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APA WF # 22-15 Removing Provider Panel Limits in the Patient Centered Medical Home (PCMH)

The proposed revisions will remove member caps for Physicians, Advanced Practice Registered Nurses (APRN), and Physician Assistants (PA) participating in SoonerCare Choice PCMH. Currently, policy only allows 2,500 members for each physician, 1,250 members for each APRN, and 1,250 members for each PA. The proposed revisions will remove the member caps, which will increase members’ access to care. The aforementioned changes will align policy with the redesign of the PCMH model.

Please view the circulation document here: APA WF # 22-15 and submit feedback via the comment box below.

Circulation Date: 06/27/2022

Comment Due Date: 07/14/2022

Medical Advisory Committee (MAC) Meeting: 07/14/2022

Board Meeting: 09/21/2022


Comments

Cindy Bacon:

I think this is a good idea and would support this change.


Rose Sloat:

This would be a great change. Access to care is a large issue and this would help tremendously.


Stephen Merrill:

The proposed rule is overdue and if implemented, will increase the efficiency of the OHCA.  It would also enhance the members' access to care.  I support the change.


Steven Goldman:

There are some concerns. How will the success of this change be measured and reported? When will OHCA report results?

While this proposal may increase the theoretical "total capacity" of the program.....will the needed increases come in the rural areas already at 80%+ of capacity, or just in the urban areas?

If a provider takes on 30% more members, will they also open 30% more appt slots for SoonerCare members? Or will there be a longer waiting period for members to get an appt? "Member access to care" may not be improved if there's a longer wait for appts.

Looking ahead to Managed Care.....in the previous RFP, each MCO could "cap" themselves and tell OHCA not to enroll more members in that MCO.....will that be true in the upcoming RFP?

Thank you.

OHCA Response:

Thank you for your comment. The Oklahoma Health Care Authority (OHCA) takes every single comment under advisement.

The OHCA will run reports to identify any providers who increase their panel size beyond 2500 and will identify those results when a substantial increase is seen for providers who have panel capacities above 2500.

It is not a requirement that a provider increase their panel capacity because of the rule change; this is a removal of a limit for those providers who may wish to increase beyond 2500. There is no mandate that providers must increase their panel sizes. The OHCA is simply empowering providers to determine what limits they need. If they wish to increase their panel size, above the 2500, they will be doing so voluntarily.

Regarding appointments and availability, the requirements to have appointments available for SoonerCare members do not change with this policy revision. Regardless of size of panel, providers are required to offer appointments at minimum, 20 or 30 hours per week depending on Tier Level and hours of operation may not be less than those offered to commercial members or traditional SoonerCare members if the provider serves only SoonerCare members. 

For future information about the OHCA's new delivery reform model, please continue to check the OHCA public website for future townhall meetings.

 


Last Modified on Jul 18, 2022