The Oklahoma Health Care Authority (OHCA) submitted the community engagement waiver amendment to the Centers for Medicare & Medicaid Services (CMS) on Dec. 7, 2018. The federal public comment period was open until Jan.18, 2019 at Medicaid.gov.

On March 5, 2018, the governor of Oklahoma signed an executive order directing OHCA to apply for waiver and state plan amendments that would allow the state to implement community engagement requirements in the state Medicaid program (SoonerCare). In addition to the executive order, HB 2932 was passed by the state legislature, in the Oklahoma 56^thSecond Legislature Session, and signed into law by Gov. Mary Fallin. HB 2932 directs OHCA to pursue modifications to Medicaid eligibility criteria so that recipients of SoonerCare coverage for certain Medicaid populations are conditional upon documentation of certain education, skills training, community engagement, or job activities.

Upon approval from CMS, the state of Oklahoma will implement community engagement requirements for certain individuals related to SoonerCare (Oklahoma Medicaid) eligibility. As a condition of eligibility for SoonerCare benefits, applicants or existing members, not otherwise exempted, aged 19-50 must provide verification of employment or community engagement in specified educational, job training or job search activities for an average of 80 hours per month. SoonerCare members who fail to meet the community engagement requirements for three months during a plan year will be disenrolled from SoonerCare until requirements are met. There is a three-month grace period before members are required to provide proof of community engagement; however, the member could also have a good cause exception.

More information about the amendment is available in this handout.

Exemptions   

Certain individuals may be exempted from the above requirements. Please visit the OHCA Policy Change Blog for details.

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Our federal oversight, the Centers for Medicare & Medicaid Services (CMS), prohibits providers from billing Medicaid members who miss scheduled appointments.

A missed appointment is not a distinct reimbursable SoonerCare (Oklahoma Medicaid) service, but a part of the provider's overall costs of doing business. The SoonerCare rate covers the cost of doing business, and providers may not impose separate charges on SoonerCare clients. Below is the Code of Federal Regulations that states that physicians who participate in Medicaid must accept Medicaid reimbursement as “payment in full."                                                       

§447.15   Acceptance of State payment as payment in full.

A State plan must provide that the Medicaid agency must limit participation in the Medicaid program to providers who accept, as payment in full, the amounts paid by the agency plus any deductible, coinsurance or copayment required by the plan to be paid by the individual. The provider may only deny services to any eligible individual on account of the individual's inability to pay the cost sharing amount imposed by the plan in accordance with §447.52(e). The previous sentence does not apply to an individual who is able to pay. An individual's inability to pay does not eliminate his or her liability for the cost sharing charge.

To learn what actions you may be allowed to take, please refer to OHCA Policies and Rules regarding SoonerCare on our website (okhca.org).

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Logisticare (SoonerRide/TripCare) 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. 

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In January 2018, OHCA published a strategic plan for 2018-2022 in accordance with Oklahoma statutes. Based on input from approximately 100 stakeholders and 100 agency employees, the plan articulated 10 primary strategies to drive OHCA’s programs and operations over the next five years. The plan is available at okhca.org/reports. To update the plan for calendar year 2019, OHCA chose to seek additional input from stakeholders outside the metropolitan areas by holding Regional Community Strategy Forums.

OHCA held public forums in Durant, Enid, Lawton, Muskogee, Oklahoma City, Tulsa and Woodward. Approximately 200 people participated including SoonerCare members, providers and community leaders.

The forums consisted of brainstorming and small-group sessions. Groups were asked to review one of the five community-oriented strategies chosen from the plan (including objectives), suggest implementation actions and performance measures, and recommend any changes.

Each group then developed one to three implementation proposals for each strategy, with particular thought to the role that their community or organization could play in the implementation.

At the end of the forum, participants were asked to comment on anything related to the strategic plan or any other health-related subject.

In general, participants’ wishes reinforced both the vision and the strategies included in the current strategic plan. Moreover, most participants identified access and education as the main concerns for the health of rural residents and proposed a number of actions to improve one or both.

OHCA appreciates the time and input given by those who attended. We will continue to provide details and updates as the plan evolves.

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The Oklahoma Mission of Mercy (OkMOM) is a two-day, free dental clinic offering treatment to patients that are either uninsured, under-insured or would normally not have access to dental care. 2019 marks the 10^th anniversary of this life-changing event, which will take place February 1 – 2 at Oklahoma Expo Hall in the OK State Fair Park (OKC). The clinic opens at 5 a.m. each day.

During OkMOM, patients receive a dental screening to identify their needs and determine a treatment plan. Each patient is then routed to the appropriate area(s) of the clinic: oral surgery, extractions, restorations, pediatrics and hygiene. 

There is no eligibility or income requirement, no identification or proof of citizenship required. Patients will be seen on a first-come, first-served basis.

Since 2010, Oklahoma Mission of Mercy has treated 14,454 patients, totaling more than $11 million in donated dental care.

To volunteer, donate or for more information, please visit OkMOM online at okmom.org. 

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Healthy nutrition does a body good – and that includes one’s teeth. Calcium-rich foods, phosphorus (found in meat, dairy, legumes and nuts) and vitamin C all contribute to healthy teeth and gums. In fact, the American Dental Association (ADA) states that, “if your nutrition is poor, the first signs often show up in your mouth.”¹

In addition to providing proper oral care and oral hygiene education, be sure to encourage patients to make smart food choices. Just sharing a few quick tips may help them to reduce the risk and pain of cavities:

• Limit sugar and empty calories.
  They offer no nutritional value but wreak havoc on teeth. Sugar is food for mouth bacteria, a main factor in developing tooth decay. This includes drinks containing sugar, such as soda, juice or even sweetened coffee. Encourage patients to keep added sugar to a minimum.
• Be careful! Some nutritious foods can harm tooth enamel, too!
  Acidic foods like tomatoes and citrus fruits (oranges, grapefruits) are healthy but can damage teeth. To enjoy them, the ADA suggests eating acidic foods as part of a meal, not by themselves.¹ Moreover, sticky, dried fruits (like raisins) let sugar linger on teeth.¹ Ask patients to select fresh fruit as a better choice.
• Watch nutritional intake.
  ChooseMyPlate.gov is a website from the Center for Nutrition Policy and Promotion, a division of the U.S. Department of Agriculture. The website offers nutrition and calorie guidelines for a healthy, balanced diet. The Academy of Nutrition and Dietetics (eatright.org) as well as the Centers for Disease Control and Prevention (CDC) also have information to help people eat and live healthier. Let your patients know about these important resources.
• Drink fluoridated water.
  Water is essential to good health. It keeps the body hydrated and it can help the body absorb more nutrients.² Water also helps to loosen and wash away food particles from teeth, but fluoridated water has the extra benefit of preventing tooth decay. What a wonder!

For patients who really struggle with nutrition and their weight, adults and children covered under SoonerCare may qualify for up to six (6) hours of nutritional counseling per year by a licensed registered dietitian. Ask them to contact their doctor for referral.

March is National Nutrition Month! Help make the most of it!

#NationalNutritionMonth

Sources:

1. American Dental Association. Nutrition: What You Eat Affects Your Teeth. (n.d.). Accessed January 23, 2019, from https://www.mouthhealthy.org/en/nutrition/food-tips
2. Eddis, Y. (n.d.). Nutrition Tips: How to Eat Healthy. Accessed January 23, 2019, from https://www.colgate.com/en-us/oral-health/basics/nutrition-and-oral-health/nutrition-tips-how-to-eat-healthy-0314

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