Archived Proposed Policy Changes

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The Oklahoma Health Care Authority (OHCA) seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed policy page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.

All comments regarding proposed administrative rules will be considered during the rulemaking process and become a part of the official work folder. All rule changes are subject to the Oklahoma Administrative Procedures Act.

Oklahoma Statutes

For Quick Reference Search; please click the applicable archive Proposed Policy Changes

2017-2018 SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Update

The Oklahoma Health Care Authority Waiver Development and Reporting unit is seeking comments from the public regarding the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver update to the extension of the Demonstration, 2017-2018. The application requests approval of the waiver in its present form, with the addition of language to specify Medical Residents must be licensed in the State in which they practice.

Please view the full 2017-2018 SoonerCare Renewal Application here: SoonerCare Renewal Application. Please note, that to view the document attachments please select the paperclip in the renewal document.

The comment period is open from August 26, 2016 until September 26, 2016. Please submit all comments by close of business, September 26, 2016, via the comment box below. The OHCA will respond in writing to any feedback received during the comment period.

The public meetings have been conducted for this waver at the locations mentioned below. Input from meeting participants was summarized and included in proposed extension submission to the Centers for Medicare and Medicaid Services.

1.April 19, 2016 5:00p.m.OPQIC Oklahoma Perinatal Quality Improvement Collaborative Meeting

2.May 19, 2016 at 1:00p.m. Medical Advisory Committee Meeting

1115 Waiver Demonstration Feedback

The Oklahoma Health Care Authority Waiver Development and Reporting unit is seeking comments from the public regarding the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Application for Extension of the Demonstration, 2016-2018. The comment period is open from now until Dec. 5, 2014. OHCA will respond in writing to any feedback received during the comment period.

Also, an overview of the feedback will be discussed in the public meetings mentioned below as received. Input from meeting participants will also be summarized and included in the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Application for Extension of the Demonstration, 2016-2018 to the Centers for Medicare and Medicaid Services.

Click here to offer feedback.

Click here to view the application for extension of SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver.

The public will have the opportunity to provide meaningful comment on the SoonerCare demonstration waiver September 9 through December 5, 2014.

1. September 16 at 5:30 p.m.
OHIP Children's Health Workgroup Meeting
OU Health Sciences Center Campus,
OU College of Medicine
Provost Conference Room (Room 223)
Bird Library
Oklahoma City, OK

Video conferencing is also available for this meeting:
-OU College of Medicine, Tulsa;
-Northwestern Oklahoma State University, Enid; and
-Eastern Oklahoma State University, Wilburton.

2. November 20 at 1 p.m.
Medical Advisory Committee Meeting
Charles Ed McFall Boardroom
Oklahoma Health Care Authority
4345 N Lincoln Blvd.
Oklahoma City, OK

SC Waiver 12-01

Modification to the Health Management Program within SoonerCare Choice

Circulated Date: 09/05/2012

OHCA Comment Due Date: 10/15/2012

Amendment Request

1115(a) SoonerCare Research and Demonstration Waiver

05/06/2014 Tribal Agenda

Circulated Date: 04/25/2014

OHCA Comment Due Date: 05/25/2014

Proposed Submittal Date: 05/09/2014

Insure Oklahoma Sponsor's Choice Option

The 1115 demonstration waiver and corresponding agency rules will be amended to reflect a third Insure Oklahoma option. The Insure Oklahoma Choice program will establish coverage for sponsoring organizations, eligible populations including dependent spouses and children, qualifying benefit plans, cost sharing and expenditure authorities. The evaluation design will be modified to incorporate the Insure Oklahoma Choice program as well.

Circulation Date: 06/12/2015

OHCA Comment Due Date: 07/17/2015

Proposed Submittal Date: 07/31/2015

Home and Community-Based Services (HBCS) Waivers’ Amendments

Community Waiver Amendment

The participant direction option has been added to the waiver for members living in non-residential settings such as their own home or the home of a family member or friend. The participant direction service delivery method has been added as an option for Habilitation Training Specialist Services and a new service, Self-Directed Goods and Services (SD-GS), has been added.

The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.

The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.

Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.

The estimate of Factor D for waiver year 5 has been updated based on Form 372 for FY18. This includes an increase in the Respite Daily in Home rate from $38.00 to $57.04.

Please view the waiver amendment in its entirety here: Community Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Homeward Bound Waiver Amendment

The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.

The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.

Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.

The estimate of Factor D for waiver year 5 has been updated based on Form 372 for FY18. This includes an increase in the Respite Daily in Home rate from $38.00 to $57.04.

Please view the waiver amendment in its entirety here: Homeward Bound Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports Waiver for Adults Amendment

The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.

A cost limit has been added for Prevocational and Supported Employment services which allows an additional $5500 per member above the $23,131.00 individual cost limit. This additional limit will allow members to access individual placement opportunities with a Job Coach, Employment Training Specialist and stabilization.

The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.

Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.

Estimate of Factor D for waiver years 4 and 5 has been updated based on Form 372 for FY18.

Please view the waiver amendment in its entirety here: In-Home Supports for Adults Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports Waiver for Children Amendment

The Level of Care Criteria section has been updated. A packet of information used to conduct an initial evaluation is compiled and submitted to the Oklahoma Health Care Authority by DHS/DDS. Included in this packet of information is a medical evaluation. Currently, the medical evaluation must be current within 90 days of the requested waiver approval date, but that time period has been changed to within one year of requested waiver approval date.

The Evaluation/Reevaluation of Level of Care section has been updated in order to clarify reports used to ensure timely reevaluations.

Electronic Visit Verification (EVV) language, found in the Financial Accountability section, has been updated.

The estimate of Factor D for waiver years 4 and 5 has been updated based on Form 372 for FY18.The above amendments will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.

Please view the waiver amendment in its entirety here: In-Home Supports for Children Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, June 30, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Community Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.

The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.

Please view the waiver amendment in its entirety here: Community Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Homeward Bound Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.

The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.

Please view the waiver amendment in its entirety here: Homeward Bound Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports Waiver for Adults Amendment

The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.

The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.

Please view the waiver amendment in its entirety here: In-Home Supports for Adults Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports Waiver for Children Amendment

The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with Intellectual Disabilities age 3 through 17. Language describing the rate determination method for Specialized Medical Supplies and Assistive Technology has been updated. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. Assistive Technology services are authorized by selecting the best bid from among a minimum of three when the cost exceeds $5000.00. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.

The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.

Please view the waiver amendment in its entirety here: In-Home Supports for Children Waiver Amendment, and submit feedback via the comment box below.

Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waivers, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

ADvantage Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the ADvantage waiver. The ADvantage waiver provides services and supports to assist older adults and adults with physical disabilities to live independently in their homes and communities. The Oklahoma Health Care Authority has an established pricing methodology for Specialized Medical Supplies and Assistive Technology that do not have fixed rates. Rates are determined using the individual rate or may also be determined using the SoonerCare reimbursement methodology. If the item is not available under the SoonerCare State Plan, but the item is essential to the member’s health and/or safety, the item may be authorized through the waiver.

The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or July 1, 2020, whichever is earliest.

Please review the waiver amendment in its entirety here: ADvantage Waiver Amendment.

Please submit all comments by close of business, April 1, 2020. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of a waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports Waiver for Adults Amendment

The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 3-5 has been made as well as an increase in the individual member cost limit. Currently, the cost limit amount is $22,235.00 per member, per plan of care year. This amount will be increased to $23,131.00. Other updates include further explanation related to the exclusion of room and board cost, clarification of provider rate methodology, the addition of Electronic Visit Verification procedure, clarification related to member safeguard procedure, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update and confirmation that Oklahoma’s Statewide Transition Plan was granted final approval.

The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports Waiver for Children Amendment

The Oklahoma Department of Human Services is seeking to amend the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with Intellectual Disabilities age 3 through 17. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 3-5 has been made as well as an increase in the individual member cost limit. Currently, the cost limit amount is $14,825.00 per member, per plan of care year. This amount will be increased to $15,426.00. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, the addition of Electronic Visit Verification procedure, clarification related to member safeguard procedure, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update and confirmation that Oklahoma’s Statewide Transition Plan was granted final approval.

The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Community Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made as well as an update of the number of unduplicated participants served through the waiver for year 5. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, clarification related to a waiver member’s medication management, critical incidents and safeguard procedure, the addition of Electronic Visit Verification procedure language, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update, confirmation that Oklahoma’s Statewide Transition Plan was granted final approval, level of care evaluation approval procedure change, Specialized Medical Supplies and Assistive Technology service definition and provider qualifications update, language clean-up to ensure reference to “mental retardation” has been changed to “intellectual disabilities”, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), confirmation that Extended Duty Nursing may be provided in a facility, Daily Living Supports and Intensive Personal Supports services may now be provided by a relative/legal guardian, Agency Companion provider qualification update and a change in the sampling approach described in the Quality Improvement Strategy for the Health and Welfare section of the waiver.

The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Homeward Bound Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. The Oklahoma Legislature mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made. Other amendments include, an update of cost neutrality information, clarification of provider rate methodology, clarification related to a waiver member’s medication management, critical incidents and safeguard procedure, the addition of Electronic Visit Verification procedure language, billing system vendor change from HP Enterprises to DXC Technology, vocational services definition and limits update, confirmation that Oklahoma’s Statewide Transition Plan was granted final approval, level of care evaluation approval procedure change, Specialized Medical Supplies and Assistive Technology service definition and provider qualifications update, language clean-up to ensure reference to “mental retardation” has been changed to “intellectual disabilities”, removal of the contracted agency staff oversight requirement from individual Homemaker providers (they are supervised by DDS Foster Care Specialists), confirmation that Extended Duty Nursing may be provided in a facility, Daily Living Supports and Intensive Personal Supports services may now be provided by a relative/legal guardian and a change in Agency Companion provider qualifications.

The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 1, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Medically Fragile Waiver Amendment

Per CFR 441.304, a waiver amendment is required for substantive changes that include an increase in slot participation for unduplicated members, the Oklahoma Health Care Authority Medically Fragile Waiver is increasing slot participation in the waiver. During Fiscal Year 19, the Medically Fragile waiver met the awarded number of slots. Awarded slots cannot not be exceeded, therefore an amendment must be submitted.

The requested effective date of the slot increase will be July 1, 2019 upon Centers for Medicare and Medicaid Services (CMS) approval. Per the HCBS Technical Guide, “A retroactive effective date can be permitted for the purpose of increasing the unduplicated number of participants”.

The Medically Fragile Waiver serves adults 19 years of age and older who have been diagnosed with a medically fragile condition who require a Hospital/Skilled Nursing Facility level of care and whose needs could not otherwise be met through another Oklahoma Waiver. All Medically Fragile Waiver members receive services in a home and community setting.

The waiver amendment is available for review here. Please submit all comments by close of business, August 2, 2019. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: QA & Community Living Services: 1915(c) Waivers.

To request a free hard copy of a waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: QA & Community Living Services: 1915(c) Waivers.

Medically Fragile Waiver Amendment Rate Increase

Pursuant to 42 C.F.R. § 441.301, the Oklahoma Health Care Authority (OHCA) is required to give public notice and receive public input on any significant proposed changes to the 1915(c) Home and Community-Based Services (HCBS) waivers.

Revisions are needed to increase the current reimbursement rates for all SoonerCare-contracted provider types by five percent (5%), with the following exemptions: services financed through appropriations to other state agencies; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); non-emergency transportation capitated payments; services provided to Insure Oklahoma (IO) members; payments for drug ingredients/physician supplied drugs; Indian Health Services/Tribal/Urban Clinics (I/T/Us); Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs). The agency’s proposed revisions are in keeping with Sections 1 and 2 of the SB 1044, 57^th Leg., 1^st Sess. (Okla. 2019), except that reimbursement rates for PACE providers (Program for the All-inclusive Care for the Elderly) will also be increased by five percent (5%). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.

The effective date of the 5% rate increase will be upon notification from the Centers for Medicare and Medicaid Services (CMS) or on 10/01/2019, whichever is first.

The Medically Fragile Waiver serves adults 19 years of age and older who have been diagnosed with a medically fragile condition who require a Hospital/Skilled Nursing Facility level of care and whose needs could not otherwise be met through another Oklahoma Waiver. All Medically Fragile Waiver members receive services in a home and community setting.

The waiver amendment is available for review here. Please submit all comments by close of business, August 3, 2019. Comments can be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105.

Attention: QA& Community Living Services: 1915(c) Waivers.

To request a free hard copy of a waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105.

Attention: QA & Community Living Services: 1915(c) Waivers.

ADvantage Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the ADvantage Waiver. ADvantage provides services and supports to assist older adults and adults with physical disabilities to live independently in their homes and communities. The Oklahoma Legislature has mandated a four percent rate increase on fixed and uniform provider rates. As a result, an update of the estimated cost of the waiver for years 4-5 has been made.

The waiver amendment is available for review here. The amendment will be effective upon approval by the Centers for Medicare and Medicaid Services (CMS) or October 1, 2019, whichever is earliest. Please submit all comments by close of business, August 3, 2019. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Medically Fragile Waiver Amendment

Revisions are needed to increase the current reimbursement rates for the Medically Fragile Waiver services by three percent (3%) with the following exemptions: services financed through appropriations to other state agencies, Durable Medical Equipment Prosthetics, Orthotics and Supplies (DMEPOS), non-emergency transportation capitated payments, services provided to Insure Oklahoma (IO) members, payments for drug ingredients/physicians supplied drugs, Indian Health Services/Tribal/Urban Clinics (I/T/U), Federally Qualified Health Centers (FQHCs), and Rural Health Centers (RHCs). All rate increases must comply with state and federal law as well as state cost reimbursement methodologies.

The waiver amendment is available for review using the following link here. Please submit all comments by close of business, October 14, 2018.

ADvantage Waiver Amendment

Pursuant to House Bill 3708, the Oklahoma Department of Human Services is increasing certain provider rates for the ADvantage program. These include a 7% rate increase for ADvantage direct care, case management and State Plan personal care effective upon CMS approval or October 1, 2018, whichever is earlier. The ADvantage waiver serves older adults and persons with disabilities who reside in a community setting.

The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers

In Home Supports Waiver for Adults Amendment

The Oklahoma Department of Human Services is seeking an amendment to the In-Home Supports Waiver for Adults (IHSW-A). The IHSW-A serves individuals with intellectual disabilities age 18 and over. The specific changes being proposed include; an updated estimate of cost for waiver years 2-5, an updated number of unduplicated participants served through the waiver for years 2-5 as well as, an increase in the individual cost limit. Currently, the cost limit is $20,761.00 per member, per plan of care year. The cost limit being proposed will increase the amount to $22,235.00. The changes are effective upon CMS approval or October 1, 2018, whichever is earlier.

The waiver amendment is available for review using the following link here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports Waiver for Children Amendment

The Oklahoma Department of Human Services is seeking an amendment to the In-Home Supports Waiver for Children (IHSW-C). The IHSW-C serves individuals with intellectual disabilities ages 3 through 17. The specific changes being proposed include an updated estimate cost for waiver years 2-5, an updated number of unduplicated participants served through the waiver for years 2-5 as well as, an increase in the individual cost limit. Currently, the cost limit is $13,844.00 per member, per plan of care year. The cost limit being proposed will increase the amount to $14,825.00. The changes are effective upon CMS approval or October 1, 2018, whichever is earlier.

The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Community Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the Community Waiver. The Community Waiver serves individuals with Intellectual Disabilities beginning at age three. The specific changes include an update of the estimated cost of the waiver for years 3-5 as well as an update of the number of unduplicated participants served through the waiver for years 3-5. The proposed changes are effective upon CMS approval or October 1, 2018, whichever is earlier.

The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers

Homeward Bound Waiver Amendment

The Oklahoma Department of Human Services is seeking to amend the Homeward Bound Waiver. The Homeward Bound Waiver serves individuals with Intellectual Disabilities who have been certified by the United States District Court for the Northern District of Oklahoma as a member of the Plaintiff Class in Homeward Bound et al., Case No. 85-C-437-e. The specific changes include an update of the estimated cost of the waiver for years 3-5 as well as an update of the number of unduplicated participants served through the waiver for years 3-5. The proposed changes are effective upon CMS approval or October 1, 2018, whichever is earlier.

The waiver amendment is available for review here. Please submit all comments by close of business, June 29, 2018. Comments may be submitted in writing to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a free hard copy of the waiver, please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers

Medically Fragile Waiver Renewal

The Oklahoma Health Care Authority is seeking a 5 year renewal of the Medically Fragile Waiver. The Medically Fragile program is a home and community-based alternative to placement in a hospital and/or skilled nursing unit of a nursing facility. The Medically Fragile waiver serves individuals 19 years of age and older who have a life-threatening condition, require frequent specialized treatment and have a dependency on medical technology. Specific changes to the renewal include, but are not limited to, (1) Modifying performance measures to adhere to CMS guidance from HCB setting regulations, (2) Adding language and performance measures to comply with Electronic Visit Verification regulations, (3) Adding language limiting conflict of interest for service plan development and monitoring with service delivery, and (4) Other changes include general clarification, alignment with state statute and cleanup.

Please view the renewal application here: Medically Fragile Waiver Renewal. Please submit all comments by close of business, March 25, 2018, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, OK 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of waivers please call 1-888-287-2433 or send your request to the Oklahoma Health Care Authority, 4345 N Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

ADvantage Waiver

The Department of Human Services lost $69 million in state funding for the State Fiscal Year 2018 as a result of the Oklahoma Supreme Court ruling the cigarette fee unconstitutional. In October, DHS was required to submit a revised budget to the Oklahoma Office of Management and Enterprise Services (OMES) to fulfill Oklahoma’s constitutional requirements for a balanced budget. The revised budget resulted in additional reductions to DHS services. The ADvantage waiver serves the frail and elderly adults with physical disabilities age 21 and over who do not have intellectual disabilities or cognitive impairment. DHS is terminating the ADvantage Waiver effective December 1, 2017.

Please view the waiver amendment here: ADvantage Waiver. Please submit all comments by close of business, November 30, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waiver amendment please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention Health Policy 1915© Waivers.

In-Home Supports Waiver for Adults

In October, the Oklahoma Department of Human Services (DHS) was required to submit a revised budget to the Oklahoma Office of Management and Enterprise Services (OMES) to fulfill Oklahoma’s constitutional requirement to maintain a balanced budget for State Fiscal Year 2018 following the loss of $69 million from their operating budget. This is the amount of appropriations DHS would have received from the cigarette fee that was ruled unconstitutional by the Oklahoma Supreme Court. When the cigarette fee was struck down, additional reductions became necessary. As a result, DHS is terminating the In-Home Supports Waiver for Adults (IHSW-A) effective December 1, 2017. The IHSW-A serves individuals with intellectual disabilities age 18 and over. Upon termination of the waiver, current service recipient’s names will be added to the statewide waiver request list for Developmental Disability Service (DDS) waiver services with his or her original application date.

Please view the waiver amendment here: In-Home Supports Waiver for Adults. Please submit all comments by close of business, November 30, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waiver amendment please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention Health Policy 1915© Waivers.

In-Home Supports Waiver for Adults Amendment

The Oklahoma Department of Human Services is seeking waiver amendment approval for the In-Home Supports Waiver for Adults (IHSW-A) to meet the balanced budget requirements as mandated by state law. The IHSW-A serves individuals with Intellectual Disabilities ages 18 and over. Due to Oklahoma’s budget crisis, costs saving actions are necessary. In an effort to minimize that impact on members served, and in lieu of an elimination of service, the individual cost limit for adults has been reduced.

Please view the renewal application here: In-Home Supports Waiver for Adults. Please submit all comments by close of business, August 14, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915© Waivers.

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention Health Policy 1915© Waivers.

In-Home Supports Waiver for Children Amendment

The Oklahoma Department of Human Services is seeking waiver amendment approval for the In-Home Supports Waiver for Children (IHSW-C) to meet the budget requirements as mandated by State law. The IHSW-C serves individuals with Intellectual Disabilities ages 3 to 17. Due to Oklahoma’s budget crisis, costs saving actions are necessary. In an effort to minimize that impact on members served, and in lieu of an elimination of service, the individual cost limit for children has been reduced.

Please view the renewal application here: In-Home Supports Waiver for Children. Please submit all comments by close of business, August 14, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention Health Policy 1915(c) Waivers.

In-Home Supports for Adults Waiver Renewal Application

The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Adults (IHSW-A) waiver. The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Specific changes include, but are not limited to, (1) Updating the rate determination methods section with details related to the fixed rate method associated with Prevocational and Supported Employment services; (2) Updating the Family Counseling service provider section; (3) Updating the Person Centered Planning and Service Delivery section; (4) Updating language regarding critical incidents and reporting, dental service providers, seclusion and restraints and supported employment services definition and limits; (5) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; (6) Updated unduplicated number of participants and reserved capacity number; and (7) Deleted Physician Services from Appendices C and J. Other changes include general clarification and cleanup.

Please view the renewal application here: In-Home Supports for Adults Waiver Renewal Application. Please submit all comments by close of business, February 3, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports for Adults Waiver Renewal Application – Extended Comment Period

The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Adults (IHSW-A) waiver. The IHSW-A serves individuals with Intellectual Disabilities age 18 and over. Specific changes include, but are not limited to, (1) Updating the rate determination methods section with details related to the fixed rate method associated with Prevocational and Supported Employment services; (2) Updating the Family Counseling service provider section; (3) Updating the Person Centered Planning and Service Delivery section; (4) Updating language regarding critical incidents and reporting, dental service providers, seclusion and restraints and supported employment services definition and limits; (5) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; (6) Updated unduplicated number of participants and reserved capacity number; and (7) Deleted Physician Services from Appendices C and J. Other changes include general clarification and cleanup.

Please view the renewal application here: In-Home Supports for Adults Waiver Renewal Application. Please submit all comments by close of business, April 14, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports for Children Waiver Renewal Application

The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The IHSW-C serves individuals with Intellectual Disabilities age 3 to 17. Specific changes include, but are not limited to, (1) Updating Person Centered Planning and Service Delivery section; (2) Unduplicated number of participants and reserved capacity numbers; (3) Updating cost data/estimates updated throughout Appendix J; (4) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; and (5) Added Prevocational and Supported Employment services for members age 16 and above. Other changes include general clarification and cleanup.

Please view the renewal application here: In-Home Supports for Children Waiver Renewal Application. Please submit all comments by close of business, February 3, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

In-Home Supports for Children Waiver Renewal Application – Extended Comment Period

The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The Oklahoma Department of Human Services is seeking a 5 year renewal of the In-Home Supports for Children (IHSW-C) waiver. The IHSW-C serves individuals with Intellectual Disabilities age 3 to 17. Specific changes include, but are not limited to, (1) Updating Person Centered Planning and Service Delivery section; (2) Unduplicated number of participants and reserved capacity numbers; (3) Updating cost data/estimates updated throughout Appendix J; (4) Updating Specialized Medical Supplies and Assistive Technology language to remove waiver coverage of incontinence supplies as these supplies are now covered by SoonerCare; and (5) Added Prevocational and Supported Employment services for members age 16 and above. Other changes include general clarification and cleanup.

Please view the renewal application here: In-Home Supports for Children Waiver Renewal Application. Please submit all comments by close of business, April 14, 2017, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

Medically Fragile Waiver Amendment

The Medically Fragile waiver is amended to propose a reinstatement of the three percent provider rate reduction that was implemented April 1, 2016. The Oklahoma Health Care Authority is proposing to reinstate the above reduced rates to select programs and provider types that the agency has identified serve our most vulnerable populations and provide access to critical programs. Additionally, clean-up changes have been made to align the waiver with policy. The proposed effective date of the changes is December 1, 2016.

Please view the waiver amendment here: Medically Fragile Waiver Amendment. Please submit all comments by close of business, August 29, 2016, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. A non-electronic version of this amendment can be requested by writing to the address above or calling 1-888-287-2443.

SoonerCare 2.0

Healthy Adult Opportunity (HAO) Demonstration Waiver Application (SoonerCare 2.0)

Effective July 1, 2021, and contingent upon the Centers for Medicare and Medicaid Services (CMS) approval, SoonerCare 2.0 will provide the coverage avenue for individuals made newly eligible for SoonerCare as of the state's July 1, 2020, expansion. This includes individuals with income up to 133% of the federal poverty level (FPL) and applicable income disregards who are not otherwise eligible for SoonerCare services provided by OHCA. SoonerCare 2.0 will implement policies to align with commercial market coverage and will:

Introduce private insurance concepts like premiums and commercial-like benefit packages to prepare members to transition from SoonerCare into private coverage.
Incentivize members to access services when and where appropriate and disincentivize inappropriate use of the emergency room with an $8 copay for non-emergency use of the ER.
Encourage individuals to address additional facets of their health by requiring participation in activities that are positively correlated with good health, including work, volunteering, and educational/vocational activities.
Encourage individuals to obtain and maintain health coverage before they are sick by eliminating retroactive coverage.
Leverage care coordination and managed care strategies to improve health outcomes and member satisfaction through better coordinated services.
Ensure appropriate coverage for eligible individuals by eliminating hospital presumptive eligibility.

The HAO Demonstration Waiver Application (SoonerCare 2.0) can be viewed in its entirety here: HAO Demonstration Waiver Application (SoonerCare 2.0).

The OHCA welcomes comments from the public regarding the HAO Demonstration Waiver Application (SoonerCare 2.0). Please submit comments via the comment box below. Persons wishing to obtain copies of the proposed waiver may do so at the following address: Oklahoma Health Care Authority, Federal Authorities Unit, 4345 N. Lincoln Blvd., Oklahoma City, Oklahoma 73105.

Written and/or oral comments or requests for copies of the proposed waiver will be accepted during regular business hours by contacting OHCA as indicated. Comments submitted will be available for review by the public Monday-Friday, 9 a.m.-4:30 p.m. at OHCA located at the above address, or viewed online at www.okhca.org/PolicyBlog . Comments will be accepted beginning March 16, 2020, through April 15, 2020.

Additionally, the OHCA will host two public hearings in which the public will be able to provide oral comments. The list of dates, times, and locations are below:

VIRTUAL MEETING
March 18, 2020 at 3:00 p.m.
VIRTUAL MEETING
March 20, 2020 at 3:00 p.m.
Register for Zoom Meeting: https://okhca.zoom.us/webinar/register/WN_v6HmJv0TQIGffw7EathJcA
VIRTUAL MEETING
March 24, 2020 at 1:30 p.m.
Register for Zoom Meeting: https://okhca.zoom.us/webinar/register/WN_0bzxX6VgQ_CDXAnTY4WDEA

To find the most up to date list of meeting locations please visit www.okhca.org/SoonerCare2.

Prior to finalizing the proposed HAO waiver, the OHCA will consider all written and verbal public comments received. The comments will be summarized and addressed in the final version to be submitted to CMS.

Provider Letters

Provider Letter OHCA 2019-06 Change in Billing for Supprelin LA

Effective July 1, 2019, the Oklahoma Health Care Authority (OHCA) will change the way Supprelin® LA for central precocious puberty is billed

Supprelin® LA is only available through the medical benefit. The current billing code used is J9226. This code may change in the future based on guidance from the Centers for Medicare and Medicaid Services (CMS). It is the provider’s responsibility to assure codes used for billing are up to date and accurate.

Supprelin LA continues to require a prior authorization (PA). The specific PA requirements for Supprelin® LA are below and can be located on the OHCA website at www.okhca.org/pa in the “Diabetes/Endocrine” therapeutic category. Use the PA form PHARM-18, which can be found on the OHCA website at www.okhca.org/rxforms.

Please view the Provider Letter in its entirety here: Provider Letter 2019-06.

Submit all comments by close of business, Friday, June 28, 2019, via the comment box below.

Provider Letter OHCA 2019-07 Provider Contract Backdating – Effective August 1, 2019

Effective August 1, 2019, the Oklahoma Health Care Authority (OHCA) will no longer backdate provider contracts prior to the date that the provider was screened.

Pursuant to federal law, the OHCA must require all participating providers to be screened in accordance with the requirements of Subpart E of Part 455 of Title 42 of the Code of Federal Regulations, titled “Provider Screening and Enrollment.” See also Oklahoma Administrative Code § 317:30-3-19.4.

Please view the Provider Letter in its entirety here: Provider Letter 2019-07.

Submit all comments by close of business, Thursday, August 15, 2019, via the comment box below.

Provider Letter 2019-08 Prior Authorization Changes for Medication Assisted Treatment – Effective July 31, 2019

The Oklahoma Health Care Authority (OHCA), in an effort to combat the prescription drug abuse epidemic in Oklahoma, is improving access for SoonerCare members to medication assisted treatment (MAT). The OHCA is currently working to change prior authorization (PA) requirements for MAT. Effective July 31^st, 2019, the OHCA will no longer require a PA on select products.

Please view the Provider Letter in its entirety here: Provider Letter 2019-08.

Submit all comments by close of business, Friday, August 23, 2019, via the comment box below.

Provider Letter OHCA 2019-16 Clarification of Laboratory Services Policy Changes

Recently, the Oklahoma Health Care Authority (OHCA) promulgated rules that updated Oklahoma Administrative Code (OAC) 317:30-5-20 Laboratory Services. The OHCA would like to clarify appropriate screening services and how such sources should meet medical criteria that is outlined in OAC 317:30-3-1(f).

Please view the Provider Letter in its entirety here: Provider Letter 2019-16.

Submit all comments by close of business, Thursday, September 12, 2019, via the comment box below.

OHCA Provider Letter 2019-17 No Prior Authorization (PA) Requirement for Psychiatric or Medical Detoxification Services Received in a Non-Psychiatric Unit of a Hospital for Adults

The Oklahoma Health Care Authority (OHCA) reminds all SoonerCare providers that the PA requirement for adult acute inpatient psychiatric admissions (effective September 17, 2018) ONLY applies when psychiatric or medical detoxification services are provided in a psychiatric unit of a general hospital. However, there is no PA requirement for psychiatric or medical detoxification services provided to adults in a non-psychiatric unit setting of a general hospital. For example, if a member who was admitted to the ICU or other hospital medical bed after an attempted suicide by alcohol overdose, has withdrawal symptoms complications, receives medical care and a psychiatric consult, and does not transfer to a psychiatric unit, a PA request is NOT required.

Please view the Provider Letter in its entirety here: Provider Letter 2019-17.

Submit all comments by close of business, Wednesday, October 9, 2019, via the comment box below.

OHCA Provider Letter 2019-19 New Out-of-State Services Rules and Supportive Processes

The Oklahoma Health Care Authority (OHCA) recently added new policies and procedures for out-of-state services. Oklahoma Administrative Code (OAC) 317:30-3-89 through 317:30-3-92 defines out-of-state services, reimbursement for these services, and payment for lodging and meals.

A comprehensive process was undertaken in formulating these policies, including: extensive research of federal and state laws, other states' Medicaid policies, and coverage by private insurance carriers; detailed review of OHCA's historical and current policies and practices regarding out-of-state care; and robust engagement with Oklahoma providers, including those affiliated with Oklahoma's three medical schools, in order to assess and strengthen OHCA's network of in-state, specialized care.

Please view the Provider Letter in its entirety here: Provider Letter 2019-19.

Submit all comments by close of business, Thursday, October 10, 2019, via the comment box below.

OHCA Provider Letter 2019-20 Prior Authorization of Medications Used to Treat Lymphoma

As authorized by Oklahoma Administrative Code (OAC) 317:30-5-77.2, effective October 15, 2019, the Oklahoma Health Care Authority (OHCA) will require a prior authorization (PA) for the following medications: Adcetris® (brentuximab vedotin), Beleodaq® (belinostat), Calquence® (acalabrutinib), Folotyn® (pralatrexate), Istodax® (romidepsin), Poteligeo® (mogamulizumab-kpkc), Truxima® (rituximab-abbs), Zevalin® (ibritumomab tiuxetan), and Zolinza® (vorinostat).

If a SoonerCare member has a paid claim for one of these medications within the last 45 days, the medication will be “grandfathered”. A "grandfathered" drug that is obtained through the pharmacy claim system will automatically be prior authorized based on past claims.

Please view the Provider Letter in its entirety here: Provider Letter 2019-20.

Submit all comments by close of business, October 17, 2019, via the comment box below.

OHCA Provider Letter 2019-21 Testosterone Replacement Therapy Prior Authorization (PA)

As authorized by Oklahoma Administrative Code (OAC) 317:30-5-77.2, effective October 23, 2019, all testosterone replacement products, including testosterone cypionate injections, will require a PA not only for pharmacy claims, but also for physician and outpatient administered drug claims as well.

The criteria and tier chart, approved by the Oklahoma Health Care Authority Drug Utilization Review (DUR) Board can be found at www.okhca.org/pa in the Diabetes/Endocrine Therapeutic Category.

All testosterone replacement products require PA. Tier-1 products do not require failed trials of other testosterone replacement products. The PA request must document two (2) morning lab tests showing pre-medication testosterone level below 300ng/dL (when applicable) and other labs necessary to demonstrate diagnosis.

Please view Provider Letter in its entirety here: Provider Letter 2019-21.

Submit all comments by close of business, October 24, 2019, via the comment box below.

OHCA Provider Letter 2019-22 Coverage of Obstetricians and Family Practice Physician for High Risk Obstetrical Services without Maternal Fetal Medicine Consultation

Beginning November 1, 2019, the Oklahoma Health Care Authority (OHCA) will add coverage pursuant to Oklahoma Administrative Code 317:30-5-22.1. This will allow obstetricians and family practice physicians to request High Risk Obstetrical services without Maternal Fetal Medicine consultation; in appropriate cases.

The obstetricians and family practice physicians must be Board eligible or Board certified. Additionally, the family practice physician must have completed an Accreditation Council for Graduate Medical Education approved residency which included appropriate obstetric training. He or she must also be credentialed by the hospital at which he or she provides obstetrical services.

Please view Provider Letter in its entirety here: Provider Letter 2019-22.

Submit all comments by close of business, November 22, 2019, via the comment box below.

OHCA Provider Letter 2020-02 Prior authorization for Soliris® - Effective May 1, 2020

As authorized by Oklahoma Administrative Code (OAC) 317:30-5-77.2, effective May 1, 2020, the Oklahoma Health Care Authority (OHCA) will be adding a prior authorization requirement for Soliris® (eculizumab) when billed through the medical benefit. Soliris® already requires a prior authorization when billed through the pharmacy benefit.

Please view the Provider Letter in its entirety here: Provider Letter 2020-02.

Submit all comments by close of business, May 1, 2020, via the comment box below.

OHCA Provider Letter 2020-03 Prior authorization of Lumoxiti– Effective Aug 1, 2020

As authorized by Oklahoma Administrative Code (OAC) 317:30-5-77.2, effective Aug 1, 2020, the Oklahoma Health Care Authority (OHCA) will be adding a prior authorization requirement for Lumoxiti^® (moxetumomab pasudotox-tdfk).

Please view the Provider Letter in its entirety here: Provider Letter 2020-03.

Submit all comments by close of business, Aug 3, 2020, via the comment box below.

OHCA Provider Letter 2020-04 High-Investment Drug Therapy Carve-Out for Inpatient and Outpatient Hospital Payment

Effective July 1, 2020, pursuant to Oklahoma Administrative Code 317:30-3-31, 317:30-5-42.20, 317:30-5-47, and 317:30-5-47.6 the Oklahoma Health Care Authority changed the billing process for certain high-investment drug therapies. This change is to improve access to expensive but highly impactful drug therapies for the SoonerCare population.

Please view the Provider Letter in its entirety here: Provider Letter 2020-04.

Submit all comments by close of business, Aug 21, 2020, via the comment box below.

Federal regulation at 42 CFR 447.203, documentation of access to care and services payments, directs State Medicaid programs to analyze and monitor access to care for Medicaid fee-for-service programs through the Access Monitoring Review Plan (AMRP). Through the AMRP, the State demonstrates access to care by measuring the following: enrollee needs; the availability of care and providers; utilization of services; characteristics of the enrolled members; and estimated levels of provider payment from other payers. The AMRP must be taken through consultation with the State's Medical Advisory Committee (MAC) and be published and made available to the public for a period of no less than 30 days prior to being submitted to the Centers for Medicare & Medicaid Services (CMS). The State submitted the initial access monitoring review plan on September 28, 2016 and must submit a revised plan every three years. The AMRP will note any access issues identified during the prior three years and if any issues were identified, the plan will include a corrective action plan. Further, the AMRP includes the State’s access to care analyses conducted for State Plan amendments that reduced and/or restructured payment rates that could diminish access to care which were promulgated and approved within the previous three years.

Please view the draft SPA pages here: 2019 Access Monitoring Review Plan, and submit feedback via the comment box below.

MAC Date: 09/05/2019

Circulation Date: 08/27/2019 – 09/26/2019

Submittal to CMS Date: 09/30/2019

Statewide Transition Plan

Pursuant to 42 C.F.R. § 441.301, the Oklahoma Health Care Authority (OHCA) is required to give public notice and receive public input on any significant proposed changes to the 1915(c) Home and Community-Based Services (HCBS) waivers.

Oklahoma Transition Plan for Home and Community-Based Services (HCBS) Settings

The purpose of this Transition Plan is to ensure the individuals receiving Home and Community-Based Services (HCBS) are integrated in and have access to supports in the community, including opportunities to seek employment, work in competitive integrated settings, engage in community life, and control personal resources. The State has prepared a revised transition plan in order to comply with federal regulations for community-based settings. Overall, the Transition Plan provides assurance that the individuals receiving HCBS have the same degree of access as individuals not receiving Medicaid HCBS. This updated Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements.

All HCBS settings have to be in compliance by March 2019. The State must continue to submit Statewide Transition Plans to CMS until both an initial and final approval of the plan is received. The following is an outline of the CMS Statewide Transition Plan submission and approval process:

Initial Proposed Plan
Clarifications and/or Modifications required for Initial Approval (CMIA): The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, but CMS has identified issues that must be resolved in the STP prior to initial approval.
Initial Approval with Milestones and a Resubmission Date: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP is sufficient, but systemic and/or site-specific assessments are not yet completed. The response to the state will vary dependent on whether the state has or has not identified settings that are presumed to have institutional characteristics and any information the state may wish CMS to consider under the heightened scrutiny process.
Final Approval: The communication CMS sends to the state notifying the state that public comment, input and summary requirements are met, the STP has provided all necessary information including but not limited to; systemic assessment, site specific assessment, settings presumed to have institutional characteristics, information regarding heightened scrutiny or the state’s decision to let the presumption stand, and clear remedial steps with milestones are delineated.
Approved Plan: The CMS approved STP.

Please view the Statewide Transition Plan in its entirety here: Statewide Transition Plan. The plan will be posted for public comments from December 22, 2016 - January 22, 2017. The Amended Statewide Transition Plan was submitted to CMS on December 22, 2016.

For more information regarding the Statewide Transition Plan, please see the training webinar video.

Previous Submissions and CMS Feedback, concerning the Statewide Transition Plan, can be viewed here:

Please submit your comments via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. A non-electronic version of this Statewide Transition Plan can be requested by writing to the address above or calling 1-888-287-2443.

Disclaimer: Oklahoma Health Care Authority (OHCA) policy comment section will be reviewed and considered under the current policy rule change. Personal information should not be shared/or submitted in the comment section. This comment section is reserved for proposed policy rule changes.

Sign up for Web Alerts to receive an e-mail when a new rule is proposed.

The Oklahoma Health Care Authority (OHCA) seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed policy page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.

All comments regarding proposed administrative rules will be considered during the rulemaking process and become a part of the official work folder. All rule changes are subject to the Oklahoma Administrative Procedures Act.

Oklahoma Statutes