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Spring 2017, Vol. 1
Dear Providers,
Oklahoma Office of Management and Enterprise Services Director Preston Doerflinger has announced a state revenue failure for 2017. To end the shortfall and maintain the legally required balanced budget, state agency appropriations are being reduced by 0.7 percent. This cut means a $4.65 million reduction to OHCA’s general appropriations.
At the February 2017 board meeting, OHCA Chief Financial Officer Carrie Evans advised the board that the agency was operating at an overall positive variance of about $4.8 million through December 31, 2016. Based on this information, we believe, barring any additional revenue failures, that we can finish this fiscal year without making additional cuts. Should we near the end of the fiscal year and determine additional funds are needed, we can move a partial or full claims cycle into state fiscal year 2018.
I appreciate your support and continued dedication to the agency and the people we serve.
Sincerely,
 Rebecca Pasternik Ikard
Chief Executive Officer
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OHCA presented its state fiscal year (SFY) 2018 budget to the House and Senate in January 2017, prior to the legislative session. The focus of the agency is to ensure SoonerCare receives adequate appropriation to maintain today’s program.
The SFY18 budget request includes funds needed to cover losses from federal matching rate changes and growth in the program, as well as reinstatement of Jan. 1, 2016, provider rate cuts, funding for SoonerHealth+, and providing certain exemptions for monthly prescription limits for members.
As session continues through the end of May 2017, OHCA will continue to meet with state lawmakers to inform them on the needs of the SoonerCare program, our providers and members.
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 Get need-to-know info on topics such as “Introduction to SoonerCare,” “SoonerCare Changes and Updates,” “Medical Authorization Tips,” “Third Party Liability Logistics,” and “Health Literacy.” Plus, participate in discussions about our new Upper Payment Limit Program as well as lead poisoning prevention. A full list of classes, course descriptions and recommended audiences is available here.
2017 Spring Provider Training Workshops will be held at four locations statewide, beginning April 13. Please visit our Training page for specific dates and to register for a workshop near you.
*Sign up to receive alerts on new training opportunities!
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Get your questions answered!
Be sure look for the Oklahoma Electronic Health Record (EHR) Incentive Program table during the Spring Provider Training Workshops.
Visit with one of our EHR experts who can detail the ins-and-outs of attesting in 2017— including Modified Stage 2 or Stage 3 reporting. You can also find out about Stage 3 requirements, to which all eligible professionals (EPs) and eligible hospitals (EPs) must adhere in 2018.
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Contracts for Behavioral Health Practitioners
– Under Supervision expire May 31, 2017. However, renewals for this
provider type can begin as early as March 18. We encourage you to start the
re-enrollment process as soon as possible through the secure OHCA Provider Portal.
Correction
The OHCA would like to correct information published in the last Provider Checkup. It stated that podiatrist contracts were set to expire on March 31, 2017; however, they do not expire until March 31, 2018.
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Proposed policy changes available for comment
OHCA welcomes your feedback on several policy changes under consideration. Please visit the Policy Blog on our website to make comments on the below state plan amendments:
- Genetic Counseling State Plan Amendment
- Title XXI Health Service Initiatives (HSI)
- Pharmacy State Plan Amendment
- APA WF# 17-01 Policy Revision to Comply with Fairness in Medicaid Supplemental Needs Trusts Act
- APA WF# 17-02 Self-Employment Language in Insure Oklahoma Individual Plan Policy
*Please be advised that the comment periods for these proposed changes vary.
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 New Training and Mentoring Opportunity for Oklahoma’s Rural PCPs: Medication-Assisted Treatment for Opioid Use Disorder
Many Oklahoma primary care providers (PCPs) are concerned about the devastating effect of opioid use disorder (OUD) on their patients and communities. However, many of them also feel overwhelmed at the prospect of offering treatment for OUD within their own practices.
The Medication-Assisted Treatment (MAT) Expansion Project aims to increase access to MAT for persons with OUD. Through training and supports, rural PCPs learn how to deliver MAT services. MAT is an evidence-based strategy for treating persons with OUD that combines the use of medications with counseling and behavior therapies to provide a whole-patient approach to treatment.
American Institutes for Research (AIR) and the state of Oklahoma are recruiting 68 internists, family medicine physicians, doctors of osteopathic medicine, physician assistants and nurse practitioners to participate in this MAT training and support program. To be eligible, participants must provide primary care services in one of the 28 counties highly impacted by OUD in the Northeastern, North Central and South Central regions of Oklahoma The rural counties of focus are: Adair, Carter, Cherokee, Coal, Craig, Delaware, Garfield, Garvin, Grant, Jefferson, Johnston, Kay, Kingfisher, Love, Marshall, Mayes, Murray, Muskogee, Noble, Nowata, Okfuskee, Ottawa, Payne, Pontotoc, Pottawatomie, Seminole, Stephens and Washington.
Participating PCPs and supporting practice staff will
receive extensive education to enable them to obtain a Drug Addiction Treatment
Act of 2000 (DATA 2000) or Comprehensive Addiction and Recovery Act of 2016
(CARA 2016) authorized waiver for prescribing buprenorphine in office-based
settings. They will also receive training and support for effective implementation
of MAT in their practices.
Recruitment for rural PCPs in Northeastern
Oklahoma (Wave 1) continues through March 30, 2017.
Selected providers from this region will implement the program from June 2017
to September 2019.
Recruitment for rural PCPs in North Central
and South Central Oklahoma (Wave 2) will occur from April 1, 2017, to Sept. 1, 2017. Selected providers from these regions
will implement the program from December 2017 to September 2019.
PCPs can earn continuing medical education
(CME) credits for attending training, with an option to fulfill the
requirements of the new American Society of Addiction Medicine (ASAM)
Fundamentals of Addiction Medicine 40-Hour Program.
For more
information on this opportunity, please visit http://OklahomaMAT.org. If you have any questions, please contact
the AIR project team at OklahomaMAT@air.org or call 866-236-4285.
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Provider resources for National Poison Prevention Week
Did you know poisoning is the most common cause of injury-related death in the Unites States? 1
In Oklahoma from 2011 to 2015, more than 3,500 people died from unintentional poisoning. Seventy percent of these unintended deaths involved prescription medications. Of that 70 percent, more than 4 out of 5 involved prescription painkillers. 2 Other common poison exposures include cleaning substances, cosmetics and personal care products. 3 The American Association of Poison Control Centers (AAPCC) has recently issued alerts concerning E-cigarettes and liquid nicotine, hand sanitizer, and laundry detergent packets. Food recalls and prescription medication alerts have also been issued. 4
In response to these alarming statistics, the National Poisoning Council has designated National Poison Prevention Week as March 19-26, 2017. During this week, various themes will receive special focus. Those themes are:
- Monday, March 20 – Children Act Fast … So Do Poisons
- Tuesday, March 21 – Poison Centers: Saving You Time and Money
- Wednesday, March 22 – Poisonings Span a Lifetime
- Thursday, March 23 – Home Safe Home
- Friday, March 24 – Medicine Safe 1
During Poison Prevention Week, the Oklahoma Center for Poison & Drug Information (OCPDI) has scheduled two Medication Take-Back Events. Patients, caregivers and other members of the public may bring unused or expired medications to these free events for proper disposal, with the exception of syringes, inhalers, or liquids. Attendees will also find valuable health information, family fun and educational booths. The Medication Take-Back Events are planned in partnership with AAPCC, Buy For Less, the Oklahoma Bureau of Narcotics (OBN) and the Coalition Against Rx Drug Epidemic. You may download flyers here for printing. Please distribute as desired.
In addition to the Poison Prevention Week activities, health care providers can utilize several ongoing poison prevention resources:
- OBN has dozens of take-back locations available throughout the year at multiple sites around the state. Find a location near you here.
- OCPDI has free resources in the form of stickers, magnets, brochures, fact sheets and posters, as well as teaching aids for elementary school students. Click here to order or download.
- Additionally, OCPDI is offering a free course entitled “Advanced Hazmat Life Support” for health care professionals and first responders. Attendees may receive 16 hours of free continuing education credits. Please visit the OCPDI website for more information.
- Health care providers and law enforcement officials can also call OCPDI at 800-222-1222 (toll free) for help in identifying an unknown medication. However, this service is not available to the public.
OCPDI provides free, confidential information 24 hours a day, 7 days a week, 365 days a year and is staffed by pharmacists and nurses who have received specialized training in toxicology. They are able to communicate in more than 150 languages. Please contact OCPDI for any poison/drug questions, exposures or emergencies.
References:
- National Poison Prevention Week. Available at: http://www.aapcc.org/prevention/nppw/. Accessed on February 13, 2017.
- Unintentional Poisoning. Available at: https://www.ok.gov/health/Protective_Health/Injury_Prevention_Service/Unintentional_Poisoning/index.html. Accessed on February 12, 2017.
- Poison Center Snapshot-2015. Available at: https://aapcc.s3.amazonaws.com/pdfs/annual_reports/2015_Annual_Report_Snapshot_FINAL_1-17-17.pdf. Accessed February 12, 2017.
- AAPCC Alerts. Available at: http://www.aapcc.org/alerts/. Accessed February 12, 2017.
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 Opportunity for
independent living increases under Living Choice Project expansion
The mission of the Oklahoma Living Choice Project is to make community living a reality for persons 19 years of age or older who have disabilities or long-term illnesses. Individuals participating in Living Choice reside in their own homes with the necessary community- based supports and services to ensure their success outside of an institutional setting.
Since its inception in 2007 more than 700 people have transitioned from institutional care into community living through Living Choice Project. Historically, Living Choice has served three populations - the frail aged, the physically disabled and the intellectually disabled.
Recently, the Living Choice received approval to cover an additional population. The program may now also assist persons residing within a psychiatric residential treatment facility (PRTF) who meet appropriate criteria to transition into community-based services. The focus will be on transitioning youth 16-18 years-old who:
- have been in an inpatient PRTF for 90 or more days during an episode of care;
- meet criteria for Level 4 on the Individual Client Assessment Record (CAR); and
- may be in the custody of Oklahoma’s child welfare agency or juvenile justice agency.
Additionally, a caregiver-rated Ohio Scale that shows critical impairment (score of 25 and higher on the Problems Subscale or a score of 44 or below on the Functioning Subscales) is necessary to meet eligibility.
The goal of including these youths in Living Choice is to improve health outcomes and to reduce the number of days they are in out-of-home placements.
Once a young person transitions from PRTF back into the community, he or she will receive community-based services. These services will be provided by youth and family teams which include physicians, psychiatrists, nurses, care coordinators, nutritionists, social workers, behavioral health professionals, dental professionals, school personnel and representatives from any system the youth may be involved in (e.g., the Office of Juvenile Affairs, Oklahoma Department of Human Services, etc.).
For more details on Oklahoma’s Living Choice Project, please visit us online at www.okhca.org/living_choice.
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 Clean up and give
Are you or someone you know spring cleaning? Dust off that old cane or other unused medical equipment and put it to good use!
OHCA (in partnership with Oklahoma ABLE Tech) oversees the Oklahoma Durable Medical Equipment Reuse Program (OKDMERP), which reassigns gently used DME to Oklahoma residents in need. While SoonerCare members have priority, all Oklahoma residents with disabilities and/or health conditions can participate in the program regardless of age, income or insurance coverage. Best of all, there is no cost to the recipient!
OKDMERP receives donations at several locations around the state. Donations include highly-requested items such as wheelchairs, nebulizers and scooters, as well as blood pressure monitors, quad canes and bath benches. To find a donation center near you, please click here.
In addition, the OKDMERP office (3325 N. Lincoln Boulevard, Oklahoma City) accepts walk-in donations every Wednesday from 8 a.m. - 4:30 p.m.
If you are interested in donating an item or you know a patient in need of equipment, please contact OKDMERP at 405-523-4810 or 800-257-1705. More information is available on the OKDMERP website.
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 Updated Insure Oklahoma income guidelines
Insure Oklahoma has updated its income guidelines for both the Employer-Sponsored Insurance and Individual Plan programs. The new income limits are effective May 1, 2017, and reflect the annual federal poverty threshold adjustments made by the Department of Health and Human Services.
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NEW ambulance coverage for Individual Plan members
Emergency ground ambulance coverage for Insure Oklahoma Individual Plan members has been added effective Sept. 1, 2016.
Due to the retroactive effective date, claims for these services may have been denied if they were submitted between Sept. 1, 2016, and Feb. 2, 2017. We encourage providers to submit any previously denied or unfiled claims for reimbursement as soon as possible. This will ensure that timely filing requirements are met. If you resubmit a claim, it must be received by OHCA no later than 12 months from the date of service. Members are responsible for service copays.
If you have questions about this coverage or how to resubmit a claim, please call the OHCA Provider Helpline at 800-522-0114.
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 The 2016 OHCA
Annual Report is now available online. You can find additional information on
OHCA’s programs and services in our online Primer.
Are you interested
in detailed measures of OHCA’s efforts and outcomes? Our 2016 Service Efforts
and Accomplishments (SEA) Report has the information you seek and is ready to
view on our website.
Please visit www.okhca.org/reports to download PDFs
of the reports above and to access our Fast Facts, read agency studies,
evaluations and more.
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 Robert Evans, MD, has rejoined the OHCA staff as senior medical director.
He worked for the agency previously as a medical director from 2013 to 2015. In the interim, he worked for the Social Security Disability Determination Division as a medical consultant.
Evans worked in private practice of anesthesiology in Shawnee and the Oklahoma City metro area before he joined the OHCA.
Outside the medical field, Evans has owned a multimedia production company since 1985. He is also a recognized authority on Ojibway (Chippewa) cultural rock painted images in Minnesota and Ontario.
Click here to read more.
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 OHCA Population Care Management Supervisor Rebekah Gossett has been recognized as a 2016 Great 100 Nurses of Oklahoma honoree and nominated for the March of Dimes Nurse of the Year in Oklahoma.
Ms. Gossett earned her Master of Science in Nursing Education from the University of Phoenix and her Bachelor of Science in Nursing from the University of Central Oklahoma. She also holds a certification in case management. Her background includes emergent and critical care as well as hospice.
Read about what drives her passion for caring for others here: http://ow.ly/3Sm9307ECuK.
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OHCA Provider Helpline: 800-522-0114
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