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Fall 2016, Vol. 1
 The Oklahoma Health Care Authority (OHCA) Board offered State Medicaid Director Becky Pasternik-Ikard the chief executive officer position at their September 8 meeting held at the Children's Center Rehabilitation Hospital in Bethany, Okla.
The board met in executive session to discuss the vacancy created by the planned September 30 departure of CEO Nico Gomez. The board later voted unanimously to offer the CEO position to Pasternik-Ikard.
“Becky brings a wealth of experience to this position; she is a master’s level nurse and attorney," said Ed McFall, OHCA Board chair. "She has been with the agency from its infancy 22 years ago and has worked tirelessly for the Oklahomans enrolled in SoonerCare and Insure Oklahoma. Becky has shown a steadfast dedication to our programs which will help her lead the agency toward fulfilling our mission."
Pasternik-Ikard will assume the duties of CEO on October 4. Gomez is vacating the position after three and a half years to become president and CEO of the Oklahoma Association of Health Care Providers. He announced his resignation on August 29.
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All SoonerCare providers and their staff are invited to attend the Fall 2016 SoonerCare Provider Training Workshop. Training will take place in:
Durant
- September 22 Lawton -
September 29
Tulsa
- October 5-6 Oklahoma City -
October 19-20
NEW Location! Guymon
- October 25 (three classes available)
Classes offered include:
- Understanding and Implementing CMS Ordering and Referring Guidelines
- Effective Provider Portal Solutions
- EDI Toolbox
- Prior Authorizations on the Provider Portal
- Automated Patient Dismissal Process
- DMEPOS Updates
- SoonerCare Pharmacy Program Overview
- SoonerCare Update and Navigating the Public Website
- EHR Incentive Program
Attendance at this workshop is highly recommended. Please visit our website for detailed class descriptions or to register.
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REMINDER: Physicians’ contracts are set to expire on Sept. 30, 2016. If you are a physician and have yet to renew your contract, please don't delay!
Physicians are OHCA's largest provider type. We encourage you to complete your renewal as early as possible.
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2016 Rule changes in effect
OHCA policy changes promulgated through the 2016 legislative session per
the Administrative Procedures Act went into effect on September 1, 2016, and
posted to the OHCA
Policy webpage. We communicated details on many of these rules in advance of their
implementation through our provider letters process; however, some rules did
not have pre-letters. Therefore, OHCA encourages you to review each rule in its
entirety. If you have any questions, please call the OHCA Provider Helpline at
800-522-0114.
Among the rules are as follows:
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Urine drug testing and prior authorization requirements webinar
OHCA revised urine drug screening and testing policy OAC 317:30-5-20.1 to update terminology of “presumptive” and “definitive” drug testing to mirror CPT/HCPCS coding reference manuals. Prior authorization (PA) for definitive drug testing went into effect March 1, 2016.
Providers have verbalized confusion on the documentation required for the PA process. This webinar is to help providers understand the differences between presumptive and definitive drug testing and what documentation is required for the PA process. We will also show providers where the requirements and forms are located on the OHCA website.
This webinar will be on September 27 at 2 p.m. OHCA recommends this presentation for all providers who provide, order and bill for urine drug testing services. We will also address your questions at that time.
Please register at http://okhca.org/provider-training.
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Billing tip
When filing a claim, providers must list a member’s name as it appears on his or her SoonerCare member ID card. This may or may not be the member’s full name.
The OHCA exchanges data with multiple local, state and national partners, and some of their systems have character limits. SoonerCare ID cards may include abbreviated names to facilitate this data sharing.
Use members' full names in your patient records and to converse with them. However, bill the name printed on his SoonerCare ID card or that displays when you check eligibility.
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Help patients stay ahead of the flu
The development and implementation of
safe and effective vaccines is one of our greatest medical achievements.
However, a report from the American Academy of Pediatrics (AAP) noted that each
year 85 percent of health care providers will have a parent refuse a vaccine
for their child. Another study showed that only 33 percent of parents believe
vaccines are necessary, safe and important. Reasons for refusal to vaccinate
have been linked to the following beliefs:
- Vaccines and/or their additives are unsafe.
- Vaccines will give the patient the disease.
- Getting the “natural” disease is healthier.
- The child’s immune system will get “overloaded”
with so many vaccinations.
 Providers can help reduce these
misplaced fears, correct misinformation and reassure parents that vaccination
is the safest and best option for their child.1 To facilitate an
effective provider-parent dialogue, the Centers for Disease Control and
Prevention (CDC) has developed resources to communicate evidence-based vaccine information
to parents. “Provider Resources for Vaccine Conversations with Parents” is
available at http://www.cdc.gov/vaccines/hcp/conversations/.
This site includes multiple links to
information for providers as well as parents. It also includes free resources
such as print materials, videos, web banners and buttons that can be shared on
practice websites and played on waiting room monitors.2
According to a University of Michigan study, the
most commonly refused vaccine is influenza. Up to 86 percent of parents refuse
to have their child receive this vaccine. It is refused at a rate nearly twice
that of any other vaccine.3 This is true despite the CDC
recommendation that everyone age 6 months and older receive the yearly
influenza vaccine.4 Pregnant women are especially encouraged to
receive a flu shot as they are at increased risk of complications from the flu.
The flu vaccination is safe during all trimesters and when received by the
mother also protects newborn children for up to 6 months after they are born.5
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Annual flu vaccinations are a covered
benefit for SoonerCare, including Soon-to-be-Sooner members. Flu
vaccine coverage is available to members age 19 and older through both the
prescription drug benefit and the medical benefit. Flu vaccines administered through the pharmacy
benefit do not count against a member’s monthly prescription limit, and there
is no copay to members. Members age 18 and younger should receive the
vaccine at a physician’s office through the federal Vaccines for Children
Program. It is important to note that the nasal spray flu vaccine is currently
not recommended by the CDC for anyone due to a demonstrated lack of
efficacy. Therefore, it is
not covered for SoonerCare members.7
Please contact Jacki Travers, Pharm.D, at
jacki-travers@ouhsc.edu or 405-271-5935, for more information on this article
or to schedule a complimentary educational visit from CARE (Collaborative
Advancement of Prescription Excellence). Current topics include Medication Prior
Authorization Training, ADHD Treatment, and Atypical Antipsychotics.
References:
1) Healy CM, Pickering LK. How to Communicate with
Vaccine-Hesitant Parents. Pediatrics. 2011;127:S127-S133.
2) Provider Resources for Vaccine Conversations with
Parents. Available at: http://www.cdc.gov/vaccines/hcp/conversations/. Accessed 8/19/16.
3) Dempsey AF, Schaffer S, et al. Alternative Vaccination
Schedule Preferences Among Parents of Young Children. Pediatrics.
2011;128:848-856.
4) Frequently Asked Flu Questions 2016-2017 Influenza
Season. Available at: http://www.cdc.gov/flu/about/season/flu-season-2016-2017.htm. Accessed 8/19/16.
5) Pregnant? Get a Flu Shot! Available at http://www.cdc.gov/features/pregnancyandflu/. Accessed 8/19/16.
6) Influenza-Associated Hospitalizations and Deaths by Age
Group, Oklahoma, October 4, 2015 – May 24, 2015. Available at: https://www.ok.gov/health2/documents/Influenza%20Hospitalizations%20and%20Deaths%20by%20AG%202012-2013%20Dec%2025a.pdf. Accessed 8/19/16.
7) ACIP votes down use of LAIV for 2016-2017 flu
season. Available at: http://www.cdc.gov/media/releases/2016/s0622-laiv-flu.html
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Opioid Overdose Education and Naloxone Distribution Program
Opioid overdose continues to be a public health concern in Oklahoma. Naloxone reverses the effects of opioid overdose and is a recommended means to save lives and reduce the overall impact of addiction. The OHCA has partnered with the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) to increase access to naloxone. Funds received from the Health Services Initiative – Children’s Health Insurance Program (CHIP) help to provide this lifesaving drug to at-risk youth through the Opioid Overdose and Naloxone Distribution (OEND) Program. OEND makes naloxone available, at no charge, to any individual 19 years of age or younger and to anyone who knows a youth who is at risk of overdose in 13 high-need Oklahoma counties.
Oklahoma’s opioid treatment programs (OTPs) and comprehensive community recovery centers (CCARCs) will serve as distribution hubs for naloxone (for a list, click here). These distribution hubs have pre-established clinical structure to provide naloxone at no charge to this specific population in need.
More details on this program will be released in late September. Additional opioid and naloxone resources can be found on the Take As Prescribed website: http://takeasprescribed.org/pharmacy-provider-resources
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Policy changes for tobacco cessation counseling
SoonerCare has now made it easier to bill for
tobacco cessation counseling. Through the SoonerCare
tobacco cessation benefit, individuals ages 12 and
older may receive up to eight counseling sessions per year.
Tobacco cessation counseling consists of the 5
As:
- Ask the member to describe their smoking use;
- Advise the member to quit
- Assess the willingness of the member to quit;
- Assist the member with referrals and plans to quit (providers can prescribe the
seven FDA-approved tobacco cessation products, and SoonerCare members can
receive them at no cost); and
- Arrange for follow-up
Tobacco cessation is a covered service when
performed by physicians, physician assistants, advanced registered nurse
practitioners, certified nurse midwives, dentists, Oklahoma State Health
Department and federally-qualified health center (FQHC) nursing staff, and
maternal/child health licensed clinical social workers with certification as
certified tobacco treatment specialists (CTTSs).
SoonerCare reimburses for tobacco cessation
counseling in addition to any other appropriate PCP care coordination payments,
evaluation and management codes, or other appropriate services rendered. However,
tobacco cessation counseling must be a significant, separately
identifiable service - unique from any other service provided on the same day.
As of September 1, 2016, documenting for the 5 As
alone on a separate note with a separate signature is no longer required. Documenting
the 5 As in sequence in an open field on the electronic health record (EHR) is
required. Chart documentation must include the member-specific information
addressed in the five steps and the time spent by the practitioner performing
the counseling. OHCA considers anything less than three minutes as part of a
routine visit.
For questions, please email Kelly.Parker@okhca.org.
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 Dr. Mike Herndon has been named chief medical officer of the OHCA. Herndon will oversee a variety of operations in the SoonerCare program.
“I look forward to leading OHCA in evaluating and developing interventions to improve health outcomes for SoonerCare members,” Herndon said. “This is an exciting opportunity to impact the quality of care SoonerCare members receive, improve provider satisfaction and collaborate with state leaders to do what is best for our members and the citizens of Oklahoma.”
Herndon previously served as OHCA’s senior medical director, where he designed the agency’s health management and pain management programs. Both initiatives assist medical providers with evidence-based and standard of care treatment strategies for SoonerCare members receiving treatment for chronic conditions.
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 OHCA Chief Dental Officer
Leon Bragg, D.D.S., will retire on Oct. 31, 2016. Dr. Bragg became the OHCA’s
first full-time dentist on Feb. 23, 2004.
In his position at OHCA, Dr.
Bragg has helped develop program policy for dental care for SoonerCare members,
established benefits standards for quality, and assisted with utilization
review for the program. He has also served as a liaison between OHCA and its
dental providers.
In addition to his role at OHCA, Dr. Bragg has been active in several local,
state and national dental organizations. Most recently, Delta Dental of
Oklahoma recognized Dr. Bragg for his service and leadership as president of
the national Medicaid
Medicare CHIP (Children's Health Insurance Program) Services Dental Association
(MSDA). In June 2006, he was invited to fellowship in the American
College of Dentists, a non-profit professional organization
comprised of dentists who have demonstrated exceptional leadership and contributions
to the profession and their community. Dr. Bragg has also served as president
of the Board of Directors for Community
Health Centers, Inc.
Prior to his OHCA
employment, Dr. Bragg maintained a private practice for more than 20 years. Later, he served as assistant professor in
Operative Dentistry and Dental Materials at the University Of Oklahoma College
Of Dentistry. During his time there, he completed a Master of Education degree
from the University of Central Oklahoma and graduated from the Oklahoma
University Health Sciences Center Faculty Development program. Dr. Bragg was also
the first Langston graduate to attend, and the second black to graduate from,
the University of Oklahoma College of Dentistry. On Aug. 1, 2003, Dr. Bragg was
named assistant dean for Clinics, the first black to hold this distinction in
the history of the dental college.
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 ABD care coordination update
SoonerHealth+ has been selected as the name for the fully capitated, statewide model of care coordination that is being developed for Oklahoma Medicaid’s Aged, Blind and Disabled (ABD) populations.
Work continues at the Oklahoma Health Care Authority (OHCA) on the Request for Proposal (RFP) for SoonerHealth+ as directed by House Bill 1566, which was passed during the 2015 legislative session. The OHCA is preparing to send the RFP to its federal partner, the Centers for Medicare & Medicaid Services, for review and approval. Upon approval, the agency plans to release the RFP later this year. (View the project timeline here.)
Also, the actuarial consultant is determining payment rates for the program. This work will continue in conjunction with finalizing the RFP and the CMS approval process.
Read more.
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OHCA names 2016 T.J. Brickner Award recipient
On September 8, 2016, OHCA named Dr. Steven Crawford the recipient of the 2016 Dr. T.J. Brickner Defender of Health Award. The award, named after a founding OHCA board member, serves to recognize a non-state employed individual who is committed to serving low income, uninsured and underinsured Oklahomans.
Crawford serves as chief of Family Medicine Service at the University of Oklahoma Medical Center hospitals, is the Christian N. Ramsey, Jr., M.D. Endowed Chair in Family Medicine and works as both a professor and chair of the OU College of Medicine's Department of Family and Preventive Medicine. Additionally, he has served as chair of the Board of Trustees of the OU Medical Center and OHCA's Medical Advisory Committee.
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From L to R: OHCA Board Chairman Ed
Mcfall, Brickner Award recipient Dr.Steven Crawford and OHCA CEO Nico Gomez. |
Get the latest from our website:
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The OHCA Board of Directors will hold its next three monthly meetings at locations across the state. These traveling meetings kicked-off with the regularly-scheduled board meeting on September 8. The itinerary is as follows:
• Duncan Regional Hospital in Duncan on October 13.
• Northwestern Oklahoma State University in Enid on November 10.
• A location to be determined in Tulsa on December 8.
The OHCA Board usually meets at the agency, in Oklahoma City; however, these traveling meetings help recognize the hometowns of individual board members who travel from outside the metro to serve the agency. These off-site meetings are at no cost to OHCA, with board members making the arrangements.
OHCA Board meetings are open to the public. For those who are unable to attend in-person, OHCA makes the meetings accessible by webinar. The webinar links post on our website.
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 Connect uninsured patients to information about Insure Oklahoma health coverage with the Insure Oklahoma Individual Plan brochure, which can be ordered and shipped to your office at no charge.
Low-income, uninsured adult patients who do not qualify for SoonerCare, Medicare or employer-sponsored health plans may qualify for coverage through Insure Oklahoma. Insure Oklahoma members pay low health insurance premiums and co-pays for covered services. To enroll in the Individual Plan, members must earn at or below 100 percent of the federal poverty level and meet additional qualifications.
These updated brochures contain new income guidelines and qualifications. Click here to order.
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The OHCA EHR Incentive Team is pleased to announce that electronic signatures are now accepted. Providers are no longer required to submit the SoonerCare Provider Agreement Signature Form with their uploaded documentation.
More program updates:
Automated Notifications/Denials
We will now send out three automated notifications to the contact email address submitted in the EHR Attestation. It is important to utilize a regularly-monitored email to ensure that you receive all messages. The messages are as follows:
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Awaiting Documents - The EHR attestation will systematically deny if supporting documents are not received (via upload or by fax) within 30 days of the Attestation submission date.
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Corrections Needed - If you do not submit corrections to the EHR Attestation within 30 days of the initial request, the EHR Attestation will systematically deny.
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Additional Documents Needed - The EHR attestation will systematically deny if additional documents required are not received (via upload or by fax) within 30 days of the initial request.
Note: We will send out a reminder notification for each message type on the 15th day following the date of the initial request.
If you have questions or need more information on the upload process, please contact the EHR Incentive Team at 405-522-7347, okehrincentive@okhca.org, or visit our website: www.okhca.org/ehr-incentive.
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OHCA Provider Helpline: 800-522-0114
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