MAC Meeting Agenda

January 20, 2011 at 1 p.m.
OHCA
Ponca Conference Room
2401 NW 23rd St, Suite 1A
Oklahoma City, OK 73107

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Tentative Agenda 

I. Welcome, Roll Call, and Public Comment Instructions

II. Approval of minutes of the November 17, 2010 Medical Advisory Committee Meeting

III. MAC Member Comments/Discussion

  • Update on Obesity Program, Juarez McCann, Budget Director

IV. Legislative Update: Nico Gomez, Deputy Chief Executive Officer

V. C-Section Update: Sylvia Lopez, M.D., Medical Review Consultant

VI. Financial Report: Carrie Evans, Chief Financial Officer

VII. SoonerCare Operations Update: Cassell Lawson, Director of Opportunities for Living Life

VIII. Program Integrity Update – Kelly Shropshire, Director, Program Integrity & Accountability

IX. Action Items: Joseph Fairbanks, Sr. Policy Specialist

OHCA Initiated

10-61 DMEPOS Provider Requirements – Durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) rules are revised to clarify OHCA's DMEPOS provider criteria.  DMEPOS providers must meet Medicare accreditation standards unless the OHCA grants an exemption based on CMS exemptions, the provider is a government-owned entity, or at a provider's request.  Revisions clarify that DMEPOS providers be located within the State of Oklahoma, unless the OHCA provides an exception to this requirement.  Additionally, DMEPOS providers must comply with Medicare DMEPOS Supplier Standards as specified in 42 C.F.R. 424.57(c). 

Budget Impact – Budget Neutral

10-66 Children's Nutrition Services - Current nutrition services policy is revised to correct references to previously revoked policy and provide clarification to current reimbursement practices and rules.

Budget Impact – Budget Neutral

Federally Initiated

10-56 Native American Cost-Sharing - OHCA cost-sharing rules are revised to comply with Federal law on Native American cost-sharing exemptions.  Native Americans are now exempt from SoonerCare co-pays or premiums when they receive services provided by I/T/U providers or through referral by contract health services. 

Budget Impact – Total impact of $876,206; State Share of $205,402

10-63 Puerto Rican Birth Certificates - Per CMS guidance and Puerto Rican law, eligibility rules are revised so that only new certified birth certificates will be accepted as verification of citizenship for Puerto Ricans who are using their birth certificate as proof of citizenship and whose eligibility for benefits will be determined for the first time on or after October 1, 2010.  This rule change does not prohibit Puerto Ricans from using other forms of citizenship verification; it only applies to the use of birth certificates.  When the applicant has not yet received his or her new certified birth certificate, reasonable opportunity to obtain citizenship verification will be afforded to the applicant.

Budget Impact – Budget Neutral

10-65 Individual Indian Money Accounts (IIM) - Policy is changed to clarify OHCA's treatment of Individual Indian Money (IIM) Accounts as a converted resource.  Funds and property held in IIM Accounts will no longer be used in an eligibility test.  References to per capita payments are removed and the period in which money disbursed from IIM accounts can be counted as a resource is revised.

Budget Impact – Budget Neutral

X. New Business

XI. Adjourn

Next Meeting:  Thursday, March 9, 2011