SoonerCare Tobacco Cessation Benefit Research indicates that no other clinical intervention can reduce illness, prevent death, or increase quality of life more effectively than tobacco cessation. Individuals enrolled in the IO IP plan access covered services through IO-participating providers. When you have questions, please call the SoonerCare Helpline at 800-987-7767 or 711 (TDD). However, there are limitations that apply to ensure that only medically necessary services are provided. SoonerCare Choice is Oklahoma’s statewide managed care model in which each member is linked to a primary care provider who serves as their 'medical home'. e) SoonerCare: All OHCA medical benefit packages including Traditional, Choice, Insure Oklahoma, SoonerPlan, and Supplemental. Since the inception of the SoonerCare … If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). g) Supplemental: A SoonerCare plan that provides medical benefits to supplement those services covered by Medicare (sometimes called “crossover”). SoonerCare Supplemental, a plan for people who are covered by Medicare. SoonerCare Choice is a program run by the Oklahoma Health Care Authority (OHCA). OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law. Like all medical insurance, SoonerCare will pay for most of your medical care. It will tell you about any changes or updates to your SoonerCare benefits. This newsletter is for SoonerCare Choice members. If an eligible person has other medical insurance, that insurance company must be billed before SoonerCare is billed. SoonerCare Choice - Overview - Oklahoma . Hearing aids; Immunizations; Incontinence Supplies for certain children ages 4-20; Incontinence Supplies (Spanish) Inpatient hospital services for patients in institutions for mental disease; Optometric or optical services, including eyeglasses; Orthodontics Waivers give states flexibility to Coverage of above benefits is dependent upon meeting requirements provided in accordance with various state and federal regulations. SoonerCare Supplemental is a plan that may help pay for Medicare cost sharing requirements if you meet low income and limited resources requirements. News Release. f) SoonerPlan: A limited package of family planning benefits. 2) Increase ITU PCMH care coordination payments to match the Arizona model for ITU medical ho mes throughout the approved demonstration period as follows: Oklahoma SoonerCare Choice SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. OHCA Contact: Jo Kilgore, Public Information Manager, (405) 522-7474. You may be a SoonerCare Choice member if: This data is treated as confidential and is stored securely in accordance with applicable law and regulations. benefits, pharmacy, X-rays, maternity care, durable medical equipment, transplants and non-emergency transportation services. 2020 SoonerCare and Insure Oklahoma Income Guidelines SoonerCare Children and Soon-To-Be-Sooners (STBS) may qualify for SoonerCare Services* if their tax household's Modified Adjusted Gross Income* (MAGI) is within the following guidelines. The medical home provider will coordinate all health care services to qualifying Oklahomans. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). Benefits for the mother end upon delivery or at time of miscarriage. All covered benefits must be medically necessary. Keep up with your SoonerCare benefits online Family planning Spring is for the birds M is for Medical Home The Oklahoma Health Care Authority appreciates ideas and thoughts from families who receive services through SoonerCare Choice. SoonerCare (Oklahoma Medicaid) covers many health care services. We want to help you understand your SoonerCare Choice benefits. Even if you have benefits in addition to SoonerCare, you are obligated to follow the rules of theprimary policy and SoonerCare. Upon transition to the Adult Group, individuals will access services through the full network of SoonerCare- This website is not compatible with Internet Explorer. You do not reside in an institution such as a nursing facility; You are not receiving SoonerCare services through a home- and community-based waiver program; You are not in a health maintenance organization. PCPs manage the basic health care needs, including after hours care and specialty referral of the members on their panel. You may be a SoonerCare Choice member if: The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Eligibility. All other insurances must be used before SoonerCare pays. Disclaimer: Clinical, legal and other comments are offered for general SoonerCare Supplemental. Click here to view proper procedures when visiting the Oklahoma Health Care Authority. Please check Chapter 30 of the OHCA Rules for the most up to date information. That is why SoonerCare offers coverage for tobacco cessation counseling and tobacco cessation products. In some cases though, SoonerCare may not pay for all or any of your medical care. It provides medical benefits to supplement Medicare Part A, Part … SoonerCare Qualification Guidelines (En español) In addition to the citizenship and the state residency requirements, an applicant must meet categorical and financial requirements. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. However, if you have specific questions about your health, please talk to your doctor. SoonerCare (Oklahoma Medicaid) covers many health care services. Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes. Ultrasound benefits * Not covered under SoonerCare CHOICE. You may be a SoonerCare Choice member if: Additionally, the OHCA will provide a prescriptio n drug benefit in accordance with section 1927 of the SSA. In exchange for this service, each PCP is prepaid a fixed monthly capitated payment for care … SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. Please visit our Qualification Guidelines page to find out if you qualify. In the SoonerCare Choice program every member has a primary care provider whose office is considered their medical home. To find out what insurance your SoonerCare Choice medical home may take, call your medical home's office. The medical home provider will coordinate all health care services to qualifying Oklahomans. Additional services for children. Part A - hospital related premium Part B - physician related premium In some cases though, SoonerCare may not pay for all or any of your medical care. SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. SoonerCare also offers several critical but optional benefits to help members maintain or increase their health status and quality of life. The current demonstration is approved for the period of August 31, 2018 through December 31, 2023. SoonerCare Supplemental is a plan that may help pay for Medicare cost sharing requirements if you have low income and limited resources. •Medical home providers will receive traditional fee for service and incentive payments. The SoonerCare CHOICE program is located in the rest of the state. For more information on SoonerCare Choice, you can download a SoonerCare Member Handbook which will provide complete enrollment and coverage details. What is a Managed Care Plan? Please visit our Qualification Guidelines page to find out if you qualify. Oklahoma's SoonerCare Choice program offers a managed care delivery system of enhanced primary care case management to qualified populations statewide. Alternative Benefit Plan template (ABP 5). This website is not compatible with Internet Explorer. However, there are limitations that apply to ensure that only... mysoonercare manage my account - Areaknowledge - … SoonerCare Traditional, a comprehensive medical benefit plan that purchases benefits for members on a fee-for-service basis. The SoonerCare Choice benefits plan does provide the enhanced benefit of unlimited physician visits (as medically necessary) as compared to the State plan which limits physician services to four visits per month, including specialty visits. The covered benefits list provided is not all-inclusive. The benefits and coverage outlined here may change. Chemotherapy … This handbook is designed to do that. When you have questions, please call the SoonerCare Helpline at 800-987-7767 or 711 (TDD). SoonerCare Choice. •SoonerCare Choice is a managed care model in which each member is linked to a primary care provider who serves as the medical home. •All SoonerCare Choice members will establish a patient-centered medical home. SoonerCare will pay for most of your medical care. It will also give you other useful news to help keep you healthy. The medical home provider will coordinate all health care services to qualifying Oklahomans. Possible covered services. SoonerCare Provider Enrollment Welcome to the online SoonerCare Provider enrollment application. SoonerCare pays only the deductibles and a portion of the co-insurance when any of the above items are covered by Medicare. Some services are for children only. SoonerCare Helpline (800) 987-7767 (800) 757-5979 (TDD) FAX: (405) 530-3426 www.OKHCA.org. Please verify coverage or consult with a SoonerCare or Insure Some of our greatest enhancements have come from members calling or e-mailing their ideas to staff members. Some members also have a provider that is part of a HAN and therefore have access to increased care coordination. Your Primary Care Provider Both SoonerCare packages have health care providers called Primary Care Providers (PCPs) to take care of you and/ or your family’s basic health care needs. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law. SoonerCare Choice is a comprehensive medical benefit plan featuring a “medical home” or a Primary Care Provider (PCP) for each member. The following programs may provide additional services or more restrictions to the services covered above for enrollees. SoonerCare Traditional covers members who are institutionalized, in state or tribal custody or enrolled under a Home and Community-Based Waiver. Health care coverage for pregnant and postpartum women eligible for SoonerCare Coverage for the pregnant woman limited to pregnancy-related health care services for the benefit of the baby. The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. Insure Oklahoma provides premium assistance to small business employees and individuals. OHCA also pays the monthly Medicare Part B premium for SoonerCare members age 65 or older and for certain blind or disabled persons. This plan is partially capitated in that primary care physicians/practitioners are paid a capitated rate for a fixed set of services. It provides medical benefits that supplement those services covered by Medicare. •PCMHs manage the basic health care needs, including after hours care and specialty ref Behavioral health and substance abuse services (outpatient) Case management services. Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes, Comparison Chart of SoonerCare Benefits and Co-pay Amounts, Cost Sharing/Out-of-Pocket Cost Exemptions, Behavioral health and substance abuse services, Mental Health and Substance Abuse Services, Prenatal, delivery and postpartum services (maternity services), Incontinence Supplies for certain children ages 4-20, Clinic services including renal dialysis services, Dentures for adults residing in nursing facilities, Federally Qualified Health Center (FQHC) services, Inpatient hospital services in an institution for mental disease for people who are 65 years of age or older *, Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID) *, Medical supplies and equipment, including diabetic supplies, Transportation to obtain covered medical care (, Inpatient hospital services for patients in institutions for mental disease, Optometric or optical services, including eyeglasses, Speech, hearing and language disorder services, Breast and Cervical Cancer Treatment Services (, Home and community-based services authorized under a waiver (. In SoonerCare CHOICE, you select a Primary Care Provider/Case Manager(PCP/ CM). SoonerCare (Family Caregiver Support Program) Printer-friendly version. The Oklahoma Health Care Authority Board Retreat … Wednesday, December 16: You may experience intermittent connectivity to the Oklahoma Health Care Authority website between 4 p.m. and 10 p.m. We apologize for any inconvenience this may cause. Ambulance. SoonerCare is a collection of Oklahoma health care benefit packages including Traditional (Fee-For-Service Medicaid), Choice (Medical Home), Insure Oklahoma, Supplemental (Medicare Crossover), SoonerPlan (Family Planning) and others. Ambulatory Surgery Center services. September 20, 2010. Your PCP/CM may be a physician, a Please visit our Qualification Guidelines page to find out if you qualify. Oklahoma's SoonerCare Choice demonstration program utilizes an enhanced primary care case management delivery system to serve qualified populations statewide. 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