OHCA Provider Checkup

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Winter 2020

Legislative Update

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

The legislative session began on Feb. 3. More than 2,200 new bills were filed in January bringing the total number of bills to 4,568. The agency is tracking legislation relating to Medicaid, pharmacy, health insurance, liens, our sister agencies and state government.

Provider Notes

Maternal Depression Screening at Well-Child Visits

The American Academy of Pediatrics recommends integrating postpartum depression surveillance and screening at the 1, 2, 4 and 6 month well-child (EPSDT) visits. SoonerCare providers are encouraged to administer this important screening at these visits. SoonerCare allows reimbursement of maternal depression screenings when provided in accordance with the AAP Bright Futures periodicity recommendations. CPT code 96161 is currently reimbursed at $5. AAP recommendations for surveillance, screening tools, follow-up and more can be accessed at https://pediatrics.aappublications.org/content/143/1/e20183259

Contracts Expiring

Licensed behavioral health professional contracts expire Feb. 28. These contracts are currently available for renewal.

Ambulatory Surgical Centers contracts expire April 30. Renewals of these contracts may begin Feb. 17.

Home Health contracts expire April 30. Renewals of these contracts may begin Feb. 17.

Anesthesiologist assistant contracts expire June 30. Renewals of these contracts may begin April 16.

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, 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 hand-washing 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.

Dental checkup

New Dental Director – Karen Luce, D.D.S.

Dr. Karen Luce will join OHCA on Feb. 18 as the new dental director. She comes to us from the University of Oklahoma College of Dentistry. After obtaining her D.D.S. degree in 2001, she completed a residency in periodontics in 2005, both at the University of Texas Health Sciences Center at Houston. Before entering academics, she practiced as a periodontist in private practice for four years and with the Cherokee Nation for six years. 

Karen Luce


Medication Therapy Management

Oklahoma Health Care Authority is partnering with the University of Oklahoma College of Pharmacy and Arine, a health care technology company, to provide free medication therapy management services to SoonerCare members identified as needing these services. MTM has been shown to reduce the harmful effects of medication-related problems and medication mismanagement.

Eligible SoonerCare members will receive a comprehensive medication review via telephone, as well as targeted counseling and education on medication and disease management where and when needed.

Clinical MTM pharmacists will use an evidence-based approach to:

  • Provide medication counseling.
  • Perform medication reconciliation.
  • Optimize medications.
  • Address barriers to access.
  • Improve quality measures.
  • Identify and answer any medication-related questions or concerns the patient might have.

The pharmacists work with clinicians and members to develop individualized plans to meet joint goals of therapy. Participating SoonerCare members will be provided digital and mailed versions of their own personalized care plans and a comprehensive medication list. The pharmacists send clinicians a list of clinical recommendations for their participating patients. Clinicians then review the clinical recommendations. Any changes in therapy are initiated and implemented by the prescribing clinician.

OHCA’s goals for this program are to increase medication safety, improve the quality of patient care and reduce unnecessary costs related to medication mismanagement.

Please call 405-339-0506 if you have any questions, would like additional information or need assistance in referring SoonerCare members into the program. Clinical pharmacists are available Monday-Friday, from 9 a.m.-6 p.m.

90-Day Maintenance Medications

SoonerCare is introducing some exciting improvements in the coverage of maintenance medications. These changes follow recent additions made to the pharmacy laws in Oklahoma. Pharmacists are now legally permitted to authorize a 90-day supply for non-controlled maintenance medications.

Many maintenance medications now process through SoonerCare for a 90-day supply without an override. Dispensing 90-day supplies of maintenance medications provides multiple benefits for SoonerCare members:

  • Increased medication adherence and persistence.
  • Reduced financial burden as members will pay a fewer number of copays.
  • Decreased impact of monthly script limit.

These benefits are fully realized when members use the same pharmacy to fill all their medications. Please continue to educate members on the benefits of medication synchronization, in addition to filling 90-day supplies of their chronic maintenance medications.

A complete list of affected maintenance medications can be found at www.okhca.org/rx. Please note that not all medications in each category can be processed for a 90-day supply. Clinical criteria and tier structure rules still apply to certain maintenance medications.

Tobacco Cessation

Feb Tobacco

Talk to Your Patients About Quitting Tobacco. One Conversation Can Change a Life.

Talk About The Risks

Tobacco use causes numerous cancers and contributes to heart disease, stroke, COPD, birth complications and much more.

The Helpline at A Glance

At the helpline, your patients have FREE 24/7 access to non-judgmental support. They can speak with trained quit coaches to set a quit date and develop a personalized quit plan. Patients 18 and older have access to a minimum two-week supply of free patches, gum or lozenges. Specialized services for pregnant women are also available.

Additional Benefits for SoonerCare Members

SoonerCare members may be eligible for additional support. Members may receive counseling as well as prescription and over-the-counter medications to help quit tobacco. With a doctor’s prescription, SoonerCare members have access to not only patches, gum and lozenges, but nasal spray, inhalers, Zyban and Chantix as well.  

FREE Materials For Your Office

The helpline has resources for health care providers as well. Visit OKhelpline.com to order free promotional materials for your office. Brochures, pens, posters, cards with quitting tips and more are available.

Start The Conversation

Talk to your patients about their tobacco use and encourage them to call 1-800-QUIT NOW or visit OKhelpline.com. One conversation can make all the difference.

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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


March 18
OHCA Board Meeting


View complete OHCA calendar here