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