Legislative Updates

Sine Die Adjournment
The 56th Legislature adjourned sine die on May 3, 2018. The governor had 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.

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.

Back to top

Beginning on or after Feb. 1, 2019, the state of Oklahoma will implement community engagement requirements for certain individuals related to SoonerCare (Oklahoma Medicaid) eligibility upon approval from the Centers for Medicare & Medicaid Services (CMS). As a condition of eligibility for benefits, applicants or existing members - not otherwise exempted - age 19-50 must provide verification of employment or community engagement in specified educational, job training or job search activities for at least 80 hours per month. This equates to approximately 6,000 current members who would be subject to these requirements. Members who fail to meet these requirements for three months during a plan year will be dis-enrolled from SoonerCare until requirements are met.

Exemptions

Certain individuals are exempted from the above requirements. Those individuals include, but are not limited to:

• pregnant women
• individuals with a disability
• a parent caretaker responsible for the care of a  dependent child under age 6
• individuals enrolled in Insure Oklahoma
• American Indians and Alaska Natives

This new eligibility criterion was directed by an executive order signed by Gov. Mary Fallin on March 5, 2018. Additionally, the state legislature passed House Bill (HB) 2932, which the governor also signed into law. HB 2932 mandated SoonerCare eligibility include criterion for work or job activities as required for the Supplemental Nutrition Assistance Program (SNAP).

Please visit the OHCA website for more information, including FAQs, timelines and other resources.

Public Comment and Input

The OHCA welcomes comments from the public regarding this amendment to the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver program. The full application waiver is available for viewing on our website through Sept. 3, 2018.

Submit your comments and questions through the OHCA Policy Change Blog or by contacting the OHCA Federal & State Reporting Division by phone at 405-522-7914 or via email: OHCAcommunityengagement@okhca.org.

The OHCA also expects to conduct several public meetings around the state July-September. Please check the agency’s website for specific dates, times and locations.

Back to top

The U.S. Food and Drug Administration (FDA) has warned against using over-the-counter (OTC) oral drug products containing benzocaine for anyone younger than two years. These products are of questionable efficacy and carry an increased risk of methemoglobinemia (a blood disorder in which too little oxygen is delivered to your cells), which may be fatal.

These products are currently still commercially available with the new contraindication against using the product for teething and for use in infants and children younger than two years for any indication.

Parents and caregivers are encouraged to follow the American Academy of Pediatrics' recommendations to ease teething pain. The safety announcement follows a previous recall recommendation concerning elevated levels of belladonna (a poisonous plant) in homeopathic teething tablets.

Back to top

Effective Aug. 1, 2018, OHCA will implement a change to the addenda record attached to your EFT (direct deposit) payment. This change is to comply with HIPAA-mandated health care EFT standards. It will not affect the EFT payment itself. 

The current addenda record for payments made by SoonerCare:

TRN*1*20180801*0000123456*1*00123456*73-1476619* 

Will become:

TRN*1*00123456*1731476619* 

(TRN *1* + warrant [payment] number +*1, followed by OHCA’s Federal Tax ID Number [no dash] + *)  

PLEASE NOTE: It is important that you contact the financial institution where your SoonerCare payments are deposited to notify them of this upcoming change. Doing so will help to ensure your EFT payments received beginning August 1 will process properly and will not delay your funds availability.

Back to top

You and your staff are invited to attend the fall 2018 SoonerCare Provider Training Workshops hosted by OHCA and DXC.

- Lawton - September 27
- Durant - October 4
- Tulsa - October 10 and 11
- Guymon - October 17
- OKC - October 24 and 25

OHCA and DXC highly recommend that all providers attend this workshop. Be sure to mark your calendar!　

We will release class descriptions, recommended audiences and registration details soon. Please visit the provider Training page of our website for updates.

Back to top

SoonerRide has long helped SoonerCare members get to and from their non-emergency health care appointments. But did you know that providers now have the ability to schedule transportation for our members as well? 

TripCare is a website that allows providers to schedule rides for SoonerCare members. The service is provided by LogistiCare, which also administers OHCA's SoonerRide program.

TripCare is at no cost to providers, but you will need an EDI form to get started. 

Providers will receive a username and password after the EDI form is submitted to LogistiCare via fax at 1-800-597-2091.

Back to top

The OHCA was notified June 27, 2018 that their proposal to become the first state Medicaid agency to move forward with negotiating value-based or outcomes-based contracts with pharmaceutical companies was approved by the federal government.

“In essence, this means that if a drug does not perform as claimed, the manufacturer will rebate the cost of the drug or another negotiated amount," said OHCA Pharmacy Director Nancy Nesser. "For example, if a drug claims to keep people out of the hospital and doesn't, the manufacturer may be liable for the cost of the hospitalization.”

Value-based contracts tie provider payments to successful clinical outcomes and effectiveness rather than simply paying for the medication. Rising prescription drug costs is one of the catalysts for the OHCA to find innovative ways to reduce Medicaid costs.

>>Read more. 

Back to top