The Oklahoma Health Care Authority (OHCA) seeks advice and consultation from medical professionals, professional and tribal organizations, and the general public in developing new or amended policies and rules. The proposed policy page is designed to give all constituents an opportunity to review and make comments regarding upcoming rule changes.

All comments regarding proposed administrative rules will be considered during the rulemaking process and become a part of the official work folder. All rule changes are subject to the Oklahoma Administrative Procedures Act. 

• Oklahoma Statutes  

APA WF# 20-01 High-Investment Drugs Carve-Out

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will allow for reimbursement of high-investment drug therapies outside of the inpatient and outpatient hospital payment methodologies. Revisions will also align policy with current practice and correct grammatical errors. 

Please view the circulation document here: APA WF# 20-01, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021

APA WF# 20-02 Retroactive Eligibility

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed rule changes provide for a retroactive period of eligibility, in accordance with 42 Code of Federal Regulations § 435.915. 

Please view the circulation document here: APA WF# 20-02, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021

APA WF# 20-03 Treatment of Lottery or Gambling Winnings for Income Eligibility

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions amend how lottery or gambling winnings of $80,000 and above, which are paid out in a single payout, and not in installments over a period of time, are counted for SoonerCare income eligibility. 

Please view the circulation document here: APA WF# 20-03, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021

APA WF# 20-04 Electronic Visit Verification (EVV)

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed new rules are needed in order to comply with the 21^st Century Cures Act which requires providers of personal care services to utilize an EVV system where visit details are documented. 

Please view the circulation document here: APA WF# 20-04, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 

APA WF# 20-05 Continuation of Services Pending Appeals

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed new rule will comply with Section 431.230 of Title 42 of the Code of Federal Regulations by describing the conditions in which Medicaid benefits will continue or be reinstated pending an appeal. Additionally, the proposed new rule will describe the application, obligations, and implications for the appellant when Medicaid benefits are continued or reinstated pending an appeal. 

Please view the circulation document here: APA WF# 20-05, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021

APA WF# 20-06B Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit.  Prosthetics and orthotics are under a separate regulation and remain an optional benefit.  

Please view the circulation document here: APA WF# 20-06B, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021

APA WF# 20-06C Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit.  Prosthetics and orthotics are under a separate regulation and remain an optional benefit.  

Please view the circulation document here: APA WF# 20-06C, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 02/22/2021

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021

APA WF# 20-06D Durable Medical Equipment (DME) and Supplies Benefit moved under the Scope of Home Health Benefit

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions are needed to comply with the Home Health final rule in which the DME and supplies benefit was revised from an optional benefit to a mandatory benefit and was made subject to the scope of the home health benefit.  Prosthetics and orthotics are under a separate regulation and remain an optional benefit.  

Please view the circulation document here: APA WF# 20-06D, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021

APA WF# 20-11 Medicare Part C (Medicare Advantage)

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will standardize the language in policy between Medicare Part A, Part B, and Part C.

Please view the circulation document here: APA WF# 20-11, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021 

Public Hearing: 01/19/2021 

Board Meeting: 01/20/2021

APA WF# 20-13 Child Support Cooperation Exemption for Recipients of Indian Health Services

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will reflect changes in federal regulations regarding a Medicaid agency's process for medical child support referrals.

Please view the circulation document here: APA WF# 20-13, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021

APA WF# 20-14 Therapy Assistants and Clinical Fellows

These rule changes were previously approved by the OHCA Board of Directors and the Governor and are currently in effect as emergency rules. Due to Oklahoma Statutes, these rules must be taken through the permanent rulemaking process. 

The proposed revisions will add physical therapy assistants, occupational therapy assistants, speech-language pathology assistants (SLPAs), and speech-language pathology clinical fellows as eligible providers that can render therapy services to SoonerCare members. Additionally, the proposed revisions will outline provider qualifications and other requirements for provision of these therapy services. Finally, revisions will be made to clarify that these providers will be reimbursed at the rate established per the Oklahoma Medicaid State Plan.

Please view the circulation document here: APA WF# 20-14, and submit feedback via the comment box below. 

Circulation Date: 02/01/2021 

Comment Due Date: 03/03/2021  

Public Hearing: 03/03/2021

Board Meeting: 03/17/2021

APA WF# 20-15A Residential Substance Use Disorder (SUD) Treatment Coverage

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will support WF 20-15B, which proposes to establish coverage of residential substance use disorder (SUD) treatment for Medicaid-eligible individuals and removes the eligibility exclusion of members in an institution for mental disease (IMD) under the SoonerCare Choice program. Lastly, the proposed revisions will also remove "family planning" references as the program is terminating due to Medicaid expansion. 

Please view the circulation document here: APA WF# 20-15A, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 

APA WF# 20-15B Residential Substance Use Disorder (SUD) Treatment Coverage

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

Emergency rule revisions established residential SUD treatment coverage for Medicaid-eligible adults, ages twenty-one (21) to sixty-four (64), and members under the age of twenty-one (21) in residential SUD treatment facilities with seventeen (17) beds or more and/or residential SUD treatment facilities with sixteen (16) beds or less. Permanent rule revisions will remove references to non-Medicaid compensable services and align covered services with the Oklahoma Medicaid State Plan. Further revisions will revise assessment and service plan timeframes and certain treatment hour requirements. Other revisions will involve limited rewriting aimed at clarifying policy language.

Please view the circulation document here: APA WF# 20-15B, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-16 Opioid Treatment Program (OTP) and Medication-Assisted Treatment (MAT) Services

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will comply with the SUPPORT Act, HR 6, and establish coverage and reimbursement of medically necessary medication-assisted treatment (MAT) services and/or medications for SoonerCare members with opioid use disorder (OUD) in opioid treatment programs (OTPs) and within office-based opioid treatment (OBOT) settings. 

Please view the circulation document here: APA WF# 20-16, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 

APA WF# 20-19A Appeals Language Cleanup

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed rule changes will replace incorrect rule section references with the appropriate references. Additionally, revisions will remove appeals language for programs that no longer exist and will identify the appropriate appeal form to fill out when filing an appeal.

Please view the circulation document here: APA WF# 20-19A, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021

APA WF# 20-19B Appeals and Incorrect References Language Cleanup

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will revise certain sections of policy that have references to incorrect or outdated sections.    

Please view the circulation document here: APA WF# 20-19B, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 

APA WF# 20-20 Pay-For-Performance Program

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will update the Pay-for-Performance (PFP) program quality measures to align with the most recent metrics modified by the Centers for Medicare and Medicaid. Additional revisions will specify the timeline in which a nursing facility can submit its quality of care documentation to be eligible for reimbursement.   

Please view the circulation document here: APA WF# 20-20, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Board Meeting: 03/17/2021

APA WF# 20-21 Employment Services Offered through Developmental Disabilities Services

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed rule revisions will describe group job placements. Additional changes will authorize remote supports for individual placements and remove the specific limit that the cost of the member's employment services, excluding transportation and state-funded services, cannot exceed limits specified in OKDHS Appendix D-26. Furthermore, changes will clarify that adult members receiving In-Home Supports Waiver (IHSW) services can access individual placement in job coaching, stabilization, and employment training specialist services; however, not to exceed limits specified in OKDHS Appendix D-26 per Plan of Care year. Additional revisions will include updates to standard policy language including cleanup of formatting and grammatical errors plus clarify and update terminology used to reflect current business practices. 

Please view the circulation document here: APA WF# 20-21, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Board Meeting: 03/17/2021 

APA WF# 20-22 Programs of All Inclusive-Care for the Elderly (PACE) Revisions

The proposed revisions will update policy regarding enrollment denials for PACE to reflect current business practices. Additional policy changes will add language to clarify and establish OHCA's role in reviewing justifications for expedited appeals from PACE organizations. These proposed rule changes will align policy with Section 460.122 of Title 42 of the Code of the Federal Regulations.   

Please view the circulation document here: APA WF# 20-22, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-23 Developmental Disabilities Services (DDS) Revisions

The proposed revisions will change the timeframe for the physical health examinations and medical evaluations that are required when applying for the DDS Home and Community-Based Services waiver from ninety (90) to one (1) calendar year. Additionally, revisions will add language for remote services that are provided in the member's home, family home, or employment site. Revisions will also address the new agency companion household criteria and new agency champion provider requirements, as well as modify the procedures for the DDS home profile process. Finally, revisions will establish new criteria on how the member is to obtain assistive technology devices and will clarify instructions to staff whom are providing Stabilization Services authorized through remote supports.

Please view the circulation document here: APA WF# 20-23, and submit feedback via the comment box below.

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-24A ADvantage Waiver

The proposed revisions will align waiver policy with the Oklahoma Health Care Authority's overarching Electronic Visit Verification rules. Additional revisions will involve eliminating or updating outdated policy and correcting grammatical errors.

Please view the circulation document here: APA WF# 20-24A, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-24B ADvantage Waiver

The proposed revisions will align waiver policy with the Oklahoma Health Care Authority's overarching Electronic Visit Verification rules. Additional revisions will involve eliminating or updating outdated policy and correcting grammatical errors. 

Please view the circulation document here: APA WF# 20-24B, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 

APA WF# 20-25 Peer Recovery Support Specialist (PRSS) Services in Indian Health Services, Tribal Programs and Urban Indian Clinics (I/T/Us)

The proposed revisions will add coverage and reimbursement of PRSS services. The proposed revisions will also support WF 20-15A&B in adding coverage and reimbursement of residential substance use disorder (SUD) treatment services. Other revisions will reorganize policy for clarity and correct grammatical errors.

Please view the circulation document here: APA WF# 20-25, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-26 Applied Behavior Analysis (ABA) Services Revisions

The proposed revisions will clarify individualized treatment plan requirements, common ABA-based techniques, medical necessity criteria, and required documentation for ABA treatment extension requests. The proposed revisions will also allow licensed psychologists to render ABA services without additional ABA-related certification requirements. Other revisions will involve limited rewriting aimed at clarifying policy language. 

Please view the circulation document here: APA WF# 20-26, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 

APA WF# 20-27 Specialty Psychiatric Residential Treatment Facility (PRTF) Staffing and Admission Revisions

This rule has previously been approved by the OHCA Board of Directors and the Governor, as an emergency rule. It is currently in effect as an emergency rule.

The proposed revisions will make changes to the specialty Acute II and PRTF staffing ratio and criteria for admission.

Please view the circulation document here: APA WF# 20-27, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-29 Provider Refund to Member when Copayment is Over-Collected

The proposed revisions will state the provider's requirement to refund any copayment collected from the member in error. 

Please view the circulation document here: APA WF# 20-29, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-31 State Treasurer’s Achieving a Better Life Experience (STABLE) Accounts

The proposed revisions further define Aged, Blind, and Disabled (ABD) resource exclusion rules regarding contributions to STABLE accounts.  

Please view the circulation document here: APA WF# 20-31, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-33 Bariatric Surgery Revisions

The proposed revisions will update bariatric surgery requirements and guidelines to reflect current business practice. Additional revisions will involve fixing grammatical and/or formatting errors, as well as, revoking obsolete sections.

Please view the circulation document here: APA WF# 20-33, and submit feedback via the comment box below. 

Circulation Date: 12/15/2020 

Comment Due Date: 01/15/2021  

Public Hearing: 01/19/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-34 Dental Revisions

The proposed rule changes will add "scaling in the presence of a generalized moderate or severe gingival inflammation" as a new procedure to dental policy. Additional revisions will specify that a caries risk assessment form must be documented when submitting a prior authorization for crowns. Further revisions will explain that written consent from a parent or court appointed legal guardian must be provided for any services that are rendered to a minor child. Finally, revisions will clarify billing language for administering nitrous oxide and involve cleanup of formatting and grammatical errors. 

Please view the circulation document here: APA WF# 20-34, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 

APA WF# 20-36A Lodging, Meals, and SoonerRide

The proposed revisions will update the lodging and meals policy by changing the allowed mileage radius from one hundred miles or more to fifty miles or more. This change improves access to the lodging and meals benefit and to medically necessary care. Additional changes will reformat and organize the existing policy in order to provide better clarity on how the approval process works for the lodging and meals benefit. Furthermore, the proposed revisions will update and reformat the SoonerRide Non-Emergency Transportation (NEMT) policy to provide more clarity to providers and members. The proposed revisions will outline the specific services that SoonerRide NEMT offers and how members and long-term care facilities can request transportation assistance through SoonerRide NEMT. The proposed revisions to lodging and meals, as well as SoonerRide, will align policy with current business practices.

Please view the circulation document here: APA WF# 20-36A, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-36B Lodging, Meals, and SoonerRide

The proposed revisions will remove duplicate policy regarding lodging, meals, and SoonerRide non-emergency transportation. The policies regarding these services are already outlined in the Oklahoma Health Care Authority's Chapter 30. 

Please view the circulation document here: APA WF# 20-36B, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 

APA WF# 20-37 Obstetrical (OB) Ultrasound

The proposed revisions will update the OB Ultrasound policy to allow for both an abdominal and vaginal ultrasound to be performed in the first trimester when clinically appropriate and medically necessary.  Policy currently only allows for either an abdominal or vaginal ultra sound.

Please view the circulation document here: APA WF# 20-37, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-38 Clinical Trials

The proposed revisions will add guidelines for coverage of clinical trials medical necessity criteria for coverage of routine care services during a clinical trial, and clarifying that experimental and investigational treatment is not covered. 

Please view the circulation document here: APA WF# 20-38, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 

APA WF# 20-39 Rural Health Clinic (RHC) and Federally Qualified Health Center (FQHC) Policy Revisions

The proposed revisions will align RHC/FQHC policy language with the Oklahoma Medicaid State Plan, federal regulations and OHCA's current business practices. 

Please view the circulation document here: APA WF# 20-39, and submit feedback via the comment box below.  

Circulation Date: 01/19/2021  

Comment Due Date: 02/18/2021   

Public Hearing: 02/23/2021 

Medical Advisory Committee Meeting: 03/11/2021  

Board Meeting: 03/17/2021 

APA WF# 20-40 Medicaid-Funded Abortion Certification Requirements

The proposed revisions will align with 63 Oklahoma Statutes § 1-741.1 and require the Certification for Medicaid Funded Abortion form to be completed by the physician and the patient.

Please view the circulation document here: APA WF# 20-40, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-41 Sunsetting of Behavioral Health Homes

The Health Homes benefit will be phased out effective September 30, 2021; thereby, rendering the associated rule language obsolete. However, other care coordination models will still be in place to still serve this population.

Please view the circulation document here: APA WF# 20-41, and submit feedback via the comment box below. 

Circulation Date: 01/19/2021 

Comment Due Date: 02/18/2021  

Public Hearing: 02/23/2021

Medical Advisory Committee Meeting: 03/11/2021 

Board Meeting: 03/17/2021

APA WF# 20-01 High-Investment Drugs Carve-Out


The proposed revisions will allow for reimbursement of high-investment drug therapies outside of the inpatient and outpatient hospital payment methodologies. Revisions will also align policy with current practice and correct grammatical errors.

Please view the circulation document here: APA WF# 20-01, and submit feedback via the comment box below.

Circulation Date: 01/15/2020

Comment Due Date: 02/14/2020

Medical Advisory Committee: 03/12/2020

Board Meeting: 03/18/2020

OK SPA 21-0009 Rate Revisions for the Specialty, Standard, and Extended Psychiatric Residential Treatment Facilities (PRTFs)

The Oklahoma Mental Health & Substance Abuse (OMHSA) will seek approval of a State Plan Amendment (SPA) to revise rates for PRTFs. The established per diem base rate for standard populations will be restored from $286.08 to $336.57 (the rate prior to the 2016 budget reduction). The established per diem base rate for standard populations will be restored from $271.61 to $319.54 (the rate prior to the 2016 budget reduction). The established per diem base rate for specialty populations will increase from $340.04 to $550.00.  

Please view the draft SPA pages here: OK SPA 21-0009, and submit feedback via the comment box below.  

Tribal Consultation: 01/05/2021 

30-day Tribal Consultation Period: 01/05/2021 – 02/04/2021 

Circulation Date: 12/28/2020  

Comment Due Date: 1/27/2021

OK SPA 21-0013 OMB Rate for Tribal Providers of Residential Substance Use Disorder Services (SUD) in a Non-IMD

The OHCA originally presented policy changes and a state plan amendment request to establish coverage and reimbursement of residential substance use disorder (SUD) treatment services for individuals under the age of 21 and individuals age 21-64 residing in facilities with 16 beds or less in September 2020. At the time of the submission, the State requested reimbursement for all providers at a State-defined per diem rate. However, since submission of OK SPA 20-0035, Residential SUD Services, the State has received further guidance from CMS of options for reimbursement methodologies of residential services to tribal providers. Therefore, the State will seek to reimburse tribal providers an outpatient OMB rate for residential substance use disorder services.

Please view the draft SPA pages here: OK SPA 21-0013, and submit feedback via the comment box below. 

Tribal Consultation Dates: 01/05/2021

30-day Expedited Tribal Consultation Period: 01/05/2021 – 02/04/2021 

Circulation Date: 01/25/2021– 02/04/2021 

Requested Effective Date: 01/01/2021 

OK SPA 21-0016 Adult Inpatient Physician & Surgical Physician Visit Limitation

Oklahoma’s (OK) state plan amendment (SPA) 21-0016 will remove the 24-day per state fiscal year limit for covered inpatient physician and surgical services provided to adult SoonerCare members. The limitation is removed to align with current practice and for the purposes of the alternative benefit plan for adults in the expansion group. 

Please view the draft SPA pages here: OK SPA 21-0016, and submit feedback via the comment box below.  

Tribal Consultation: 01/05/2021  

60-day Tribal Consultation Period: 01/05/2021 – 03/06/2021  

Circulation Date: 01/05/2021   

Comment Due Date: 02/04/2021  

OK SPA 21-0019 Applied Behavior Analysis (ABA) Psychologist Requirements

The proposed revision will allow licensed psychologists to render ABA services without additional ABA-related certification requirements.  

Please view the draft SPA pages here: OK SPA 21-0019, and submit feedback via the comment box below.   

Tribal Consultation: 01/05/2021 

60-day Tribal Consultation Period: 01/05/2021 – 03/06/2021  

Circulation Date: 01/21/2021 

Comment Due Date: 02/20/2021 

Enrollment of Certain Medicaid Members under the Demonstration and Implementation of SoonerSelect Managed Care Model, effective: October 1, 2021, contingent upon CMS approval

With this amendment request, the OHCA seeks approval of the following modifications to the 1115(a) demonstration Special Terms and Conditions (STCs) for the current extension period that will be effect through the end of the waiver demonstration on December 31, 2023: 

• Add the Expansion Adult Group under the Demonstration for the purposes of waiving retroactive eligibility and enrolling the Expansion Adult Group in SoonerSelect, the State’s comprehensive Medicaid managed care model; 
• Add the Former Foster Care Group under the Demonstration for the purpose of enrolling this Group in SoonerSelect; and
• Enroll qualified individuals in SoonerSelect, with a targeted effective enrollment date of October 1, 2021.

The requested amendment does not change the budget neutrality model for current Demonstration populations. 

The OHCA welcomes comments from the public regarding the amendment to the SoonerCare Choice and Insure Oklahoma 1115(a) demonstration waiver program. Please view the waiver amendment in its entirety here: OK Waiver Amendment, Managed Care Organizations(MCO), and submit feedback via the comment box below.  

The public notice for the waiver may be viewed on the Agency’s Policy change and Native American Consultation webpages. The amendment will be available for a 30-day public comment period from January 4, 2021 through February 5, 2021.  

Tribal Consultation Dates: 07/07/2020 

60-day Tribal Consultation Period: 07/07/2020 – 09/05/2020

30-day Circulation Date: 01/04/2021 – 02/05/2021

Requested Effective Date: 10/01/2021

OHCA Comment Response: Oklahoma joins 40 other states in engaging with managed care organizations to assist them in administering certain Medicaid benefits. This is one of the largest contracts procured in the state’s history. The contracts were competitively bid and were selected after a technical evaluation and oral presentations. The four chosen partners will allow the State to improve health outcomes for Oklahomans; move toward value-based payment and away from payment based on volume; improve SoonerCare beneficiary satisfaction; improve access to prevention and treatment services through better care coordination; and increase cost predictability in the State. 

SoonerCare Choice Post Award Forum - The annual Post Award Forum is held to report the progress of Oklahoma’s SoonerCare Choice section 1115(a) Medicaid demonstration project and solicit feedback from the public.  Any comments received will be included in the waiver’s semi-annual and annual reports to CMS.

Please view the most recent annual report here: 2019 SoonerCare Choice Annual Report, and submit feedback via the comment box below. A presentation on the demonstration’s progress will be held at the Medical Advisory Committee (MAC) meeting on March 11, 2021, at 1 PM in the OHCA boardroom at the OHCA offices located at 4345 N. Lincoln Blvd., Oklahoma City, OK 73105.  

Due to the current public health emergency and the associated social distancing guidelines, persons wishing to present their views in writing or obtain copies of the SoonerCare Choice annual report may do so via mail by writing to: Oklahoma Health Care Authority, Federal Authorities Unit, 4345 N. Lincoln Blvd., Oklahoma City, Oklahoma 73105, or by email at federal.authorities@okhca.org. Written comments or requests for copies of the annual report will be accepted by contacting OHCA as indicated. Comments submitted through the OHCA policy blog will be available for review online on the Policy Blog. Other written comments are available upon request at federal.authorities@okhca.org.  

Circulation Date: 12/11/2020 – 03/11/2021

1915(c) HCBS ADvantage Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval

The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the ADvantage Waiver. The goal of the program is to provide services for members ages 21-64 with a physical disability and/or members age 65 and older who are Medicaid eligible and who meet nursing facility level of care to remain at home or in the residential setting of their choosing while receiving the necessary care.  

The waiver renewal updates the unduplicated number of participants and the State's financial estimates for waiver years 1-5. The waiver renewal also allows the contracted Financial Management Services provider (FMS) the option to provide self-directed services via the Electronic Visit Verification system (EVV) in order to comply with federal regulation. Additional service updates include: adding the option to complete medical eligibility assessments through an electronic format (phone, video conference, etc.); updating services and supports provided by a legally responsible individual to reflect current OHCA policy; and removing the self-evaluation tool as means to evaluate the Case Managers Interdisciplinary Team meeting (IDT) facilitation performance. Further updates include escalated issues processes and timelines; how to notify Adult Protective Services of abuse, neglect, and exploitation (a/n/e); OHS fair hearing notification language; references to Oklahoma Administrative Code policies; and revising rates for waiver services to match OHCA rate methodologies. Other changes include general clarification, alignment with state statute, and clean-up throughout the waiver document. 

Please view the renewal application here: 1915(c) HCBS ADvantage Waiver Renewal. 

Please submit all comments by close of business, March 2, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

1915(c) HCBS In-Home Supports Waiver for Children Amendment effective:  upon CMS approval or July 1, 2021, whichever is earlier

The Oklahoma Department of Human Services (OHS) is seeking to amend the In-Home Supports Waiver for Children serving individuals ages 3-17 through a combination of community resources, SoonerCare services such as the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program, and waiver services. OHS/DDS case managers help identify concerns and coordinate, locate, and secure needed services. OHS/DDS case managers also help families recognize natural supports that may already be available.  

The waiver amendment proposes to decrease the unduplicated number of participants for waiver year 5. The amendment adds a telehealth delivery option for Family Training services and the option for electronic signature for service plan developments. Further updates allow for OHS/DDS case management and quality assurance staff the option of monitoring members in their own home via phone calls or video conferencing. Critical event or incident reporting requirements are also updated. 

Please view the waiver amendment here: 1915(c) HCBS In-Home Supports Waiver for Children Amendment, and submit feedback via the comment box below.  

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

1915(c) HCBS In-Home Supports Waiver for Adults Amendment effective: upon CMS approval or July 1, 2021, whichever is earlier

The Oklahoma Department of Human Services (OHS) is seeking to amend the In-Home Supports Waiver for Adults. The purpose of the In-Home Supports Waiver for Adults (IHSW-A) is to assist members in their goal to lead healthy, independent, and productive lives to the fullest extent possible; promote the full exercise of their rights as citizens of their community, state, and country; and promote the integrity and well-being of their families.  

The waiver amendment increases the unduplicated number of participants and updates the participant-directed and quality payment sub-components to the supported employment services for waiver year 5.  The amendment adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as for OHS/DDS case management and quality assurance staff the option of monitoring members in their own home via phone calls or video conferencing. Critical event or incident reporting requirements are also updated. 

Please view the waiver amendment here: 1915(c) HCBS In-Home Supports Waiver for Adults Amendment, and submit feedback via the comment box below. 

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

1915(c) HCBS Homeward Bound Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval

The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the Homeward Bound Waiver. The Homeward Bound waiver is intended to better meet the needs of members representing the Plaintiff Class in Homeward Bound et al v. The Hissom Memorial Center et al, United States District Court, Northern District of Oklahoma, Case No. 85-C-437-e. The Homeward Bound waiver is a self-determined waiver which services include residential and comprehensive supports for class members.  

The waiver renewal will decrease the number of participants served and update the unduplicated number of participants, the State's financial estimates, and add the supported employment service quality payment sub-component for waiver years 1-5. The 12-month period amount for all prevocational services and supported employment services combined will increase. The renewal adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as the option of monitoring members in their own home via phone calls or video conferencing for OHS/DDS case management and quality assurance staff. Critical event or incident reporting requirements are also updated. 

Please view the renewal application here: 1915(c) HCBS Homeward Bound Waiver Renewal, and submit feedback via the comment box below. 

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

1915(c) HCBS Community Waiver Renewal effective: 07/01/2021 through 06/30/2026; contingent upon CMS approval

The Oklahoma Department of Human Services (OHS) is seeking a 5-year renewal of the Community Waiver which serves individuals with intellectual disabilities beginning at age three. Services are provided with the goal of promoting independence through the strengthening of the member’s capacity for self-care and self-sufficiency.  

The waiver renewal will decrease the unduplicated number of participants, reserved capacity, and the State's financial estimates for waiver years 1-5 and increases the 12-month period amount for all prevocational services and supported employment services combined. The renewal adds remote supports services, the provision of habilitation training specialist (HTS) within an acute care hospital, as well as a participant-directed service delivery method and a quality payment option for supported employment services. Additional service updates include increasing the number of members receiving specialized foster care in the home and adding a telehealth delivery option for the following services: speech therapy, physical therapy, occupational therapy, audiology, psychology, nutrition, family training, family counseling, nursing, and dental services. Further updates allow for the option of electronic signature for service plan developments as well as the option of monitoring members in their own home via phone calls or video conferencing for OHS/DDS case management and quality assurance staff. Critical event or incident reporting requirements are also updated. 

Please view the renewal application here: 1915(c) HCBS Community Waiver Renewal, and submit feedback via the comment box below. 

Please submit all comments by close of business, February 24, 2021, via the comment box below. Written comments will also be accepted and can be sent to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers. 

To request a hard copy of the waivers please call 1-888-287-2443 or send your request to the Oklahoma Health Care Authority, 4345 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105. Attention: Health Policy 1915(c) Waivers.

2017-2018 SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver Update  

The Oklahoma Health Care Authority Waiver Development and Reporting unit is seeking comments from the public regarding the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver update to the extension of the Demonstration, 2017-2018. The application requests approval of the waiver in its present form, with the addition of language to specify Medical Residents must be licensed in the State in which they practice.  

Please view the full 2017-2018 SoonerCare Renewal Application here: SoonerCare Renewal Application. Please note, that to view the document attachments please select the paperclip in the renewal document.

The comment period is open from August 26, 2016 until September 26, 2016. Please submit all comments by close of business, September 26, 2016, via the comment box below. The OHCA will respond in writing to any feedback received during the comment period.

The public meetings have been conducted for this waver at the locations mentioned below. Input from meeting participants was summarized and included in proposed extension submission to the Centers for Medicare and Medicaid Services.

1.April 19, 2016 5:00p.m.OPQIC Oklahoma Perinatal Quality Improvement Collaborative Meeting