| Medicaid Rule Change in Oklahoma |
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Alert: Proposed Change in Medicaid Rules in Oklahoma This message is to alert you to a proposed Oklahoma Medicaid regulatory change that could significantly impact your hospital. Below is an outline of the proposed change and actions you can take to voice your concerns about the proposed rule change. What is the rule? OAC 317:35-6-60, certification for SoonerCare Medicaid programs affected? Pregnant Women and Families with Children (SoonerCare) Current rule? Medicaid applications for Pregnant Women and Families with Children may be approved for medical services provided on or after the first day of the month of application. Proposed rule? Medicaid applications for Pregnant Women and Families with Children will not be retroactive, and “…may be certified for a medical service on or after the first day of certification. The period of certification may not be for a retroactive period.” Impact to Oklahoma hospitals? If a patient is not currently enrolled in Medicaid (they present as self-pay), your current hospital stay for this population of patients (SoonerCare) will not be covered by Medicaid. What can you do? Submit comments to the Oklahoma Hospital Association and the Oklahoma Health Care Authority. OHCA is accepting written and oral comment through February 15th, and a public hearing on this regulation will be held on February 17th. (Contact information is below). Additional Information: We have been consulting with Rick Snyder, VP of Finance and Information Services, at the Oklahoma Hospital Association (OHA). OHA has had discussions with the Oklahoma Health Care Authority (OHCA) regarding the impact of this rule on hospitals. The information we received from the Oklahoma Hospital Association is as follows: 1. OHA and OHCA have discussed allowing a hospital’s form 08MA005E, Notification of Needed Medical Services, be retroactive 5 days. (This form is an electronic version of the MSMA5). This would only allow 5 days retroactivity for hospitals, not other providers. 2. Once form 08MA005E is filed, it is treated as an application for Medicaid, and the patient will have 10 days to complete the application process. OHCA is considering extending the time frame from 10 days to 15 days to complete the application process. 3. OHCA is considering an exception process that would allow hospitals to call provider services to ask for exceptions to either initiate the application or to extend the application process. This would have to be done on a case by case basis. 4. At this time, it is unclear as to whether these processes would be included in the new regulation, or whether it will merely be stated in OHCA policy. If these processes discussed between OHA and OHCA are not in the regulation, they are not enforceable. How can you voice your concerns? We are urging medical providers to contact both the OHA and OHCA to voice your concerns about the proposed change to OAC 317:35-6-60. Since patients do not have access to the necessary information and verifications to complete applications while they are in the hospital, it is our opinion that Form 08MA005E should be retroactive 30 days, and that patients should be given 30 days to complete the application process once Form 08MA005E is submitted. The contact information for the Oklahoma Hospital Association (OHA) is: The contact information for the Oklahoma Health Care Authority (OHCA) is: If you have any questions regarding this memo, please contact: |