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Fall 2018
In collaboration with state and legislative leadership, the Oklahoma Health Care Authority (OHCA) has implemented 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 are being used for the increases, which went into effect on Oct.1, 2018.
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.
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 dentists, hospitals and pharmacies.
Read more.
PLEASE NOTE: The OHCA Provider Helpline is your first line of contact for questions about the rate change that may be specific to your situation. You can reach the Provider Helpline by calling 800-522-0114 for assistance.
However, general details regarding the new methodology/rate structure, exclusions and impact are available on our website - okhca.org. These can be found in the Board agenda from Sept. 13, 2018, as well as the September agenda of the OHCA State Plan Amendment Rate Committee (SPARC).
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You are invited to participate in an OHCA Regional Strategy Forum near you. This event focuses on what you, a key stakeholder, have to say.
The OHCA will host meetings around the state with providers, members, community partners and other stakeholders to learn about their experiences with our programs and get input and ideas on how OHCA can best implement the five-year Strategic Plan moving forward. Facilitated small group sessions will consider OHCA’s current and future operations based on agency goals and targeted focus areas.
Please join us for this event. OHCA Strategy Forums will be held in following Oklahoma cities: OKC (10/24/18), Woodward (10/25/18), Enid (10/26/18), Muskogee (10/29/18), Durant (11/1/18), Tulsa (11/5) and Lawton (11/9/18). To register, please click on your Forum of interest.
The Forum is open to anyone interested in attending. Registration is not required but will help us in our planning.
Hope to see you there!
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The Oklahoma Health Care Authority (OHCA) recently received notification that Insure Oklahoma, the state’s premium assistance program for businesses and employees, has been reauthorized by the federal Centers for Medicare & Medicaid Services (CMS) for another five years.
Historically, the Insure Oklahoma program has been reauthorized on a yearly basis. However, this year CMS approved the waiver to secure the program for five years, effective Aug. 31, 2018, through Dec. 31, 2023.
“We are very pleased with the decision to renew Insure Oklahoma for five more years. This successful program provides Oklahomans with an affordable option for health care coverage,” said OHCA CEO Becky Pasternik-Ikard.
As of October 1, nearly 4,600 businesses and more than 19,600 lower-income Oklahomans are enrolled in either Insure Oklahoma’s Employer-Sponsored Insurance (ESI) plan or Individual Plan. Under the ESI plan, private health premium costs are shared by Insure Oklahoma (60 percent), the employer (25 percent) and the employee (15 percent). The Individual Plan allows those who don’t have access to health insurance through their employer -- including the self-employed, temporarily unemployed and college students -- to buy health benefits directly through the state.
Insure Oklahoma is funded by the state’s tobacco tax matched with federal Medicaid funds.
For more information about Insure Oklahoma, call 888-365-3742 or visit www.insureoklahoma.org.
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Fall SoonerCare Provider Training Workshops are in progress!
Hosts OHCA and DXC invite you and your staff to join us for one of the remaining dates:
- October 10 and 11 - Tulsa
- October 17 - Guymon
- October 24 and 25 - OKC
Topics include: Provider Portal Utilization, Focus Forward Oklahoma (LARC training), Medical Authorizations Using InterQual®, SoonerCare Population Care Management Services, Submitting Authorizations in PICIS, SoonerCare School-based Services, the HPV Vaccine in Cancer Prevention, the Oklahoma Tobacco Helpline, and more.
We highly recommend that all providers attend this workshop.
Complete class descriptions and registration information are available at http://www.okhca.org/provider-training.
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Oklahoma Senate Bill (SB) 1446, an act regarding the regulation of opioid drugs, goes into effect November 1, 2018. SB1446, which will limit the initial prescription for all opioids to a seven-day supply, was signed by the Gov. Mary Fallin on May 2, 2018. The new law addresses opioid abuse by establishing prescribing limits, requiring continuing education on controlled substance prescribing, and expanding required use of the prescription monitoring program (PMP) by prescribers.
SB1446 establishes guidelines to be adopted by prescribers that limit the number of days supply and number of prescriptions for the treatment of acute pain.
Coinciding with SB1446, SoonerCare will allow a quantity of eight (8) units per day for acute opioid therapy up to a seven-day supply. Prescriptions written for opioid therapy greater than or equal to an eight-day supply will be limited to a quantity of four (4) units per day.
If you have questions regarding this change or need more information, please call the SoonerCare Pharmacy helpdesk at 800-522-0114, option 4.
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Caring for patients may begin well before they check-in to your facility. Just getting a member in to be seen can be a roadblock, but it doesn't have to be. TripCare gives providers a way to help members obtain reliable transportation to and from their office visits with a simple log-in.
Much like members use SoonerRide to schedule rides for their non-emergency health care appointments, TripCare allows providers to schedule patient transportation - and at no cost!
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Just imagine being able to increase care access and coordination with a few clicks of the mouse! That could mean fewer missed appointments and/or scheduling conflicts.
Download this 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.
Both TripCare and SoonerRide are operated by Logisticare.
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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, 2018 – Thanksgiving
December 24-25, 2018 – Christmas
January 1, 2019 – New Year’s Day
January 21, 2019 – Martin Luther King, Jr. Day
OHCA staff will be ready to address any concerns you have during normal business hours.
Thank you.
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1. I am still awaiting a decision regarding a prior authorization (PA) I submitted
for comprehensive orthodontics. Why is it taking so long?
When submitting a PA for comprehensive orthodontics, please be sure to fill out all necessary forms completely. This includes the DEN-2 (referral), DEN-6 (HLLD) and Caries Risk Assessment. Failure to do so will delay review and possible treatment.
Providers are notified via the OHCA Provider Portal Secure Site as to whether services are denied or approved. A letter is also mailed to the member’s family.
Visit our Dental Providers webpage for complete details.
2. Which fee should I provide on the dental claim form – my full fee or SoonerCare’s
allowable fee?
All SoonerCare-contracted providers should submit their full fees on billing rather than using our fees, even though we will only pay our fee schedule.
The reasoning? The American Dental Association (ADA) explains it like this: “Fees reported to the plan on claim forms are used to monitor trends and serve as the basis for the allowable amounts the payer sets for the area. This analysis will not reflect true market trends if dentists in that area aren’t submitting their full fee.”
Check out ADA Q&A: Dental Benefits to learn more.
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An annual dental evaluation and health screening event co-sponsored by the OHCA at the Riverside Indian Boarding School recently helped about 534 students get dental exams and supplies.
The OHCA was joined by the Oklahoma State Department of Health (OSDH), Indian Health Services (IHS), Absentee Shawnee Tribe, Little Axe Health Center, and Blue Cross and Blue Shield of Oklahoma (BCBSOK) to sponsor the 12th annual event. New to the list of sponsors this year was the American Heart Association (AHA).
"I am very pleased this event has grown to include nearly 10 different partners that share the common goal of improving the health status of the Riverside students,” said Dana Miller, OHCA Tribal Government Relations Director.
In this Aug. 24, 2018 photo, OHCA Tribal Government Relations Director Dana Miller gives two Riverside students toothpaste and toothbrushes provided by sponsor Colgate-Palmolive during the annual Riverside Indian School Health Fair in Anadarko, Okla.
Students received onsite dental evaluations, eye screenings, behavioral health screenings, and body mass index (BMI) measurements. They also received information discussing the effects of using tobacco on their teeth, gums and body. Students also learned how to achieve and maintain good oral health. Any follow up care needed for the students was coordinated by the Indian Health Service.
OHCA staff extends appreciation to Colgate-Palmolive who donated toothbrushes and toothpaste, Little Axe Health Center who provided dental floss, and all partners who provide education and supplies to promote healthy living.
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October is National Dental Hygiene Month. We want dental hygienists and patients to celebrate together by working to maintain healthy smiles!
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!
And, don't forget to remind parents and caretakers of children covered under SoonerCare that they have access to many important dental services. This includes full exams, teeth cleanings, fillings for cavities, fluoride treatments, dental sealants and more.
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Plus, adults can learn how to help keep their child’s teeth in top shape by downloading our handy Dental Tips sheets:
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Two OHCA Board members have recently been reappointed.
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.
In addition, Tanya Case, of Duncan, was recently appointed to a second four-year term on the OHCA Board. She was first appointed in 2014 by former Speaker of the House Jeff Hickman and most recently by Charles McCall, current Speaker of the House of Representatives.
As two of the seven OHCA board members, Bryant and Case oversee the agency that is responsible for the care and well-being of more than 1 million Oklahomans each year including children, pregnant women, individuals with disabilities and seniors. Additionally, they are responsible for the oversight of a more than $5 billion budget to accomplish the mission of the agency to responsibly purchase health care in the most efficient and comprehensive manner possible.
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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.
Case worked in health care in Oklahoma for 35 years with most of those years spent in executive leadership positions of health plans. She retired in November 2015 as the Executive Director of the Oklahoma Temporary High Risk Pool (OTHRP) which was Oklahoma’s Pre-Existing Condition Insurance Plan (PCIP) created by the Affordable Care Act in March 2010. During her tenure with OTHRP, Case served on the board of directors of the National Association of State Comprehensive Health Insurance Plans (NASCHIP), serving as Chairman from 2014-15.
Case has also served as the director of the Oklahoma Office of Rural Health, Oklahoma State Department of Health (OKC); the director of First Health West, a physician/hospital network (Lawton); the director of Prime Advantage, a HMO owned and operated by Comanche County Hospital Authority which served as a commercial and Medicaid HMO; and the executive director of Lawton Community Health Center.
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OHCA Provider Helpline: 800-522-0114
Dental Prior Authorization Unit: 405-522-7401
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