SoonerCare rule changes proposed

Posted on: 12/19/18

The Oklahoma Health Care Authority (OHCA) posted a set of proposed rules for the SoonerCare (Medicaid) program on Dec. 17. Comments are invited on these proposals through Jan. 16, 2019.

APA WF# 18-06 would establish a prior authorization requirement for inpatient psychiatric services for adults. Revisions will also align the time requirement of the first individual treatment by the physician to the requirement of completion of the psychiatric evaluation. Some language cleanup is also included.

APA WF# 18-10 would amend the Oklahoma EHR Incentive Program policy by changing policy regarding the required SoonerCare patient volume criteria and about documentation to support or correct the provider’s EHR attestation.

The comment period is closed now for APA WF # 18-08, which proposed to terminate eligibility of members when mail is returned with address unknown. This proposal was said to expedite compliance with the Act to Restore Hope, Opportunity and Prosperity to Everyone (HOPE Act), House Bill 1270 in 2018, which requires OHCA to contract with one or more independent vendors to verify member eligibility.

These and other current rule proposals are found under the “Policy Change Blog” at the bottom of the page.  (Rick Snyder)

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