Legislative Updates

Sine Die Adjournment
The 56th Legislature adjourned sine die on May 3, 2018. The governor has 15 days – through May 18 – to sign or veto bills passed in the final week of session. After sine die, bills that are not signed by the governor are considered vetoed.

State Fiscal Year 2019 Appropriations
SB 1600, which makes appropriations to state agencies for the upcoming fiscal year, was signed by the governor on April 30. The Oklahoma Health Care Authority (OHCA) state fiscal year appropriations total $1.13 billion.

Work Requirements
Gov. Fallin issued a work requirements executive order (EO) on March 5 to direct OHCA to develop recommendations for a Medicaid work requirements program. OHCA will provide recommendations to the governor and Legislature within six months of the EO.

In addition to the governor’s EO, the following companion legislation was passed:

• HB 2932 – Directs OHCA to seek a work requirements waiver and specifies program criteria. (Signed by governor, May 7, 2018)

Other OHCA Legislation

• SB 972 – Requires OHCA to examine the feasibility of a state plan amendment for diabetes self-management training. (Governor signed, April 12, 2018)
• SB 1053 –Authorizes Oklahoma Department of Veterans Affairs to obtain certification through the federal Centers for Medicare & Medicaid Services (CMS) and accept payments/reimbursements from Medicare and Medicaid programs for services provided through Oklahoma veterans centers. (Governor signed, April 24, 2018)
• SB 1591 – Provides authority for OHCA to establish a supplemental reimbursement program for certain ground emergency medical transportation services. (Signed by governor, May 8, 2018)
• SB 1605 – Directs OHCA to increase provider reimbursement rates and provides other legislative direction for SFY19. (Signed by governor, May 10, 2018)

Upcoming Dates
The 57th Legislature will convene Jan. 8, 2019, at noon and recess no later than 5 p.m. the same day. The governor’s state address will be Monday, Feb. 4, 2019, at noon.

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 A new federal law mandates electronic visit verification (EVV) for home health care services requiring an in-home visit that are covered under a state plan or under a waiver of the plan. Implementation will begin on Jan. 1, 2019, for personal care services and Jan. 1, 2023, for home health services.

In obligation to the Oklahoma Open Meeting Act, the OHCA will host stakeholder meetings to include input from members, family caregivers and individuals who furnish personal care services or home health services.

The first stakeholder meeting will take place at the Health Care Authority (4345 N. Lincoln Blvd., OKC) on June 13, 2018, at 9:30 am. A second stakeholder meeting will be held in Tulsa, OK, on July 11. The time and location of the Tulsa meeting will be announced in the near future. 

Please refer to our website (www.okhca.org) for more information and to register for the events.

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Regarding childhood vaccinations

Providing childhood immunizations is a requirement of our SoonerCare primary care physicians (PCPs). 

As per Oklahoma Administrative Code (OAC) 317:30-5-1155, enrollment in the Vaccines for Children (VFC)  program is no longer a condition of contracting for SoonerCare Choice (patient-centered medical home) providers; however, all SoonerCare PCPs maintain the responsibility of providing immunizations for children assigned to their panel. Providers should administer immunizations in accordance with the Centers for Disease Control Advisory Committee on Immunizations Practices.

For your convenience, a variety of printer-friendly immunization schedules is available on the OHCA public site. This includes a Spanish version.

To access the full scope of OHCA’s policies and rules for the SoonerCare program, please visit www.okhca.org/policies-and-rules. You can access the policy for the EPDST screening criteria at OAC 317:30-3-65.

We strongly encourage providers who have assigned pediatric patients to contact the Oklahoma State Department of Health (OSDH) to discuss enrollment in the VFC program. Information is also available on the OSDH website.

Additional resource:

Oklahoma State Department of Health. Immunizations: Information for health professionals. https://www.ok.gov/health/Disease,_Prevention,_Preparedness/Immunizations/Information_for_Health_Professionals/index.html

Changes to the PA process for medical providers

Effective June 4, 2018, the OHCA will embed InterQual® evidence-based questions and answers for certain imaging and pain management prior authorization (PA) requests into the SoonerCare Provider Portal PA function. This is the second phase of our InterQual® implementation, as previously described in Provider Letter 2017-35. 

The transition will take place during the next 12 months and will include most medical PA requests*.

Also effective June 4, 2018, the OHCA will implement near real-time adjudication (15 minutes or less) for certain imaging study PAs. To accomplish this, imaging PAs will require electronic attachments upon submission that support the PA request.

The InterQual® process and adjudication changes will be covered in the spring Provider Training events being held in May and June. We encourage all medical providers to sign up for a training session near them in order to prepare for these upcoming changes. You can sign up on the OHCA Training webpage.

If you have any questions about these PA process changes or the InterQual® implementation, please call the OHCA Provider Helpline at 800-522-0114.  

* As a reminder: Approved PAs are not a guarantee of payment due to a variety of reasons (such as eligibility, etc.).

In 2017, only 61 percent of SoonerCare members received a prescribed prenatal vitamin while pregnant. That number falls well short of the recent March of Dimes survey indicating 97 percent of women nationally received a prenatal vitamin or multivitamin during their current or last pregnancy. The March of Dimes survey also points to the importance of health care providers as the primary source of pregnancy education. The survey reported 92 percent of women taking prenatal vitamins were acting upon a specific recommendation from their health care provider.

SoonerCare providers are uniquely positioned to have a significant positive impact on prenatal care for our members! A current list of prenatal vitamins available without prior authorization is available at http://www.okhca.org/rx. These preferred vitamins may require prescription but do not require a copay.

Preeclampsia

May is National Preeclampsia Awareness Month. The Preeclampsia Foundation has provided free resources for patients at risk for preeclampsia and for those who have already experienced preeclampsia.

The United States Preventive Services Task Force recommends use of low-dose (81mg) aspirin, after 12 weeks gestation, for patients at high risk of developing preeclampsia. The American College of Obstetricians and Gynecologists offers complete treatment and prevention guidelines on its website.

Read about two more P's: Past-date Insulin and Prior Authorizations, in the complete article on our Pharmacy webpage. 

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The OHCA is engaged in an effort to improve the quality of prenatal care for our members. A recent review of pharmacy claims between 2012 and 2017 showed the following:

• The percentage of members utilizing a prenatal vitamin has dropped from 76 percent to 61 percent.
• Most pregnant members only had two paid claims for prenatal vitamins.

The goal is to improve the utilization of prenatal vitamins in pregnant members receiving SoonerCare services. Maternal nutrition, including adequate vitamin and mineral intake before and during pregnancy, can improve the chances of having a healthy pregnancy.

It is important that providers note the following regarding coverage of prenatal vitamins:

• Preferred prenatal vitamins do not require a prior authorization.
• All preferred prenatal vitamins have a $0 copay when filled as a prescription.

Help your patients have the healthiest pregnancies possible - prescribe prenatal vitamins and encourage their use!

Updated versions of the preferred prenatal vitamin list are always available on our Pharmacy webpage: http://www.okhca.org/rx.*

More details are available in Provider Letter 2018-08. If you have any questions, please contact the Pharmacy Help Desk at 800-522-0114, option 4.

*This list may change from time to time based on market conditions.

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Specialists and hospitals that are contracted with OHCA to see TXIX and SoonerCare members can also see Insure Oklahoma Individual Plan (IP) members without any additional contracting. 

Insure Oklahoma IP is a managed care program in which members have a primary care provider (PCP) and obtain referrals for most services. When checking eligibility, Insure Oklahoma IP members will show as PUB.

As a provider of service to these members, providers receive 100 percent of the SoonerCare allowable for covered services plus any applicable copay. Copays range from $4 for an office visit to $50 for an inpatient hospital admission. 

The processes for checking eligibility, submitting claims, referrals and prior authorization are the same as for the SoonerCare program.

Have questions? Please contact the OHCA Provider Helpline at 800-522-0114.

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Gov. Mary Fallin recently appointed Stanley F. Hupfeld, of Oklahoma City, to the OHCA Board.

Hupfeld currently serves as senior consultant of INTEGRIS Health following a career with the health care system that spans more than 30 years. He became President and Chief Executive Officer of Oklahoma Healthcare Corporation and its subsidiaries, including Baptist Medical Center of Oklahoma, on March 30, 1987.  In 1995, he led the merger of Baptist Medical Center, Southwest Medical Center, and Baptist Healthcare of Oklahoma to form INTEGRIS Health, an integrated delivery system comprising 13 hospitals, all in Oklahoma.  After 23 years as President and Chief Executive Officer of INTEGRIS Health, Hupfeld transitioned January 2010 to Chairman of the INTEGRIS Family of Foundations then into his current position.

“Mr. Hupfeld brings a wealth of health care experience to this appointment," said OHCA CEO Becky Pasternik-Ikard. "We’re excited to have him join our board and look forward to working together for our SoonerCare and Insure Oklahoma programs.”

Read more.