September 2026
Starting on Jan. 1, 2027, a new federal law (H.R. 1, the One Big Beautiful Bill Act) requires some SoonerCare members ages 19-64 to work, go to school or help in their community. This will ensure those members keep their SoonerCare health coverage. Members can review the Work Requirements Screener to see if they may be impacted.
Please advise your patients to make sure their information is up to date in the MySoonerCare.org member portal. Tell them to be on the lookout for mail from SoonerCare or the Oklahoma Health Care Authority. Members will get a yellow letter if they are impacted.
Order a Free Poster!
A poster advising members of next steps is now available to order for your office or clinic. Visit the OHCA publications page to order your free copies in English and Spanish.
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H.R. 1 has also changed the rules for who can receive federally funded SoonerCare. Starting Oct. 1, 2026, some noncitizen members who are currently eligible for full SoonerCare benefits may no longer qualify under the new federal law.
Members should ensure their citizenship status is updated and correct in the MySoonerCare.org member portal. Please encourage patients who receive this communication to update their information, including Social Security number, citizenship or immigration status, mailing address, email address and phone number.
Providers should continue to verify SoonerCare eligibility through the normal eligibility verification process.
Starting Jan. 1, 2027, new federal rules require Medicaid providers to include specific patient details directly on all submitted clinical images for prior authorizations. Any request missing this information will be returned unprocessed.
Under CMS interoperability and data standards (42 CFR Parts 431, 435, 438, 456 and 457), state Medicaid agencies and managed care plans must set up secure electronic systems — prior authorization APIs — to verify patient identities and streamline prior approvals.
To match clinical records directly to a patient's digital identity, every image submitted must clearly display the following details:
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Patient info: Member name, member ID and date of birth
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Provider info: Provider name and provider ID
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Service info: Date the image was taken and the specific tooth number(s) (if applicable)
Ensure your imaging software or submission process automatically attaches these required identifiers. Submissions lacking any of these details after the Jan. 1, 2027, deadline will be rejected and sent back.
OHCA will host a webinar designed to prepare providers for the mandatory transition from legacy bundled maternal codes to the American Medical Association (AMA)’s unbundled codes by Jan. 1, 2027. The webinar will be held from 10-11:30 p.m., Thursday, Oct. 1. The recommended audience is OHCA contracted maternal care providers and billing staff who provide services and submit claims. Register for the webinar.
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September is a time to raise awareness about childhood obesity and to encourage healthy eating habits and education that will empower children and families. Childhood obesity can lead to having an increased risk of developing type 2 diabetes, high blood pressure, heart disease and other diseases.
Qualifying adults and children may receive up to six hours of nutrition counseling with a registered dietician. Registered dieticians can assist with the management of childhood obesity by creating nutritious and balanced meal plans with a family-focused approach that keys in on health lifestyle changes, whole foods and maintainable behavior change that is age appropriate.
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You don’t need to have a long discussion with your patients about tobacco to have a long-lasting impact. Just follow the 5 A’s for a simple way to guide the conversation:
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ASK about tobacco use.
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ADVISE them to quit.
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ASSESS their willingness.
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ASSIST them with support and resources.
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ARRANGE a follow-up.
A few minutes of encouragement from a trusted provider can help a patient take the first step toward quitting. If you’re interested in learning more about tobacco cessation best practices, the SoonerQuit program can assist you in creating a tobacco-free environment for staff and patients.
This September, the Oklahoma Tobacco Helpline is offering eight weeks of free nicotine replacement therapy, including patches, gum or lozenges, to help reduce nicotine cravings and provide support while quitting. Encourage your patients to take advantage of this limited-time offer before it ends on Sept. 30.
SoonerCare members may also have access to additional benefits that support their quit journey and overall health. Eligible patients can receive cessation counseling and medications, and they may qualify for free low-dose CT lung cancer screenings. Encourage your patients to learn more about these resources and take advantage of the benefits available to them.
Finally, don't forget to stock up on free materials for your office including pens, brochures, prescription pads and more. Visit the helpline to order.
Mavyret® (glecaprevir/pibrentasvir) is currently SoonerCare’s only preferred direct-acting antiviral medication for treatment of chronic hepatitis C virus (HCV). It is available without prior authorization through an ongoing OHCA initiative. Mavyret can be prescribed and dispensed as a full 8-week course all at once.
Other direct-acting antivirals follow the PA criteria and require three forms to begin treatment.
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The medication-specific PA form (e.g., Harvoni®, Pharm-33)
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Hepatitis C Therapy Intent to Treat Contract form (Pharm-28)
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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).
Prescribers should follow current guidelines and Mavyret prescribing information when initiating testing for chronic hepatitis C, selecting an appropriate treatment regimen, and performing all necessary monitoring. CDC and AASLD-IDSA guidance recommend HCV screening for all adults age 18 years and older at least once in their lifetime. Additionally, screening during each pregnancy and regular screenings for individuals with risk factors are recommended. Common risk factors include but are not limited to current or prior injection drug use, HIV, liver disease or hemodialysis.
Before treating, prescribers should verify the member's SoonerCare or SoonerSelect eligibility is in effect long enough to complete treatment. All patients receiving HCV treatment should be monitored for adherence and counseled regarding the importance of adherence and finishing treatment.
Questions about SoonerCare pharmacy benefits? Contact the SoonerCare Pharmacy Help Desk at 405-522-6205, option 4, or toll-free at 800-522-0114, option 4.
Questions about SoonerSelect pharmacy benefits? Contact the pharmacy help desk associated with your member’s health plan.
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What should I do if a PA submission is placed under “pending documents” status?
To ensure that provider submissions for PAs are not canceled due to missing any required documents for SLP or PT/OT, PAs will be placed under pending documents status instead. Whenever a PA is placed under pending documents status, it is because one or more of the required documents for clinical review is missing and the reviewer commentary provided within the PA portal will elaborate on exactly what document(s) are missing.
Providers will have 14 days from the date of the initial PA submission to provide the missing documentation, which can be done on the PA portal. If additional documents are provided, then the PA will be reviewed again for medical necessity of services requested with the original valid start date in place. If the additional documents are not provided on the PA portal within the 14-day timeline, then the PA will be denied.
Whenever a PA is placed under pending documents status, this status will be visible to the provider on the PA portal. The submitting provider can then click “view original request” for the PA in the portal. The provider will then be able to add any required missing documents for a second review in the attachments area of the PA within the portal, and then click submit. Please note that a new PA is not being submitted here, the original PA submission is simply being updated to meet document requirements for a second review while retaining the original requested start date on the PA.
Is there a final approval of new CPT codes that will replace CPT code 92507 for SLP services?
Please review the July 2026 provider newsletter’s therapy FAQ section. CPT code 92507 is confirmed to be differentiated into multiple specific timed CPT codes effective Jan. 2, 2027, however, the finalization of these CPT codes which are currently in placeholder status, should occur by October 2026. OHCA will provide a list of the approved CPT codes for use within a timely future newsletter topic.
We continue to recommend that all providers submitting a PA request for CPT 92507 ensure a PA end date of Dec. 31, 2026, at the latest. New PAs for 2027 dates of service will need to be submitted starting in mid-December, using the new 2027 codes (which will be listed in a future newsletter topic).
Oklahoma ABLE Tech does more than provide gently used durable medical equipment (DME) through its Reutilization Program. As Oklahoma’s Assistive Technology Act Program, ABLE Tech offers a variety of services that help Oklahomans with disabilities access the technology, resources and support they need to live, learn and work more independently.
How ABLE Tech Can Help
Device Demonstrations: Not sure which assistive technology (AT) is right for you? Try different AT devices and explore your options before making a purchase. Device demonstrations provide hands-on opportunities for individuals, families and professionals to make informed decisions.
Short-Term Device Loans: Borrow AT devices for up to six weeks and try them in your own environment. Short-term loans can help you make purchasing decisions, provide backup equipment or meet temporary needs. Don't miss the AT Respite Kit project, created specifically for caregivers and care recipients.
Financial Loans: ABLE Tech partners with financial institutions to provide low-interest financing options for individuals who need to buy AT and DME.
Digital Accessibility: ABLE Tech provides training, evaluations and technical assistance to help organizations improve the accessibility of websites, documents and other digital content.
Training and Technical Assistance: Professionals and organizations can receive guidance on selecting, implementing and integrating AT in settings like education, employment and community living.
Public Awareness and Advocacy: ABLE Tech works to increase awareness of AT through outreach, events, educational resources and advocacy.
Whether you're looking for AT for a patient or someone you support, ABLE Tech can help you explore your options. Learn more about ABLE Tech’s programs and services at okabletech.org.
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