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Fall 2017
 The Oklahoma Health Care Authority (OHCA) was
notified by the Office of Management and Enterprise Services (OMES) on October
2, 2017, that the agency must submit a revised budget by October 10. The new
budget must accommodate for the $70 million state funds that were appropriated
to the OHCA and lost when the Oklahoma Supreme Court ruled the $1.50/pack smoking
cessation fee as unconstitutional.
In order to comply with the OMES request and
transparency requirements, the agency has announced potential provider rate
reductions should no additional revenues be found. These rate reductions, if
approved by the OHCA board, will be effective December 1, 2017.
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The agency is proposing a 9 percent across-the-board
rate reduction for all providers with a few exceptions, including nursing
facilities. This would decrease the physician fee schedule from 86.57 to 78.78
percent of the Medicare fee schedule. Nursing facilities will see a 4 percent
rate reduction in addition to the loss of all coinsurance and deductible
payments for Medicare Part A and B crossover claims as well as the elimination
of reimbursement for therapeutic leave days excluding intermediate care
facilities for Individuals with Intellectual Disabilities (ICF-IID).
The smoking-cessation fee accounted for a 7
percent loss of the agency’s base appropriation. Those state funds would have
been matched by $105 million in federal funds to contribute toward the agency’s
total budget of about $5.6 billion.
“The Oklahoma Health Care Authority continues
to work hand-in-hand with the Oklahoma legislature and are optimistic that
together we will continue to protect providers from rate reductions,” said OHCA
CEO Becky Pasternik-Ikard. “However, we must also answer this request from OMES
and provide a worst-case budget scenario.
“We will continue to openly communicate these
requirements with providers, the legislature and other stakeholders while
reemphasizing that it is our goal to protect the program from further
reductions. In the event the agency receives any additional funding this fiscal
year, we can revisit these reductions and the budget we plan to file with
OMES.”
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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:
- Select the Eligibility Tab.
- Check the member’s eligibility.
- 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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Effective Nov. 1, 2017, adult dental services are limited to emergency extractions only.
At their September meeting, the OHCA Board of Directors voted unanimously to approve rule revisions that clarify dental coverage for adults.
Policy was initially intended to cover "emergency extractions" and was later revised to "medically necessary extractions." The intent of that change was to ensure the emergency extractions were medically necessary; therefore, the policy has reverted back to the original language to include the term "emergency." Adult dental coverage is outlined in OHCA policy 317:30-5-696(1).
Additionally, the latest revisions add new language regarding the medically-necessary images and oral examination that can accompany an emergency extraction.
Budget Impact for the amended policy will result in approximately $479,017 of state share savings for eight months of state fiscal year 2018 (July 1, 2017 - June 30, 2018).
This proposed rule change (17-14 - Adult Dental Emergency Extractions) posted on the OHCA Policy webpage for a public comment from September 6 - 21, 2017.
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 Occasionally billing errors occur. The OHCA finds that the most common dental errors are billing the wrong tooth number or quadrant.
If an error does occur, please do not void a dental claim that is past the six month timely filing deadline. Instead, submit an HCA-15 for an adjustment to a paid claim detail.
You can download the form on the public website at www.okhca.org/forms.
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 SoonerCare Provider Training Workshops give providers an opportunity to get their questions answered and to learn how to work with SoonerCare better.
Fall sessions cover proper documentation; understanding and correcting claim denials; the ins-and-outs of provider enrollment; and more. Please visit the OHCA Training page at www.okhca.org/xCourses.aspx for a complete course list and to register for a workshop near you.
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We hope to see you at one of the remaining workshops:
- 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.
There is additional training available online specific to dental providers.
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OHCA Dentist Dr. Courtney Barrett has been selected as a representative to the Oral Health Technical Advisory Group (OTAG). This group provides Dr. Barrett an opportunity to discuss emerging issues with her peers in other states and to learn about new developments in oral health policy.
Dr. Barrett represents Region 6, which is comprise of Arkansas, Louisiana, New Mexico, Oklahoma, and Texas.
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An annual dental evaluation and health screening event co-sponsored by the Oklahoman Health Care Authority (OHCA) at the Riverside Indian Boarding School recently helped about 515 students get dental exams and supplies.
Photo: Kolten Horsechief (right), Riverside Indian School student, receives toothpaste from OHCA staff member Johnney Johnson at the annual Riverside Dental event on August 31, 2017.
The OHCA was joined by the Oklahoma State Department of Health (OSDH), Indian Health Services (IHS), Southern Plains Tribal Health Board (SPTHB), Absentee Shawnee Tribe, Little Axe Health Center, and Blue Cross and Blue Shield of Oklahoma (BCBSOK) to sponsor the 11th annual event. New to the list of sponsors this year was the American Heart Association (AHA)
“It’s an honor to work alongside all of these wonderful partners and the Riverside Indian Boarding School staff to help make a positive difference in the lives of these kiddos,” said Dana Miller, OHCA Tribal Government Relations director.
Read more here.
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 October is not only time for tricks and treats but it is
also National Dental Hygiene Month (NDHM).
Help young boos and ghouls indulge in their sweet spoils and
practice good oral health maintenance with five simple tips!
1. Suggest healthy alternatives to candy.
Sugar-free gum a smart choice for Halloween
bags. This gum, which contains the artificial sweetener xylitol, helps fight the
bacteria in plaque and the acid that eats away at tooth enamel.
Sugar-free candy is another option.
However, try to avoid lollipops and other hard varieties.
2. Recommend limiting the amount of time sugar is in contact with a
child’s teeth.
Children should be encouraged to eat only a
small amount of candy in one sitting, followed by a glass of water (preferably
fluoridated) and thorough tooth brushing. It is not a good idea to allow a
child to graze on candy, as this will increase the amount of time sugar is in
contact with teeth.
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 3. Remind parents that children should eat all foods in moderation.
Although sweets are blamed for much
tooth decay, all foods — even healthy alternatives to candy, such as fruit and
nuts — can promote tooth decay if eaten in excess.
4. Explain to parents how to set up a candy bank.
Ask parents to allow their child to
make daily withdrawals from the bank and monitor the progress. This way, they
can control how much candy the child consumes.
5. Take time to brush up on children’s oral health habits.
What better time than now to treat
kids to a little reminder about the importance of healthy teeth and gums? Treating
them to a new toothbrush and some flavored floss would be a nice touch. Or, how
about a sample size of fluoride toothpaste? As a bonus, “treats” like these set
children up for healthier dental habits just in time for the holidays.
Promoting good oral health doesn’t have to be scary this
time of year!
Start the conversation about fresh breath, strong teeth and
healthy gums! The
American Dental Hygienist Association (ADHA) encourages everyone to BRUSH
twice a day, FLOSS regularly, RINSE with mouthwash, and CHEW sugar-free gum
after meals for a lifetime of smiles.
Information
adapted from the Academy of General Dentistry
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OHCA Provider Helpline: 800-522-0114
Dental Prior Authorization Unit: 405-522-7401
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