OHCA Provider Newsletter • April 2023

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SoonerCare Provider Memo

April 2023

PLEASE NOTE: Beginning in May, OHCA will be issuing the Provider Memo on a monthly basis to ensure we continue meeting your needs with timely content and updates. 

Included in This Edition

Be Sure to Check Your Patients' Eligibility

SoonerCare has restarted eligibility reviews for all SoonerCare members. Those members who are no longer eligible will have their eligibility ended in phases over the next 9 months. If any of your patients are among the first group of ineligible members, their last day of SoonerCare coverage will be April 30.

It is crucial that you check your patients' eligibility. Watch this helpful video to learn more.

Eligibility must be verified on the service date before services are rendered. When checking eligibility on the provider portal, a single service date must be used; date span searches will not provide accurate information. If further education is needed or questions arise, please call the Provider Helpline at 800-522-0114 or email us at SoonerCareEducation@okhca.org.

Traylor Rains to Serve on National Medicaid Board

Photo of Traylor Rains

The National Association of Medicaid Directors (NAMD) elected Oklahoma State Medicaid Director Traylor Rains to serve as a south region representative on its Board of Directors. 

“I am honored to represent Oklahoma and 11 other southern states on the NAMD board,” said Rains. “This is an exciting opportunity to highlight the innovation happening in Oklahoma’s Medicaid program at the national level as well as help shape federal Medicaid policies.” 

Read the news release. 

HIPAA Telehealth Compliancy Post-PHE

When the public health emergency (PHE) ends on May 11, 2023, the stay of enforcement for using HIPAA-compliant platforms and devices for telehealth will lift. Providers using non-HIPAA-secure platforms must transition to a platform for health care use. 

In June 2022, the Office of Civil Rights issued FAQs on audio-only telehealth to provide additional clarification, including how you can continue to use audio-only modalities after the PHE. HIPAA-covered entities can use remote communication technologies to provide telehealth services, including audio-only services, in compliance with the HIPAA Privacy Rule. Learn more. [LINK TO WEBSITE PAGE TO COME]

Are You Taking Advantage of the Nutrition Benefit?

Photo of fresh cherries

You know that obesity often leads to other chronic diseases. But did you know that SoonerCare offers a medical nutrition therapy benefit? It's available to members in need of counseling. It will help your patients achieve a healthier weight while better learning to manage chronic diseases with the help of a registered dietitian. Learn more about the nutritional services benefit and refer your patients today.

We Need Your Feedback

OHCA is asking rendering providers to complete a survey about their experience with SoonerCare. You should have received a postcard with the link to the survey — we ask that you please complete it by April 28. Rendering providers can also use this link to complete the survey. Your feedback is invaluable, and we are committed to using it to improve your experience and help you serve SoonerCare members.

Enroll Now to Render DSMES Services

More than 75% of SoonerCare members aren't aware that diabetes education is a covered benefit. SoonerCare members may receive 10 hours of training during the first year. Members are eligible for two hours of individual or group instruction each subsequent calendar year.

If you are a certified diabetes educator, pharmacist, registered dietitian or registered nurse with training in diabetes self-management and affiliated with an accredited Diabetes Self-Management Education and Support (DSMES) program, you may qualify to render these services. A new contract is necessary. Our members need your expertise, so start the two-step enrollment process today! Email providerenrollment@okhca.org with your questions.

In addition to diabetes education, SoonerCare covers continuous glucose monitors for qualifying members at the pharmacy point-of sale with a prior authorization and covers 90-day fills of many diabetes maintenance medications. Given the recent increase in use of diabetes (and similar) medications for weight loss, it is important to remember that medications for weight loss are currently not covered by SoonerCare.

Tobacco Helpline Benefits for Moms and Moms-to-Be

Photo of a pregnant woman

Pregnancy can be one of the most exciting times in a woman’s life, but also one of the most stressful. The Oklahoma Tobacco Helpline offers benefits and support for expecting and new mothers looking to quit tobacco. 

It can come in many forms, such as coaching and a caring online community — perfect for mothers needing extra encouragement. The Helpline’s nicotine replacement therapy (NRT) — patches, gum or lozenges — is suitable for moms-to-be and protects the baby’s health. 

It is never too late to quit tobacco. Encourage your patients who are pregnant, hoping to become pregnant or navigating life with a newborn to reach out to the Oklahoma Tobacco Helpline

Aspirin for the Prevention of Preeclampsia

SoonerCare recently began including over-the-counter (OTC) 81 mg aspirin as a covered pharmacy benefit without a prior authorization (PA) when used exclusively for pregnant members at risk for preeclampsia. The U.S. Preventive Services Task Force (USPSTF) recommends the use of low-dose aspirin (81 mg/day) after 12 weeks of gestation in patients who are at high risk for preeclampsia (grade B recommendation). Coverage of 81 mg aspirin requires a prescription and counts toward the member’s monthly prescription limit. Prescriptions may be filled for up to a quantity of 100 tablets for a 100-day supply and may be written as “low-dose aspirin” or “aspirin 81 mg” Information regarding coverage of OTC low-dose aspirin, including a list of covered NDCs, can be found by visiting the OHCA Pharmacy webpage and clicking on Covered Over-the-Counter and then Aspirin.

We'll Help You Create a Tobacco-Free Environment

Photo of doctor talking to patient with little boy

A tobacco-free environment is the safest when receiving patients, vendors and visitors. Create a tobacco-free environment policy in minutes with the customizable template available to all providers and offices from SoonerCare. A member of the SoonerQuit team can help you get a policy in place within minutes and, in certain cases, they can provide your office with free signage for inside and outside of your facility. Find out more at the SoonerQuit for Providers webpage.  

Hepatitis C Virus (HCV) Treatment Coverage

MAVYRET® (glecaprevir/pibrentasvir) is SoonerCare’s only preferred direct-acting antiviral (DAA) medication for the treatment of HCV. It is available without prior authorization (PA) as part of an initiative by OHCA to cure HCV in the SoonerCare population.

For other DAAs, the PA criteria are still in effect and PA forms are still required. Additionally, PA requests for other DAAs require a patient-specific, clinically significant reason the member cannot use MAVYRET. The specific PA requirements are on the OHCA website in the Hepatic Disorders therapeutic category. Initial PA requests for all other DAAs besides MAVYRET must be submitted using all 3 PA forms:

  1. The medication-specific PA form (e.g., HARVONI®, Pharm-33)
  2. Hepatitis C Therapy Intent to Treat Contract form (Pharm-28)
  3. Hepatitis C Therapy Pharmacy Agreement form (Pharm-29)

Continuation requests for each refill must be submitted using the Hepatitis C Therapy Continuation form (Pharm-30). Find the PA forms are located on the OHCA website.

Please follow current guidelines and MAVYRET prescribing information when initiating testing for HCV, selecting an appropriate treatment regimen, and performing all necessary monitoring. Before starting therapy for HCV, prescribers are encouraged to verify that the member's SoonerCare eligibility is in effect long enough to complete treatment. All patients should be monitored and counseled regarding the importance of compliance and finishing treatment.

Transportation Service Through Living Choice

SendaRide is a non-emergency medical transportation service. It is offered through Oklahoma's Living Choice program, which is an initiative designed to help qualified Oklahomans transition from nursing homes back into the community. SendaRide is invaluable for these members as it ensures they have door-to-door transportation for doctor's appointments. The service also supports individuals with mobility assistance needs. 

Coming in May: Medical Equipment Drive

ABLE illustration

Oklahoma ABLE Tech proudly partners with OHCA to provide the Device Reutilization Program. Thanks to this partnership, thousands of Oklahomans have received needed durable medical equipment (DME) at no cost.

donation drive will be from 9 a.m.-2 p.m., May 19, at the Southeast Expo Center in McAlester. Oklahoma ABLE Tech will accept gently used, durable medical equipment that’s ready for a new home, and they will retrieve, refurbish, repair and reassign equipment to Oklahomans in need. The Kiamichi Economic Development District of Oklahoma (KEDDO) Area Agency on Aging sponsors the event. For more ways to donate, visit ABLE Tech's Device Reutilization donate webpage.

Help Shape the Future for Older Oklahomans

Oklahoma is developing a Multisector Plan on Aging to help support the needs of aging Oklahomans today and into the future. By 2030, the population of older Oklahomans is projected to increase by 21.3% and, for the first time in the known history of our state, seniors are expected to outnumber children.

To better shape the future landscape for older Oklahomans, Oklahoma Human Services is hosting listening sessions to welcome feedback on the current issues facing our aging population, especially those ages 65 and older. We value your opinion as a provider and invite you to join one of the sessions and share your experience and input. 

Complete Dentures Allowance

OHCA policy regarding removable prosthetics, including full and partial dentures, allows SoonerCare members one appliance per arch every five years for adults under 25; and one appliance per arch every seven years for adults 25 years and over. Immediate dentures are allowed one per arch per lifetime. A complete denture will not be allowed within five or seven years — depending on the member's age — of receiving any other full or partial denture appliance, including an immediate denture. Learn more at OHCA's Dental Services webpage.

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