of care to our clients that we strive for. Like most of healthcare currently, these blanket rules continue to run down our system and pile unnecessary admin work on private providers that is unnecessary. Our clients see no benefit from this extra work. Let us spend our time learning new interventions, reading latest research, and using those to creatively implement modern interventions for our clients. That’s what benefits the citizens in this state receiving services. Helping our clients get well is what drives down healthcare cost. Not more admin work. These rules are steps backward. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. 

Krystal Haltom:

Can someone tell me why we thought this would be a great idea? I’m all for patient care, but in order to have patient care, you need providers. This bill will put so many providers out of business causing poor patient care. We have to pay for continuing education, our license, billing systems, and do not get raises. I’m making less than a manager who doesn’t have a bachelors degree AND I HAVE A MASTER DEGREE. Oklahoma cares none about mental health and if you did, you’d take care of the providers too.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.

Haley Smith:

Please do not pass this bill. 

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. 

Kayla Martel:

This would be seriously detrimental to mental health initiatives across the state. We are in severe need of more mental healthcare providers and ANY bill passed that could unnecessarily put providers out of business is harmful. Not to mention, provider income is low as it is. This would be a terrible move for our state.

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. 

Leslie Roberts:

My clients would be horrified to know other providers they saw knew they saw a therapist. Their information is no longer private.  Many of my clients work in healthcare!  We aren’t paid enough to cover these costs. Your requirement, your bill?  

OHCA Response:

We appreciate you expressing your concerns regarding the mandated participation. Rest assured that we take patient privacy very seriously and ensure that all data is only accessed in approved ways, compliant with HIPAA, and our Terms & Conditions and Network Policies. Please note that any 42 CFR Part 2 data is not part of the type of data to be sent to the HIE. If you find that you will not be able to meet the mandate due to technological or financial burden, you may request a hardship exemption by submitting a request to the Office of the State Coordinator for HIE through the application (https://myhealthaccess.net/apply), describing in detail, your situation as to why you are not currently able to meet the mandate. Please note that if approved, the hardship exemption will be approved for a limited time frame at which point you will need to either meet the requirement or submit a new request for a hardship exemption.