MAC Meeting Agenda

January 21, 2010 at 1 p.m.
OHCA Board Room
4545 N. Linicoln, Suite 124
Oklahoma City, OK 73105

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Tentative Agenda

I. Welcome, Roll Call, and Public Comment Instructions

II. Approval of minutes of the November 19, 2009 Medical Advisory Committee Meeting

III. MAC Member Comments/Discussion

IV. Provider Services Support Update: Paul Keenan, MD, Chief Medical Officer

V. Program Operations & Benefits Update: Becky Pasternik-Ikard, Chief Operating Officer

VI. Legislative Report: Nico Gomez, Deputy Chief Executive Officer

VII. Federal Guidelines on Copayments: Tywanda Cox, Director, Health Policy

VIII. Financial Report: Carrie Evans, Chief Financial Officer

IX. Action Items: Traylor Rains, Policy Development Coordinator

OHCA Initiated

09-20 Eligibility Rules – Medical Assistance for Adults and Children-Eligibility rules are revised to provide clarification to employees of the Oklahoma Department of Human Services and the Oklahoma Health Care Authority when determining an individual's eligibility for Medicaid.  The proposed revisions will: (1) incorporate current procedures and terminology; (2) remove obsolete language; and (3) update incorrect policy citations and form references.  Revisions are needed to provide consistency and clarity within agency rules.
Budget Impact – Budget neutral

09-64 Targeted Case Management (TCM) Revisions – TCM rules are revised to combine adult & children outpatient BH TCM rules into one streamlined set. Revisions also include broadening TCM to all BA/BS level degrees to increase access across the state. Revisions were also made to provide more consistency with DMHSAS policy.
Budget Impact – Estimated cost savings of $65,280. 

09-68 Licensed Alcohol and Drug Counselors (LADCs) as Licensed Behavioral Health Professionals (LBHPs) – Children's inpatient psychiatric treatment rules are being revised to add LADCs as LBHPs. This addition would expand the type of licensure their staff can hold in order to provide the services required, as well as allow greater access to care for SoonerCare children that receive inpatient psychiatric treatment services.
Budget Impact – Budget Neutral

09-77 Hospital Acquired Conditions – Agency rules are created to establish policy for hospital acquired conditions.  Rules will set policy to no longer reimburse the extra cost of treating certain categories of conditions that occur while a member is in the hospital.  For discharges, hospitals will not receive additional payment for cases in which one of the selected conditions was not present on admission.  Payment will be made as though the secondary diagnosis was not present.  The selected conditions that OHCA will recognize are those conditions identified as non-payable by Medicare.  Rules will also include the avoidance of SoonerCare to act as a secondary payer for Medicare non-payment of the recognized hospital acquired conditions.
Budget Impact – Estimated budget savings not quantifiable by OHCA at this time.

09-78 Licensed Behavioral Health Professionals (LBHP) – Rules are being revised to allow for direct contracting by licensed master's level behavioral health professionals. By allowing contracting with these providers it will increase specialist access, decrease use of ER and inpatient psych, and increase crisis intervention. The allowance of the direct contracting will also divert RTC usage due to LBHPs being more accessible.
Budget Impact – SFY 2011 Cost Savings $156,144; SFY 2012 Cost Savings $5,111,520 (RTC diversion) 

10-02 Therapeutic Foster Care (TFC) revisions – Outpatient behavioral health rules are revised to change the reimbursement methodology for services provided in Therapeutic Foster Care settings from an all inclusive per diem payment to fee-for-service.  The requirement of "unbundling" per diem rates has been an ongoing trend for CMS and this change more closely aligns our reimbursements with CMS preferences and requirements. 
Budget Impact – The estimated cost to OHCA for the remainder of SFY10 is $456,372. However, the Agency expects to realize a savings beginning next fiscal year by diverting members from more costly inpatient stays by giving them access to community based alternatives. 

10-03 Federally Qualified Health Centers (FQHC) Reimbursement Clarification – Revisions are made to the Agency's FQHC rules to provide further clarification as to which services and service providers trigger payment of the Prospective Payment System (PPS) rate. 
Budget Impact – Budget Neutral

OKDHS/DDSD Initiated

09-72 DDSD Rule Clean-up – The purpose of this rule is to revise Developmental Disabilities Services policy, for permanent rule making to (1) clarify levels of support, outside employment guidelines and termination guidelines for Agency Companion Services (2) specify review/approval process for Habilitation Training Services (HTS) and clarify proper utilization of HTS  (3) clarify the termination process of foster care providers, (4) clarify the process for provision of nutrition services (5) clarify requirements for installation of architectural modifications (6) clarify services and provider requirements relative to specialized medical equipment (7) clarify responsibilities of Adult Day Services and Daily Living Supports providers (8) clarify member eligibility for residence in a  group home (9) clarify the process for documenting the need for an enhanced rate in an employment setting (10) revise policy to limit state dollar reimbursement for absence of a member receiving waiver services to not exceed 10% of the authorized units for employment services.

Additionally Chapter 30 rules are revised for permanent rule making to (1) clarify provider eligibility requirements for Home and Community Based services providers  (2) clarify the provision of Home and Community Based Dental Services (3) specify that physical and occupational therapists and physical therapy assistants must have non-restricted licenses and clarify the provision of Habilitation Training Services.
Budget Impact – Budget neutral

X. New Business

XI. Adjourn

Next Meeting:  Thursday, March 25, 2010