1115(a) Demonstration Waiver Supplemental Payment Amendment

Pursuant to 42 CFR § 431.408, the Oklahoma Health Care Authority (OHCA) is providing public notice of its plan to submit an amendment to the existing approved 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.

The proposed amendment would add supplemental payments to qualified entities for residency training and loan repayment programs in recognition of the higher cost associated with service delivery and physician recruitment and training to maintain sufficient access to quality preventive, primary and specialty healthcare for SoonerCare members.

It is the intent of the Oklahoma Health Care Authority to submit the amendment no later than January 19, 2018 with an effective date on or after March 1, 2018.  The total estimated annual budget impact is one hundred and five million dollars ($105,000,000) of which the estimated state share is forty-three million, five hundred one thousand, five hundred dollars ($43,501,500) which is funded by participating entities.

A public meeting will be held at the following location:

January 18, 2018 at 1:00 p.m.
Medical Advisory Committee             
Ed McFall Boardroom 
Oklahoma Health Care Authority 
4345 N. Lincoln Blvd, Oklahoma City, OK.  

Additionally, a special tribal consultation was held January 12, 2018 at 3:00 p.m. at the above location.

Please view the waiver amendment in its entirety here: 1115 Supplemental Payment Amendment

The OHCA welcomes comments from the public regarding the amendment to the SoonerCare Choice and Insure Oklahoma 1115(a) Demonstration Waiver program. The application waiver will be posted online at the OHCA Public Webpage from January 15, 2018 through January 19, 2018. 

Comments and questions may be submitted online at the Policy Change Blog and the Native American Consultation Page or by contacting Bill Garrison, OHCA Federal & State Reporting Coordinator by telephone at 405-522-7914.

Please view additional documents here:

  1.  Budget Neutrality for 1115 Waiver Amendment
  2.  Budget Neutrality for 1115 Waiver Amendment Worksheet
  3.  Waiver Projects Currently Undergoing Application or Amendment

 




Comments

Order:

Anonymous
Oklahoma has such a primary care and mental health physician shortage that these schools are necessary to not only provide future physicians but also to provide care in their clinics to the most vulnerable patients in Oklahoma. Without the OU and OSU physician networks SoonerCare patients and those without insurance would have no where to go except for the local hospital ERs. This program will provide the access to care that is needed for these patients.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/17

Anonymous
OSU and OU provide services to medicaid patients that no other groups provide. Whether it be specialty care or rural doctors, without OSU and OU some patients may have no where to go.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/17

Anonymous
Resident physicians and medical students from OU and OSU take care of patients across the state. This program allows them to continue to reach across the state to provide care to Medicaid patients and those without insurance. Since we are a state that did not expand medicaid we have higher number of uninsured unlike some other states.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/17

Rick Snyder, OHA
The Oklahoma Hospital Association fully supports the proposed amendment to the existing approved 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.
Hospitals are deeply concerned about Medicaid funding for resident training programs in the state. Oklahoma is in the midst of a physician shortage, and experiencing health care access issues in many rural areas. Stable, well-funded physician training programs are essential in addressing these issues, and will play a vital role in improving the health of Oklahomans.
The proposed waiver program will ensure SoonerCare members’ continued access to comprehensive primary and specialty care in academic settings, and the maintenance and retention of Oklahoma-trained providers to serve SoonerCare members for years to come.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/17

Anonymous
OU Physicians and OSU Physicians networks provide a great service in their teaching clinics and at their teaching hospitals (OU Medical Center and OSU Medical Center). Without their clinics and hospitals several patients, including Medicaid patients, would lose access to primary and specialty care physicians. A lot of the Oklahoma Medicaid provider infrastructure is based around OU and OSU.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/17

Zack Stoycoff
Oklahoma continues to suffer from a trained physician shortage, which decreases the quality of available health care and lowers the overall health of our residents. The best way to reverse that physician shortage is to train physicians locally, especially since physicians are much more likely to stay and practice near where they are trained. The business community has long maintained that local programs like the Oklahoma State University Center for Health Sciences and the University of Oklahoma Health Sciences Center are essential to address our physician shortage. Our state already ranks 45th for physicians per capita, and we cannot afford to slip any further. The shortage we experience today is only going to grow in the years ahead. Statewide, we need to train more physicians – not less – each year just to keep from falling even further behind other states in the provision of health care to our residents.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/17

Emily Shipley, State Chamber of Oklahoma
We are writing to support the 1115(a) amendment adding supplemental funding for residency training and loan repayment programs.
The State Chamber is concerned about access to Medicaid services in certain parts of the state if this amendment is not approved as drafted. The Oklahoma State University College of Osteopathic Medicine (OSU) and the University of Oklahoma’s College of Medicine (OU) represent one-third of SoonerCare providers and the loss of that capacity would overburden the entire Oklahoma health care system, rendering it unable to provide appropriate levels of care.
With 1 in 4 Oklahomans on Medicaid, we are aware that our health care infrastructure is dependent on the Medicaid program and its reimbursements. In addition to our concerns about access to care, the business community is focused on maintaining a strong health care system in the state, as it often serves as an economic development tool. Without a strong system and a quality provider, businesses will not relocate to the state and existing businesses could suffer.
As you would expect, our businesses rely on higher education institutions in Oklahoma to prepare and train our workforce both in health care and other industries. Oklahoma’s two primary medical institutions have a proven track record of producing skilled and prepared physicians for rural and urban communities across the state. Medicaid beneficiaries are positively served by the providers these institutions produce.
Without this supplemental funding, Oklahoma’s medical education pipeline and access to care will be negatively impacted in years to come. We appreciate your commitment to working with the state’s medical schools to resolve this matter.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/17

Anonymous
The services that the state universities (OU and OSU) provide through their physician networks and training clinics is necessary for the SoonerCare program to continue to survive.
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/18

Charles L Spicer, Jr. FACHE
As CEO of the OU Medical System, I am writing in support of the Oklahoma Health Care Authority’s amendment to the 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.
OU Medical Center and The Children’s Hospital count on this funding for physician training and the services they provide to the state’s most needy and vulnerable patients. Without this waiver, programs will be in jeopardy and access to care, particularly for specialty services, will be unnecessarily threatened.
We respectfully ask the Centers for Medicare and Medicaid to approve this waiver amendment. This program has demonstrated success and has served a critical role in improving access to care for the past 20 years. Thank you for your time and support of the people of Oklahoma.
Sincerely,
Charles L. Spicer
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/18

Terry Taylor, President
The Oklahoma Health Center Foundation is writing in support of the OHCA amendment to the 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.
Because of this waiver, physicians affiliated with the University of Oklahoma and Oklahoma State University have been able to provide much-needed health care to the state’s most needy and vulnerable patient populations. Without this waiver, these medical services would be jeopardized and many citizens’ access to primary and specialty care would be unnecessarily threatened, particularly in rural Oklahoma and other underserved communities.
For the past 20 years, this waiver has played a critical role in Oklahoma’s comprehensive efforts to improve the overall health of its people. For over 50 years, the Oklahoma Health Center Foundation has supported the vital mission of healthcare for the citizens of our state, and we respectfully ask the Centers for Medicare and Medicaid Services give this request your utmost consideration and approve the waiver amendment in the interest of Oklahoma public health.
Sincerely,
Terry W. Taylor
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/18

Kenneth E. Calabrese, DO
On behalf of more than 2,000 osteopathic physicians and students, the Oklahoma Osteopathic Association would like to express its support of the OHCA’s 1115(a) extension waiver.
The proposed waiver amendment regarding supplemental payments for residency training programs and physician loan repayment would continue support for crucial access points to the SoonerCare population. Due to unique structures in Oklahoma, the ability for the payments to help offset the indirect expenses associated with residency programs and graduate medical education is critical. Without them, Oklahoma’s healthcare delivery infrastructure would be greatly diminished. The federal government’s investment in these programs ensures access to care for the underserved while improving health outcomes by undergirding the physician workforce. We appreciate your commitment to a sustainable resolution for our patients.
Kenneth E. Calabrese, DO
President, Oklahoma Osteopathic Association
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/18

Rodd Moesel
Oklahoma Farm Bureau’s mission is to improve the lives of rural Oklahomans. As such, we strongly support the state’s pursuance of a supplemental payment for Oklahoma’s medical schools. As president of the state’s largest farm organization with some 90,000 member families, I can say our members value any effort to improve health care and access to health care, especially in rural parts of Oklahoma. The proposed 1115(a) waiver amendment regarding supplemental payments for residency training programs and physician loan repayment would continue support for crucial access points to the SoonerCare population.
It’s critical that Oklahoma have the funds to help offset the indirect expenses associated with residency programs and graduate medical education. Without them, Oklahoma’s healthcare delivery infrastructure is greatly diminished. The importance of this funding is enhanced by Oklahoma State University’s priority in rural health care and investment in their rural residency programs. The federal government’s investment in these programs is well placed due to the positive long-term effects on the physician workforce, especially in rural areas.
The survival and prosperity of families and businesses in rural Oklahoma depend on accessible quality health care. OKFB represents farmers and ranchers in every county in Oklahoma with operations of all sizes who grow and raise crops and livestock in literally all segments of agriculture and our members have voted policy from the grassroots level to support these efforts to train more physicians and to recruit more doctors and critical health care to rural Oklahoma.
Thank you for your consideration in this matter.
Rodd Moesel
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/18

Kevin Taubman, MD
On behalf of the Oklahoma State Medical Association’s nearly 4,000 physician and medical student members, I am writing in support of the OHCA amendment to the 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.
Thanks in part to this waiver, state physicians with OU and OSU have been able to provide valuable health care to our state’s most vulnerable and at-risk patients. If this waiver is not renewed, medical services for thousands of at-risk Oklahomans will be placed in jeopardy.
This waiver is vital to Oklahoma’s efforts to protect access to care and improve the health of its citizens. We respectfully request that the Centers for Medicare and Medicaid Services act quickly to approve the waiver and promote public health in Oklahoma.
Sincerely,
Kevin Taubman, MD
President, Oklahoma State Medical Association
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/19

Derek Sparks, Greater Oklahoma City Chamber
On behalf of the Greater Oklahoma City Chamber of Commerce, we are voicing our support for the OHCA amendment to the 2018 Section 1115(a) extension waiver for the SoonerCare Choice and Insure Oklahoma programs.
Over the last two decades, this waiver has made it possible for physicians affiliated with the University of Oklahoma and Oklahoma State University to provide much-needed, lifesaving health care to our most needy and vulnerable patient populations. These critical medical services would be jeopardized without this waiver and many citizens’ access to primary and specialty care would be unnecessarily threatened, particularly in rural Oklahoma and other underserved communities, including the Oklahoma City metro area.
With the support of this waiver, OU and OSU doctors also train future physicians in a clinical setting, preparing them for service in other communities across the state. This training and mentorship are essential for Oklahoma to address its statewide physician shortage and ensure that its people have adequate health care services.
With those factors in mind, we respectfully ask the Centers for Medicare and Medicaid Services to approve the waiver amendment in the interest of Oklahoma public health.
Thank you for your time and consideration.
Sincerely,
Derek Sparks
Government Relations Manager
Greater Oklahoma City Chamber
OHCA Staff Reply
Thank you for your feedback. OHCA considers all input seriously and will take your comments under advisement.
1/19


Name (optional)


Email (optional)


Comment


 



Please note that all comments must be reviewed and approved prior to posting. Approved comments will be posted Monday through Friday between the hours of 7:30 a.m. – 4 p.m. Any comments received after 4 p.m. will be posted on the following business day.