|
December 2022
OHCA’s mission statement expresses the importance of optimizing accessibility and quality of health care and improving health outcomes for Oklahomans. However, OHCA has noted significant access challenges since implementing the adult dental benefit.
In an effort to build and strengthen the SoonerCare network of dental providers, OHCA has increased reimbursement rates for dentists:
- 5% rate increase for pediatric dentists
- 14% rate increase for adult dentists
It is hoped that these revised rates will attract more dentists to serve both adults and children. A robust SoonerCare provider network is essential to aiding access to care as well as improving overall oral health outcomes.
Learn more about OHCA's services for dental providers.
OHCA is expanding coverage for SoonerCare members receiving pregnancy and postpartum services. Two major policy changes will help ensure that more women have access to better, longer health care.
The first change is to increase Oklahoma’s income threshold for full-scope pregnancy-related benefits from 138% to 205% of the federal poverty level (FPL).
Secondly, OHCA will be providing eligible, new mothers with up to 12 months of continuous postpartum coverage. SoonerCare currently provides full-scope pregnancy benefits, including 60 days of postpartum coverage for women with incomes up to 138% of the FPL.
Both of these policy changes go into effect on Jan. 1, 2023.
Effective Oct. 1, 2022, Expansion Adults residing in long-term care (LTC) facilities — including nursing facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) — may receive hospice services.
NF and ICF/IID room and board per diem rates are reimbursed to the in-home hospice provider at a rate equal to 95% of the facility’s per diem rate. Hospice providers are responsible for passing the room and board payment through to the NF or ICF/IID. If Medicare is the primary payer of hospice benefits, OHCA will only reimburse the hospice provider for coinsurance and deductible amounts and will continue to pay the room and board to the nursing facility.
For more information, please contact the LTC Financial Management Unit at 405-522-7306.
OHCA is asking rendering providers to complete a survey about their experience with SoonerCare. Be on the lookout for a postcard in your mailbox in early January.
Your feedback is invaluable, and we are committed to using it to improve your experience and help you serve SoonerCare members.
|
SoonerCare provider contracts will include language recommending a tobacco-free environment. Implementing a tobacco-free environment is beneficial to employees, patients, and visitors as it supports the creation of a safe and healthy workplace, helps protect against second and third-hand smoke exposure, and encourages people to quit. Generating awareness of this change through signage, decals and other means of communication is highly encouraged.
To support providers, a self-guided web-based tool with customizable options allows a clinic to update or develop a new policy at their convenience. Providers interested in this initiative will receive assistance with implementing a tobacco-free workplace policy, education and awareness materials, and training related to tobacco cessation best practices.
For assistance with developing or updating a tobacco-free environment policy or obtaining signage, email SoonerQuit.
OHCA has updated our Patient Dismissal Process for our Patient-Centered Medical Homes. It includes new dismissal guidelines for inactive members, which are members that have not been seen by the provider in at least 24 months. The updated process can be found on our PCMH webpage under the PCP Tools and Resources section. Dismissal requests continue to be electronic and done on the secure provider portal.
Your SoonerCare patients are eligible to receive up to 10 hours of free education and support from a diabetes expert. The instruction provides your patients with the knowledge, skill and ability necessary for diabetes self-care.
This training must be prescribed by a physician or qualified non-physician provider who is actively managing the member’s diabetes. Areas of focus include:
- Lowering A1C level
- Avoiding unwanted complications
- Preparing fast and easy healthy meals
- Having fun moving more
- Learning better ways to monitor blood sugar
To learn more about this benefit, visit the OHCA webpage or view the flyer.
Routine prenatal care is essential to the health and wellbeing of both the mother and baby. The American Academy of Family Physicians emphasizes the importance of correct dating of the pregnancy to allow for appropriate treatment of preterm labor and to prevent unnecessary inductions. Providers should ensure their pregnant patients are up-to-date on all immunizations and that they receive all recommended tests during pregnancy.
Nutritional counseling is another essential element of prenatal care. In addition to eating a healthy diet, pregnant women should take a prenatal vitamin (PNV) to help support the growth and development of their baby. A daily PNV with at least 400 mcg of folic acid is recommended before conception and during pregnancy to reduce the risk of neural tube defects such as anencephaly and spina bifida. PNVs are important during the postpartum period as well. Another important PNV component is docosahexaenoic acid (DHA), an omega-3 fatty acid which is one of the building blocks of fetal brain and retinal tissue. It is recommended that pregnant women consume at least 225 mg of DHA per day. This can be achieved by consuming 1-2 servings of seafood per week. PNVs contain other vitamins and minerals, in addition to folic acid and DHA. It is important to ask your patients about their PNV usage to ensure they are getting the most appropriate vitamins and minerals. Please encourage your pregnant patients to continue daily use of PNVs throughout their pregnancy and in the postpartum period.
SoonerCare covers PNVs at no cost to women of childbearing age, and PNVs do not count against the member’s monthly prescription limit. Most PNVs are available through SoonerCare without prior authorization. SoonerCare provides coverage for nutritional counseling for pregnant members and other members as well.
For more information, please visit SoonerCare Pregnancy Services. If you have questions about PNV coverage or preferred PNVs, please call the Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.
At the beginning of the COVID-19 pandemic, the federal government declared a public health emergency (PHE). During the PHE, we are required to continue SoonerCare coverage for all members even though there are some members who no longer qualify for benefits.
Example of reasons why a member may no longer qualify for benefits:
- Your salary is now higher than the required amount to receive SoonerCare benefits
- Someone has moved in or out of your household
- Your contact information and/or documents are not updated at MySoonerCare.org
There will come a time when the PHE will end. Once we know the day, we will send notifications to those people who no longer will receive SoonerCare benefits. Those members determined to be ineligible for benefits will be removed from SoonerCare in phases focusing on the member’s benefit utilization and critical health issues.
Members should take time to think about their health care needs and plan in case their SoonerCare coverage ends. Please go to MySoonerCare.org to learn more.
Have you heard a member story that is too good not to share? We would love to spread the word with our members and other stakeholders as well! Send all the details to the OHCA team at strategiccommunications@okhca.org. This story may be shared on social media, in emails and other communications.
|
