Native American Consultation Page

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The Oklahoma Health Care Authority (OHCA) seeks advice from Indian Health Services,tribal organizations and urban lndian clinics (I/T/U) in developing new or amended state plans, waiver amendments,or policy changes.

The Native American page is designed to notify Indian Health Services,tribal organizations and urban lndian clinics of any state plan, waiver, or proposed rule changes by providing an online tribal consultation forum.

This forum will provide I/T/U's an opportunity to review and make comments.

Please use the feedback forms below in the applicable  proposed change box to give feedback on the proposed policy change.

 

 

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Use the links below to make suggestions on rules not currently being considered for change.

 

 

 Proposed Policy, State Plan, and/or Rate Changes

   Circulated
Date
   

   Proposed Change Work Folder   

   Description of Change   

   OHCA Comment
Due Date
   

   OHCA Public Hearing/MAC/Board
Dates & Agendas
   

Provider Letter 

 

    Circulated
Date
    

    Proposed Changes    

    Description of Change    

   OHCA Comment
Due Date
    

 06/30/2015 

 Provider Letter OHCA 2015-11 

  Feedback Form  

 OHCA is proposing to require prior authorization (PA) for more than 10 units of CPT code 88271, a molecular cytogenetics code used to bill each DNA probe, effective August 1, 2015.  Please submit all comments by close of business, July 30, 2015 via the feedback form link. Thank you for your participation in the process.  

 07/30/2015 

   07/27/2015 

 Provider Letter OHCA 2015-18 

Feedback Form  

 OHCA is proposing to pay for the incontinence supplies (diapers, pull-ons, underpads and wipes) for children ages 4 through 20 under EPSDT,  effective July 1, 2015. These supplies must be medically necessary. Please submit all comments by close of business, August 26, 2015 via the feedback form link. Thank you for your participation in the process. 

 08/26/2015   

  07/27/2015

Provider Letter 2015-19

Feedback Form

OHCA is proposing to accept electronic referrals only  for claims processing, all paper SC-10 referrals will become void, effective November 1, 2015. In order to allow time for providers that are still utilizing paper referrals to transition to electronic, claims for dates of service through October 31, 2015 will continue to process based on either an active paper or electronic referral, regardless of the date billed.  Claims submitted with dates of service that are on or after November 1, 2015 will deny if an electronic referral has not been submitted. Please submit all comments by close of business, August 26, 2015 via the feedback form link. Thank you for your participation in the process. 

 08/26/2015   

 

 

1115 Waivers 

  Circulated
Date
  

  Proposed Change

  Description of Change  

 OHCA Comment
Due Date
  

 Proposed Submittal Date

06/12/2015

Insure Oklahoma Sponsor's Choice Option  

Feedback Form

The 1115 demonstration waiver and corresponding agency rules will be amended to reflect a third Insure Oklahoma option. The Insure Oklahoma Choice program will establish coverage for sponsoring organizations, eligible populations including dependent spouses and children, qualifying benefit plans, cost sharing and expenditure authorities. The evaluation design will be modified to incorporate the Insure Oklahoma Choice program as well. 

07/17/2015

07/31/2015

 

 

     Home and Community-Based Services (HCBS) Waivers  

Circulated Date
 
Proposed Changes
 
Description of Change
 
OHCA Comment Due Date
 
Proposed Submittal Date
 
7/27/2015 Termination of the My Life;
My Choice Waiver
8/25/2015 N/A
7/27/2015

   1915c Waiver Amendment   

Termination of the Sooner
Senior Waiver 
8/25/2015 N/A

 

SoonerCare Choice (SC) Waivers 

 

Circulated
Date

Waiver Application/Amendment

 Waiver Program

OHCA Comment
Due Date

Proposed Submittal Date

 

 State Plan Amendment (SPA)

Circulated
Date

Proposed
Change

Description of Change

OHCA Comment
Due Date

Proposed Submittal Date

07/15/2015

Mental Health Substance Use Screening 

Feedback Form 

 

Rules were revised during 2015 permanent rulemaking to add coverage of Mental Health/Substance Use Disorder (MH/SUD) screens provided in outpatient behavioral health agencies. ODMHSAS proposes to reimburse for screens provided by qualified providers using approved evidence based tools at a rate of $25.32 per event.

08/11/2015

N/A

07/15/2015

 Independent Practitioners Rate Equalization

Feedback Form

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) proposes to revise the payment methodology for independent Licensed Behavioral Health Practitioners (LBHPs) in order to equalize payment for their services with the payments made for services provided by the same level of provider in an outpatient behavioral health agency setting. This change is being proposed due to the agency budget shortfall of SFY2016. This change does not affect the methodology for Physicians, Psychiatrists or Psychologists.

08/11/2015

N/A

07/15/2015

  Severe Combined Immunodeficiency Disorder (SCID) Newborn Screen

 Feedback Form

 

The Oklahoma State Department of Health (OSDH) has recently (February 2015) added a new test to the existing state-mandated panel for newborn screening (NBS). This test, which screens for Severe Combined Immunodeficiency Disorder (SCID), was approved as part of the national Recommended Uniform Screening Panel (RUSP) for newborn testing, which includes 31 core disorders and 26 secondary disorders, in May 2010. The OSDH NBS Program has systematically adopted all testing reflected in the nationally-recognized RUSP. SCID includes more than 10 genetic disorders characterized by profound defects in both cellular immunity and specific antibody production, and is estimated to occur in about 1/33,000 births. Early identification of the asymptomatic SCID infant during the first few weeks of life is essential for successful treatment, which generally involves allogeneic hematopoietic stem cell transplantation. SCID infants who are treated early have almost 10-fold lower total clinical care costs compared with those treated later.  If undiagnosed, SCID infants usually die from severe infections with the first year of life. Unfortunately, while SCID is potentially treatable, it is infrequently recognized prior to the onset of devastating infec­tions. 

This test will also detect clinically important, non-SCID T-cell-related lymphocyte deficiencies in newborns, which can also be associated with serious morbidities in early childhood. Currently more than half of the babies born in the US are screened for SCID. SCID testing in newborns involves real-time PCR – a technology that is currently not part of other NBS testing – to amplify T-cell receptor excision circles (TRECs). The OSDH Public Health Laboratory (PHL) secured funding from the CDC in 2013 to develop the capacity to offer SCID screening of newborns in Oklahoma; these funds were used to purchase equipment, reagents and consumables for test validation and to hire testing personnel. Following comprehensive test validation, the OSDH PHL implemented routine, population-based SCID screening of newborns in February 2015. The CDC funds were not intended, and are insufficient, to sustain any long term testing; therefore, OSDH is requesting a charge of $6 to be added to the current fee in order to offset the added costs incurred in performing SCID screening. These costs included those associated with laboratory analysis of dried blood spot specimens and follow-up triage of presumptive cases by Screening and Special Services.

08/11/2015

N/A

07/15/2015

 Exome Sequence Analysis

 Feedback Form

 

The Oklahoma Health Care Authority (OHCA) recommends adding a rate for a new code (81415) for exome sequence analysis. 

08/11/2015

N/A

07/15/2015

 ADvantage and State Plan Personal Care Providers

Feedback Form

 Reimbursement for services will be changed to the following rates:  CD-PASS Personal Service Assistant, $3.20; Advanced Personal Service Assistant, $3.84; and Optional Expense, $.97; Case Management-Standard, $13.75; Case Management Very Rural, $19.69; Transitional Case Management – Very Rural, $19.69; Transitional Case Management – Standard, $13.75. Also, Personal Care, $3.78; Advanced Supportive Restorative, $4.07; In-home Respite, $3.78; Extended Respite per day, $160.07; Assisted Living – Standard, $44.01; Assisted Living – Intermediate, $59.40; and Assisted Living – High, $83.09.

08/11/2015

N/A

07/15/2015  

Developmental Disabilities Services Providers 

Feedback Form

 Reimbursement for services will be changed to the following rates:  Homemaker (State Fund)/Homemaker Respite, $3.20; Habilitation Training Specialist (State Fund), $3.78; Self-Directed Habilitation Training Specialist, $3.78; Intensive Personal Supports (State Fund), $3.78; Daily Living Supports (Therapeutic Leave), $143.97. Also, Group Home Respite Six Bed, $67.79; Seven Bed, $57.90; Eight Bed, $50.66; Nine Bed, $ 46.32; 10 Bed, $42.70; 11 Bed, $40.05; and 12-Bed, $37.63. Also, Group Home Community Living/Respite Six Bed, $125.45; Seven Bed, $121.35; Eight Bed, $111.46; Nine Bed, $103.74; 10 Bed, $97.46; 11 Bed, $92.16; 12 Bed, $87.09; Group Home Alternative – Four Bed, $272.85; Agency Companion-Close (Therapeutic Leave)/Respite, $90.23; Agency Companion-Enhanced (Therapeutic Leave)/Respite, $117.49; Agency Companion-Pervasive (Therapeutic Leave)/Respite, $1128.34; and Agency Companion-Intermittent (Therapeutic Leave)/Respite, $62.97. Additionally, Center Based Prevocational Services (State Fund), $4.67; Community Based Prevocational Services (State Fund), $9.34; Pre-vocational HTS-SUPP Supports (State Fund), $11.77; Enhanced Community Based Prevocational (State Fund), $12.47; Community Based Individual Services (State Fund) $15.13; Job Stabilization/Extended Services, $1.29; Job Coaching Service, $3.12; Enhanced Job Coaching Service, $3.63; Job Coaching Individual Services (State Fund), $4.15; Employment Specialist, $5.66; Transportation – Mileage Indirect, $.47; and Transportation-Adapted-Non-emergency Van, $1.21. 08/11/2015

N/A

07/17/15

 Hospitals Deemed Disproportionate Share

Feedback Form

Due to reductions in Agency budgets for SFY 2016, ODMHSAS is seeking to amend a State Plan page related to the deemed disproportionate share payment for hospitals to have the denominator include days attributable to Medicaid patients between 21 and 65 years of age in an Institution for Mental Diseases (IMD). The change is necessary in order to increase revenues to Griffin Memorial Hospital to balance ODMHSAS' state budget in accordance with Article 10, Section 23 of the Oklahoma Constitution, which prohibits a state agency from spending more money than is allocated.

09/16/2015

09/30/2015

Disclaimer: Oklahoma Health Care Authority (OHCA) policy comment section will be reviewed and considered under the current change. Personal information should not be shared/or submitted in the comment section. This comment section is reserved for proposed rule changes.