Why Must Oklahoma Medicaid Providers Take Part in the HIE?
This week marks the one-year anniversary of mental health professionals from across Oklahoma gathering at the State Capitol to protest the requirement to take part in the Health Information Exchange. The Oklahoma State Health Information Exchange, otherwise known as OKSHINE, is a database that maintains electronic medical records that are accessible by participating healthcare providers. The legislation that created Oklahoma’s HIE initially required all healthcare providers who are located or licensed in Oklahoma connect to the HIE and provide access to client records. Mental health professionals advocated against the requirement for mental healthcare and substance abuse treatment records to be included in the exchange due to the potential sensitive information documented in progress notes, as well as the expected $5,000 cost to connect their records to the MyHealth Access Network, the non-profit contracted with the State of Oklahoma to manage the HIE. In June, OHCA announced that providers would be eligible to register for an exemption from participation in OKSHINE.
According to the OHCA emergency rules for OKSHINE, “All providers that register an exemption shall be granted such exemption and shall not be subject to pay subscription fees and/or connection fees.” As the law currently stands, unless a provider has been granted an exemption, they are required to report data to the HIE. However, as of last week the Oklahoma House of Representatives passed House Bill 3556, which, if signed into law, would update the language of the HIE law by replacing “shall” with “may” and allow provider participation in the HIE to be optional. Also according to OHCA, there is currently “no penalty” for providers who do not participate in the HIE. Though providers may be granted exemptions from participation and there is currently no sanction for failure to comply with the mandate to connect to the state HIE, many mental health therapists may still be required to take part due to the state’s new managed care initiative.
SoonerSelect Health, Oklahoma’s managed care program, is set to launch in April of this year. Through SoonerSelect Health, OCHA has contracted with three insurance companies, Aetna Better Health, Humana Healthy Horizons, and Oklahoma Complete Health, to provide Medicaid health care benefits. Providers must contract with each designated insurance company providing a SoonerSelect insurance plan to their clients. According to an OHCA Question and Answer Webinar on the HIE, “Medicaid Managed Care Organizations will require all contracted providers to be participants in the HIE in good standing” and that there may be “significant contractual implications to non-participation.” Therefore, even if HB 3556 is passed into law, Oklahoma mental healthcare providers may still be required to participate in OKSHINE if they provide Medicaid services.
The Oklahoma Counseling Institute Staff reached out to Shay Espinosa, LPC, an administrator of the Facebook page Oklahoma Providers for Privacy and organizer of grassroots initiatives against the HIE mandate, for comment on the requirement. Her practice, Integrated Therapy Solutions of Oklahoma, is an Oklahoma Medicaid provider. According to Ms. Espinosa,
“I can see both sides of the HIE when it comes to managed care. In a perfect world, it would be used with good intentions to reduce spending and costs (in healthy ways that don’t harm clients). Unfortunately, we’re not in a perfect world - we’re in Oklahoma.
I do not think simply because a client is below the poverty line and cannot afford cash pay for protection of their information is fair. I hate that already marginalized people and families may be forced to participate or not seek care because they do not feel safe.
As a provider, being torn between stopping acceptance of Medicaid because we disagree with the HIE has been difficult.
We have chosen to continue to accept Medicaid, and instead focus on training our clinicians on writing notes that protect and honor our clients while still meeting documentation requirements. We have amazing providers and our Medicaid clients deserve to continue to receive the best of the best.”
According to the Oklahoma SoonerSelect Quality Strategy report, OHCA has required that all contracted entities (CEs), including Aetna Better Health, Humana Healthy Horizons, and Oklahoma Complete Health, take part in the HIE. According to the September 2023 final report, “As required by OHCA, the CEs will participate in the State Designated Entity for Health Information Exchange (SDE-HIE) for submission of encounter data and exchange of clinical information.” Therefore, though each CE requires providers to participate in the HIE, it appears as though the mandate may originate from OHCA. It is unclear if an exemption provided by OHCA would exempt SoonerSelect providers from participating in the HIE. For more information on OKSHINE, the HIE, or SoonerSelect, contact the Oklahoma Healthcare Authority.
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