'The program is not ready': Oklahoma provider raises concerns with SoonerSelect
OKLAHOMA CITY (KFOR) – An Oklahoma provider told News 4 she's concerned the new SoonerSelect program isn't ready to serve a major portion of Oklahoma.
The change impacts about 80 percent of the more than one million Oklahomans enrolled in the state's Medicaid program.
The Oklahoma Health Care Authority (OHCA) said three contracted entities were selected to provide privatized health care options for Oklahomans:
OHCA told News 4 Oklahoma Complete Health will also work for the children’s specialty program, which covers all Medicaid services, besides dental, for current and former foster care children, kids involved in juvenile justice and kids receiving adoption assistance.
The three entities are using specific strategies to help achieve various goals:
- Incentivizing and encouraging primary care.
- Reducing unnecessary emergency room visits by investing in early, preventive treatment.
- Expanding the primary care provider and specialist networks.
All health plans will have the same health care services offered by SoonerCare, including medically necessary prescriptions, health services and behavioral health services. Every plan also provides extra value-added benefits to enhance health outcomes for members:
- Monetary incentives for attending well-child and annual primary care visits.
- Enhanced vision services for adults such as eye exams and funds for contacts or eyeglasses.
- Home-based asthma interventions such as deep cleaning carpet and hypoallergenic bedding.
- Nutrition support including meals or money to address food insecurity.
- Healthy weight incentives including memberships to local community organizations and gyms.
- Legal assistance, including criminal record expungement.
"Our issue as providers is the program is not ready," said Shay Espinosa, a licensed counselor at Integrated Therapy Solutions of Oklahoma.
She penned the open letter below expressing her frustrations to OHCA, the contracted companies, news media and others:
In the letter, Espinosa outlined a major concern surrounding Aetna which, as of Thursday morning, didn't have a provider manual posted on its website.
"It tells us everything that we're going to need to do, how we will submit claims, what's going to be required for claims," said Espinosa.
News 4 reached out to Aetna and OHCA for clarification on when the manual would be posted to give providers enough time to review it before April 1.
News 4 never heard back from Aetna, but received the following statement from OHCA:
The Aetna Better Health’s SoonerSelect provider manual has been in development to ensure providers have the information they need. The manual has undergone thorough review by OHCA and Aetna and is now available.
OHCA has been working with providers and all three of the SoonerSelect contracted entities for several months to ensure a smooth transition knowing providers and members may have questions. OHCA's top priority is actively engaging with the CEs to guarantee our providers and members receive the support they need and know there is a 90-day continuity of care period to ensure all providers are compensated for their services during this transition phase.
OHCA is confident SoonerSelect is ready to launch on April 1 and [is] excited for Oklahomans to have access to expanded and improved services.
Oklahoma Health Care Authority
"We go live on Monday and we're all expected to still be business as usual," said Espinosa. "If this fails, the amount of money it will cost to clean it up will take years."
Some other providers News 4 spoke with Thursday disagreed with Espinosa that the program isn't ready to launch.
"We feel very confident that the end product is going to be something that Oklahomans can all be proud of," said Dr. Jesse Campbell with Mercy Hospital. "This plan for the first time in a long time for our Medicaid population allows us to put that patient in the middle of the care, which is where they deserve to be."
Espinosa said she doesn't disagree that privatized health care could benefit the state in the long run, but believes this specific plan needs more time before it's rolled out after last minute.
"I think it can be great for Oklahoma if we do it right," said Espinosa. "We're asking as providers, we would like to see a 90 day delay."