Ambulatory Surgery Center services. 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. Part A - hospital related premium Part B - physician related premium You may be a SoonerCare Choice member if: SoonerCare (Oklahoma Medicaid) covers many health care services. SoonerCare Choice - Overview - Oklahoma . SoonerCare Choice is a comprehensive medical benefit plan featuring a “medical home” or a Primary Care Provider (PCP) for each member. September 20, 2010. Eligibility. Additionally, the OHCA will provide a prescriptio n drug benefit in accordance with section 1927 of the SSA. This newsletter is for SoonerCare Choice members. Some services are for children only. OHCA Contact: Jo Kilgore, Public Information Manager, (405) 522-7474. You may be a SoonerCare Choice member if: This handbook is designed to do that. SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. Please verify coverage or consult with a SoonerCare or Insure Alternative Benefit Plan template (ABP 5). SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. News Release. Ultrasound benefits * Not covered under SoonerCare CHOICE. Please visit our Qualification Guidelines page to find out if you qualify. It provides medical benefits that supplement those services covered by Medicare. Please visit our Qualification Guidelines page to find out if you qualify. Disclaimer: Clinical, legal and other comments are offered for general To find out what insurance your SoonerCare Choice medical home may take, call your medical home's office. Some of our greatest enhancements have come from members calling or e-mailing their ideas to staff members. OHCA also pays the monthly Medicare Part B premium for SoonerCare members age 65 or older and for certain blind or disabled persons. Insure Oklahoma provides premium assistance to small business employees and individuals. Possible covered services. It provides medical benefits to supplement Medicare Part A, Part … 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. •PCMHs manage the basic health care needs, including after hours care and specialty ref 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 Even if you have benefits in addition to SoonerCare, you are obligated to follow the rules of theprimary policy and SoonerCare. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). •Medical home providers will receive traditional fee for service and incentive payments. If an eligible person has other medical insurance, that insurance company must be billed before SoonerCare is billed. SoonerCare (Oklahoma Medicaid) covers many health care services. Benefits for the mother end upon delivery or at time of miscarriage. What is a Managed Care Plan? Behavioral health and substance abuse services (outpatient) Case management services. 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. f) SoonerPlan: A limited package of family planning benefits. When you have questions, please call the SoonerCare Helpline at 800-987-7767 or 711 (TDD). 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. It will also give you other useful news to help keep you healthy. SoonerCare Supplemental. Chemotherapy … SoonerCare Choice. 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 SoonerCare Supplemental, a plan for people who are covered by Medicare. The current demonstration is approved for the period of August 31, 2018 through December 31, 2023. SoonerCare Traditional, a comprehensive medical benefit plan that purchases benefits for members on a fee-for-service basis. Oklahoma's SoonerCare Choice program offers a managed care delivery system of enhanced primary care case management to qualified populations statewide. We want to help you understand your SoonerCare Choice benefits. If you are experiencing difficulties, please try a different Internet browser (Chrome, Firefox, Edge or Safari). This plan is partially capitated in that primary care physicians/practitioners are paid a capitated rate for a fixed set of services. 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. The SoonerCare CHOICE program is located in the rest of the state. The benefits and coverage outlined here may change. For more information on SoonerCare Choice, you can download a SoonerCare Member Handbook which will provide complete enrollment and coverage details. •All SoonerCare Choice members will establish a patient-centered medical home. SoonerCare Choice is a primary care case management program. •SoonerCare Choice is a managed care model in which each member is linked to a primary care provider who serves as the medical home. 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. 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'. SoonerCare Traditional covers members who are institutionalized, in state or tribal custody or enrolled under a Home and Community-Based Waiver. However, there are limitations that apply to ensure that only... mysoonercare manage my account - Areaknowledge - … Waivers give states flexibility to Like all medical insurance, SoonerCare will pay for most of your medical care. Electronic Health Record Incentive Program, SoonerCare Out-of-State Services Rule Changes. This website is not compatible with Internet Explorer. In SoonerCare CHOICE, you select a Primary Care Provider/Case Manager(PCP/ CM). In some cases though, SoonerCare may not pay for all or any of your medical care. PCPs manage the basic health care needs, including after hours care and specialty referral of the members on their panel. The medical home provider will coordinate all health care services to qualifying Oklahomans. This website is not compatible with Internet Explorer. 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 (. benefits, pharmacy, X-rays, maternity care, durable medical equipment, transplants and non-emergency transportation services. SoonerCare Provider Enrollment Welcome to the online SoonerCare Provider enrollment application. 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. That is why SoonerCare offers coverage for tobacco cessation counseling and tobacco cessation products. SoonerCare also offers several critical but optional benefits to help members maintain or increase their health status and quality of life. In the SoonerCare Choice program every member has a primary care provider whose office is considered their medical home. SoonerCare pays only the deductibles and a portion of the co-insurance when any of the above items are covered by Medicare. 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. Please visit our Qualification Guidelines page to find out if you qualify. Some members also have a provider that is part of a HAN and therefore have access to increased care coordination. SoonerCare (Family Caregiver Support Program) Printer-friendly version. 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. 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. Click here to view proper procedures when visiting the Oklahoma Health Care Authority. Coverage of above benefits is dependent upon meeting requirements provided in accordance with various state and federal regulations. Please check Chapter 30 of the OHCA Rules for the most up to date information. Additional services for children. SoonerCare Helpline (800) 987-7767 (800) 757-5979 (TDD) FAX: (405) 530-3426 www.OKHCA.org. e) SoonerCare: All OHCA medical benefit packages including Traditional, Choice, Insure Oklahoma, SoonerPlan, and Supplemental. SoonerCare Qualification Guidelines (En español) In addition to the citizenship and the state residency requirements, an applicant must meet categorical and financial requirements. Upon transition to the Adult Group, individuals will access services through the full network of SoonerCare- The medical home provider will coordinate all health care services to qualifying Oklahomans. 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