ADvantage Administration Unit Update: Rates Reduction
Jan. 15, 2010
The Oklahoma Health Care Authority (OHCA) Board considered the following item at their Jan. 14, 2010 OHCA Board Meeting. This is a step the OHCA is taking to balance their SFY 10 Budget. From their posted agenda:
Action Item – Consideration and Vote to revise State Fiscal Year 2010 OHCA Budget Work Program to achieve a balanced budget a) Consideration and Vote to reduce total expenditures by review and revision of provider rates to be effective April 1, 2010. Rate reductions are to be in an amount sufficient to balance the State Fiscal Year 2010 OHCA budget, accommodating reduced allocation of general revenue for December 2009 and January 2010 as instructed by the Office of State Finance. Rate reductions are to be applied across-the-board to all provider types to the extent possible and in accordance with applicable Medicaid requirement
The across the board rate reductions are scheduled to be effective April 1, 2010. By approving this item, OHCA staff will be instructed to take the necessary steps by law to change rates. This includes rates and standards meetings and public comments and then approval of each reduction by the OHCA Board in March. With the large and varied providers and rates, it would take until April to complete the steps necessary to reduce the rates.
The percentage amount by which each rate will be reduced is not known by OKDHS at this time. We anticipate the rate cut to be between 2.5 percent and 4 percent. We believe that the same percentage reduction will be applied to all services but we do not have confirmation of that yet.
What we currently understand is that waiver services’ rates are scheduled to be included if the rate for that service is based on a rate for the service under the Medicaid state plan. For example, personal care is a state plan service and its rate will receive the percentage cut. Since the rate paid for ADvantage personal care is the same as state plan personal care, it would also be subject to the reduction. However, it is our understanding that ADvantage case management is not based on a state plan service rate so it would not be reduced.
We are reviewing the ADvantage rates and how they were established to estimate which rates might be subject to the reduction. It is likely that some but not all ADvantage rates will be subject to the reduction.
This process has just begun and there are many unknowns at this point. It is our intent to work with the OHCA to minimize any adverse impact to the ADvantage Program members as well as those receiving state plan personal care. As OKDHS learns more detail, we will keep all of our stakeholders up to date.
Question regarding this request should be directed to Provider Questions.
Thank you for your assistance.