OHCA considers service and rate reductions

Posted on: 9/28/17

The Oklahoma Health Care Authority (OHCA) Board on Sep. 27 discussed contingency plans for dealing with potential appropriation cuts. OHCA CFO Carrie Evans said the plans are evolving and provided the current version to the Board.

Rate reductions, across the board with few exceptions, would cut spending about $9.7 million for each one percent reduction in rates. Of this, $4.0 million is state funded, and $5.7 million is from federal matching.  If nursing home payment rates are excluded from the cuts, savings would be about $7.7 million for each one percent reduction, made up of $3.2 million state and $4.5 million federal matching.

The agency may eliminate its payments for Medicare coinsurance and deductibles for Medicare/Medicaid dual eligible members. Currently, OHCA pays hospitals 75 percent of deductibles and 25 percent of coinsurance amounts not paid by Medicare. This would reduce payments to hospitals by about $19.2 million in the second half of the state fiscal year. A similar reduction for nursing home deductibles and coinsurance would save about $3.5 million.

OHCA expects to be able to absorb reductions of about $14.6 million this fiscal year because of the availability of one-time savings.

OHCA will make program changes to four services without waiting for any funding reduction:

Patient-centered medical home (PCMH) payments: OHCA pays a monthly care coordination payment to primary care physicians (PCPs) for each SoonerCare Choice member linked to the PCP. Starting Jan. 1, 2018, OHCA will base these monthly payments on the number of linked SoonerCare Choice members who have had a visit with their PCP within the previous 15 months. Care coordination payments for new members linked to the practice would not begin until after the first visit. OHCA projects this will reduce payments by about $4.8 million for the second half of the state fiscal year.

Cystic fibrosis screening: OHCA will limit coverage of cystic fibrosis transmembrane conductance regulator (CFTR) testing. This is not the routine cystic fibrosis screening that all newborns receive. For more information, see Provider Letter 2017-30.

Adult dental extractions: OHCA proposes to limit adult dental services to emergency extractions, rather than medically necessary extractions.

Member date specific end dates: End date member eligibility based on a 12-day rule instead of the end of the month. Excludes aged, blind, disabled, long term care, and Insure Oklahoma members.

Other than these four specific program changes, OHCA will wait and see if spending reductions are required as a result of Oklahoma’s special legislative session.

The summary of potential budget reductions provided to the Board on Sep. 27 may be found here. (Rick Snyder)