OHCA Provider Newsletter • February 2023

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SoonerCare Provider Memo

February 2023

Included in This Edition

SoonerCare Renewals Are Restarting

Due to COVID-19, Medicaid renewals were paused. However, Oklahoma and all other states are required to restart eligibility reviews for Medicaid members. Earlier this month, OHCA sent a purple letter and email to members who are no longer eligible to receive Medicaid (SoonerCare). 

Ineligible members will be disenrolled from SoonerCare over a period of nine months. Oklahoma Human Services (OHS) will disenroll ineligible members who enrolled through OHS over a period of 12 months. This will only affect members who are no longer eligible to receive SoonerCare coverage.

OHCA will consider a member's situation when determining the coverage end date. Critical health conditions, financial need and benefit use are some of the circumstances OHCA will review to decide end dates.

Please let your SoonerCare members know that it is very important to make sure OHCA has the latest mailing address, email address and phone number on file so we can reach out to them with important information about their SoonerCare benefits. Please encourage them to update or complete their information by logging in to MySoonerCare.org.

There is additional information available on the OHCA renewals page. It includes downloadable flyers that you may wish to print and hang in your clinic. The flyers are available in English and Spanish.

Spread the Love During National Heart Month


February is all about hearts and heart health, and one of the best ways your patients can keep their ticker strong is to quit tobacco. As you know, smoking is a major cause of heart disease, and it’s responsible for 25% of heart-related deaths. Once your patient quits tobacco, their heart rate will start to decrease in as little as 20 minutes. After one year of living tobacco-free, their risk of heart disease will be cut IN HALF.

Inspire Change with the Helpline

Remind your patients that the best present they can give themselves — and the people they love — is a longer, healthier and tobacco-free life! Since its inception, the Helpline has served over 490,000 Oklahomans. That’s 490,000 lives changed for the better. For more information on our services, inspiring success stories and answers to commonly asked questions, visit OKHelpline.com.

Start the Conversation with FREE Materials

The Oklahoma Health Care Authority (OHCA) and the Tobacco Settlement Endowment Trust (TSET) are partnering to connect you with free materials and resources, including Oklahoma Tobacco Helpline pens, brochures, clipboards and badge reels. That way, you can keep healthy living top-of-mind in your office or clinic and promote a healthier Oklahoma before you start the conversation.  

Get your FREE Helpline materials at tset.ok.gov/order.

Dental Fee Rate Change

CMS approved a rate change of the dental fees effective Oct. 1, 2022. Therefore OHCA has conducted claims reprocessing of dental claims for dates of service Oct. 1-Dec. 22, 2022. If claims were billed below the usual customary fee, those will need to be canceled and resubmitted. Claims billed under usual customary fees will not be affected.

When updating treatment plans for an approved prior authorization, the current authorization needs to be canceled, and a new submission will need to take place for the updated course of treatment. Please attach all customary documentation per OHCA policy, rules and guidelines.

OHCA has a page devoted to dental services that contains links to policy, the dental fee schedule, dental forms and other useful information. Learn more.

Prescribe or Deprescribe?

Pills on table

Clinical inertia” is defined as lack of treatment intensification in a patient not at evidence-based goals for care. A related term, “therapeutic inertia,” specifically addresses the role played by medication in a treatment strategy. Questions surrounding treatment intensification are faced by clinicians nearly every day. However, sometimes patients need to de-intensify treatment.

Thankfully, there is a growing body of evidence-based resources to assist providers in scaling back medications or deprescribing. By some estimates, deprescribing could help prevent nearly 7% of all hospital admissions. Classes of medications that are considered strong candidates for deprescribing include:

Deprescribing is best accomplished in a stepwise manner with a shared-decision approach. Effective communication addressing patient goals is critical to the success of any deprescribing efforts. If you have questions about deprescribing, please contact Jacki Travers, Pharm.D., by phone at 405-271-5935 or by email at jacki-travers@ouhsc.edu.

Pediatric Insomnia Updates

SoonerCare provides multiple Tier 1 options for the treatment of adult members with insomnia. Most Tier 1 medications are available for most members without prior authorization; however, age restrictions, quantity limitations or special criteria may apply. Members who do not achieve adequate clinical success with Tier 1 medication trials may qualify for a higher-tiered mediation. Prior authorization is required for all insomnia medications for members younger than 19 years of age. Prior authorization criteria for insomnia medications can be found on OHCA's website in the Central Nervous System/Behavioral Health category within the Anxiolytic/Hypnotic subcategory.

The American Academy of Sleep Medicine (AASM) created a provider fact sheet on insomnia. They highlight the importance of treating insomnia and describe ways providers can help their patients. The safety and efficacy of agents currently approved for adults with insomnia have not been established in the pediatric population.

Currently, there is no Food and Drug Administration (FDA)-approved treatment for insomnia in pediatric patients, which causes the prescribing patterns to vary from clinician to clinician. The CHEST Guidelines recommend behavioral therapy as first-line treatment, and adjunctive pharmacotherapy may be considered when tailored to a patient’s age and comorbidities. Behavioral therapy includes sleep logs to monitor sleep, good sleep hygiene and behavior modifications.

There is limited evidence showing melatonin to be effective for insomnia in pediatric patients, specifically those with autism spectrum disorder. In addition, clonidine has been used as an off-label indication for insomnia in pediatric patients with ADHD as a comorbid condition. Patients should be monitored for concerns of hypotension or rebound hypertension when initiating treatment with clonidine.

Other medications such as antidepressants, anticonvulsants and antipsychotics have been used off-label to treat insomnia based on any child’s comorbidities. The purpose of off-label use is for the benefit of the patient when a specific indication is not approved for the medication.

For the treatment of insomnia in pediatric patients, it is imperative to weigh the risks and benefits of the prescribed medications, as many medications have side effects and may not be safe for pediatric use. Since the effects of medications for insomnia in children have not been established, it is important to use the available evidence and published literature to guide the decision-making process. The insomnia section of the Oklahoma Pediatric Psychotropic Medication Resource Guide has additional information on treatment considerations for pediatric insomnia, as well as for pediatric SoonerCare members on psychotropic medications.

Diabetes and Heart Disease

As clinicians, you know that diabetes and heart disease often go hand in hand. Did you know SoonerCare offers a benefit to members having trouble controlling their diabetes? Members can get up to 10 hours a year of self-management instruction through the Diabetes Self-Management Education & Support program (DSMES). Learn more and refer your patients today.

Tobacco Cessation Microlearns

SoonerQuit microlearn graphic

Did you know OHCA’s SoonerQuit program now offers tailored microlearns on their SoonerQuit for Providers page to assist providers with technical training for tobacco cessation and other related information? Microlearns are compact e-presentations from qualified staff that provide education related to tobacco cessation counseling, payments and codes, Nicotine Replacement Therapy, the Oklahoma Tobacco Helpline, and other valuable materials! 

Microlearns are between 3 and 6 MINUTES! Just enough time to catch up on the latest learning information about the SoonerQuit program, resources, training and techniques! All the microlearns can be found on the SoonerQuit Provider page under Presentations.

February is National Cancer Prevention Month

According to the World Cancer Report, cancer was responsible for the death of 10 million people in 2020 alone. SoonerCare is dedicated to helping fight and prevent diseases like cancer with an annual low-dose CT lung cancer screening for SoonerCare members ages 50-80 who meet the criteria. If you would like information on utilizing these benefits for your patients, practice or facility, contact SoonerQuit today at SoonerQuit@okhca.org

We Need Your Feedback

Five stars

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 March.

Your feedback is invaluable, and we are committed to using it to improve your experience and help you serve SoonerCare members.

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