OHCA Provider Newsletter • September 2023

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SoonerCare Provider Memo

September 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 4 months.

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.

Upcoming Provider Events

OHCA is hosting town hall meetings throughout the state to answer provider and stakeholder questions about SoonerSelect. To learn more about SoonerSelect, visit OHCA's SoonerSelect page. You can also view previous town halls.

  • Tulsa Town Hall
    Friday, Sept. 22, 2023 • 10 a.m. 
    Register to attend
  • Duncan Town Hall
    Wednesday, Oct. 18, 2023 • Time TBA
    Watch the town hall page for details and registration information

The Provider Training page on OHCA's website offers a list of upcoming webinars, as well as replays of past webinars, how-to videos and other resources. Upcoming events include:

  • Tobacco-Free Environmental Policy Webinar 
    Tuesday, Sept. 26, 2023 • 2-3:30 p.m.
    Register to attend
  • SoonerRide Webinar
    Tuesday, Oct. 3, 2023 • 10-11:30 a.m.
    Register to attend
  • Long-Acting Reversible Contraceptive Training 
    Saturday, Oct. 14, 2023 • Oklahoma City
    Saturday, Dec. 9, 2023 • Tahlequah
    Saturday, March 9, 2024 • Oklahoma City
    Saturday, April 13, 2024 • Tulsa
    Learn more

The Momentum Conference

Momentum Conference graphic

The Oklahoma Department of Mental Health and Substance Abuse Services is combining two of its most popular conferences — Justice & Recovery and Prevention & Recovery — into one can't-miss event: Momentum: Prevention, Justice, Recovery from Dec. 5-7, 2023.

Held at Embassy Suites in Norman, this three-day conference is dedicated to mental health, prevention, recovery and criminal justice behavioral health. Engage with leaders, gain practical tools and learn leading strategies in over 40 sessions. Help build the Continuum of Care, reduce suicide rates and substance abuse and address childhood obesity at the largest conference of its kind in Oklahoma.

Visit the Momentum web page to view the agenda, registration and fee information.

Physician Visit Requirement Removed for Naloxone

OHCA is pleased to announce that SoonerCare now covers various naloxone products for members with no physician visit necessary. A standing order is now in place authorizing pharmacists at contracting pharmacies to initiate a prescription, dispense and be reimbursed for naloxone for SoonerCare.

A pharmacist utilizing this standing order must:

  • Dispense naloxone in one of the formulations listed on the order and provide appropriate supplies for administration.
  • Maintain a copy of the standing order at the pharmacy.
  • Designate the prescriber as the designated physician pursuant to the standing order.
  • Comply with all Oklahoma State Board of Pharmacy requirements for prescription orders, labeling, recordkeeping and counseling.
  • Provide additional resources on drug overdose and naloxone use to the patient. See standing order for resource examples.

Read the press release or view the flyer for more information. If you have any questions regarding this change, please call the OHCA provider helpline at 800-522-0114.

Important Conversations to Impart

Photo of young girl smoking an e-cigarette

Your expertise is crucial role in guiding your patients toward healthier life choices. That's why we want to underscore the importance of encouraging patients to cease smoking combustible cigarettes and refrain from using e-cigarettes as a cessation tool.

To date, no e-cigarettes have been approved as safe or effective cessation products by the FDA. It’s vital to ask your patients about tobacco and e-cigarette use and encourage them to quit by referring them to the Oklahoma Tobacco Helpline.

SoonerCare provides coverage for cessation medications for your patients and will reimburse you for tobacco cessation counseling. Prescribing approved NRT, combined with a Helpline referral, significantly enhances your patients’ odds of successfully quitting for good.

The Oklahoma Tobacco Helpline also offers free promotional materials for your office, including pens, posters and downloadable materials. Together, let’s make Oklahomans healthier! 

Diabetes Coverage

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

Providers seeking to provide diabetes self-management education and support (DSMES) services must meet qualifications and must complete the DSMES-specific enrollment process, including:

  • Enroll the specific DSMES program as a diabetes self-management group, then,
  • Enroll each specific provider as a diabetic educator, connecting them to the DSMES program.

DSMES providers must complete the DSMES-specific process even if they are already an enrolled SoonerCare provider. For additional provider enrollment questions, call 800-522-0114, then choose option 5. Or email your questions to ProviderEnrollment@okhca.org.

In addition to diabetes education, SoonerCare also covers continuous glucose monitors for qualifying members at the pharmacy point of sale. Some members may require prior authorization. SoonerCare also covers 90-day fills of many diabetes maintenance medications. Given the recent increase in off-label 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.

Call the SoonerCare Pharmacy Help Desk at 405-522-6205, option 4, or 800-522-0114, option 4, if you have questions about a particular medication’s coverage or other pharmacy benefit questions.

Occupational, Physical and Speech Therapy FAQs

Photo of man in physical therapy

Are therapy units timed?

Speech therapy units are untimed, but most occupational and physical therapy units are timed in 15-minute increments. To prevent processing errors, ensure units are calculated correctly. For example: 1 occupational therapy visit of 45 minutes would be 1x3 units = 3 requested units, with each unit equaling 15 minutes. The requested number of visits should equal the requested number of units. 

When do I need a new provider Rx?
For occupational therapy, physical therapy and speech therapy, the provider Rx is valid for one year from the signature date. For speech evaluations, the Rx is valid for 90 days. The evaluation must be completed within that 90-day period. If additional time is needed, at the end of 90 days, a new Rx script must be submitted.

My prior authorization (PA) is almost expired. Can I submit another one before it expires?  
The new PA must begin on the day after the old PA expires. PA durations cannot overlap with another open PA. To ensure faster processing times, please do not submit multiple PAs for the same member. If you have questions about a specific PA, you can check the status in the provider portal.  

For more information, refer to therapy-specific guidance sheets and the provider handbook.  

Oklahoma ABLE Tech Device Reutilization Program

Oklahoma ABLE Tech, OHCA's partner for the Durable Medical Equipment Reuse Program, assists in collecting durable medical equipment (DME) that is no longer used. ABLE Tech hosts a website to easily access this service and it will help you learn about all aspects of the program services including:

  • How to donate DME to the program
  • How to apply to receive DME
  • How to list DME on the exchange site
  • Various grant collaborations that help ABLE Tech fund DME
  • How to receive replacement DME in the event of a disaster

ABLE Tech has recently updated its website to make it easier for users to navigate the program. Take a look, and feel free to share any feedback with abt.marketing@okstate.edu.

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