SoonerCare 9 percent rate cut moves forward

Posted on: 11/9/17

The Oklahoma Health Care Authority (OHCA) board will meet today to finalize a 9 percent across-the-board decrease to payment rates for most providers, effective Dec. 1. OHCA must cut expenditures because the special session of the Legislature has not replaced funding lost when the $1.50 per pack cigarette “fee” was ruled unconstitutional by the Oklahoma Supreme Court.

On Nov. 2, OHCA’s State Plan Amendment Rate Committee (SPARC) approved cuts for recommendation to the OHCA board. This step is required by the federal Medicaid program. OHA’s Rick Snyder, along with representatives of nursing homes and other providers, spoke against the rate cuts at the SPARC meeting. But OHCA has no other options for cuts of this size. The specific recommendations to the OHCA board are:
  • A 9 percent rate cut for nearly all provider services other than long-term care, private-duty nursing, and a few other services;
  • A 4 percent rate cut for services provided by nursing facilities, intermediate care facilities for individuals with intellectual disabilities, and nursing facilities for individuals with Acquired Immune Deficiency Syndrome (AIDS); and
  • Elimination of the Medicare Part A and Part B coinsurance and deductible on crossover claims to nursing facilities.
Through separate processes for the same funding crisis, the Oklahoma Department of Mental Health and Substance Abuse Services has announced the end of psychiatric residential care, including residential services provided by hospitals, and of nearly all outpatient behavioral health services. The Department of Human Services will end its Advantage waiver program of in-home supports for seniors, along with other in-home and adult day services. (Rick Snyder)

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