Health policy waiver updates
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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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Health policy waiver updates

Health Policy & Waiver Updates

Native American Tribal ConsultationOctober 12, 2011Tywanda M. Cox, Policy Director


Family planning changes

Family Planning Changes

  • Effective August 31, 2011-Family Planning covered benefit under the State Plan

  • State Plan vs. Waiver


Family planning changes cont

Family Planning Changes (Cont.)

  • Additional services under the State Plan

    • Coverage of Gardasil

    • Essure

    • Implanon

    • SoonerRide

    • TPL

  • Cooperation with Child Support Enforcement


Tribal consultation

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)


Tribal consultation cont

Tribal Consultation (Cont.)

  • Online Proposed Changes

    www.okhca.org ITU Public Notices


Targeted case management tcm

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


Tcm reimbursement

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


Tcm reimbursement cont

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


Tcm reimbursement cont1

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


Tcm rate process

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


Health policy contact information

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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