By now, you are probably aware that the Oklahoma Supreme Court ruled the $1.50 per pack smoking cessation fee as unconstitutional. This action affects the Oklahoma Health Care Authority (OHCA) in two ways. 

First, research shows a correlation between price increases for cigarettes and decreased smoking rates. Decreased smoking rates would likely have a positive effect on the agency’s budget in the future. 

Second and more immediate, the OHCA would have received $70 million of the fee’s total appropriation towards our state fiscal year (SFY) 2018 base appropriation. This ruling creates a considerable hole in our budget. If the $70 million isn’t replaced, the agency will also lose about $105 million in federal matching funds. The OHCA’s total state appropriation for SFY18 is $1,025,516,034. Our total budget for SFY18 is $5,664,319,830.

Furthermore, the state’s SFY18 budget has a total shortfall of $215 million as a result of the Supreme Court ruling. We are working closely with state leadership to determine how this deficit will be handled. 

On September 6, Gov. Mary Fallin issued a statement announcing plans to call a special session beginning September 25, 2017, with the intent to adjust the current fiscal year budget. As the OHCA awaits the outcome of this special session, we continue to work to avoid provider rate reductions, if at all possible.

Another outstanding funding issue that the agency is watching is the reauthorization for funding of the Children’s Health Insurance Program (CHIP). Within our program, CHIP is operated as part of SoonerCare. Should enhanced CHIP funding not be reauthorized, the agency stands to lose about $49 million in federal funds in SFY18. 

To file a balanced budget and accommodate for this potential loss in federal funding, the agency announced plans to push two claim runs into July 2018. This will help to ensure that the SoonerCare program is able to operate through SFY18, which ends June 30.

Positive news regarding the CHIP program came out of Washington Sept. 12 when it was announced that the Senate Finance Committee had agreed to a proposed five-year funding extension for the program. The OHCA will continue to monitor the situation closely.

Your continued service to our SoonerCare and Insure Oklahoma members is more important than ever. We at the OHCA appreciate your patience as we work through these circumstances.

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Effective November 1, 2017, the OHCA will no longer be mailing plastic member ID cards. This is part of our continuing efforts to be fiscally responsible and reduce paper usage.

This change applies to both SoonerCare and Insure Oklahoma members, as well as children who receive SoonerCare dental benefits under a parent’s Insure Oklahoma Employer-Sponsored Insurance plan.

However, if a physical member ID card is needed, members have the ability to print cards from their Member Portal. 　

As an added convenience, providers now have the option to print ID cards from the SoonerCare Provider Portal. To print a member ID card from the Portal, simply:

1. Select the Eligibility Tab.
2. Check the member’s eligibility.
3. Select "Display Member ID Card." 

The button will not display if the member does not currently have eligibility.　 

If you have any questions, please call the OHCA Provider Helpline at 1-800-522-0114.

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It’s time for the fall 2017 SoonerCare Provider Training Workshops, and we’re getting down to business!

This session covers: patient-centered medical home (PCMH) updates; understanding and correcting claim denials; documentation; Federal and State Authorities policy; provider enrollment; SoonerCare wellness benefits (tobacco cessation); and Vaccine for Children (VFC) provider training.

Full course descriptions and registration details are available on the provider training page of our website: www.okhca.org/xcourses.aspx.

OHCA highly recommends that all providers attend a workshop. We hope to see you at one of the following trainings:　 

• Lawton            September 28
• Durant             October 5
• Tulsa               October 11 - 12
• OKC                October 25 - 26
• Guymon*         November 1

SoonerCare Provider Training Workshops are hosted by OHCA and DXC Technology (formerly Hewlett Packard Enterprise).

*Only PCMH, claim denials, and documentation classes available.

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Contracts for the following providers expire soon. We encourage you to start the re-enrollment process as soon as possible through the secure OHCA Provider Portal.

Contracts expiring Sept. 30, 2017:

• Dentist
• Genetic counselor
• Independent diagnostic testing facility
• Independent lab
• Lactation consultant
• Maternal and infant health licensed clinical social worker
• Room & board

Contracts expiring Nov. 30, 2017:

• Certified nurse midwife
• Certified nurse practitioner
• Certified registered nurse anesthetist
• Certified nurse specialist
• Group
• OSU and OU physicians
• Rural health clinics

OHCA appreciates your attention to this matter and looks forward to your continued partnership.

Helping members quit tobacco

Every year, on the third Thursday of November, smokers across the nation take part in the American Cancer Society Great American Smokeout. They may use the date to make a plan to quit, or plan in advance and then quit smoking that day. As a trusted healthcare provider, you are in a unique position to help your patients quit tobacco for good. That is why SoonerCare offers coverage for tobacco cessation counseling and tobacco cessation products.

SoonerCare reimburses providers who use the “5As” approach to tobacco cessation developed by the Agency for Healthcare Research and Quality and endorsed by the U.S. Public Health Service. The 5 As are:

1. Ask the member to describe their smoking use;
2. Advise the member to quit
3. Assess the willingness of the member to quit;
4. 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
5. Arrange for follow-up

What’s the word about GERD?

In recent years, the percentage of adults taking proton-pump inhibitors (PPIs) with a prescription has more than doubled. During the same time, PPI-associated adverse effect reports have also doubled. Additionally, nearly one-third of patients taking PPIs purchase them over-the-counter.1,2 

Currently, up to half of all PPIs from any source are being taken incorrectly and concerns have been raised about their long-term use.2 The American Gastroenterological Association recently issued a practice update to address this topic. The risks of PPI-associated adverse effects are summarized in the following table: 3

With kids returning to the classroom and school physicals in full swing, now may be the first time that many children have been seen up-close by adults other than their parents or caregivers in the last few months. In state fiscal year 2016 (July 1, 2015 – June 30, 2016), the Oklahoma Department of Human Services (DHS) identified 61,683 children for whom an investigation of alleged abuse and/or neglect was completed and a finding made. Unfortunately, child abuse and neglect don’t take a summer vacation.

Teachers and pediatricians can be lifelines for children suffering in silence. Every year more than 3.6 million referrals are made to child protection agencies involving more than 6.6 million children (a referral can include multiple children). Sadly, between four and seven children lose their lives to child abuse and neglect every day in the U.S.(1)

Don’t miss opportunities for diagnosing abuse

According to “The Evaluation of Suspected Child Physical Abuse” from the Committee on Child Abuse and Neglect, physicians may find identifying and reporting suspected abuse difficult, but “Proper management of minor but suspicious injuries provides an opportunity for early recognition and intervention to protect vulnerable children.” The committee places infants and toddlers at highest risk.

Inaccurately attributing trauma, overlooking injuries as accidental or missing signs of trauma altogether are among the common problems that contribute to increased morbidity and mortality for physically abused children. Another factor is the physician’s decision not to report suspicious injuries to the proper authorities.(2)

Take action!
Failure to report child abuse is a misdemeanor offense.

If you suspect abuse or neglect of child, please contact the Oklahoma Child Abuse Hotline at 1-800-522-3511. Service is available 24 hours a day.

If the child is in immediate danger, please call 911 or local law enforcement right away.

To learn more about child abuse prevention, please contact the Family Support & Prevention Service (FSPS) at the Oklahoma State Department of Health (OSDH): 405-271-7611 or online at http://.fsps.health.ok.gov. 

You may also download the FSPS Child Abuse Hotline Card here.

Sources:

1.        Child Abuse Statistics & Facts. Accessed May 15, 2017. Available at https://www.childhelp.org/child-abuse-statistics/

2.        Christian, Committee on Child Abuse and Neglect. The Evaluation of Suspected Child Physical Abuse. Pediatrics. 2015;135(5):e1337–e1354. Accessed August 16, 2017. Available at http://pediatrics.aappublications.org/content/135/5/e1337. 

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