Update on the Medicaid Nursing Facility Upper Payment Limit (UPL) program

Posted on: 9/7/16


This week the Oklahoma Health Care Authority (OHCA) gave an update to and got feedback from representatives of the OHA, the Oklahoma Association of Health Care Providers (OAHCP), and LeadingAge Oklahoma.

OHCA has submitted to CMS the question about Oklahoma (Title 60) public trusts’ ability to make intergovernmental transfers (IGTs) to OHCA. This program can only be funded by IGTs, so it will be limited to non-state government owned nursing homes. No feedback on this question has yet been received from CMS.

OHCA has engaged Myers & Stauffer as their technical consultant for the nursing facility UPL program, and the agency held an all-day kick-off meeting with their consultant last week. Myers & Stauffer serves many state Medicaid agencies, and is OHCA’s auditor for their Disproportionate Share Hospital (DSH) program. The implementation work plan is drafted but not yet finalized. A Data Use Agreement allowing Myers & Stauffer access to the Minimum Data Set (MDS) of SoonerCare residents of participating facilities has been submitted to CMS for approval. Myers & Stauffer is creating a secure website/portal for participating facilities with information, forms, and the communication of amounts and calculations.

OHCA plans to submit the State Plan Amendment authorizing this program to CMS in October or November. Once approved, the program will be effective retroactively to Oct. 1, 2016. No funds will be exchanged until CMS has approved the program.

Agency rules for the program will be posted this week on OHCA’s Proposed Policy Changes page. The rules will be reviewed by OHCA’s Medical Advisory Committee on Sept. 15, and approved by their board on Oct. 13.

OHCA, OAHCP, and the Oklahoma State Department of Health have been working on improvements in the Certificate of Need process for nursing facilities, and have involved Novitas in improvements in the Change of Ownership approval process. OHCA is studying issues related to facilities’ starting date in this program following a change in ownership and new SoonerCare provider contract. Generally, the plan is for new participants in the program to enter quarterly, but OHCA has been asked to allow monthly entry during the startup period of this program.

OHCA is working on education and communication for eligible facilities.  (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.