SoonerCare proposes outpatient testing limits

Posted on: 2/15/19


The Oklahoma Health Care Authority has proposed a rule limiting expenditures for outpatient diagnostic testing, laboratory, and radiological services for most adults in the SoonerCare (Medicaid) program to $500 per year.

The rule allows for “extensions” of the $500 limit when medically necessary. The extension procedures do not apply to individuals under 21 years of age, or in hospital emergency rooms.  Extension procedures do not apply to magnetic resonance imaging (MRI), magnetic resonance angiography (MR), positron emission tomography (PET) scans, cardiac catheterization procedures, pregnancy-related services, and several other categories of outpatient care.

Some diagnoses are considered to be categorically medically necessary and do not require review for medical necessity. These are malignancies, human immune-deficiency virus (HIV), acquired immunodeficiency syndrome (AIDS) and end-stage renal failure.  All other diagnoses are subject to review before benefits can be extended.

The rule is posted for public comment through March 9, 2019. To review the rule, and to comment, click here, and select “OK SPA 19-05 Limitation of Outpatient Laboratory, X-Ray, and Select Machine Testing Services for Adults.” (Rick Snyder)

Save the dates for OHA 2022 events

Posted on: 2/18/22


It’s a new year and a new lineup of important events for you and your staff. Don’t miss out on these opportunities to engage in advocacy, education and networking all year long. Mark your calendar now!

OHA Advocacy Day - Tuesday, April 5, Oklahoma History Center. Join us for our annual legislative day. We will begin with a member briefing at 3 p.m., followed by a legislative reception at 5 p.m. Watch for registration materials soon.

OHA-PAC Golf Tournament - Tuesday, June 21, Jimmie Austin Golf Club at OU, Norman. Time and details TBA.

OHA Health Care Leaders Forum - Tuesday, July 19 - Thursday, July 21, Shangri-La Resort, Grand Lake. Watch for registration soon!

OHA Connect 22 - Wednesday, Nov. 9 - Friday, Nov. 11, Oklahoma City Convention Center and Omni Hotel, downtown Oklahoma City. Plan now to attend OHA’s annual conference and exhibit hall. More details to come.

Details on these events and other upcoming education opportunities will be available on the OHA website.