Skip to main content

Provider Update: August 13, 2018

To: All ADvantage Providers

Subject: ADvantage and State Plane Personal Care Rate Increases

The Medicaid Services Unit is pleased to announce the approval of rate increases by the Centers for Medicare and Medicaid (CMS) and Oklahoma Health Care Authority (OHCA).

The table below shows the current rate and the new rate for each service impacted which will be effective retroactively to July 1, 2018.  All rates are per unit unless otherwise indicated by an asterisk (*).  State Plan services are included in these rates as indicated below; however, the State Plan Skilled Nursing rate is still in the approval process.  The pending new rate and effective date for State Plan Skilled Nursing will be provided to you as soon as that information becomes available.

Service Service
State Plan Personal Care T1019 $3.78 $4.05
State Plan Skilled Nursing T1001 $54.00 pending
ADvantage Personal Care T1019 $3.78 $4.05
Respite - In Home  T1005 $3.78 $4.05
Respite - In Home Extended S9125 $160.77 $168.80*
Advanced Supportive/Restorative T1019-TF $4.07 $4.35
CM Standard T1016 $13.75 $14.70
Transitional CM Standard T1016-U3 $13.75 $14.70
CM Very Rural T1016-TN $19.69 $21.05
Transitional CM Very Rural T1016-TN-U3 $19.69 $21.05
Adult Day Health  S5100-U1 $1.88 $2.00
Adult Day Health - Therapies S5105-TG $10.00 $11.25
Adult Day Health - Personal Care S5105 $7.50 $7.95
Hospice S9126 $119.10 $123.80*
Registered Nurse - Home Health Setting G0299 $13.50 $15.00
Registered Nurse - Extended State Plan G0299-TF $13.50 $15.00
LPN - Home Health Setting G0300 $13.50 $14.00
LPN - Extended State Plan G0300-TF $13.50 $14.00
RN Assessment/Evaluation T1002 $13.50 $15.00
Assisted Living - Standard T2031 $44.01 $47.10*
Assisted Living - Intermediate T2031-TF $59.40 $63.55*
Assisted Living - High T2031-TG $83.09 $88.90*
Home Delivered Meals S5170 $4.88 $5.15
Personal Services Assistant S5125 $3.20 $3.42
Advanced Personal Services Assistant S5125-TF $3.84 $4.11
Optional/Budget Expense T2025 $0.97 $1.04

As you know, the current Waiver Management Information System (WMIS) is being replaced by the Harmony WMIS system.  This replacement is on-target to go-live on August 27, 2018.  During the conversion of information from the old system to Harmony, the new rates reflected in the table will be implemented.  All impacted prior authorizations will reflect the new rate backdated to the effective date (July 1, 2018). 

Due to the effective date of Harmony go-live, managing the conversion in the existing WMIS system is prohibitive.  The effective date to begin billing at the new rate is August 27, 2018.  To receive the new rate on any claims already filed with dates of service between July 1, 2018 and August 26, 2018, the claim must be voided and rebilled.

*Reminder: Claim processing through Harmony does not begin until October 1, 2018.

If you have any questions regarding the information provided above, please feel free to contact us via SmarterMail at:

Back to Top