APA WF# 24-34 Community Health Services
These rule changes are currently approved as Emergency Rules and must be promulgated as Permanent Rules.
The Oklahoma Health Care Authority (OHCA) is seeking approval of rules and a state plan amendment to provide coverage and reimbursement for community health services. These services are performed by community health workers (CHW) within a public health clinic setting. CHWs are critical members of the public health workforce who assist the community with access to services. Specifically, CHWs will be able to provide various screening assessments, health education, health system navigation, and other advocacy-type services. The request to provide coverage for CHWs came from the Oklahoma State Department of Health (OSDH), who will provide the state funding.
Please view the circulation documents here: APA WF# 24-34 and submit feedback via the comment box.
Circulation Date: 12/2/2024
Comment Due Date: 1/6/2025
Public Hearing: 1/6/2025
Board Meeting: 1/15/2025
Submit a Comment
After you submit your comment, you should be re-directed to a confirmation page. If you are not, please submit your comment through e-mail to federal.authorities@okhca.org.
Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.
Comments
Steven:
Based on OHCA response to earlier comments, more clarification would be helpful. The OHCA response was: (1) Reimbursement will not be available for assistance provided for initial enrollment, as only contracted choice counselors may help enroll SoonerSelect members.
Question: (1a) Initial applications for SoonerCare can be completed with no SoonerSelect choice required (as new members are auto-assigned). And there are categories of new SoonerCare applicants who are not eligible for SoonerSelect. If a CHW does not counsel about SoonerSelect plan options or assist with SoonerSelect plan selection, is reimbursement for CHW services available for an initial application for SoonerCare? This is important since there is a 2-to-6-week delay before a SoonerSelect plan starts, but there is coverage from "regular" SoonerCare immediately. The patient populations served by CHWs tend to need the personal enrollment assistance and swift access to care and services.
(1b) Similarly, assisting a member with renewal or re-activation of SoonerCare coverage does not require SoonerSelect plan choices. If a CHW does not counsel about SoonerSelect plan options or assist with SoonerSelect plan selection, is reimbursement for CHW services available for a renewal or re-activation application for SoonerCare? This would seem to align with the "health system navigation" and "advocacy-type services" listed in the description of the rule change. Thank you.
Steven:
Another earlier response from OHCA would be aided by further clarification, please. The OHCA response was: (2) The “health system navigation” and “social resource navigation” services of a CHW do include assistance with completing applications or enrollments that will increase access to care and services to help address health and social needs. Question: (2) What other "applications or enrollments" do qualify for CHW service reimbursements? An OHS "OKDHS-Live" website application for medical services? An OHS "OKDHS-Live" website application for SNAP, WIC or other social needs? Applications for housing assistance? Applications for Legal Aid assistance? A drug manufacturer's patient assistance program? The "Rx4Okla.com" program? A Health Insurance Marketplace application on "HealthCare.gov"?
Thank you.
