Optional benefits for SoonerCare members along with provider rate reductions up to 25 percent are being considered as the Oklahoma Health Care Authority (OHCA) prepares for its state fiscal year 2018 appropriation.

In years past, SoonerCare (Oklahoma Medicaid) has avoided eliminating a few of the optional benefits as defined by the federal government due to the catastrophic outcomes of cutting those benefits. To shore up the budget in the past, the agency has reduced provider rates and eliminated and reduced benefits for adults such as sleep studies, perinatal dental, durable medical equipment purchases, prescription drug limits, etc. 

In state fiscal year 2017, the agency was fortunate that its appropriation was kept relatively flat which allowed the program to continue without further reductions to benefits or rates. However, with federal funds shrinking again and state appropriations likely being reduced in SFY18, protecting optional benefits may no longer be an option for OHCA.

Benefits the agency is evaluating for elimination or reduction include pharmacy, behavioral health and durable medical equipment. Programs being evaluated include the breast and cervical cancer treatment program and the waiver-funded Medically Fragile program and Program of All-inclusive Care for the Elderly (PACE). Other benefits under consideration for elimination include private duty nursing services, adult organ transplants, dialysis, hospice services, physical and occupational therapy, and speech, hearing and language disorder services. The agency must consider the projected savings of eliminating each optional benefit versus potential costs in other areas that may be created by their elimination.

OHCA is beginning its public notification process to reduce SoonerCare (Oklahoma Medicaid) provider rates. Meetings have been scheduled for the next few weeks with all of the state’s provider groups beginning Tuesday, April 11, with the Oklahoma Hospital Association.

“At our March board meeting, we presented budget scenarios based on state leadership’s request ranging from a 5 percent to a 15 percent reduction in state appropriations,” said OHCA CEO Becky Pasternik-Ikard. “While we don’t know our final appropriation, we must be prepared for a reduction. In order for us to meet our obligations to the federal government, we have to get the process started.” 

It takes OHCA approximately 60 days to implement provider rate changes because of public notification requirements. To eliminate benefits, OHCA must allow for about 90 days to amend rules and up to 45 days to receive the governor’s approval under emergency rulemaking. Due to these timelines, additional action may be needed to achieve the fiscal year savings in less than 12 months.

A 25 percent rate reduction will put SoonerCare physician rates at about 65 percent of the Medicare rate. In addition to physician rates, these reductions will affect all provider types including hospitals, pharmacy, durable medical equipment suppliers and nursing facilities.

“We are looking at reductions that threaten our health care infrastructure for Oklahoma’s neediest citizens,” said Ikard. “On the member side, if we have to eliminate the remaining optional benefits, we will be putting people’s lives at stake. On the provider side, with a rate cut of this magnitude, we may see more providers, particularly in the rural areas, close up shop.”

“We realize the potential consequences, but we recognize we are out of options,” she added.

Following the meetings with the provider groups, the agency will present the reductions at the required public meetings listed below.

• Medical Advisory Committee (MAC) (open meeting) – May 18
• State Plan Amendment Rate Committee (SPARC) (open meeting) – May 23
• OHCA Board (open meeting) – May 25 

All meetings will be held at the OHCA in the Charles (Ed) McFall Boardroom, 4345 N. Lincoln Blvd., Oklahoma City. Anyone interested in the SoonerCare program is encouraged to attend.

Additional information about these meetings, including agendas, will be posted at www.okhca.org/calendar as the information becomes available. 

Read more news about the budget here.

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I would like to share a couple of thoughts regarding ways to improve the oral health of the approximately 650,000 kids served by SoonerCare.

Recently, I read a research article by Sonya Mitchell, et al., entitled “Satisfaction with dental care among patients who receive invasive or non-invasive treatment for non-cavitated early dental caries: findings from one region of the National Dental PBRN.” According to the article, patient satisfaction affects his or her reason for choosing a dentist, keeping appointments and complying. 

Literature supports that a healthy dentist-patient relationship contributes to higher patient satisfaction. Additionally, patients are more positive about a dental practice when they feel the dental team listens to their concerns. Although placement of dental restorations is one of the most commonly performed procedures by general dentists, we know very little about patient satisfaction with visits concerning caries management and dental restorations. 

In my experience, I have seen many dentists choose an invasive approach rather than noninvasive treatment methods for early caries. This is in contrast to current best practices. 

Dr. Mitchell’s article states that, “More recent published literature supports the benefits of minimally invasive dentistry. For example, an FDI World Dental Federation policy statement on managing dental caries supports minimally invasive operative interventions. Also, the American Academy of Pediatric Dentistry’s published Guideline on Restorative Dentistry recommends active surveillance of non-cavitated carious lesions with preventive management. Nonetheless, third party payers reimburse surgical procedures at a higher rate than the surveillance procedures that are consistent with evidence-based dentistry policy statements.”  

The decision to place the first restoration on a tooth surface is an important one because it is often the beginning of an unfortunate cycle of restoration replacement over subsequent years. Each succeeding restoration is progressively larger. Ultimately, this leads to a large restoration that places the tooth at high risk for extraction.  

Approaches that delay placement of the first restoration may be key to improving the long-term effectiveness and quality of dental care. This is particularly important for pediatric patients, as we want to help ensure their dental health for a lifetime.

Mitchell’s article also indicates that patients (or in the case of SoonerCare kids, their caregivers) need help understanding why noninvasive treatment is advantageous. “Drill and fill” has been so common over the last few decades that it may be difficult to explain this new school of thought. 

Furthermore, I venture to say that some of my partner dentists may also benefit by updating their knowledge and practice in caries diagnosis and management. 

It is worth your time to read the research report. 

Dr. Leon Bragg
Chief Dental Officer

Reference: 
Mitchell ST, Funkhouser E, Gordan VV, et al. Satisfaction with dental care among patients who receive invasive or non-invasive treatment for non-cavitated early dental caries: findings from one region of the National Dental PBRN. BMC Oral Health. Published March 27, 2017. Accessed March 29, 2017. 

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"Dental Policy and Prior Authorization" is just one of many workshops available during 2017 Spring Provider Training.

This course gives you a thorough look at current OHCA dental policy, coverage for new procedures, and how to submit a dental prior authorization (PA) on the SoonerCare Provider Portal. We recommend this class for all dental providers and dental billing staff.

Also available this session is need-to-know info on topics such as “Introduction to SoonerCare,” “SoonerCare Changes and Updates,” “Third Party Liability Logistics” and “Health Literacy.” Plus, you may 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 in Lawton, Okla. 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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OHCA dentist Dr. Courtney Barrett and other OHCA staff members treated 19 children, ages 1 - 5, at Sustainable Science Academy in the heart of Oklahoma City. The children received dental screenings, fluoride varnish treatments, oral hygiene instruction and nutritional counseling.

Toothpaste, toothbrushes and dental floss were distributed to the children at no cost, as well as stuffed animals, stickers and coloring sheets. OHCA staff also led the children in a fun SoonerFit break to encourage them to care for their physical health 

2017 marks the 15th anniversary of Give Kids a Smile®.

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