A five percent increase was approved for most SoonerCare or Oklahoma Medicaid providers at the Oklahoma Health Care Authority (OHCA) Board meeting on Aug. 21.
The actual rate increase goes into effect Oct. 1 only if it receives approval from Center for Medicare & Medicaid Services (CMS). The rate increase is mandated by Senate Bill 1044.
Kevin Corbett, OHCA CEO, said the goal is to pay providers competitive rates for services for SoonerCare members.
“The rate increase mandated by SB1044 will help us sustain and continue to build our network of providers across the state,” Corbett said. “A strong provider network ultimately benefits our SoonerCare members by improving access to care.”
Under SB 1044, rate increases will cover “services financed through appropriations to other state agencies; Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS); non-emergency transportation capitation payments; services provided to Insure Oklahoma (IO) members; payments for drug ingredients/physician supplied drugs; Indian Health Services/Tribal/Urban Clinics (I/T/U); Federally Qualified Health Centers (FQHCs); and Rural Health Centers (RHCs).”
Statistics show that if and when the five percent rate increase goes into effect, SoonerCare physician rates, for the first time since mid-2014, will surpass 90 percent at a total of 93.63 percent of the Medicare physician fee schedule. The 2014 drop back came from “state budget reductions resulted in a 7.75 percent reduction to rates, dropping them to 89.25 percent of Medicare.”
Studies show the rate increase for the final portion of state fiscal year 2020 will provide an “estimated” budget impact of $62.8 million, “of which $21.3 million is state share.” In the first full year of the rate increase, state fiscal year 2021, brings in an estimated total of $85.65 million, “of which $28.3 million is state share.”