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.

 

 

nacp 

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

 

        Proposed Policy 

 

 

  Circulated
Date
  
 

  Proposed Change Work Folder   

  Description of Change   

  Comment
Due Date
  
 

  OHCA Public Hearing/MAC/Board
Dates & Agendas
  
 

 01/16/2015  

 APA WF # 14-02 

 Feedback Form  

 FQHC & RHC Encounter Limitation — Rules are revised to limit encounters within Federal Qualified Health Centers (FQHC) and Rural Health Clinic Services (RHC) to one encounter per member per day as well as limit encounters to a total of four visits per member per month for adults. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

  

 APA WF # 14-04  

 Feedback Form  

  

 Hospital Readmission Rules are amended to reduce/deny payment for preventable readmissions that occur within 30 days from discharge. The current policy reviews readmissions occurring within 15 days of prior acute care admissions or a related condition to determine medical necessity and appropriateness of care. If it is determined either or both admissions may be inappropriate, payment for either or both admissions may be denied.    

02/16/2015  

  

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

  

 APA WF # 14-05  

 Feedback Form  

  

 Policy Change for Member Copayments — Agency cost-sharing rules are revised to permit an increase of copays to the federal maximum. Additionally, policy is amended to add diabetic supplies and smoking cessation counseling and products to the service copayment exemption list in order to ensure member have access to necessary services that improve member health outcomes.   

02/16/2015  

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015 

  

 APA WF # 14-07 

 Feedback Form  

  

 Policy Change for Oxygen and Oxygen Equipment — Oxygen and oxygen equipment rules are revised to require a prior authorization after the initial three months. In addition, rules are revised to clarify arterial blood gas analysis (ABG) and pulse oximetry testing and Certificate of Medical Necessity requirements. Rules for rental oxygen are amended to clarify that reimbursement for rented oxygen concentrators includes both stationary and portable oxygen systems.   

02/16/2015 

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

01/16/2015 

 APA WF # 14-12  

 Feedback Form  

 Elimination of Hospital Leave Rules are revoked to eliminate payment for hospital leave to nursing facilities and ICF/IIDs to reserve beds for members who are absent from the facility. Hospital leave is planned or unplanned leave when the patient is admitted to a licensed hospital. 

02/16/2015 

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF 14-13 

 Feedback Form  

  

 Psychosocial Rehabilitation (PSR) Service Eligibility Criteria & PSR Day Program Progress Note Clarification — Rules are amended to add eligibility criteria required in order to receive psychosocial rehabilitation (PSR) services. Adult PSR services will be limited to members with a history of psychiatric hospitalization or admissions to crisis centers; have been determined disabled by the Social Security Administration for mental health reasons; or who are residing in residential care facilities. Children's PSR services will be limited to members with a history of psychiatric hospitalization or admissions to crisis centers; have been determined disabled by the Social Security Administration for mental health reasons; or have a current Individual Education Plan (IEP) for emotional disturbance. Revisions to outpatient behavioral health rules are also made to clarify that daily or weekly summary notes and related requirements are for rehab day programs only and that all other rehab should follow general progress note requirements, to create a distinction in terminology between Licensed Behavioral Health Professionals (LBHPs) who are fully licensed by their respective licensing board and those individuals who are under supervision for licensure from an approved licensing board (Licensure Candidates). Additionally, rules are amended to clarify that group psychotherapy is not reimbursable for children younger than 3. The aforementioned clarification was as oversight in last year’s rule promulgation cycle, and other grammatical changes. 

02/16/2015 

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

  

 01/16/2015  

  

 APA WF # 14-14A   

 Feedback Form  

  

Conflict of Interest Policy Policy is revised to ensure all 1915(c) waiver programs comply with federal regulation regarding conflict of interest provisions for case management services.  The regulation states providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual, must not provide case management or develop the person centered service plan.is revised to include all 1915(c) waiver programs to comply with 42 CFR 441.301 regarding conflict of interest provisions for case management services.  These emergency changes are necessary as the regulation states providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual, must not provide case management services or develop the person centered service plan.  Without the recommended changes, the State is out of compliance with CMS and may be in risk of losing federal funding. Additionally, rules are modified to provide clarification within the institutional transition case management service definition. Without the recommended changes, the policy will remain inconsistent with references to institutional transition as transitional case management services. 

 02/16/2015 

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

  

 APA WF # 14-14B 

 Feedback Form  

  

 Conflict of Interest Policy  Policy is revised to ensure all 1915(c) waiver programs comply with federal regulation regarding conflict of interest provisions for case management services.  These emergency changes are necessary as the regulation states providers of HCBS for the individual, or those who have an interest in or are employed by a provider of HCBS for the individual, must not provide case management services or develop the person centered service plan.  Without the recommended changes, the State is out of compliance with CMS and may be in risk of losing federal funding. Additionally, rules are modified to provide clarification within the institutional transition case management service definition. Without the recommended changes, the policy will remain inconsistent with references to institutional transition as transitional case management services. 

02/16/2015  

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

  

 APA WF # 14-15 

 Feedback Form  

  

 Behavioral Health Outpatient Billable Hours — Rules are revised to limit the number of hours that outpatient behavioral health rendering providers can be reimbursed to 35 hours per week. Additionally, rules are revised to correct scrivener’s errors made during the 2014 permanent rulemaking session. The 2014 permanent rules clarified that individual and group psychotherapy services as well as testing cannot be provided to children ages 0-3.Rules are revised to limit the number of hours that outpatient behavioral health rendering providers can be reimbursed to 35 hours per week. Additionally, rules are revised to correct scrivener’s errors made during the 2014 permanent rulemaking session.  

02/16/2015 

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

  

 01/16/2015  

  

 APA WF # 14-16 

 Feedback Form  

 Health Homes — Rules are added to create coverage guidelines for Health Homes. Health Homes are created to promote enhanced integration and coordination of primary, acute, behavioral health, and long-term services and supports for persons across the lifespan with chronic illness. The purpose of the Health Home is to improve the health status of SoonerCare members with Serious Mental Illness or Serious Emotional Disturbance by promoting wellness and prevention and to improve access and continuity in healthcare for these members by supporting coordination and integration of primary care services in specialty behavioral healthcare settings. Additionally, rules are added to create a distinction between LBHPs and Licensure Candidates.  

  

02/16/2015 

  

 Public Hearing: 02/18/2015   

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-17 

 Feedback Form  

 Moving to an SSI Criteria State for Determining Medicaid Eligibility for Aged, Blind, and Disabled Individuals — In order to come into compliance with federal regulations, rules regarding eligibility determinations for Aged, Blind, and Disabled (ABD) individuals applying for Medicaid services are amended. Policy changes include adding new language regarding the Asset Verification System to check the income or resources of ABD applicants held at financial institutions, updating how resources are counted towards the maximum resource limit, exempting the value of one automobile regardless of its value from the maximum resource limit, expanding the income disregards list, and disregarding $20 of unearned income. Rules regarding income received from capital resources and rental property are amended to deduct the severance tax from the gross income for ABD applicants. Rules regarding infrequent or irregular income are amended to better match the Social Security Administration rules for determining Supplemental Security Income.  

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-19A  

 Feedback Form  

 Transition of 1915(c) WaiversThe OHCA is exploring options to transition the operational functions of its internal 1915c Waiver services and responsibilities.  The two (2) internal waivers include: (a) My Life My Choice and (b) Sooner Seniors.  Factors under consideration and exploration to transition the operational waiver responsibilities include, but are not limited to, contracting with an external entity to perform all operational services or transitioning some or all members into other existing waivers as applicable. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-19B 

 Feedback Form  

 Transition of 1915(c) WaiversThe OHCA is exploring options to transition the operational functions of its internal 1915c Waiver services and responsibilities.  The two (2) internal waivers include: (a) My Life My Choice and (b) Sooner Seniors.  Factors under consideration and exploration to transition the operational waiver responsibilities include, but are not limited to, contracting with an external entity to perform all operational services or transitioning some or all members into other existing waivers as applicable. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-20  

 Feedback Form  

 Hospital Presumptive Eligibility — In compliance with Section 1920A of the Act and federal regulations 42 CFR 435.1100-1110, OHCA is implementing Hospital Presumptive Eligibility (HPE). HPE allows participating hospitals to make presumptive eligibility (PE) determinations, on behalf of the agency, for applicants who are deemed eligible for Medicaid services based on preliminary information provided by the applicant. Hospitals may then provide services under HPE and bill OHCA. Hospitals are guaranteed payment for HPE services, regardless of whether or not the applicant is later found eligible for SoonerCare. The rules will delineate the parameters of the HPE program, eligibility guidelines, and hospital participation rules. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-22  

 Feedback Form  

 Update to DME Policy — Policy is revised to update Part 17 (Medical Suppliers) in Chapter 30 to clarify rules for durable medical equipment (DME) services. Changes include updating billing and PA requirements for DME items, updating the list of DME items that require a certificate of medical necessity, clarifying that repairs for rental DME items are not covered, and revising the definition of invoice. Additionally, language is added to clarify that only one wheelchair is covered and deemed medically necessary; back-up wheelchairs are not covered items.  

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-23  

 Feedback Form  

 DDS Third-party Employers — The proposed amendments revise rules to implement policy changes recommended during the annual Developmental Disabilities Services (DDS) policy review process.  The policy changes recommended will assist DDS in becoming compliant with the new regulations of the Fair Labor Standards Act (FLSA) for "domestic service" employees, who provide "companionship services" to members.  The Department of Labor has issued a new final ruling that precludes third party employers from claiming the companion exemption.  These changes will become effective January 1, 2015. 

02/16/2015 

 Public Hearing: 02/18/2015     

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-25   

 Feedback Form  

 Dental — The proposed dental policy is revised to align practice with the Code on Dental Procedures and Nomenclature (CDT) and to ensure the delivery of dental services meets the standard of care. Proposed revisions include the elimination of the perinatal dental program, guidelines for x-rays, comprehensive and periodic oral evaluations, and dental sealants. Rules are revised to add coverage for the replacement of sealants; current policy restricts coverage for replacement sealants when medically necessary. Revisions also include clean-up to remove language regarding composite and amalgam restorations as it is referenced in a different section. Proposed revisions outline guidelines for stainless steel crowns to clarify that placement is allowed once for a minimum period of 24 months as well as other clean-up for clarity.  

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-28   

 Feedback Form  

 Allergy Testing Rules — The Agency's rules are revised to establish policy for the appropriate administration of allergy testing and immunotherapy services. Criteria include: definition of allergy testing and immunotherapy, coverage requirements, non-covered services, reimbursement conditions, appropriate delivery sites, provider qualifications, and documentation requirements for home administration of immunotherapy. Additionally, revisions include clean-up to remove allergy reimbursement language from injection policy as it is referenced in the new section.  

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-33   

 Feedback Form  

 Policy Change for the Tax Equity Fiscal Responsibility Act (TEFRA) Program — Policy is amended to change the TEFRA program eligibility rules to match federal guidelines for level of care (LOC). Changes include replacing all TEFRA language regarding mental retardation or ICF/MR to individuals with intellectual disabilities or ICF/IID. Rules regarding ICF/IID LOC eligibility will change to match current DSM-5 and SSA guidelines regarding intellectual disabilities. Specific LOC criteria for determining both hospital and nursing facility will be added to coincide with the ICF/IID criteria. TEFRA rules will also allow one additional psychological evaluation after the age of six, as medically needed. Finally, the Definitions section is updated to include the term "Ineligible Spouse". 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-34 

 Feedback Form  

Waiver Services List — The revisions amend rules to implement policy changes recommended during the Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) annual policy review process.  The recommended policy revisions will position DDS to utilize best practice in the administration of the statewide Request for Waiver Services list.    

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-36   

 Feedback Form  

 Long-Term Care Rule Changes — Long-term care eligibility rules are clarified to be more consistent with 42 U.S. Code § 1396p. Changes include increasing the home equity maximum amount to $500,000 plus the increase by the annual percentage increase in the urban component of the consumer price index, and allowing the individual to decrease this equity interest through the use of a reverse mortgage or home equity loan. The term "relative" is removed from the home exemption rules for members who fail to return back home from a long-term care institution. The term "assets" is changed to also include annuities purchased by, or on behalf of, an annuitant seeking long-term care services.  

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-38  

 Feedback Form  

 Individual Plan of Care — Inpatient psychiatric hospital policy is revised to clarify that the member's signature on the Individual Plan of Care is required at the time of completion. However, if the member was too physically ill or their acuity level precluded them from signing the plan of care and/or the plan of care review at the time of completion, the member must sign the plan when their condition improves but before discharge. Rules are also revised to indicate that the individual plan of care must adhere to the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM). 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-39   

 Feedback Form  

 Therapeutic Foster Care — Agency policy is revised to indicate a 1.5 hours daily limit on services billed by the Treatment Parent Specialist (TPS) within the Therapeutic Foster Care (TFC) setting. This change in policy aligns with limitations delineated within the State Plan for this particular provider and setting. Additionally, rules are revised to make a distinction between LBHPs and Licensure Candidates.      

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-42   

 Feedback Form  

 History and Physical Evaluation — Policy is revised to reflect that the History and Physical (H&P) should be completed within 24 hours after admission into an inpatient psychiatric hospital. Current agency rules reflect a timeframe of 48 hours to complete the H&P after admission into an inpatient psychiatric hospital. This change in policy is to comply with federal regulation. Rules are also amended to clarify that a psychiatric evaluation is performed by an allopathic or osteopathic physician with a current license and a board certification/eligible in psychiatry. Further, rules are amended to clarify that the psychiatric evaluation is completed within 60 hours of admission to an inpatient psychiatric facility to align with federal regulations. Revisions to the rules will also require that providers be responsible for any federal overpayment identified by CMS, even if the amount exceeds the liability described in the SQR audit findings. Additionally, rules are amended to reflect a distinction of LBHPs and Licensure Candidates. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-44 

 Feedback Form  

 Electronic Notices — OHCA allows electronic notices to be sent to SoonerCare members' designated email addresses. Members may actively select that they wish to receive electronic communications from the agency through the SoonerCare application. The agency will confirm that the member is informed of their right to change this election at any time, ensure that members receive mailed notice of this election, and that all notices are posted on the SoonerCare application for member viewing within one business day. In instances of failed electronic communications, the agency will notify the member, through the mail, of this failed correspondence and that action is necessary. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-45 

 Feedback Form  

 Psychiatric Residential Treatment Programs Staffing Ratios — Agency policy is revised to indicate that non-specialty Psychiatric Residential Treatment Facilities (PRTF) should have a staff to member ratio of 1:6 during routine awake hours and 1:8 during sleeping hours. Additionally, changes are made to clarify that staffing ratios should always be present for each individual unit not by facility or program. Historically, PRTFs have had misunderstandings in regard to staffing ratios. Placing ratios in the rules clarifies ratio expectations. Additionally, this rule clarifies what a unit is in a PRTF.  

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-46A   

 Feedback Form  

 DDS The revisions amend rules to implement policy changes recommended during the Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) annual policy review process.  The recommended policy revisions will position DDS to utilize best practice in the administration of the statewide Request for Waiver Services list. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-46B 

 Feedback Form  

  DDS The revisions amend rules to implement policy changes recommended during the Oklahoma Department of Human Services (DHS) Developmental Disabilities Services (DDS) annual policy review process.  The recommended policy revisions will position DDS to utilize best practice in the administration of the statewide Request for Waiver Services list. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-47   

 Feedback Form  

 Combined Psychiatric Evaluation & History and Physical Evaluation — Policy is revised to indicate that when the H&P or a combined H&P and psychiatric evaluation are completed by an allopathic or osteopathic physician with a current license and a board certification/eligible in psychiatry, the assessment(s) may count as the first visit by the physician in active treatment. Current language may create confusion as to whether these assessments count toward the first visit by the physician under active treatment; inclusion of this language provides clarity. Additionally, rules are revised to include a distinction between LBHPs and Licensure Candidates. 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

  

 APA WF # 14-48 

 Feedback Form  

  

 Targeted Case Management —The Agency is proposing rule revisions to its behavioral health case management policy in order to clarify existing service limits within administrative code. Changes are also made in order to create distinction between fully licensed "Licensed Behavioral Health Professionals" and "Licensure Candidates" who are actively and regularly pursuing board approved supervision. Revisions are also proposed in order to correct scrivener’s errors made during the 2014 permanent rulemaking session.  

 

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

 APA WF # 14-49A 

 Feedback Form  

 Insure Oklahoma Eligibility — The methodology for determining Insure Oklahoma (IO) eligibility, for both IP and ESI, is changing to the Modified Adjusted Gross Income (MAGI) methodology. The MAGI methodology will supersede previous IO eligibility criteria. The new rules will reference the MAGI methodology rules already established at OAC 317:35-6-39 through 317:35-6-54. Additional changes include amending the requirement that member's notify the agency of changes in household circumstances from within 30 calendar days to 10 days. Rules will be added to indicate changes in the member's household circumstances may require an eligibility redetermination for IO. References to IO's various FPLs will be removed; IO's income standards will now be published online using standard IO Income forms. Additionally, the reasonable opportunity for SoonerCare members to obtain citizenship or alienage documentation is changed from 60 days to 90 days.   

02/16/2015 

 Public Hearing: 02/18/2015    

  MAC: 03/12/2015  

  Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-49B 

 Feedback Form  

 Insure Oklahoma Eligibility — The methodology for determining Insure Oklahoma (IO) eligibility, for both IP and ESI, is changing to the Modified Gross Adjustment Income (MAGI) methodology. The MAGI methodology will supersede previous IO eligibility criteria. The new rules will reference the MAGI methodology rules already established at OAC 317:35-6-39 through 317:35-6-54. Additional changes include amending the requirement that member's notify the agency of changes in household circumstances from within 30 calendar days to 10 days. Rules will be added to indicate changes in the member's household circumstances may require an eligibility redetermination for IO. References to IO's various FPLs will be removed; IO's income standards will now be published online using standard IO Income forms. Additionally, the reasonable opportunity for SoonerCare members to obtain citizenship or alienage documentation is changed from 60 days to 90 days.    

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-50 

 Feedback Form  

 Telemedicine — The OHCA rule for Telemedicine is being revised to clarify the definition for telemedicine, and to remove the definitions sections for consistency. Proposed changes also remove coverage guidelines to expand the scope of the telemedicine delivery method. Revisions remove requirements for a presenter at the originating site to align with the Oklahoma Medical Licensure rules, and to remove guidelines regarding the required use of OHCA-approved telemedicine networks. Proposed revisions also eliminate the originating site fee payment. Additional clean-up ensures no restrictions on services rendered using the telemedicine delivery model. 

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-52A   

 Feedback Form  

 SoonerRide — Rules remove mention to inpatient under the exclusion group as this is not considered an eligibility standard. Rules also remove coverage for non-emergency transport to VA facilities as these facilities are not contracted with the Oklahoma Health Care Authority. Rules also clarify coverage guidelines for escorts and remove mention of the My Life, My Choice group as the waiver is set to expire.  

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-52B 

 Feedback Form  

 SoonerRide — Rules remove mention to inpatient under the exclusion group as this is not considered an eligibility standard. Rules also remove coverage for non-emergency transport to VA facilities as these facilities are not contracted with the Oklahoma Health Care Authority. Rules also clarify coverage guidelines for escorts, and rules remove mention of the My Life, My Choice group as the waiver is set to expire.   

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-53 

 Feedback Form  

 Mental Health Substance Use Screenings — The Agency is proposing rule revisions to its outpatient behavioral health policy in order to add service coverage for mental health/substance use disorder screening for SoonerCare adult and child members within an outpatient behavioral health agency setting. Changes are also made in order to create distinction between fully licensed "Licensed Behavioral Health Professionals" and "Licensure Candidates" who are actively and regularly pursuing board approved supervision.  

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-55   

 Feedback Form  

 Distinction Between LBHP & Licensure Candidate — The Agency is proposing rule revisions to its behavioral health policy in order to create a distinction in terminology between Licensed Behavioral Health Professionals (LBHPs) who are fully licensed by their respective licensing board and those individuals who are under supervision for licensure from an approved licensing board (Licensure Candidates). Revisions are also proposed in order to correct scrivener’s errors made during the 2014 permanent rulemaking session.  

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-58   

 Feedback Form  

 High Risk Obstetrical Services — OHCA rules for high risk obstetrical (HROB) services are revised to increase access in rural areas. Currently high risk obstetrical services are allowed only after an evaluation with Maternal Fetal Medicine doctor and the member is deemed high risk; enhanced services are allowed, only after a prior authorization request and treatment plan are initiated and submitted by the MFM. The initial intent of the HROB program was to promote the establishment of a relationship between the MFM's in urban areas with mothers located in rural communities. However, it appears that pregnant women rural communities rarely travel to the urban areas to receive services. Allowing the general OB to request the HROB services/package for pregnant women will allow ensure pregnant women with high risk conditions receive HROB services. 

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

 01/16/2015  

   

 APA WF # 14-60   

 Feedback Form  

 Federal Qualified Health Centers (FQHC) Rules are revised to allow FQHC's to be reimbursed at the PPS rate immediately upon receiving their Health Resources and Services Administration (HRSA) grant award letter. Currently, OHCA requires the facility to submit the award letter and their Medicare certification number before they can contract as an FQHC. In the interim, facilities contracted as a clinic and were paid the fee for service (FFS) rate.Rules are revised to remove the requirement for FQHC's to submit the Medicare Certification number in conjunction with the Health Resources and Services Administration (HRSA) grant award letter.  

02/16/2015 

 Public Hearing: 02/18/2015    

 MAC: 03/12/2015  

 Board: 03/26/2015  

     Home and Community-Based Services (HCBS) Waivers 

The Oklahoma Health Care Authority will host a public meeting on the proposed transition plans February 3, 2015 in the OHCA board room at 10:30 a.m.  

The OHCA office is located at 4345 N. Lincoln Blvd, Oklahoma City, Oklahoma 73105.  

 Circulated
Date
  

 Proposed
Changes
  

 Description of
Change
  

 OHCA Comment
Due Date
  

 Proposed Submittal Date  

 01/15/2015 

  ADvantage Waiver Transition Plan  

 Advantage Waiver 15-01    

  Feedback Form     

 The Proposed ADvantage Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings.  

 02/15/2015 

 N/A 

 01/15/2015 

 Community Waiver Transition Plan 

 Community Waiver 15-02     

  Feedback Form  

 The Proposed Community Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings. 

 02/15/2015 

 N/A 

 01/15/2015 

  IHS for Adult Waiver Transition Plan      

 IHS-A Waiver 15-03  

   
 Feedback Form   

 The Proposed In-Home Support for Adult Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings. 

 02/15/2015 

 N/A 

 01/15/2015 

  IHS for Children Waiver Transition Plan  

 IHS-C Waiver 15-04   

 
 Feedback Form   

 The Proposed In-Home Support for Children Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings. 

 02/15/2015 

 N/A 

 01/15/2015 

  Homeward Bound Waiver Transition Plan      

 Homeward Bound Waiver 15-05  

  Feedback Form  

 The Proposed Homeward Bound Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings. 

 02/15/2015 

 N/A 

 01/15/2015 

  Medically Fragile Waiver Transition Plan      

 Medically Fragile Waiver 15-06   

 
  Feedback Form   

 The Proposed Medically Fragile Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings. 

 02/15/2015 

 N/A 

 01/15/2015 

  My Life; My Choice Waiver Transition Plan      

 My Life, My Choice Waiver 15-07   

 
  Feedback Form  

 The Proposed My Life; My Choice Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings. 

 02/15/2015 

 N/A 

 01/15/2015 

  Sooner Seniors  Waiver Transition Plan  

 Sooner Seniors Waiver 15-08   

   
  Feedback Form  

 The Proposed Sooner Seniors Transition Plan outlines the proposed process that Oklahoma will be utilizing to ensure implementation of the new HCBS requirements for residential and non- residential settings. 

 02/15/2015 

 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 

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.