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Fall 2016, Vol. 2
The permanent rulemaking process is starting at the agency. The first set of proposed rules will be available for comment at www.okhca.org/rule-changes on Dec. 16, 2016. The second round of proposed rules will post in January 2017.
The public, SoonerCare members and providers, other state agencies and OHCA staff and leadership may request changes in policy. Proposed permanent rules may include proposals for new programs and/or policies or amendments to current policies. They also include rules previously promulgated on an emergency basis.
As required by state statue, OHCA provides a Rule Impact Statement for each proposed rule. This includes the legal authority, possible impact to providers and/or members, projected budget impact and reason for the proposed changes. We also highlight all text changes.
Permanent rule recommendations go to the Legislature and Governor for action in the spring. We encourage you to review the proposed rules and give your input.
Click the image below for more details on our rulemaking process.
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Three provider types have contracts set to expire on Dec. 31, 2016 - Medicare crossover, free-standing dialysis center and birthing center. However, these providers can log on to the secure OHCA Provider Portal to start renewing their contracts now.
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Emergency rules affecting obstetrical care
On Oct. 13, 2016, the OHCA Board of Directors voted to amend agency rules to reinstate the bundled reimbursement structure for OB care.
Agency rules are amended to reinstate the use of the global care CPT codes for routine OB billing. These codes can be used if the provider oversees a member's care for longer than one trimester. The reinstatement of the global reimbursement is necessary to prevent an unintended administrative burden to providers.
These rule changes have been determined to be budget neutral and went into effect on November 22, following action from the governor.
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Dr. Bragg retirement update
In the OHCA Provider Checkup Newsletter (Fall 2016, Vol.1), we announced that Chief Dental Officer Dr. Leon Bragg would be retiring on October 31, 2016. We are pleased to relay that, since that announcement, Dr. Bragg has suspended his retirement until next year.
Dental code activated for silver diamine fluoride
OHCA has opened dental code D1354 for use of silver diamine fluoride (SDF), for "interim caries arresting medication application.” SDF is a major topic of discussion in dentistry lately. It has been described as “a caries ‘silver-fluoride bullet,’”1 and some have ventured to say it could eliminate the use of the drill altogether in treating children’s cavities.2
SDF is noninvasive, quick and inexpensive, which makes it an attractive option for treating SoonerCare children.
Dental code D1354 can be used to bill for services provided to SoonerCare members. To limit any abuse, the following administrative rules are in place (subject to change):
- For a child who is documented to be unable to receive restorative services in the typical office environment;
- A tooth that has been treated with SDF should not have any non-carious structure removed;
- A tooth that has been treated with SDF should not receive any other permanent restorative treatment for three months following an application;
- Reimbursement for extraction of a tooth that has been treated with SDF will not be allowed for three months following an application;
- Reimbursement is available once every 184 days for two occurrences per tooth in a lifetime;
- Reimbursement will be equal to that of a sealant, currently $22.56, limited to eight teeth per series
For more information on SDF and its usage, you may want to read “UCSF Protocol for Caries Arrest Using Silver Diamine Fluoride: Rationale, Indications and Consent” (Horst JA, Ellenikiotis H, Milgrom PL. J Calif Dent Assoc. January 2016).
Sources:
1. Rosenblatt A, Stamford TC, Niederman R. Silver diamine fluoride: a caries "silver-fluoride bullet". J Dent Res. 2009 Feb;88(2):116-25. doi: 10.1177/0022034508329406.
2. Saint Louis C. A Cavity-Fighting Liquid Lets Kids Avoid Dentists' Drills. New York Times. July 11, 2016. Accessed September 28, 2016.
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Riverside Dental Event
OHCA helped 500 students at Riverside Indian Boarding School (Anadarko, Okla.) to start their school year with healthier smiles at the 10th annual Riverside Dental Event on Sept. 2, 2016. Students received dental hygiene tools and full health screenings provided by the OHCA and our community partners. Read more.
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Prescribing codeine for children
The American Academy of Pediatrics (AAP) recently issued new guidance surrounding the use of codeine for pediatric patients. The AAP urges prescribers to avoid prescribing codeine for pediatric patients. The recommendation is based on regular reports of life-threatening or fatal respiratory depression.
The majority of cases occurred within the recommended dose and dosing interval for analgesic or antitussive indications. The potential risk associated with codeine is due to wide interpatient variability in drug metabolism. Codeine metabolizes to morphine via CYP2D6. Receiving the indicated codeine dose may result in responses ranging from a lack of effect to fatalities related to excessive morphine levels.
AAP recommendations are consistent with other groups that have issued similar warnings associated with pediatric use of codeine:
- 2011 - World Health Organization
- 2012, 2013 - Food and Drug Administration (FDA)
- 2013, 2015 - European Medicines Agency
- 2013 - Health Canadian
- In December 2015, the FDA voted by an overwhelming majority to recommend that codeine in the treatment of cough in all patients up to 18 years of age be contraindicated. Final FDA action is pending.1
Under Oklahoma Pharmacy Law 475:30‐1‐14, 160 milligrams of codeine may be dispensed to patients age 18 and over, without a prescription, if the patient has not received an equivalent amount of codeine, morphine, or opium within the last 48 hours.2 Parents and caregivers should be advised of the significant risks associated with use of codeine for pediatric patients, even without a prescription.
References:
1) Tobias JD, Green TP, at al. Codeine: Time to say “No.” Pediatrics. September 2016. Available at http://pediatrics.aappublications.org/content/early/2016/09/15/peds.2016-2396 . Accessed September 20, 2016.
2) Oklahoma Pharmacy Law Book 2016. Laws and Rules Pertaining to the Practice of Pharmacy. September 2016. Available at https://www.ok.gov/pharmacy/documents/2016%20LAW%20BOOK.pdf . Accessed September 20, 2016.
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Limit use of fluoroquinolone antibiotics
The Food and Drug Administration (FDA) recently issued a new warning for fluoroquinolones, restricting the use of these antibiotics in common infections due to disabling and potentially permanent side effects of the tendons, muscles, joints, nerves and central nervous system that can occur together. It has been determined that these rare risks far outweigh the benefits when using fluoroquinolones for uncomplicated urinary tract infections, acute bacterial sinusitis and acute bacterial exacerbation of chronic bronchitis.
This pertains to all fluoroquinolones that are used systemically.
This recent warning has been issued in addition to the existing warnings for worsening myasthenia gravis, potentially irreversible peripheral neuropathy and increased risk of tendinitis and tendon rupture. The warning is based on an FDA committee finding that two or more coexisting side effects present an increased risk for irreversible damage that can occur from hours to weeks after exposure. Drug labels and Medication Guides must be updated to reflect the severity of the possible side effects.1
Patients should discontinue exercising and contact their health care professional immediately if they experience any of the following symptoms while being treated with a fluoroquinolone: 2, 3, 4
- Tendon, joint or muscle pain
- Swelling or bruising around any joints
- Inflammation
- “Pins and needles” tingling or pricking sensations
- Confusion
- Hallucinations
- Seizures
Fluoroquinolones should be reserved for conditions that do not have alternative treatment options such as:1
- Anthrax
- Bacterial pneumonia
- Plague
Even when indicated, prescribers should use extreme caution when prescribing fluoroquinolones for patients with a history of joint disease.2
References:
1) FDA Updates Warnings for Fluoroquinolone Antibiotics. U.S. Food and Drug Administration. Available at: http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm513183.htm. Accessed September 7, 2016.
2) Information for Healthcare Professionals: Fluoroquinolone Antimicrobial Drugs. Available at: http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm126085.htm. Accessed September 7, 2016.
3) Press Announcement- FDA Drug Safety Communication: FDA Advices Restricting Fluoroquinolone Antibiotic Use For Certain Uncomplicated Infections; Warns About Disabling Side Effects That Can Occur Together. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm500143.htm. Accessed September 7, 2016.
4) Fluoroquinolones. Drug Facts and Comparisons. Fact & Comparisons [database online]. St. Louis, MO: Wolters Kluwer Health, Inc. 2016. Accessed September 8, 2016.
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Applying for Insure Oklahoma during federal open enrollment
The federal government’s annual open enrollment period is in full swing. If someone you know has applied through the federal marketplace and wasn’t eligible for federal assistance or SoonerCare, there’s still another coverage option to consider: Insure Oklahoma.
Oklahomans who are interested in applying for Insure Oklahoma must apply through the SoonerCare/Insure Oklahoma application; eligibility for applications referred to OHCA from the federally-facilitated marketplace are not automatically reviewed for Insure Oklahoma. For more information or to apply, visit www.insureoklahoma.org.
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SoonerCare shines as mobile health messaging model
For the third year in a row, Oklahoma continues to lead the nation in Text4baby (T4b) enrollments per 1,000 live births. T4b is the nation’s only free mobile health messaging service for pregnant women and mothers with infants under age one.
Oklahoma not only won the 2016 State Enrollment Contest (June 5 – Oct. 8, 2016) among Medium States, it outranked all other participating states in the percentage of pregnant and new moms who enrolled during the contest period. (Oklahoma came in at 11.6 percent; Louisiana, which placed second overall, had 4 percent.) OHCA has been integrating T4b enrollment into our outreach and enrollment efforts with pregnant women and caretakers of infants, including implementing an automatic notification process via text message for members to easily opt-in to receive T4b messages. Additionally, state partners have continued to reach moms with the service through a variety of media and advertisement outlets, during prenatal and pediatric appointments, in birthing hospitals, in WIC clinics, in faith-based organizations and through community outreach events.
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In addition, the OHCA’s work with Text4Baby was recently accepted as an Innovation Station Emerging Practice by the Association of Maternal & Child Health Programs (AMCHP). This honor recognizes SoonerCare’s state-level efforts to increase health outcomes for its maternal-child members, regarding the work as an innovative resource and a best practice to be replicated across the country, particularly among the Medicaid population. In fact, Hawaii and Louisiana have already received grant funding from AMCHP to duplicate out process. Check out AMCHP’s Innovation Station to learn more about OHCA’s work.
Text4baby is a free service of ZERO TO THREE and Voxiva, Inc. Women who sign up for the service by texting BABY to 511411 (or BEBE for Spanish) receive free SMS text messages each week timed to their due date or baby’s date of birth. These messages focus on a variety of topics critical to maternal and child health, including birth defects prevention, immunization, nutrition, seasonal flu, safe sleep and more. T4B service can be canceled at any time by texting STOP and HELP for help.
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Connecting more members to mobile information
Recently, OHCA began sending important health information through text messages to our larger SoonerCare membership. These Connect4Health messages promote SoonerCare benefits, helpful resources (such as the Member Portal, SoonerRide transportation services, and the OK Tobacco Helpline), health tips, appointment reminders, SoonerCare application renewal reminders and more!
More than 63,400 SoonerCare members received a text invitation to enroll in Connect4health from July to September 2016 and more than 14,300 of them opted in.
To opt-in to the program, existing members may update their contact information at www.mysoonercare.org. New SoonerCare members are automatically enrolled into Connect4Health but have the option to opt out.
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Don’t miss your last chance to save!
Time to benefit from the Electronic Health Records (EHR) Incentive Program is winding down. The deadline to start the attestation process is March 30, 2017. Any eligible hospital or professional who would like to begin participating must start NOW.
Remember, if you see Medicare members, this is one way to avoid the reduction in payment from Medicare.
If you have any questions or concerns regarding this program, please contact the EHR Incentive Team at EHRIncentive@okhca.org or by phone at 405-522-7347. You may also visit us online here.
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Fee schedules updated
The Title XIX and Insure Oklahoma (IO) provider fee schedules were updated on Oct. 1, 2016. To view, please click here.
Care coordination update and clarification
The OHCA is exploring ways to improve health care services for SoonerCare’s aged, blind and disabled (ABD) populations. During the 2015 legislative session, House Bill 1566 was passed which directed the OHCA to develop a request for proposal (RFP) for a care coordination model for this population. The agency selected a fully capitated, state-wide model of care coordination and named the initiative SoonerHealth+.
Although OHCA has not yet released the RFP or awarded any contracts, some health care companies may already be contacting you to determine if you would be interested in contracting with them. You are in no way obligated to do so. However, if the RFP is awarded, the selected health care companies must have a provider network in place in order to serve ABD enrolled members.
The OHCA is currently developing the RFP for release on November 30. Based on our current timeline, if the RFP is awarded, beginning in spring of 2018, SoonerCare ABD members that you serve will be enrolled in a managed care organization (MCO), which will be responsible for their health care needs. At that time, to continue to serve those ABD members, you would need to be contracted with the MCO selected. However, until the RFP is awarded, the OHCA is not working with or endorsing any health care company seeking to be the chosen MCO.
More information on SoonerHealth+ is available on our website. OHCA will provide additional details on SoonerHealth+ as they become available.
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Guarding against influenza is a public health priority this time of year. SoonerCare covers flu vaccinations for many of our members, and our state agency partner, the Oklahoma State Department of Health (OSDH), offers flu shots at the county health departments statewide. County health departments accept SoonerCare as payment for flu vaccine, and there is no charge for children 18 years of age and younger who are eligible for SoonerCare.
Flu vaccination is recommended each year for everyone 6 months of age and older. Please note: County health departments are not offering the flu mist, as it is no longer recommended by the CDC.
Flu shots for pregnant women are extremely important for their health and the health of their newborns. SoonerCare encourages obstetricians to coordinate with the member’s primary care provider to ensure that these members receive the flu vaccine. Administration by either provider type is covered. (Please note: SoonerCare coverage of immunizations for members less than 19 years of age must be provided through the Vaccines for Children program, as mandated by federal law.)
A detailed fee schedule for OSDH flu shots is available here. Oklahoma and Tulsa County residents should check with their city-county health departments for their fee schedules.
In addition to getting a flu vaccination, providers should talk to their patients ages 65 years of age and older, and those with chronic health conditions, about being vaccinated against pneumococcal pneumonia - a common and potentially serious complication of the flu. This vaccine is also available at county health departments.
For more information, call a local county health department or visit the OSDH website at www.health.ok.gov.
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OHCA Provider Helpline: 800-522-0114
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