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New policies affect SoonerCare services

Members of SoonerCare will now find it a little more difficult to seek specialty medical care outside the state of Oklahoma due to new policies set to take effect Sept. 1, according to a presentation at Comanche County Memorial Hospital recently.

Representatives from the Oklahoma Health Care Authority were at the hospital recently to discuss changes to rules relating to out-of-state specialty services and new rules regarding residency verification.

“We believe these changes will maintain and strengthen SoonerCare members’ access to quality care as well as control our program costs,” said Dr. Mike Herndon, OHCA Chief Medical Officer, in a prior press release. “We also want to ensure Oklahomans are using our excellent Oklahoma providers and specialists when possible.”

During the presentation, Herndon outlined several significant changes to SoonerCare that will impact members. One of the most significant changes is that single-case agreements and contracts will no longer be allowed.

In 2019 the Oklahoma legislature passed HB 2341, which expressly limited SoonerCare members’ services to in-state providers when possible, Herndon said. He also said that federal law limits reimbursement for services, which limits the contract rates that SoonerCare can offer.

The changes will also limit self-referrals by SoonerCare members to out-of-state providers. Members will now be required to run any requests for out-of-state services through a SoonerCare contracted provider, Herndon said. Failure to get prior approval from SoonerCare may result in a member being responsible for medical costs.

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