Medicaid managed care update

Posted on: 9/14/16

The Oklahoma Health Care Authority (OHCA) met with stakeholders Tuesday, Sept. 13, on new developments in its managed care program under development for aged, blind, and disabled SoonerCare (Medicaid) members. This program will be known as SoonerHealth+.

OHCA is finalizing its model contract for managed care plans, and expects to submit it to the Centers for Medicare & Medicaid Services (CMS) for approval within a few days. OHCA is also developing requirements for the proposals to be submitted by managed care plans, and is working with its rate consultant, Mercer, to develop the actuarially sound capitation rates (per member, per month) that OHCA proposes to pay the plans.

OHCA announced at the meeting that the managed care plans will not be submitting rate proposals for the contracts. Instead, OHCA will set the rates, and will evaluate and select plans based on their access, quality, and patient- and family-centered care coordination. With the request for proposals (RFP), OHCA will publish the predetermined rates, historical cost and utilization data, and information on how the rates were set.

OHCA will accept proposals for east and west Oklahoma service areas. The east area will be anchored by Tulsa, and the west area by Oklahoma City. Areas will be defined by counties. OHCA has not yet finalized the county boundaries for these areas. Plans will propose to serve either service area, or both.

The timeline for SoonerHealth+ anticipates issuing the RFP in November or December, with plan proposals due in February or March, 2017. Contracts will be awarded in late spring.  Enrollment would begin in January 2018, and services would start in April 2018.

Most SoonerCare members with intellectual and developmental disabilities (I/DD) will be added to SoonerHealth+ in the second year of the program, to allow more time for planning and transitional activities. These participants in any of three waiver programs are already receiving home and community-based services. The I/DD members receiving “state plan only” services will be added to SoonerHealth+ at its inception, so that they may benefit from its care coordination.

Presentation slides from the Sept. 13 meeting will be added to OHCA’s SoonerHealth+ page(Rick Snyder)

OHA Partners with Qualivis 

Qualivis was developed as a collaborative effort among multiple state hospital associations to meet the temporary staffing needs of member hospitals and health systems.

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