SoonerSelect FAQ for Providers
Oklahoma Health Care Authority (OHCA), in partnership with contracted entities (CEs) or health plans, will implement a new health care delivery model called SoonerSelect. This model will consist of health and dental CEs that will be responsible for coordinating whole-person care for enrollees.
The following SoonerCare populations must enroll in SoonerSelect:
- Low-income parents
- Pregnant women
- Adults ages 19-64
The SoonerSelect Children’s Specialty Program includes children in foster care, former foster children up to age 25, juvenile justice-involved children, and children receiving adoption assistance.
American Indian/Alaska Native members will have the option to enroll in a SoonerSelect plan.
This change will go into effect on the following dates, pending federal approval:
- February 2024: SoonerSelect dental program
- April 2024: SoonerSelect health and Children’s Specialty Program
SoonerSelect intends to streamline administrative processes for providers. For example, CEs must:
- Use a single vendor for credentialing and provider portal. Until July 1, 2025, all SoonerSelect CEs will approve providers actively enrolled with OHCA without requiring full credentialing. CEs will leverage existing credentialing for providers who are already credentialed with a CE either for SoonerSelect or for another existing product line.
- Utilize the standardized OHCA-developed prior authorization request criteria.
- Utilize online prior authorization requests.
- Pay 90% of complete or “clean” claims within 14 days of receipt and 99% of all clean claims within 90 days of receipt.
All the CEs are required to credential and recredential network providers through a single, consolidated provider enrollment and credentialing process. Additionally, all CEs are required to use the same single credentialing verification organization (CVO) certified by a CMS-approved accrediting organization as part of the provider credentialing and recredentialing process.
However, in order to make the transition to SoonerSelect easier on the provider community, from now until July 1, 2025, all SoonerSelect CEs will approve providers actively enrolled with OHCA without requiring full credentialing. Providers must still be contracted with each CE that is serving the provider’s patients transitioning into SoonerSelect, but providers will not have to go through full credentialing until July 1, 2025.
Each CE will continue to pay providers for the services they are rendering. CEs will also pay providers who may be outside their network at the same rate as their own providers for the first 90 days after launch. After this period, all contracted providers will receive 100% of the reimbursement rate for the applicable service based on OHCA’s fee schedule until 2026. Providers will also have the opportunity to enter into value-based contracts with the CEs.
Each CE has the option to offer extra benefits to help improve the health of its members.
Examples of extra benefits similar programs in other states include:
- Program for new and expecting mothers with customized support and care.
- Expanded nutritional counseling for members with chronic conditions.
- Home meal delivery during post-hospitalization, acute in-patient stay, and postpartum.
The state invited proposals from all entities, including those that were provider-led, to serve SoonerSelect enrollees. The state reviewed all proposals and selected CEs that best fulfilled all requirements set by the state.
The key difference is the inclusion of provider-led entities (PLEs), which is mandated by state legislation. CEs must either qualify as a PLE or contract with one. To qualify as a PLE, an entity must meet at least one of the following two requirements:
- A majority of the entity's ownership is held by Medicaid providers in Oklahoma or is held by an entity that directly or indirectly owns or is under common ownership with Medicaid providers in Oklahoma.
- A majority of the entity's governing body is composed of individuals who:
- Have experience serving Medicaid members and:
- Are licensed in Oklahoma as physicians, physician assistants, nurse practitioners, certified nurse-midwives, or certified registered nurse anesthetists
- At least one member is a licensed behavioral health provider, or
- Are employed by a hospital or other medical facility licensed by and operating in Oklahoma; or an inpatient or outpatient mental health or substance abuse treatment facility or program licensed or certified by and operating in Oklahoma,
- Represent the providers or facilities described above, including, but not limited to, individuals who are employed by a statewide provider association, or
- Are non-clinical administrators of clinical practices serving Medicaid members.
- Have experience serving Medicaid members and:
You may receive a letter of intent from prospective CEs as they begin building their proposed provider network. Once contracts are awarded, providers may contact the CE directly to inquire about enrollment and credentialing. The dental CEs, DentaQuest and LIBERTY Dental, have begun reaching out to providers. The SoonerSelect health and Children’s Specialty Program CEs will begin contacting providers in the summer of 2023. OHCA will be holding meetings over the summer, providing the opportunity for providers to meet the selected contracted entities.
Under federal regulation, OHCA is prohibited from requiring a CE to execute any provider agreements beyond the number necessary to meet the needs of enrollees. A CE is also prohibited from excluding any essential community providers, which include the following provider types:
a. FQHCs and RHCs
b. Family planning providers (Title X family planning clinics and Title X “look-alike” family planning clinics)
d. County health departments or city-county health departments
e. Government-funded/operated CMHCs/CCBHCs
f. Government-operated state mental health hospitals
g. State agencies including but not limited to OJA, OSDH and OHS
h. Local, regional and state educational services agencies
i. Local health departments
j. Long-term care hospitals serving children (LTCHs-C)
k. A teaching hospital owned, jointly owned, or affiliated with and designated by the University Hospitals Authority, University Hospitals Trust, Oklahoma State University Medical Authority, or Oklahoma State University Medical Trust
l. A provider employed by or contracted with, or otherwise a member of the faculty practice plan of a public, accredited medical school in this state or a hospital/health care entity directly or indirectly owned or operated by the University Hospitals Trust or the Oklahoma State University Medical Trust
m. A provider employed by or contracted with a primary care residency program accredited by the Accreditation Council for Graduate Medical Education
n. A comprehensive community addiction recovery center
o. A hospital licensed by the state of Oklahoma, including all hospitals participating the in the Supplemental Hospital Offset Payment Program
p. Certified Community Behavioral Health Clinics (CCBHCs)
q. Other entities certified by CMS as an essential community as specified under 45 C.F.R. § 156.235
At its discretion, OHCA may add additional providers as essential community providers if the provider either offers services that are not available from any other provider within a reasonable access standard, or provides a substantial share of the total units of a particular service utilized by the enrollees within the region during the last three (3) years, and the combined capacity of other service providers in the region is insufficient to meet the total needs of the enrollees.
CEs will provide care management and population health services to coordinate the care of enrollees. CEs will offer person-centered and holistic care that identifies and addresses its enrollees' physical health, behavioral health, and community and social support needs. To help ensure models of care are developed to meet the needs of Oklahoma’s Medicaid enrollees, each CE must contract with at least one local Oklahoma provider organization.
A local Oklahoma provider organization can be any state provider association, accountable care organization, Certified Community Behavioral Health Clinic (CCBHC), Federally Qualified Health Center (FQHC), Native American tribe or tribal association, hospital or health system, academic medical institution, currently practicing licensed provider, or other local Oklahoma provider organization.
Indian Health Care Providers (IHCPs) will continue to be reimbursed by OHCA for services that are eligible for one hundred percent (100%) federal reimbursement. The CEs will make payments to IHCPs for covered services not eligible for one hundred percent (100%) federal reimbursement and provided to enrollees who are eligible to receive services through the IHCP, regardless of whether the IHCP is within the CE’s network. The reimbursement will be equal to the applicable encounter rate published annually in the Federal Register by the IHS. In the absence of a published encounter rate, the CE will reimburse the amount the IHCP would receive if the services were provided under the state plan FFS methodology.
In the event the amount the IHCP receives from the CE is less than the amount the IHCP would have received under FFS or the applicable encounter rate published annually in the FR by the IHS, the CE will make a supplemental payment to the IHCP to make up the difference. For more information, please review OHCA’s tribal health care updates.
SoonerSelect requires CEs to proactively address and improve the quality of care in rural parts of Oklahoma. All CEs must not only meet required network adequacy standards set by the state, but they must also implement innovative approaches to improve access to care for Oklahomans living in rural areas.