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Health Policy & Waiver Updates

Health Policy & Waiver Updates. Native American Tribal Consultation October 12, 2011 Tywanda M. Cox, Policy Director. Family Planning Changes. Effective August 31, 2011-Family Planning covered benefit under the State Plan State Plan vs. Waiver. Family Planning Changes (Cont.).

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Health Policy & Waiver Updates

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  1. Health Policy & Waiver Updates Native American Tribal ConsultationOctober 12, 2011Tywanda M. Cox, Policy Director

  2. Family Planning Changes • Effective August 31, 2011-Family Planning covered benefit under the State Plan • State Plan vs. Waiver

  3. Family Planning Changes (Cont.) • Additional services under the State Plan • Coverage of Gardasil • Essure • Implanon • SoonerRide • TPL • Cooperation with Child Support Enforcement

  4. Tribal Consultation • Conducted three (3) Face to Face Meetings • Forty (48) Participants • 19 Tribal & IHS Organizations represented • Consultation and Input • Proposed State Plan Changes Fourteen (14) • Proposed Rule Changes Six (6) • Proposed Waiver Changes Three (3)

  5. Tribal Consultation (Cont.) • Online Proposed Changes www.okhca.org ITU Public Notices

  6. Targeted Case Management (TCM) • Comprehensive assessment and periodic reassessment of individual needs • Development (and periodic revision) of a specific care plan • Referral and related activities • Monitoring and follow-up activities

  7. TCM Reimbursement • Targeted Case Management is reimbursed using a prospective flat rate • The rates are based on an average of direct, general and administrative and information technology costs

  8. TCM Reimbursement (Cont.) • Direct costs include those items necessary for the provision of the service such as: • Salaries • Benefits • travel costs • phone • training • professional clinical consultation

  9. TCM Reimbursement (Cont.) • Providers must provide OHCA their costs associated with providing TCM to eligible populations in order to calculate a rate • This can be achieved in several ways • Historical claims data • Approved cost allocation plans • Random Moments Time Study

  10. TCM Rate Process • Rate methodology established • Rate methodology presented to the State Plan Amendment Rate Committee (SPARC) • If approved by SPARC, presented to OHCA Board of Directors (Board) • If approved by the Board, submitted to CMS amendment to the State Plan

  11. Health PolicyContact Information • Tywanda Cox-Health Policy Director-405-522-7153 • Traylor Rains-Policy Coordinator-405-522-7202 • Melinda Jones-Waiver Administration Director (1915-C)-405-522-7125 • Kimrey McGinnis-Waiver Coordinator (1115) 405-522-7652 • Lathonya Shivers-Program Administration Director 405-522-7507

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