Home Health RCD: Oklahoma Transition to Cycle 2

As the Review Choice Demonstration (RCD) for home health agencies (HHA) in Oklahoma continues, the time for Cycle 2 is approaching.

If an HHA's full affirmation rate or claim approval rate is 90 percent or greater for the previous six-month period, the provider may choose one of the subsequent review options:

• Choice 1: Start or continue participating in pre-claim review (PCR) for another cycle
• Choice 3: Selective postpayment review of a statistically valid random sample (SVRS) of claims every six months for the remainder of the demonstration
• Choice 4: Spot Check Review of five percent of claims every six months to ensure continued compliance

Note: If an HHA is eligible for a subsequent review option but does not make a selection during the selection period, the HHA will be placed in Choice 3.

If an HHA’s full affirmation rate is less than 90 percent for the previous six-month period, it may choose one of the initial review options:

• Choice 1: Start or continue participating in PCR for another cycle
• Choice 2: 100 percent postpayment review

With the announcement of the extension of the demonstration, Choice 3: Minimal postpayment review with 25 percent payment reduction has been removed as an option. This makes Selective Postpayment Choice 3 and Spot Check Choice 4 moving forward. Providers in Choice 3 Minimal Review at the time of the announcement are to be contacted by Palmetto GBA representatives to move to another selection. 

Note: If an HHA is eligible for an initial review option, but does not make a selection during the selection period, the HHA will be placed in Choice 2.

For those options that are evaluated every six months, the claims or PCR requests reviewed during the cycle will determine the provider’s results. Providers will continue in their selected option during the calculation and selection period. The affirmation rate calculation period occurs during the month of June 2024, with result letters being sent to HHAs by the end of June 2024. The selection period for Cycle 2 will take place from July 1, 2024, through July 14, 2024. HHAs that do not make a selection during that time period will default to either Choice 2 or Choice 3 as noted earlier in this article.

Transition Timeline

As providers transition from Cycle 1 to Cycle 2, please be advised of the actions required when changing from one choice to another. Also note that:

• Any claim with a date of service on or after 12/01/2023 is subject to the RCD program in Oklahoma
   
• If your selection changes, remember that the date of submission determines which RCD selection applies to your claims, not the dates of service