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, State Plan, and/or Rate Changes 

The rate and methodology changes will be presented to the State Plan Amendment and Rate Committee on June 18, 2015 at 10:00 AM and the OHCA Board of Directors on June 25, 2015 at 1:00 PM. Both meetings will be held at the OHCA offices located at 4345 N. Lincoln Blvd., OKC, OK 73135 in the OHCA Board Room. 

Written and oral comments will be accepted during regular business hours by contacting Tywanda Cox at the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd., Oklahoma City, Oklahoma, 73105, Telephone 405-522-7153.  Comments so submitted will be available for review by the public Monday – Friday, 9:00 a.m. to 4:30 p.m., at OHCA at the above address. 

The following budget reduction proposals address changes in policy, rates, and/or methodology. The final State Plan Amendment and Rate Committee briefs, describing each measure in greater detail, will be posted on the OHCA web page on or before June 17, 2015. 

 

  Circulated
Date
  
 

  Proposed Change Work Folder   

  Description of Change   

  OHCA Comment
Due Date
  
 

  OHCA Public Hearing/MAC/Board
Dates & Agendas
  
 

Policy Changes 

05/06/2015

APA WF 15-03    

Feedback Form 

DRG Hospital — The proposed policy revisions clarify reimbursement methodology for DRG hospitals. Rules state that covered inpatient services provided to eligible members admitted to acute care and critical access hospitals will be reimbursed the lesser of the billed charges or the DRG amount.  

06/07/2015

MAC: 05/21/2015

Board: 06/25/2015 

05/06/2015

APA WF 15-04    

Feedback Form  

 Revoke payment for removal of benign skin lesions and eliminate coverage for adult sleep studies — The proposed policy revisions revoke payment for removal of benign skin lesions for adults. In addition, the proposed policy revisions eliminate coverage for adult sleep studies. 

 

06/07/2015

 

MAC: 05/21/2015

Board: 06/25/2015 

05/06/2015

APA WF 15-05   

Feedback Form  

High Risk Obstetrical Services — The proposed policy revisions to the High risk Obstetrical   program include: allowing the provider to be  Board Eligible or Board Certified, decreasing the number of units allowed for ultrasounds from six to three; decreasing the number of units for a singleton fetus for biophysical profiles/non-stress tests or any combination thereof to a total of 5, with one test per week beginning at 34 weeks gestation and continuing to 38 weeks; and, decreasing the number of ultrasounds currently granted to the Maternal Fetal Medicine (MFM) doctors to assist in the diagnosis of a high risk condition from six to one. These changes align with the current standards of care and reflect the current number of ultrasounds and biophysical profiles currently being utilized. 

06/07/2015

MAC: 05/21/2015

Board: 06/25/2015  

05/06/2015

APA WF 15-06   

Feedback Form  

Coverage for Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) — The proposed policy revisions regarding coverage for durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) restrict coverage for continuous positive airway pressure devices (CPAP) to children only.  

06/07/2015

MAC: 05/21/2015

Board: 06/25/2015  

05/06/2015

APA WF 15-08  

Feedback Form  

Urine drug screening and testing — The proposed policy revisions establish policy for the appropriate administration of urine drug screening and testing to align with recommended allowances based on clinical evidence and standards of care. Criteria include: purpose for urine testing, coverage requirements, non-covered testing, provider qualifications, and medical record documentation requirements necessary to support medical necessity. Additionally, revisions include clean-up to reimbursement language from general laboratory services policy. 

06/07/2015

MAC: 05/21/2015

Board: 06/25/2015 

05/06/2015

APA WF 15-09   

Feedback Form 

Timely Filing — The proposed policy revisions are to restrict the timely filing of claims for reimbursement from 12 months to six months. In addition, policy regarding resubmission is revised to update the deadline from 24 months to 12 months. Changes to the timely filing restrictions are in accordance with federal authority. Remove changes to timely filing for Medicare crossover claims in the proposed rule at 317:30-5-44. Timely filing for crossover claims will remain one year. In addition, language corrections are included 

06/07/2015

MAC: 05/21/2015

 Board: 06/25/2015 

State Plan and/or Rate Changes 

05/06/2015

State Plan Amendment & Rate Change 

Feedback Form 

DRG Hospital Readmissions - The OHCA proposes to reduce payment for hospital readmissions occurring within 30 days since the last hospital discharge date. OHCA will set the target to 102% for CY 2015, decreasing 1% per year until the target is 100%.  A target of 102% means we would allow a hospital to have 102% of the potentially-preventable admissions that we would expect based on statewide data before we assess a penalty.  

06/07/2015

MAC: 05/21/2015

SPARC: 06/18/2015

 Board: 06/25/2015 

05/06/2015

State Plan Amendment & Rate Change 

Feedback Form 

DRG Hospital Outlier Payment - The OHCA proposes to reduce DRG outlier payments by increasing DRG threshold to $50,000. Currently the DRG threshold is $27,000.  

06/07/2015

MAC: 05/21/2015

SPARC: 06/18/2015

 Board: 06/25/2015

05/06/2015

 State Plan Amendment & Rate Change 

Feedback Form 

DRG Hospital Lesser of Transfer Fee or DRG - The OHCA proposes to pay lesser of transfer fee or DRG. Payment to the receiving Facility, if it is also the final discharging Facility, will be at the DRG allowable. Currently, both are paid at the DRG allowable. No outlier payments will be allowed for transfers. 

06/07/2015

MAC: 05/21/2015

 SPARC: 06/18/2015

 Board: 06/25/2015

05/06/2015

 State Plan Amendment & Rate Change 

Feedback Form 

Physician Services in Facility Setting - The OHCA proposes to pay like Medicare for physician services performed in a facility setting.  

06/07/2015

MAC: 05/21/2015

 SPARC: 06/18/2015

 Board: 06/25/2015

05/06/2015

State Plan Amendment & Rate Change 

Feedback Form 

Mid-level Practitioner Reimbursement - The OHCA proposes to reduce payments to mid-level practitioners to 85% of the appropriate OHCA physician fee schedule. 

06/07/2015

MAC: 05/21/2015

 SPARC: 06/18/2015

 Board: 06/25/2015

05/06/2015

State Plan Amendment & Rate Change 

Feedback Form 

Nursing Facility Crossovers - The OHCA proposes to reduce payments for coinsurance and deductibles from 100% to 75%. 

06/07/2015

 

MAC: 05/21/2015

 SPARC: 06/18/2015

 Board: 06/25/2015

05/06/2015

State Plan Amendment & Rate Change 

Feedback Form 

Durable Medical Equipment - The OHCA proposes to reimburse for stationary oxygen using the Medicare competitive bid rate. In addition, the agency proposes to eliminate coverage for sterile water and gloves. 

06/07/2015

MAC: 05/21/2015

 SPARC: 06/18/2015

 Board: 06/25/2015

 

05/06/2015

Rate Change 

Feedback Form   

 Polycarbonate Lenses - The OHCA proposes to reduce payments for polycarbonate lenses to $10 per lens. 

06/07/2015

MAC: 05/21/2015

 SPARC: 06/18/2015

 Board: 06/25/2015

 

1115 Waivers 

 

  Circulated
Date
  
 

  Proposed Change 

  Description of Change   

 OHCA Comment
Due Date
  
 

 Proposed Submittal Date 

05/05/2015 

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.  

06/05/2015 

07/20/2015 

 

 

     Home and Community-Based Services (HCBS) Waivers  


 
 

 

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.