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Winter 2018
The Oklahoma Health Care Authority (OHCA) board met in special session on Dec. 29, 2017, and voted to reverse provider rate reductions which were approved on December 1 and scheduled to go into effect January 1.
During the second special session, the Oklahoma legislature passed an additional appropriation providing the agency with $17.7 million. These funds coupled with the $22.8 million that was provided when Governor Mary Fallin approved sections of the appropriations bill on November 17 give the agency enough funds to operate at current levels until April.
The OHCA had already taken several budget balancing actions preparing for the agency’s $70 million reduction to its appropriation due to the loss of the smoking cessation fee and in order to submit a balanced budget. Several program changes have been implemented in state fiscal year (SFY) 2018 that produce savings of approximately $3.2 million for SFY18. In addition, $4.65 million in 2017 general revenue was returned to the agency in SFY18 and the agency had $12 million in carryover from SFY17.
On December 1, the OHCA board approved across-the-board provider rate reductions of 6 percent and 1 percent for nursing facilities as well as eliminating Medicare crossover coinsurance and deductible payments for nursing facilities to be effective Jan.1, 2018. Read more.
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The OHCA invited approximately 100 key stakeholders to provide input for its five-year Strategic Plan (2018-2022) during an on-site forum at the agency. The October 11-12 session focused on developing action plans for the OHCA and creating outcome measurements for goals and objectives. Focus areas for this strategic plan include:
- Access to health care in rural areas;
- Economic and racial disparities in health status and outcomes;
- Effectively changing individual health-related behaviors;
- Quality improvement in OHCA’s programs and processes; and
- Budget effectiveness, including revenue implications of any new state or federal action.
Vision of Success
The group developed a vision of success in response to this question: “Assuming the agency had necessary resources and made significant progress towards its goals, what would Oklahoma’s health care environment be like at the end of 2022?” The vision included culture and behavior changes resulting in healthier Oklahomans, a stable and coordinated provider network, a focus on preventive care and care coordination, and an outstanding agency fully funded because of its administrative excellence and clear contribution to health outcomes.
Employee Engagement and More Critical Components
Using all this input, as well as feedback from the October 2017 OHCA Annual Tribal Consultation, the agency held three employee planning sessions in November; more than 60 people participated.
Staff reviewed and enhanced the ideas developed during the Strategy Forum and added some of their own. In addition, these small groups of employees further developed specific action plans including implementation milestones, risk analysis and contingency planning.
The OHCA also invited SoonerCare/Insure Oklahoma members and additional stakeholders to provide input through online surveys held in September and December, respectively.
Next Steps
The OHCA is on schedule to have a draft strategic plan in February 2018. The Dental Checkup will bring you more details as they become available.
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Dental policy now includes language allowing dental providers to submit the diagnostic cast or photographic images as evidence of medical necessity for dental services. This program update took effect Sept. 1, 2017.
This affects policy at OAC 317:30-5-696, OAC 317:30-5-698 and OAC 317:30-5-700.1. The OHCA encourages you to read each rule in its entirety. More information can be found in Provider Letter OHCA 2017-15 at www.okhca.org/providerletters.
If you have any questions regarding this rule change, please call the OHCA Provider Helpline at 1-800-522-0114.
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Permanent rulemaking process in effect
OHCA’s permanent rulemaking process is underway. The first set of proposed rules were made available for comment at www.okhca.org/rule-changes on Dec. 15, 2017. The second round of proposed rules posted Jan. 17, 2018.
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.
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.
Outpatient hospital dental and ENT rates
The OHCA proposes an increase in the reimbursement rate for certain outpatient dental services provided in an outpatient hospital. These services will be reimbursed on a cost basis effective on or after Jan. 1, 2018. Dental and ear, nose and throat (ENT) surgical procedures will be classified into a payment group based on CPT codes.
All procedures within this payment group will be paid a single rate. The new rate for these services will be cost-based and will equalize the rates to improve access for dental services rendered in the hospital setting.
To view and/or leave comments about these changes, please visit the OHCA Proposed Changes webpage.
To learn more about OHCA's rulemaking processe, click the flow chart image.
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You and your staff are invited to attend one of the spring 2018 SoonerCare Provider Training Workshop hosted by OHCA and DXC Technology (formerly Hewlett Packard Enterprise).
- Durant - May 1
- Tulsa - May 9 and 10
- Lawton - May 17
- OKC - May 23 and 24
- Guymon - June 20
OHCA and DXC highly recommend that all providers attend a workshop in their area. Be sure to mark your calendar!
Watch for class descriptions, recommended audiences and registration details in the spring 2018 Provider Checkup (April). Updates will also post to the provider training page of our website.
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There is additional training available online specific to dental providers.
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The New Year is a time for healthy resolutions, which makes it the perfect time to discuss how patients can quit, or stay tobacco free.
You’ve probably discussed the need to quit smoking with your patients. Maybe some are already in the process of quitting. Your professional advice and words of encouragement could be just the push they need.
For starters, you can review the 5As approach to tobacco cessation. SoonerCare reimburses dentists for performing the 5As counseling with patients. Additionally, there are a few tips you can share to help them fight stress, avoid triggers and battle cravings. Here are a few:
STAY RESTED
A good night’s sleep helps reduce stress.
REDUCE CAFFEINE
Too much coffee amplifies stress levels
DRINK WATER
Water calms cravings and flushes toxins.
CHANGE ROUTINE
Encourage your patients to change up their morning routines by brushing their teeth first thing.
TALK TO SOMEONE
Talking to loved ones helps overcome stress and cravings. It also lets family and friends know they’re quitting.
EAT BETTER
When people eat poorly, they give themselves permission to do other unhealthy things.
Make sure your patients know about the Oklahoma Tobacco Helpline. FREE, nonjudgmental support is available 24/7. For more tips and information, visit OKhelpline.com.
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The 2018 Oklahoma Mission of Mercy (OKMOM) two-day, free dental clinic is February 2-3 at the Choctaw Event Center in Durant. OKMOM offers dental treatment to patients who are uninsured, under-insured or who have trouble accessing care. Services provided include oral surgery, extractions, restorations, pediatrics and hygiene.
OKMOM is staffed by volunteers, and patients are seen on a first-come, first-served basis. There are no eligibility or income requirements to be treated.
Organizers anticipate 2,000 patients to be seen and need volunteers to serve in numerous roles, including dentists, hygienists, dental assistants, front office staff, nurses, physicians, translators, food service, crowd control and more.
To register as a volunteer, donate or refer someone in need, please visit the OKMOM website.
OKMOM is produced by the Oklahoma Dental Association, Oklahoma Dental Foundation, Delta Dental and Delta Dental Foundation. The Oklahoma State Department of Health endorses the event.
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OHCA Provider Helpline: 800-522-0114
Dental Prior Authorization Unit: 405-522-7401
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