OHCA Provider Newsletter • July 2023

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SoonerCare Provider Memo

July 2023

Included in This Edition

Confirm Your Patient's Eligibility

SoonerCare eligibility reviews are ongoing. Those members who are no longer eligible are having their coverage ended in phases over the next 6 months. If any of your patients are among the ineligible, their SoonerCare coverage will be ending or may have already ended.

It is important that you continue to check eligibility for your patients. 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.

Delivery System Reform Town Halls

OHCA will host town hall meetings throughout the state to answer provider and stakeholder questions about our new delivery reform program, SoonerSelect. Upcoming locations and dates include:

Poteau: Monday, Aug. 7, 2023 • 11 a.m. 
Enid: Monday, Aug. 21, 2023 • 11 a.m. 
Tulsa: Date to be announced
Oklahoma City: Date to be announced

The SoonerSelect Town Hall page will be updated with dates and registration information as it becomes available.

To learn more about SoonerSelect — who the contracted entities are, when the plans begin and what populations are affected — visit OHCA's SoonerSelect page. Also, be sure and browse the Provider FAQ page and download the guide.

Doula Services are Now Covered

Photo of pregnant woman

Beginning July 1, all SoonerCare members who are pregnant or within the postpartum period are now eligible for up to eight doula visits per pregnancy. Doula services must be recommended by a physician or other licensed practitioner of the healing arts who is operating within the scope of their practice under state law.

The following providers may recommend doula services:

  • Obstetricians
  • Certified nurse midwives
  • Physicians
  • Physician assistants
  • Certified nurse practitioners

Learn more or visit the OHCA page about covered doula services.

Pediatric Antipsychotic Medication Use

For the past 3 years, antipsychotics have been the largest class of prescribed medications for members covered by SoonerCare. Especially for children and adolescents, these medications can present significant potential for harm as well as possible benefit. Providers are encouraged to follow best practice recommendations when prescribing these medications, especially for children in the foster care system, where these medications are often used and misused disproportionately. Best practice guidance includes limiting antipsychotic use to the context of psychotic disorders rather than using them for behavioral problems.

If you are concerned that your prescribing is currently not in keeping with best practice recommendations, please consider using the following resources:

  • Peer-to-peer consultation with an OHCA child psychiatrist — call 405-522-7597 to schedule a consultation
  • Project ECHO (Extension for Community Health Care Outcomes) for pediatric behavioral and emotional health
  • Oklahoma Child and Adolescent Psychiatry and Mental Health Access Program (OKCAPMAP)

For SoonerCare medication-related questions, including antipsychotic medications, contact the Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.

Your Provider Role in Tobacco Cessation

Photo of doctor talking to patient

The Transtheoretical Model of Change is an innovative approach for patient health behavior modification. It recognizes the progressive journey that patients navigate when attempting to adopt healthier habits, typically over several years, split into five stages:

  • Pre-Contemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance

In the earlier stages, patients may show no immediate intentions to change or might express apprehension to change. As they progress to the Preparation state, they begin to demonstrate intent and small behavioral adjustments. This leads to the Action stage where noticeable behavior modifications occur. 

Visit the SoonerQuit page to read more about the Transtheoretical Model of Change (found under Program Forms) and for additional ways to help patients in their tobacco cessation journey.

The Dangers of Diabetes and Smoking

We know that patients who have diabetes and smoke are more likely to have complications that are worse than people who have diabetes but don’t smoke. SoonerCare offers two benefits to assist members with these challenges (tobacco cessation medications and diabetes self-management education and support services). Check out the SoonerQuit for Providers page and the Diabetes page to learn more and refer your patients today.

Help Clear the Oklahoma ABLE Tech Waitlist

Oklahoma ABLE Tech helps people with disabilities and aging individuals acquire needed durable medical equipment (DME) and assistive technology (AT) to live more independently. One of the ways this is done is through the Device Reutilization Program. This program is 100% operated through community donations. Without community donations, ABLE Tech does not have a robust inventory and waitlists continue to grow.

Currently, 355 devices are needed to clear the DME waitlist. If acquired, they would change the lives of more than 300 Oklahomans. With just $10,000, the waitlist can be cleared entirely.

To schedule a pick-up or drop-off for your new or gently used DME, call 405-967-6010 or email atreuse@okstate.edu. For details about how to make a monetary donation, contact Program Manager Shelley Gladden at 405-744-9863 or shelley.gladden@okstate.edu.

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