OHCA Provider Checkup

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Fall 2019, Vol. 2

Legislative Update

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

October and November were filled with several interim studies ranging from medicated assisted treatment, mental health coverage and rural health care. OHCA presented a study on children with Type 1 diabetes and a study on Pediatric Acute-onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections, also known as PANS and PANDAS, medical coverage.

Several rules are going through the permanent rule-making process and can be found on OHCA's policy blog webpage.

Provider Notes

Provider Services

A Look at Lead Poisoning Prevention

There is no safe level of lead, and children younger than age 6 are most vulnerable to lead poisoning. Children are at risk for lead poisoning from exposure to lead-based paint in older homes, imported toys, makeup, jewelry, lead glaze on pottery, and dishware and many other common items.

The Centers for Medicaid and CHIP Services requires all children enrolled in Medicaid undergo blood lead testing at 12 months of age and again at 24 months. In addition, any child who has failed to do so at their 12 and 24-month early and periodic screening, diagnostic and treatment visits must have at least one blood lead test prior to reaching age 6.  

A confirmatory venous blood lead test is necessary to confirm any elevated finger stick (capillary) blood lead result. For children with elevated blood lead levels, it is important to ask questions of the parents regarding the child’s environment and other potential sources of lead exposure. Remember to screen other children living in the same household if one child has a confirmed elevated blood lead test. 

Anticipatory guidance for parents:

  • Encourage parents to model good handwashing techniques for their children, to help them avoid ingesting lead dust and to prevent other illnesses.  
  • Parents who live in homes built prior to 1978 should practice good housekeeping and clean using wet methods such as damp towels and wet mops. This helps not to stir up lead dust. 
  • Only certified professionals should attempt to remove lead-based paint. Incorrect removal of lead-based paint can spread lead dust and other hazards throughout the entire home. 
  • According to the Centers for Disease Control and Prevention, parents should ensure children eat nutritious meals rich in iron, calcium and vitamin C. Doing so can decrease lead absorption.

Prevention is key when it comes to lead poisoning. If you would like additional information, please contact the Oklahoma Childhood Lead Poisoning Prevention Program at the Oklahoma State Department of Health: 405-271-6617. 

Remember, if you are using a point-of-care lead testing device (such as Lead Care II), you are required to report ALL testing results to OCLPPP.

Continuous Glucose Monitoring Systems

OHCA is pleased to announce continuous glucose monitoring systems will be available through pharmacies effective Jan. 1, 2020. Please see our continuous glucose monitoring provider letter sent Nov. 18 for more information.


Burden and Prevention of Influenza and Pertussis among Pregnant Women and Infants

Recommended vaccines for pregnant women:

  • The Centers for Disease Control and Prevention recommends all women receive an influenza vaccine at any point of pregnancy during flu season.
  • CDC recommends all women receive a Tdap vaccine during the 27th through 36th week of each pregnancy, preferably during the earlier part of this time period.

Tips for improving vaccination rates:

  • Use presumptive language to state which vaccines the patient needs to receive.
  • Talk about the child's vaccinations during the prenatal visit to prepare the patient for after the child is born.
  • Having a reminder system can help improve vaccination rates.

Safety of vaccines:

Effectiveness of vaccines:

  • 40% less risk for influenza-associated hospitalization in pregnant women.
  • 72% less risk for influenza-associated hospitalization in infants younger than 6 months old.
  • 78% less cases of whooping cough in infants younger than 2 months old.
  • 91% less cases of whooping cough-associated hospitalization in infants younger than 2 months old.

Tobacco Cessation

December Tobacco

The Greatest Holiday Gift for Your Patients? Free Support to Quit Tobacco.

The holidays are a time of cherished traditions: grandma’s casserole, family reunions and chestnuts roasting. For many however, the holidays can also be a stressful time. Holiday stress is a major stumbling block for patients who are quitting tobacco, but you can help by referring them to the Oklahoma Tobacco Helpline.

Talk to your patients about their tobacco use and encourage them to call 1-800-QUIT NOW or visit OKhelpline.com. With an online community and nonjudgmental quit coaches, they will find support through the holiday season and beyond. Plus, this help comes with a great stocking stuffer — a two-week supply of free patches, gum or lozenges. SoonerCare members even qualify for additional benefits.

To show some tobacco-free holiday spirit in your office, be sure to check out our free promotional materials for health care providers. Posters, fact sheets, brochures and more are available at OKhelpline.com and are delivered straight to you.

With your care, support and encouragement, your patients can stay tobacco free for the holidays — and all the days to come.

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Topical Corticosteroids

Topical corticosteroids, also known as TCS, are used to treat a wide variety of skin diseases and conditions. They are generally well-tolerated and are available in a variety of formulations such as cream, gel, spray, ointment, shampoo, suspension, lotion, solution and foam.

SoonerCare provides coverage for multiple TCS agents and a variety of formulations within each potency class. Many agents are available without prior authorization. Providers recently received notice of changes in coverage of these medications. Effective Nov. 12, several medications were moved to new tier categories.

  • Temovate (clobetasol propionate 0.05% ointment) moved from Tier-3 to Tier-1. Prior authorization is no longer required.
  • Diprosone (betamethasone dipropionate 0.05% ointment) and Trianex (triamcinolone acetonide 0.05% ointment) moved from Tier-1 to Tier-2.
  • Apexicon (diflorasone diacetate 0.05% cream and ointment) and Apexicon E (diflorasone diacetate/emollient 0.05% cream) moved from Tier-2 to Tier-3.

Current users of these medications were not grandfathered. All members receiving these medications will require a manual prior authorization submitted by their prescriber. Specific prior authorization criteria and tier charts for TCS medications can be downloaded by visiting www.okhca.org/pa and clicking topical under therapeutic categories.


Electronic Health Record Incentive Program

2019 electronic health record attestations are now being accepted for first-year meaningful users.

Providers beyond their first year of meaningful use can start submitting attestations on Jan. 1, 2020.

All 2019 attestations must be submitted by March 31, 2020.

Hospitals are no longer able to participate in the Medicaid Promoting Interoperability (EHR Incentive) Program.

Please note: For program year 2019, eligible professionals will attest to a 90-day reporting period for meaningful use but are required to report on a full year for clinical quality measures. The only exception is for eligible professionals in their first year of meaningful use.

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 www.okhca.org/ehr.

Global Message

Agency Updates

OHCA CEO Kevin Corbett named Trae Rahill chief of strategic innovation. Rahill most recently was a director of operations at Mercy and has worked in clinic operations for six years.

At OHCA, he will focus on finding innovative solutions to improve health outcomes and ensure good stewardship of taxpayer funds. Working with the experienced and talented OHCA team, Rahill will be at the center of the agency’s efforts to make models of its programs and practices for other organizations seeking to keep up with the ever-changing world of health care.


Trae Rahill - Chief of Strategic Innovation


Provider Resources

Web Alerts

Online Training


Order Publications

Statistics and Data

Newsletter Archive

Checkup Statement

Information contained within this newsletter 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


Dec. 18
OHCA Board Meeting

Dec. 24-25
OHCA Closed

Jan. 1
OHCA Closed

Jan. 20
OHCA Closed

*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