OHCA Legislative Update and Fall Provider Training Workshop Dates

Provider trainings, important pharmacy alerts, tobacco cessation resources and new OHCA board members

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Summer 2019

Legislative Update - Health Care Working Group

State budget issues continue to impact operations at the Oklahoma Health Care Authority

The 20-member Health Care Working Group includes nine members of each chamber and two members of Gov. J. Kevin Stitt's administration, Deputy Secretary of Health and Mental Health Carter Kimble and Deputy Secretary of State Samantha Davidson.

The bipartisan working group is focused on developing a solution for improving Oklahomans’ access to health care.

8/14/2019 – Representatives from the Oklahoma State Department of Health and the Oklahoma Health Care Authority gave presentations on their respective roles in overseeing and encouraging healthy outcomes for all Oklahomans. OSDH highlighted the state's historically low national rankings and health outcomes. OHCA summarized the population currently covered by SoonerCare.

8/21/2019 – The working group focused on the Department of Corrections in the second meeting as it relates to Medicaid. Officials discussed health care costs and mental health for those who are incarcerated by DOC. The University Hospitals Authority and Trust gave a presentation on medical services provided to DOC by OU Medical Center. OHCA was also present and answered multiple questions from working group members.

8/28/2019 – Hudson College of Public Health gave numerous policy recommendations, and Stigler Health & Wellness Center discussed federally qualified health centers.

9/4/2019 – Deputy Secretary of Health Carter Kimble discussed Medicaid and numbers about Oklahoma’s insured and uninsured. The group also heard from Mostly Medicaid and Government Affairs and Innovation.

9/18/2019 – Duncan Regional Hospital President and CEO Jay Johnson and OU Medicine President and CEO Chuck Spicer presented their views on the state of health care access in Oklahoma. Dr. Kayse Shrum, president and CEO of OSU Health Sciences and dean of the College of Osteopathy, spoke of her center’s mission to educate primary care physicians, especially those in rural areas.

9/25/2019 – Representatives from the Chickasaw Nation's Division of Health and the Cherokee Nation’s Health Services gave an overview of the tribal health system and how it interacts with federal and state government.

Provider Notes

Provider Services

2019 Fall Provider Training Workshop

Smiling doctor and nurses standing outside a hospital

You and your staff are invited to attend the 2019 Fall SoonerCare Provider Training Workshop hosted by OHCA and DXC Technology.

OHCA and DXC urge all providers, office managers, administrators and their staffs to attend this workshop. We will be covering important information and topics for multiple provider types.

Classes include: Adjustments and Third Party Liability; Dental Basics and Beyond; HMS: Medicaid Third Party Liability – Disallowance Overview; Lead Poisoning Prevention 101; Long Term Care Pay for Performance; SoonerCare Changes and Updates; SoonerCare Pharmacy Program Updates; SoonerQuit for Providers; Utilizing Your Provider Portal; and What’s New in Out of State Services?

Class descriptions explain the covered topics and recommended audience. Presentations will be posted one week before the scheduled workshop for providers to download and view. Classes will fill up soon, so mark your calendar and register now.

The workshop dates and locations are as follows:

Duncan – Oct. 3
Tulsa – Oct. 9 & 10
Oklahoma City – Oct. 17 & 18
Guymon – Oct. 24

» Register for the 2019 Fall Provider Training Workshop 

» Click here for Class Descriptions

PCMH Redesign Planned for October 2020 - Requesting Stakeholder Input

Based on provider suggestions collected in 2016 and 2017, OHCA is now prepared to bring a new value-based enhanced design to the providers in the Patient Centered Medical Home program (SoonerCare Choice, SoonerCare Choice ITUs and Insure Oklahoma Individual Plan). The new design will include increased care coordination payments along with performance measures that have been recommended by providers in previous workgroups. Providers will receive payments based on what they bring to the program, particularly integration with behavioral health services and social determinations and substance use disorder screening and referral. The anticipated start date is October 2020, dependent on CMS approval.

A stakeholders meeting was held on Sept. 17. Additional opportunities to learn about the new design and to provide input will be available in October. Attendance details can be found here.

Provider Contracts

Hospice, Physician Assistants and Licensed Behavioral Health Professional Contract Term and Renewal Dates

Hospice contracts expire Dec. 30. Renewals of these contracts may begin Oct. 17.

Physician assistants contracts expire Jan. 1. Renewals of these contracts may begin Nov. 17.

Licensed behavioral health professional contracts expire Feb. 28. Renewals of these contracts may begin Dec. 15.

If you have any questions, please contact Provider Enrollment at 800-522-0144, option 5.


New Boxed Warning for Insomnia Medications


The U.S. Food and Drug Administration has added its most serious warning to certain insomnia medications. The boxed warning is due to rare but serious side effects including sleepwalking, sleep driving and engaging in other activities while not fully awake, with some of these behaviors resulting in death. Risks appear to be higher for eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien, Ambien CR, Edluar, Intermezzo, Zolpimist) than other prescription medicines used for sleep. The boxed warning adds to the previous concerns noted in January 2013, May 2013, and May 2014.

The new warning includes a contraindication to avoid use in patients who have previously experienced an episode of complex sleep behavior with eszopiclone, zaleplon or zolpidem. Health professionals should advise their patients that these behaviors are rare, but serious, and have led to death. Patients should discontinue taking these medicines and notify their provider if they experience any episodes of complex sleep behavior. For additional information on healthy sleep habits, visit the National Heart, Lung, and Blood Institute for resources, including: Your Guide to Healthy Sleep and Insomnia: Relaxation techniques and sleeping habits.

Phase 4 Opioid Limits Go Into Effect


The final phase of daily opioid morphine milligram equivalent limits went into effect on Oct. 1, 2019. The gradually implemented changes address the current recommendations issued by the Centers for Disease Control and Prevention.

Beginning in Oct. 2019, a claim will process without a prior authorization if the member’s total daily MME does not meet or exceed 90. The limit applies to both short-acting and long-acting formulations. Providers can access a patient’s MME totals by consulting the Oklahoma Prescription Monitoring Program Aware system. OHCA encourages providers to access the PMP site and begin tapering (where appropriate) those members who meet or exceed the 90 MME threshold. If the member requires daily MME totals meeting or exceeding 90, the provider can submit a MME override request via form PHARM-111, available on the SoonerCare website (OHCA Pharmacy Forms). Current opioid prior authorization criteria and tier structure rules will continue to apply.

Medications provided for medication-assisted treatment are exempt from this policy. For more information regarding MAT coverage policies visit http://www.okhca.org/opg. For more information regarding the current opioid epidemic in Oklahoma, MAT and a list of available treatment centers and resources, visit https://okimready.org/. The OHCA is engaged in an effort to combat the prescription drug abuse epidemic in Oklahoma.

Pregnant and Breastfeeding Dietary Recommendations

Fish and Tomatoes

“Fish and shellfish are an important part of a well-rounded diet. However, we know many consumers worry about mercury… In fact, we have seen that women in the U.S. who are pregnant are consuming far less than the recommended amount of seafood.” This observation came from Susan Mayne, Ph.D., director of the FDA’s Center for Food Safety and Applied Nutrition. In response to the trend, the FDA updated advice regarding fish consumption for young children and women who are pregnant, breastfeeding, or may become pregnant. The purpose of the update is “to make sure Americans are equipped with this knowledge so they can reap the benefits of eating fish, while choosing types of fish that are safe for them and their families to eat," Mayne said.

The FDA guidelines recommend adults eat at least 8 ounces of seafood per week based on a 2,000 calorie diet. Women who are pregnant or breastfeeding should have 8-12 ounces of low-mercury seafood each week (see below). The FDA’s July revision highlights the nutritional value of fish and the associated health benefits such as, growth and development during pregnancy and early childhood; improved heart health and lowered risk of obesity. Young children and women who are pregnant, breastfeeding or may become pregnant should avoid fish with the highest mercury levels.

Pregnant Food Chart


Dental Provider Tips

Tips to make your life as a SoonerCare provider easier when submitting a prior authorization request (to prevent your request from being pended back to you for documentation)

  • Member name and date taken should be on all photos, images and radiographs.
  • If requesting a third year of orthodontic treatment, members must have had a cleaning within the past year. If a cleaning was provided by a dentist who is not a SoonerCare provider, please document the dentist's name and the date of service.
  • Please ensure all forms are filled out completely: HLLD (DEN-6), Referral for orthodontics (DEN-2) and Caries Risk Assessment.

Did you know? 
OHCA has a page devoted to dental services – it contains links to policy, the dental fee schedule, dental forms and other useful information.

Tobacco Cessation

Quit Now

The Easiest Path to Healthier Patients

What if there were a simple way to lessen the risk of life-threatening conditions like mouth and throat cancer, heart disease and Type 2 diabetes? It all starts with one conversation.

Start a Tobacco-Free Journey
Talk to your patients about quitting tobacco with the Oklahoma Tobacco Helpline. With 24/7 nonjudgmental support and fully customizable services, the helpline gives your patients the resources they need to quit.

Plus, when tobacco users combine medications with counseling, they’re twice as likely to quit. Whether you are prescribing NRTs or smoking cessation medications, the helpline offers additional support for your patients.

Discover Life-Changing Services
Encourage your patients to register for the helpline at 800-QUIT NOW or OKhelpline.com. In just a few minutes, they can set a quit date and create a customizable quit plan. With the help of a specially trained quit coach, they can sign up for coaching calls; helpful tips; and a two-week supply of patches, gum or lozenges.

All Oklahomans older than 13 are eligible for helpline services. Plus, additional resources are available to SoonerCare members, Native Americans and pregnant women.

Get Started
Want to jumpstart the dialogue? The helpline offers free promotional items like posters, fact sheets and brochures. Just visit OKhelpline.com.

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Developmental Screening for Primary Care Practices

Why Developmental Screening?

  • Saves time and improves care.
  • Evidence-based screenings can be reimbursed.
  • Boosts the identification rate of at-risk children resulting in earlier intervention services.
  • Parents who report receiving developmental assessments are more likely to report other anticipatory guidance (toilet training, reading, discipline) and are more satisfied with pediatric care.

How Often Do I Conduct Screenings?

  • The American Academy of Pediatrics' guidelines suggest using a validated tool at 9, 18 and 30 months or at 24 months if there is no 30-month visit.  
  • AAP guidelines.

Some Recommended AAP Screening Tools:

  • Ages and Stages Questionnaire/Social Emotional.
  • Parents’ Evaluation of Developmental Status.
  • Modified Checklist for Autism in Toddlers.
  • AAP guidelines.

Other Helpful Resources:

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Global Message

CPT Code 96110

This global message is sent to remind providers OHCA began reimbursing CPT code 96110 (developmental screening) in addition to any appropriate E&M codes billed on the same day by the same provider. In 2019, CPT codes 96112 and 96113 were added in addition to CPT code 96110. 

It is recommended pediatric primary care providers use a standardized tool to screen infants and toddlers at 9, 18, 24 or 30 months. It is also recommended an Autism-specific screening be performed at 18 or 24 months based on the AAP Bright Futures latest edition. The use of a standardized screening tool is also appropriate at other times if concerns are identified through routine surveillance or if a parent or caregiver raises concerns.

Documentation of the screening must include the screening tool used, the results of the screen, any referrals needed or made, and follow-up care or recommendations. The screening documentation must be separate from documentation related to other services performed that day and must be appropriately signed by the rendering practitioner.

Agency Updates

Gov. Kevin Stitt appointed Kevin Corbett as the new CEO of Oklahoma Health Care Authority in August. Corbett previously served as the interim CFO of Lagoon Water Solutions and was a senior partner and risk advisory practice lader with Ernst & Young.

Corbett has appointed Ellen Buettner as OHCA's new chief of staff and Shelley Zumwalt as the chief of communications and strategic engagement. Buetnner previously served as the chief of legislative affairs for the Oklahoma Office of Attorney General, and Zumwalt served as the director of Public Affairs for the Office of Management and Enterprise Service.

Corbett also appointed Melody Anthony state Medicaid director and reappointed her as chief operating officer. Anthony has more than 20 years of service in health care.

Corbett 3

           Kevin Corbett - Chief Executive Officer


           Ellen Buettner - Chief of Staff


Shelley Zumwalt - Chief of Communications and Strategic Engagement


  Melody Anthony - Chief Operating Officer and State Medicaid Director


Provider Resources

Web Alerts

Online Training


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Statistics and Data

Newsletter Archive

Checkup Statement

Information contained within is subject to change. Be sure to check OHCA Provider LettersGlobal Messages and Web Alerts at www.okhca.org for the most up-to-date information.


Appointment Reminders


October 9
Drug Utilization Review Board Meeting

October 11
Long Term Care Services Supports Advisory Committee Meeting

October 16
OHCA Board Meeting

October 26
Member Advisory Task Force

November 7
Medical Advisory Committee Meeting

November 8
Long Term Care Services Supports Advisory Committee Meeting

November 13
Drug Utilization Review Board Meeting

*All meetings take place at OHCA offices (4345 N. Lincoln Blvd., Oklahoma City), in the Ed McFall Boardroom, unless otherwise noted.

View complete OHCA calendar here