OK SPA 21-0031 Adult Expansion Alternative Benefit Plan (ABP) Service Delivery System Update

The Oklahoma Health Care Authority (OHCA) seeks to add the current Primary Care Case Management (PCCM) service delivery system, the Patient Centered Medical Home (PCMH), to the Adult Expansion Alternative Benefit Plan (ABP). As part of the SoonerCare Choice coordinated care delivery system, all new Expansion Adult members will select a PCMH for primary care and care coordination. Additionally, Expansion Adult members will be eligible to receive Health Management Program (HMP) and Heath Access Network (HAN) support based on their health status and coordinated care needs. Benefits will be reimbursed through the State’s fee-for-service (FFS) methodology and providers will be eligible to receive a per member per month (PMPM) care coordination payment. Expansion adults will be a mandatorily enrolled population, other than during a period of presumptive eligibility. American Indian/Alaskan Native (AI/AN) members will be a voluntary PCCM enrollment population that may choose not to opt-in to the service delivery system. The Agency intends to submit the SPA to the Centers for Medicare & Medicaid Services (CMS) on or after July 1, 2021.

Please view the draft SPA pages here: OK SPA 21-0031 and submit feedback via the comment box below.

14-Day Tribal Consultation Period: 06/16/2021 – 06/30/2021 

Circulation Date: 06/16/2021  

Comment Due Date: 06/30/2021

Tribal Consultation: 07/06/2021