Policy Update 3/29/22

By Cassidy Heit posted 03-29-2022 13:07


Managed Care Bill Moves to House

SB 1337, which would direct the Oklahoma Health Care Authority (OHCA) to transition to a third-party managed care system advanced off the Senate floor Wednesday afternoon.The bill directs OHCA  to enter into contracts with managed care organizations (MCOs), accountable care organizations (ACOs), or provider-led net organizations that will assume financial risk, operational accountability, and statewide or regional responsibility for the delivery of capitated care. It requires OHCA to issue requests for proposals no later than January 1, 2023 for Medicaid services as well as with dental benefits managers. It requires the proposed services to cover pregnant women, children, deemed newborns, parents and caretakers, and the expanded population for the Medicaid services.

Pharmacy Management Bill Passes OK Senate

SB 1860, sponsored by Sen. Greg McCortney, R-Ada, was approved by the Oklahoma State Senate last week. Its author stated Tuesday that the bill is an attempt to strengthen the right of Oklahomans to use the pharmacy of their choice. McCortney was the Senate sponsor of the 2019 Patient’s Right to Pharmacy Choice Act, which was signed into law by Governor Stitt.

SoonerCare Provider Town Hall

The Oklahoma Health Care Authority would like your feedback on the Comprehensive Quality Strategy, which aims to make health care services better for your patients and community. The town hall will be held at the Renaissance Tulsa Hotel and Convention Center on Thursday, April 14 from 8 AM to 4 PM (lunch provided). Discussion topics include social determinants of health, decreasing obesity, decreasing smoking, and teen pregnancy. Click here to register to attend.

COVID-19 Supplemental Funding Status Unclear

The FY22 omnibus appropriations package signed into law this month did not include $15.6 billion in COVID-19 supplemental funding, though the House wants to vote on a separate COVID-19 supplemental funding bill that would provide funding to reimburse medical providers for COVID-19 testing, treatment, and vaccines for the uninsured. According to the White House, if the bill does not pass, the Administration will have no more funding for federal COVID-19 supplies and treatment resources. As a result, free COVID treatments like monoclonal antibodies will become more expensive, and two antiviral drugs authorized to treat COVID under emergency use will be unavailable commercially. Democrats and Republicans are still debating how to offset the supplemental funding, which Republicans indicate must happen for legislation to move forward. The National Association of Community Health Centers (NACHC) elevated the importance of this funding for health centers in a letter to the leaders of the House and Senate Appropriations Committees.

HRSA Administrator Gives Update on COVID Uninsured Programs

Due to a lack of additional COVID funding from Congress, HRSA’s COVID-19 Uninsured Program stopped accepting claims for testing and treatment on March 22, 2022. Last week, HRSA Administrator Carole Johnson told stakeholders that claims that have been submitted by these deadlines will be paid subject to eligibility and availability of funds. The Uninsured Program and the COVID-19 Coverage Assistance Fund will also stop accepting vaccination claims due to a lack of additional COVID funding from Congress on April 5, 2022 at 10:59 PM CT.

CMS Vaccine Mandate Enters Full Enforcement Phase

Health care providers in “Group Two” states (which includes Oklahoma) are expected to be in full compliance with the CMS COVID-19 vaccine mandate. For health centers, full compliance means that:
  • Appropriate Policies and Procedures have been developed and implemented.
  • 100% of “staff” (meaning all persons to whom the vaccine mandate applies, which includes volunteers, board members, etc.) have either:
    • Completed their “vaccine series” (meaning 2 Pfizer or Moderna, or one J&J); note that while boosters are strongly encouraged, they are NOT required.
    • Been approved for an exemption or delay.
For more information on the CMS vaccine mandate in general, see the 1/14/22 CMS guidance and the CMS vaccine mandate toolkit.

OHCA Asks Providers to Help Prepare for End of PHE

The Oklahoma Health Care Authority (OHCA) is encouraging SoonerCare beneficiaries to log into their accounts online to update information to avoid losing coverage when the public health emergency (PHE) expires.

During the PHE, Medicaid agencies have not been allowed to terminate coverage, but since PHE has been in effect, over 175,000 members have outstanding document requests. To help with those outstanding requests and avoid termination or a lapse in coverage, OHCA is encouraging members to:
  • ensure their login and password work.
    • If not, access account using a PIN.
    • If PIN is lost, call now for PIN reset. 
  • login to their accounts and update:
    • email addresses.
    • phone number.
    • income information.
    • address.
    • household information.
    • SSNs for babies born in the last 2 years.
    • any missing or outdated information.  
SoonerCare is also asking providers to help by updating patients' case information, renewing cases now instead of waiting for the renewal date, and encouraging members to access their online account. Some members may not have touched their case for 3-6 years due to passive renewal and PHE. This will help members avoid calling in at the same time and having a long wait period for PIN Reset. Their PIN number can also be found on the top right corner of any “DET letter.”