SoonerCare rate cuts planned for Dec. 1

Posted on: 10/4/17

The Oklahoma Health Care Authority (OHCA) has begun the process of reducing provider payment rates to accommodate the $70 million in state funds that were lost from the agency’s SFY18 base appropriation when the smoking cessation fee was ruled unconstitutional.

The OHCA State Plan Amendment Rate Committee (SPARC) has scheduled a public hearing for Thursday, Nov. 2, at 11 a.m., in the OHCA Board Room, to discuss provider rate reductions. Recommendations from the SPARC committee will be presented Nov. 9 to the agency’s board of directors. If approved, the rate reductions will be effective Dec. 1.

Rate changes under consideration include:
  • A 9 percent across-the-board provider rate reduction: The proposed reduction excludes services financed through appropriations to other state agencies, services provided under a waiver, and services where a reduction could severely limit access or not cover costs (in the aggregate). While this list of exclusions is fairly comprehensive, it is not exhaustive.
    • Complex Rehabilitation Technology Provider Services
    • Long-term care facilities
    • Child abuse exams
    • Non-emergency transportation
    • Insure Oklahoma
    • Payments for drug ingredients/physician supplied drugs
    • Services provided under a waiver
    • Services paid for by other state agencies
    • Services provided to Native Americans through Indian Health Services/Indian/Tribal/Urban Clinics
    • Private Duty Nursing
    • Emergency Transportation
    • FQHCs/RHCs
    • Choice Care Coordination
  • Nursing home Medicare Part A and B cross-over claims reduction: Current rate methodology pays 20 percent of Medicare Part A coinsurance and deductible and 75 percent of Medicare Part B coinsurance and deductible on crossover claims to nursing homes. The proposed rate methodology is to pay nothing towards Medicare Part A and B coinsurance and deductible on crossover claims to nursing homes.
  • Long-term care facilities rate reduction: The OHCA is proposing a 4 percent reduction to all Institutional Long-Term Care provider rates. 

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