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Fall 2018, Vol. 1
 Program and administrative savings, record drug rebate collections fund rate increases
In collaboration with state and legislative leadership, the Oklahoma Health Care Authority (OHCA) will give the first across-the-board reimbursement rate increases since 2009 to long-term care and other SoonerCare (Oklahoma Medicaid) providers. The
OHCA Board unanimously voted to approve the rate increases at the September 13 meeting.
No new state dollars, carryover or other one-time funds will be used for the increases, which go into effect on Oct.1, 2018.Â
Consistent with the legislative direction of Senate Bill 1605 that was signed into law in May 2018, OHCA proposed using program and administrative savings and record drug rebate collections to increase the provider rates by four percent for long-term care facilities and three percent for other certain contracted provider types or groups.
As also directed in the legislation, these rate increases will be in compliance with federal and state law and regulations, as well as state cost reimbursement methodologies.Â
A three percent rate increase puts SoonerCare PCP rates at about 89.17 percent of the Medicare physician fee schedule. In addition to PCP rates, the three percent increase will affect most provider types including hospitals, dentists and pharmacies.
Read more here.
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From Aug. 16, 2018, the Oklahoma Health Care
Authority (OHCA) has held a series of listening sessions statewide regarding
changes to the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration
Waiver programs’ work and community engagement requirements. Agency leadership
and program staff traveled across the state to take questions and comments from
the public about the proposal.
Potential community partners and entities that can offer
engagement and training opportunities as part of the proposed new SoonerCare
eligibility requirements were encouraged to participate in the public comment
period.
The public has also been able to submit comments
online at the OHCA
Policy Change Blog or on the Native
American Consultation Page.
You can read more about the proposed waiver and
who it may affect in our
special handout.
Public comments
close September 30.
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After Gov. Mary Fallin signed an executive order in March
2018 and the legislature passed HB 2932, the OHCA was directed to pursue
modifications to Medicaid eligibility criteria so that SoonerCare (Oklahoma
Medicaid) coverage for certain Medicaid populations is conditional upon
documentation of certain education, skills training, work, or job activities.
The OHCA will have to apply for a waiver
amendment from the Centers for Medicare & Medicaid Services and receive
approval in order to implement the work/community engagement requirements.
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SoonerCare may be complex, but it doesn’t have to be complicated. You and your staff can learn what it takes to navigate SoonerCare expertly behind the scenes. Starting September 27, OHCA will bring some of our hottest topics, latest updates and new processes to Lawton, Durant, Tulsa, Guymon and OKC.
Fall Training topics include, but are not limited to: how to use the SoonerCare Provider Portal (including claims and reconciliation); submitting medical PAs for InterQual®-related procedures and troubleshooting errors; requirements for rendering and billing SoonerCare for school-based health services; contraceptive access in Oklahoma; how to submit PAs into the Department of Mental Health system (PICIS); and care management services offered for SoonerCare members.
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Please visit the Training page of our website for complete course listings, descriptions and to register for an event near you.
- Lawton - September 27
- Durant - October 4
- Tulsa - October 10 and 11
- Guymon - October 17
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OKC - October 24 and 25
OHCA and DXC host the SoonerCare Provider Training Workshops. We highly recommend that all providers attend a training in their area.
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Holiday season is upon us, which means OHCA
offices will be closed on several dates. These closings are by Executive Order,
for observance of the following state holidays:
Nov. 12, 2018 -- Veterans' Day
Nov. 22-23, 2018Â -- Thanksgiving
OHCA staff will be ready to address any concerns
you have during normal business hours.
Thank you.
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The Oklahoma Health Care Authority (OHCA) has
made policy changes, which were issued through the 2018 legislative session per
the Administrative Procedures Act. All policy changes went into effect Sept. 14,
2018, and can be viewed on the Policy webpage. You will find a sampling of these changes listed below. Full
details are also available in provider letters 2018-18, 2018-19, 2018-20, and 2018-21 at okhca.org.
Medically Fragile Waiver revisions
Medically Fragile policy at OAC 317:50-1-2,
317:50-1-3,
317:50-1-5,
317:50-1-6,
317:50-1-9,
317:50-1-11,
317:50-1-12
and 317:50-1-14
is revised to update the overview, services, and annual re-evaluation sections
of existing policy for general clarification and alignment with the approved
waiver. Additional changes include new language provides guidelines on when to
update the Uniform Comprehensive Assessment Tool, new environmental
modifications service guidelines, as well as direction on how to submit payments
for this service, among others.
Expedited appeals updates
Appeals policy is amended at OAC 317:2-1-2
and added at OAC 317:2-1-2.5 to clarify timelines for appeal decisions.
Additionally, a new section outlines expedited appeals that are required in
cases in which an appellant's life or health could be in jeopardy.
Prior authorization updates
The addition of prior authorization (PA) policy
at OAC 317:30-3-31 and 317:30-3-32 clarifies the scope of a section as
encompassing all PAs. Revisions add language about how a provider can obtain
information on how and/or where to submit PA requests. Additionally, revisions
update a list of services requiring a PA and more.
Pharmacy policy updates
Amendment of pharmacy policy at OAC 317:30-3-57,
317:30-5-70,
317:30-5-70.1,
317:30-5-70.2,
317:30-5-72,
317:30-5-72.1,
317:30-5-76,
317:30-5-77.2,
and 317:30-5-78.1 clarifies
eligible provider qualifications for pharmacies. Revisions outline that
pharmacies may be selected for audits; therefore, pharmacy records must be
available for seven years. Additionally, naloxone for use in opioid overdose
will not count toward the prescription limit. Revisions also remove coverage
for over-the-counter cough and cold medicine. New rules require providers to
dispense brand-name medication when the net cost to the agency of the brand-name
medication is lower than the net cost of the generic medication. Finally,
language clarifies and outlines claim submission and reversals when members do
not pick up medications in a timely manner.
The OHCA
encourages you to review each rule change in its entirety. Moreover, please inform your administrative, billing, and compliance departments about these policy changes.
If you have any
questions regarding these rule changes, please call the OHCA Provider Helpline
at 1-800-522-0114.
Â
These
rule changes were posted to the OHCA Proposed Policy Changes website on
December 15, 2017, through January 16, 2018; or January 17, 2018, through
February 16, 2018, during the 2018 permanent rulemaking session.
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Logisticare (SoonerRide) needs your help to verify visits to
your facility by SoonerCare members. Logisticare arranges non-emergency
transportation for medically-necessary health care appointments.
OHCA has authorized Logisticare to conduct daily surveys on
a small number of randomly-selected SoonerCare providers and members. Their
calls are to confirm that you saw a member, as a patient, on a specific date
and time. These surveys also help OHCA to satisfy federal requirements from the
Centers for Medicare & Medicaid Services (CMS).
LogistiCare has a signed HIPAA agreement with OHCA. If
contacted, please instruct your staff to cooperate with the LogistiCare
representative by checking your records. Representatives will identify
themselves and the purpose of the call.
We thank you in advance for your cooperation. If you have questions
about these surveys, please call the OHCA Provider Helpline at
800-522-0114.Â
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Focus Forward Oklahoma, a program of the Oklahoma Health Care Authority, is focused on increasing access to and utilization of long-acting reversible contraceptives (LARCs) in Oklahoma. Training sessions provide the most up-to-date information on LARC, patient-centered counseling and hands-on clinical skills for insertion/removal of LARC devices. Trainings are at no cost to providers.
Upcoming
sessions:
OHCA
offers LARC provider training through partnership with the following training sites:
- University of Oklahoma
Health Sciences Center, Clinical Skills Education and Testing Center (CSETC) in
Oklahoma City
- Oklahoma State University
Center for Health Sciences Clinical Skills and Simulation Center (OSU) in Tulsa
- University of Oklahoma
Tulsa Simulation Lab (SCOUT)Â
For more
information, please email focusforwardok@okhca.org
or register online at okhca.org/LARCTraining.
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Sickle Cell Disease in Brief
September
is National Sickle Cell Awareness Month. Sickle cell disease (SCD) is a group
of inherited red blood cell disorders. Sickle cells can get stuck in small blood
vessels and block the flow of blood and oxygen to organs in the body. These
blockages cause repeated episodes of severe pain, organ damage, serious
infections, or even stroke.
SCD is a
disease that worsens over time. Various treatments are available that can
prevent complications and lengthen the lives of those who have this condition;
however, options differ for each person depending on the symptoms and severity.
Treatment may include the FDA-approved medications hydroxyurea or Endariâ„¢, or even
a stem cell/bone marrow transplant – which can actually cure SCD in some cases.
Statistics
SCD affects millions of
people throughout the world. It is particularly common among those whose
ancestors came from sub-Saharan Africa; Spanish-speaking regions in the Western
Hemisphere (South America, the Caribbean, and Central America); Saudi Arabia;
India; and Mediterranean countries such as Turkey, Greece, and Italy. In the
United States, the exact number of people living with SCD in the U.S. is
unknown (there is no national registry). However, the Centers for Disease
Control and Prevention (CDC) estimate that:
- SCD affects approximately 100,000 Americans.
- SCD occurs among about 1 out of every 365 Black or African-American births.
- SCD occurs among about 1 out of every 16,300 Hispanic-American births.
- About 1 in 13 Black or African-American babies is born with sickle cell trait (SCT).
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Barriers to Care
It used to be that many children born with SCD did not survive to adulthood. As a result, specialists (hematologists) adept at treating SCD only saw pediatric patients. Today, many patients living with SCD survive into middle age or beyond (cite); however, they are finding it difficult to access adequate health care. There aren’t enough specialists who treat adult SCD patients, and many primary physicians aren’t familiar with the complexities of treating the condition with confidence. As a result, may SCD patients frequent emergency rooms for episodic care – which presents its own set of challenges.
- People with SCD experience longer wait times in the ER and triage.
- People with SCD often have the receipt of pain medication delayed or denied by ER staff unfamiliar with them or their condition.
- The biases (conscious or unconscious) and stereotypes of health care providers influence the care, or lack of care, provided to people with SCD.
The internet is full of
stories of people who have SCD who have endured inadequate treatment in ERs. (For
example – Being dismissed as drug-seekers.) ER staff and PCPs must do all they can to increase their awareness of
SCD and provide culturally competent care for patients.
Patient
Emergency Guidance: When to see the Doctor
It is very important that
every person with SCD have a plan for how to get help immediately — at any hour
— if there is a problem. Advise patients
with SCD to go to an emergency room or urgent care facility IMMEDIATELY for:
- Fever above 101°F
- Difficulty breathing
- Chest pain
- Abdominal swelling
- Severe headache
- Sudden weakness or loss of feeling and movement
- Seizure
Priapism – painful erection of the penis
that lasts more than 4 hours
A
doctor should be called right away for:
- Pain
anywhere in the body that will not go away with treatment at home
- Any
sudden problem with vision
To learn
more about the management and treatment of SCD, please visit these helpful websites:
National Heart, Lunch, and Blood Institute
(NHLBI):
Evidence-Based
Management of Sickle Cell Disease: Expert Panel Report
Â
American Society of Hematology (ASH) Sickle Cell Call
to Action:
Advocacy: ASH sickle cell
disease initiative
Sickle
cell disease resources
Â
Further Reading:
Key
Study Findings: Are family physicians comfortable treating people with sickle
cell disease?
The journal Anemia published a study that analyzed physician
survey responses related to knowledge and attitudes toward care and treatment
of patients with SCD. One thousand forty-two practicing physician members of
the Council of Academic Family Medicine organizations submitted surveys. Only
1 in 5 surveyed physicians reported being comfortable treating patients with
SCD.
Mainous AG, Tanner
RJ, Harle CA, Baker R, Shokar NK, Hulihan MM. Attitudes toward Management of
Sickle Cell Disease and Its Complications: A National Survey of Academic Family
Physicians. Anemia. 2015;2015:1-6. doi:10.1155/2015/853835.
Â
This
article was written in conjunction with Supporters of Families with Sickle Cell
Disease, Inc. (http://sicklecelloklahoma.org) – an Oklahoma family support
nonprofit organization – contracted OHCA.
Â
Sources
-
Centers for
Disease Control and Prevention. Sickle Cell Disease. cdc.gov/ncbddd/sicklecell. Accessed
August 2, 2018.
-
Hulihan, M. and Kaur, M. Sickle Cell Disease in
the Emergency Department. https://www.hhs.gov/blog/2017/06/26/sickle-cell-disease-in-the-emergency-department.html.
Accessed August 15, 2018.
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![[Logo] Treating for Two - Safer Medication Use in Pregnancy](http://content.govdelivery.com/attachments/fancy_images/OKHCA/2018/09/2121912/2191653/logo-treating-for-two-safer-medication-use-in-pregn_crop.jpg) ADHD meds during pregnancy
According
to the Centers for Disease Control and Prevention (CDC), 9 in 10 women take some
type of medication while pregnant and medication
use during pregnancy is increasing over time. Safe and appropriate
medication use during pregnancy is particularly important to SoonerCare members
since they represent more than one-half of all
deliveries in Oklahoma.
While the risks and benefits of any medication should
be discussed with each patient, a recent study
highlighted the specific risks associated with medications used to treat
attention-deficit hyperactivity disorder (ADHD) during pregnancy. During the
time from 1998 to 2011, the study found an increase in ADHD medication use by
pregnant women and an increase in three specific birth defects. When ADHD
medications are taken early in the pregnancy, there is an increased risk of
these birth defects:
Each year nearly
half of all pregnancies are unplanned and ADHD medications represent
the second most prescribed class of
medications for SoonerCare members.1 Given these two contributing factors,
ADHD medication use in females of reproductive age could result in early
pregnancy exposure, a critical period for fetal development.
Providers are encouraged
to utilize the Treating
for Two program consisting of multimedia tools, infographics,
podcasts, and key research findings. This CDC program will assist SoonerCare
providers as they protect the health of women and babies by choosing the safest
treatment options available.
Â
References:
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Oklahoma
Health Care Authority, DUR Board Packet, April 11, 2018. Holderread B. Available
at https://www.okhca.org/about.aspx?id=490. Accessed August 10,
2018.
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In this Friday, Aug. 24, 2018 photo, OHCA Tribal Government Relations Director Dana Miller gives Riverside student Alex Chasanah toothpaste and a toothbrush provided by sponsor Colgate Palmolive during the annual Riverside Indian School Health Fair, in Anadarko, Okla. This year, more than 500 students received health screenings and dental supplies. The annual health fair is put on by the Oklahoma Health Care Authority, Blue Cross Blue Shield, American Heart Association and Colgate Palmolive. Other partners involved in pulling the day together were the Southern Plains Health Board and the Absentee Shawnee Tribe of Oklahoma.
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Dental health affects one’s overall health. That’s why it’s
important that health care providers encourage patients to practice good oral
hygiene daily and visit their dentists regularly.
October is National
Dental Hygiene Month. Be sure to start the conversation about the Daily
4 and what a difference brushing, flossing, rinsing and chewing can make for
your patient’s oral health!
Remind parents and caretakers of children covered under
SoonerCare that they have access to important dental services. This includes full
exams, teeth cleanings, fillings for cavities, fluoride treatments, dental
sealants and more.
Members can learn more about SoonerCare
Dental and get helpful oral health tips at okhca.org/dental. Â
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Eligible professionals (EPs) and hospitals (EHs) who have not
participated in the Electronic Health Record (EHR) Incentive Program prior to
2016 are no longer able to participate in the program.Â
Any EH participating in the program must attest
in consecutive years. Hospitals are no longer able to skip a year.
The completion date for Program Year 2018 was Aug. 31,
2018. Â
Please note: For Program Year 2018, EPs and EHs may attest
to a 90-day reporting period for Meaningful Use but are required to report on a
full year for clinical quality measures, or CQMs. The only exception is for EPs
in their first year of Meaningful Use. They cannot submit their 2018
attestation any earlier than Jan. 1, 2019.
If you have any questions or concerns regarding this
program, please contact the EHR Incentive Team at EHRIncentive@okhca.org or by
phone at 405-522-7347. You can also visit us online at okhca.org/ehr.
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Did you know?
A record number of kids participate in Medicaid/CHIP – 93.7
percent among eligible children in 2016. (Health
Affairs, August 2018)
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Initiative will
enhance the leadership capacity of Medicaid directors to deliver high-quality,
cost-effective health care services.
Becky
Pasternik-Ikard, Chief Executive Officer of the Oklahoma Health Care Authority
(OHCA), is one of six Medicaid directors chosen to participate in the Medicaid Leadership Institute, a
national initiative directed by the Center for Health Care Strategies (CHCS)
and made possible by the Robert Wood Johnson Foundation (RWJF). The program
offers a unique opportunity for Medicaid directors from states across the U.S.
to develop the skills necessary to successfully lead and improve their
essential state programs and impact key health outcomes in an ever-changing
policy and financing environment.
Pasternik-Ikard was competitively
selected to participate in the leadership development program along with five
additional Medicaid directors: Idaho,
Louisiana, Rhode Island, Texas, and Virginia.
Read more here.
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On August 3, Gov. Mary Fallin announced she has reappointed
Ann Bryant to the Oklahoma Health Care Authority (OHCA) Board.
Bryant, of Enid, will serve a four-year term effective Sept.
2, and expiring Sept. 1, 2022. She serves on the board as a consumer member
from the Third Congressional District.
Bryant has served on the OHCA Board since 2010. Fallin
reappointed her in 2014.
The
OHCA board directs the actions and oversees the operation of the Health Care
Authority. The seven board members are
appointed by the governor, president pro tempore of the Senate, and the speaker
of the House of Representatives.
Bryant is a member of the Garfield County Health Planning
Coalition, and helped establish Enid’s Sexual Assault Nurse Examiner program. She
currently services as president of the Oklahoma state chapter of P.E.O, a
women’s philanthropic organization whose mission is to help women reach their
educational goals.
She previously worked as a medical microbiologist at St.
Mary’s Hospital in Enid, and at Smith Cline Laboratory in Waltham,
Massachusetts.
She earned a bachelor of science degree in microbiology and
clinical laboratory science from South Dakota State University and interned at
Creighton Memorial Hospital in Omaha, Nebraska.
She had her husband, James Sears Bryant, have four grown
children.
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OHCA registered nurses Cheryl
Moore (recently retired), Carolyn Reconnu-Shoffner, Pam Jackson and Marlene
Asmussen attend the Great 100 Nurses Celebration of Oklahoma in Catoosa Monday,
Sept. 10, 2018, as Moore, Jackson and Asmussen were honored. Reconnu-Shoffner was
among three agency nurses honored in 2017. Read More here.
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The OHCA conducted an
extensive Strategy Forum last year in order to get input from stakeholders as
we developed our Strategic Plan for the next five years. The response from that
Forum has been very helpful in guiding the future of OHCA. As we wrap up the
first year of the Strategic Plan, the agency is reaching out for feedback from
our stakeholders again.Â
This time, OHCA will hold stakeholder meetings
around the state to learn about their experiences with the current program. We
also want to get input and ideas on
how OHCA can best implement
the Strategic Plan moving forward.
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Who should attend?
The meetings are open to anyone
interested in attending. This includes SoonerCare members, providers and
representatives of organizations that assist and advocate for SoonerCare
members. These public meetings will include an update on OHCA’s progress, but our
main goal is to hear from stakeholders like you.
Where and when are the meetings?
There
are seven meetings scheduled in late October and early November, as listed below. Complete details will post soon on the OHCA website - okhca.org.
10/24/18         OKC                          OHCA Boardroom                                                  Â
10/25/18Â Â Â Â Â Â Â Â Â Â TO BE ANNOUNCEDÂ Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â Â
10/26/18         Enid                          Northwestern
Oklahoma State University      Â
10/29/18         Muskogee                 Muskogee Public
LibraryÂ
11/01/18         Durant                      Choctaw Nation Headquarters
11/05/18         Tulsa                        James O.
Goodwin Health Center
11/09/18         Lawton                     Comanche
County Memorial Hospital
We will set up a registration
soon for you to sign up to attend. A reservation is not required, but it will
help us with our planning.
We hope to see you at a
meeting in your area!
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Talking to your patients about quitting tobacco can be difficult, but it’s
important. Many patients face different challenges when trying to quit tobacco
and the Oklahoma Tobacco Helpline (OTH) offers specialized assistance for
support.
Pregnant Patients
When female smokers find out they are pregnant, they might come to their
doctor for advice on their next steps.
Pregnant smokers tend to feel very nervous about quitting tobacco. Many
want to quit for their baby’s health, but they often think it’s too late to
quit or that their baby will suffer withdrawal symptoms. Advising them on the
impact tobacco can have on their baby — and that quitting is the best option — can
help your patients improve their health and their child’s health.
The OTH provides FREE, nonjudgmental support to help pregnant women quit
their own way. They can speak to a Quit Coachâ„¢, who can help them
through the process. Plus, they can utilize customizable services such as text,
email and phone support. Patients may need additional approval from their
doctor to receive nicotine replacement therapies (NRTs).
Mental Health Patients
Nearly half of all cigarettes produced are smoked by people with mental
health problems. Some mental health providers and facilities may focus solely
on treating the mental illness of their patients and not their tobacco use. However,
patients are often interested in quitting.Â
Research has shown that adult smokers with mental illness can still
benefit from tobacco cessation treatments. OTH Quit Coaches are specially
trained to help those struggling with tobacco use and mental health.
All Oklahomans
The OTH is available to all Oklahomans who want to quit tobacco. With
free services — including free nicotine replacement therapies and 24/7 quit
coaching — freedom from tobacco is just a phone call away. Call 1-800-QUIT NOW
or visit OKhelpline.com.
Free promotional materials such as fact sheets, brochures and posters are
available at OKhelpline.com. Providers can offer support in a quitting journey
so patients know they have the encouragement to succeed.
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OHCA Provider Helpline: 800-522-0114
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