OK
Oklahoma House Bill HB2807

Oklahoma 2022 Regular Session

Oklahoma House Bill HB2807 Compare Versions

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2828 STATE OF OKLAHOMA
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3030 1st Session of the 58th Legislature (2021)
3131
3232 HOUSE BILL 2807 By: Sneed
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3838 AS INTRODUCED
3939
4040 An Act relating to insurance; creating the Oklahoma
4141 Out-of-Network Surprise Billing and Transparency Act;
4242 providing for applicability; defining ter ms;
4343 requiring policies to reference certain rates;
4444 providing for certain baseline charges; limiting rate
4545 increases; authorizing the Attorney General to bring
4646 a civil action for certain required usual, customary,
4747 and reasonable reimbursement rates; authoriz ing the
4848 Attorney General to bring a civil action for surprise
4949 billing prohibition; providing for emergency services
5050 provided by an out-of-network provider; providing for
5151 emergency services provided at an out -of-network
5252 facility; providing for nonemergency services
5353 provided by an out-of-network provider at an in -
5454 network facility; providing for nonemergency services
5555 provided by an out-of-network provider at an out -of-
5656 network facility; requiring the Insurance
5757 Commissioner to select an organization to maintain a
5858 benchmarking database; providing for availability of
5959 arbitration; requiring participation for certain
6060 cases; providing time limitation for requesting
6161 arbitration in certain cases; requiring written
6262 notice; directing the Insurance Commissioner to
6363 promulgate rules for submitting multiple claims to
6464 arbitration; limiting issues arbitrator may address;
6565 providing for basis for determination; prohibiting
6666 civil action until conclusion of arbitration;
6767 exempting arbitration from the Uniform Arbitration
6868 Act; providing for selection and approval of
6969 arbitrators; providing for arbitration procedures;
7070 providing for arbitrator decision; requiring written
7171 notice; providing fo r court review of arbitrator
7272 decision; providing for bad faith in arbitration;
7373 providing penalties; directing the Insurance
7474 Commissioner and the Oklahoma Board of Medical
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101101 Licensure and Supervision to adopt certain rules;
102102 requiring Insurance Department and Oklahoma Board of
103103 Medical Licensure and Supervision to maintain certain
104104 information; requiring the Insurance Department to
105105 conduct biennium study; requiring written report to
106106 Legislature; requiring written notice of benefits and
107107 billing prohibitions; amending 12 O.S. 2011, Section
108108 1854, which relates to the Uniform Arbitration Act;
109109 providing an exceptio n; providing for codification;
110110 and providing an effective date.
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114114
115115 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
116116 SECTION 1. NEW LAW A new section of law to be codified
117117 in the Oklahoma Statutes as Section 6060.60 of Title 36 , unless
118118 there is created a duplication in numbering, reads as follows:
119119 Sections 1 through 21 of this act shall be known and may be
120120 cited as the "Oklahoma Out -of-Network Surprise Billing and
121121 Transparency Act".
122122 SECTION 2. NEW LAW A n ew section of law to be codified
123123 in the Oklahoma Statutes as Section 6060.61 of Title 36, unless
124124 there is created a duplication in numbering, reads as follows:
125125 The Oklahoma Out-of-Network Surprise Billing and Transparency
126126 Act shall apply to all state -regulated health benefit plans except:
127127 1. HealthChoice health benefit plans administered by the
128128 Oklahoma Office of Management and Enterprise Services;
129129 2. Medicaid;
130130 3. Medicare; and
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157157 4. The Employee Retirement Income Security Act of 1974 health
158158 benefit plans.
159159 SECTION 3. NEW LAW A new section of law to be codified
160160 in the Oklahoma Statutes as Section 6060.62 of Title 36, unless
161161 there is created a duplication in numbering, reads as follows:
162162 As used in the Oklahoma Out -of-Network Surprise Billing and
163163 Transparency Act:
164164 1. "Arbitration" means a process in which an impartial
165165 arbitrator issues a binding determination in a dispute between a
166166 health benefit plan issuer or administrator and an out -of-network
167167 provider and/or facility or the provider or facility's
168168 representative to settle a health benefit claim;
169169 2. "Geozip" means an area that includes all zip codes with
170170 identical first three digits;
171171 3. "Surprise billing" means the practice by a health care
172172 provider or facility who does not, or is un able to, participate in
173173 an enrollee's health benefit plan network, and charges an enrollee
174174 the difference between the provider's or facility's fee and the sum
175175 of what the enrollee's health benefit plan pays and what the
176176 enrollee is required to pay in appli cable deductibles, copayments,
177177 coinsurance or other cost -sharing amounts required by the health
178178 benefit plan; and
179179 4. "Usual, customary, and reasonable rate" or "UCR rate" means
180180 the eightieth percentile of all charges for the particular health
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207207 care service performed by a health care provider in the same or
208208 similar specialty and provided in the same geographical area as
209209 reported in an independent benchmarking database maintained by a
210210 nonprofit organization specified by the Insurance Commissioner;
211211 provided, the nonprofit organization shall not be financially
212212 affiliated with an insurance carrier or health care provider.
213213 SECTION 4. NEW LAW A new section of law to be codified
214214 in the Oklahoma Statutes as Section 6060.63 of Title 36, unless
215215 there is created a duplication in numbering, reads as follows:
216216 All health insurance benefit policies must reference the usual,
217217 customary, and reasonable rate for the purpose of providing an
218218 enrollee with reimbursement transparency for out -of-network health
219219 care providers and facilities. The charges for services reflected
220220 by the Current Procedural Terminology code as reflected in the
221221 eightieth percentile of charge data supplied by an independent
222222 benchmarking database on November 1, 2021 , shall constitute th e
223223 baseline for provider or facility charges. Beginning November 1,
224224 2021, provider or facility charges may change anytime the charge
225225 data supplied by an independent benchmarking database changes, but
226226 may not increase at a rate greater than the Consumer Pri ce Index.
227227 SECTION 5. NEW LAW A new section of law to be codified
228228 in the Oklahoma Statutes as Section 6060.64 of Title 36, unless
229229 there is created a duplication in numbering, reads as follows:
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256256 If a health benefit plan issuer or admin istrator has restricted
257257 or prohibited a health care provider or health care facility from
258258 billing an insured, participant or enrollee for applicable
259259 copayment, coinsurance, and deductible amounts required under the
260260 Oklahoma Out-of-Network Surprise Billing and Transparency Act, the
261261 Attorney General may bring a civil action in the name of the state
262262 to ensure the health care provider, health care facility or
263263 administrator may bill an enrollee the applicable copayment,
264264 coinsurance, and deductible amounts. If t he Attorney General
265265 prevails in an action brought against a health benefit plan issuer
266266 or administrator, the Attorney General may recover reasonable
267267 attorney fees, costs and expenses, including court costs and witness
268268 fees incurred in bringing the action.
269269 SECTION 6. NEW LAW A new section of law to be codified
270270 in the Oklahoma Statutes as Section 6060.65 of Title 36, unless
271271 there is created a duplication in numbering, reads as follows:
272272 If a health care provider, health care facility or administrator
273273 has billed an enrollee an amount greater than the applicable
274274 copayment, coinsurance, and deductible amount s required under the
275275 Oklahoma Out-of-Network Surprise Billing and Transparency Act, the
276276 Attorney General may bring a civil action in th e name of the state
277277 to ensure the enrollee is not responsible for an amount greater than
278278 the applicable copayment, coinsurance, and deductible amounts. If
279279 the Attorney General prevails in an action brought against a health
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306306 benefit plan issuer or administr ator, the Attorney General may
307307 recover reasonable attorney fees, costs and expenses, including
308308 court costs and witness fees incurred in bringing the action.
309309 SECTION 7. NEW LAW A new section of law to be codified
310310 in the Oklahoma Stat utes as Section 6060.66 of Title 36, unless
311311 there is created a duplication in numbering, reads as follows:
312312 A. When an enrollee in a health benefit plan that covers
313313 emergency services receives the services from an out -of-network
314314 provider or out-of-network facility, the health benefit plan shall
315315 ensure that the enrollee shall incur no greater out -of-pocket costs
316316 for the emergency services than the enrollee would have incurred
317317 with an in-network provider.
318318 B. If a covered person receives covered emergency ser vices by
319319 an out-of-network provider or out -of-network facility, the carrier
320320 shall pay the out-of-network provider directly and the initial
321321 payment shall be the greater of the:
322322 1. Medicare rate;
323323 2. In-network rate;
324324 3. Usual, customary, and reasonable rat e; or
325325 4. Agreed upon rate.
326326 C. The insurer shall make the payment required by this section
327327 directly to the provider no later than, as applicable:
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354354 1. Thirty (30) days after the date the insurer receives an
355355 electronic clean claim for those services that in cludes all
356356 information necessary for the insurers to pay the claim; or
357357 2. Forty-five (45) days after the date the insurer receives a
358358 nonelectronic clean claim for those services that includes all
359359 information necessary for the insurer to pay the claim.
360360 SECTION 8. NEW LAW A new section of law to be codified
361361 in the Oklahoma Statutes as Section 6060.67 of Title 36, unless
362362 there is created a duplication in numbering, reads as follows:
363363 A. If a covered person receives covered services at an in-
364364 network facility from an out -of-network provider, the carrier shall
365365 pay the out-of-network provider directly and initial payment shall
366366 be at the usual, customary, and reasonable rate or at an agreed upon
367367 rate.
368368 B. The enrollee who receives care shall not be responsible for
369369 any amount greater than his or her applicable in -network copayment,
370370 coinsurance, and deductible amount s.
371371 C. The insurer shall make payment required by this section
372372 directly to the provider no later than, as applicable:
373373 1. Thirty (30) days after the date the insurer receives an
374374 electronic clean claim for those services that includes all
375375 information necessary for the insurers to pay the claim; or
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402402 2. Forty-five (45) days after the date the insurer receives a
403403 nonelectronic clean claim for those services that includes all
404404 information necessary for the insurer to pay the claim.
405405 SECTION 9. NEW LAW A new section of law to be codified
406406 in the Oklahoma Statutes as Section 6060.68 of Title 36, unless
407407 there is created a duplication in numbering, reads as follows:
408408 A. If a covered person with out -of-network health benefits
409409 elects to receive covered services at an out -of-network facility
410410 from an out-of-network provider, the carrier shall pay the out -of-
411411 network provider and facility directly and the initial payment shall
412412 be paid at the usual, customary, and reasonable rate or an agreed
413413 upon rate.
414414 The enrollee who receives care shall not be responsible for any
415415 amount greater than his or her applicable out -of-network copayment,
416416 coinsurance, and deductible amount s.
417417 B. The insurer shall make the payment required by this section
418418 directly to the provider and facility no later than, as applicable:
419419 1. Thirty (30) days after the date the insurer receives an
420420 electronic clean claim for those services that includes all
421421 information necessary for the insurer to pay the claim; or
422422 2. Forty-five (45) days after the date the insurer receives a
423423 nonelectronic clean claim for those services that includes all
424424 information necessary for the insurer to pay the claim.
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451451 C. Nothing in this section shall be construed to prohibit an
452452 out-of-network provider or out -of-network facility from accepting
453453 less than the usual, customary, and reasonable rate so long as an
454454 agreement has been made between the enrolle e and out-of-network
455455 health care provider or out -of-network facility.
456456 SECTION 10. NEW LAW A new section of law to be codified
457457 in the Oklahoma Statutes as Section 6060.69 of Title 36, unless
458458 there is created a duplication in numbering , reads as follows:
459459 A. A health care or medical service or supply provided at a
460460 location that does not have a zip code is considered to be provided
461461 in the geozip area closest to the location at which the service or
462462 supply is provided.
463463 B. The Insurance Co mmissioner shall select an organization to
464464 maintain a benchmarking database in accordance with this section.
465465 The organization shall not:
466466 1. Be affiliated with a health benefit plan issuer or
467467 administrator, a health care practitioner or other health care
468468 provider; or
469469 2. Have any other conflict of interest.
470470 C. The benchmarking database shall contain the following
471471 information necessary to calculate, with respect to a health care or
472472 medical service or supply, for each geozip area in this state:
473473 1. Percentiles of billed charges for all out -of-network
474474 providers and facilities; and
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501501 2. Percentiles of rates paid to participating providers and
502502 facilities.
503503 D. Insurers shall be required to submit data necessary for the
504504 use of the benchmarking database as specifie d in this section.
505505 E. The Commissioner may adopt rules governing the submission of
506506 information for the benchmarking database.
507507 SECTION 11. NEW LAW A new section of law to be codified
508508 in the Oklahoma Statutes as Section 6060.70 of Tit le 36, unless
509509 there is created a duplication in numbering, reads as follows:
510510 A. An out-of-network provider, out -of-network facility, and
511511 health benefit plan issuer or administrator may request arbitration
512512 of a settlement of an out -of-network health benefi t claim through a
513513 portal on the Oklahoma Insurance Department's website if:
514514 1. There is an amount billed by the out -of-network provider or
515515 out-of-network facility and unpaid by the issuer or administrator
516516 after copayments, coinsurance, and deductibles for which an enrollee
517517 may not be billed; or
518518 2. a. The required usual, customary, and reasonable rate
519519 paid by an insurer is deemed unreasonable, and
520520 b. The health benefit claim is for:
521521 (1) nonemergency care provided at an out -of-network
522522 facility,
523523 (2) nonemergency care provided by an out -of-network
524524 provider,
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551551 (3) emergency care provided at an out -of-network
552552 facility,
553553 (4) emergency care provided by an out -of-network
554554 provider, or
555555 (5) an emergency claim denial is based on a review of
556556 the patient's diagnosis code.
557557 B. If a person requests arbitration under this section, and
558558 depending on who initiates, the out -of-network provider, out -of-
559559 network facility, or a representative of the provider or facility,
560560 and the health benefit plan issuer or the administrator, as
561561 appropriate, shall participate in the arbitration.
562562 C. Not later than ninety (90) days after the date an out -of-
563563 network provider or out -of-network facility receives the initial
564564 payment for a health care or medical service or supply, the out -of-
565565 network provider, health care facility, or representative of the
566566 out-of-network health care provider or out -of-network facility,
567567 health benefit plan issuer or administrator may request arbitration
568568 of a settlement of an out -of-network health benefit claim through a
569569 portal on the Department's website if:
570570 1. There is an amount billed by the out -of-network provider or
571571 out-of-network facility and unpaid by the issuer or administrator
572572 after copayments, coinsurance, and deductibles for which an enrollee
573573 may not be billed; or
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600600 2. a. The required usual, customary, and reasonable rate
601601 paid by an insurer is deemed unreasonable, and
602602 b. The health benefit claim is for:
603603 (1) nonemergency care provided at an out -of-network
604604 facility,
605605 (2) nonemergency care provided by an out -of-network
606606 provider,
607607 (3) emergency care provided at an out -of-network
608608 facility,
609609 (4) emergency care provided by an out -of-network
610610 provider, or
611611 (5) an emergency claim denial is based on a review of
612612 the patient's diagnosis code.
613613 D. Nothing in this section shall prohibit a hea lth care
614614 provider or facility from utilizing arbitration in cases where
615615 medical necessity is disputed.
616616 E. If a person requests arbitration, the out -of-network
617617 provider, out-of-network facility, or an appropriate representative,
618618 and the health benefit plan issuer or administrator, as appropriate,
619619 shall participate in the arbitration.
620620 F. The party who requests arbitration shall provide written
621621 notice on the date the arbitration is requested in the form and
622622 manner prescribed by Insurance Commissioner rule to :
623623 1. The Department; and
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650650 2. Each party.
651651 G. In an effort to settle the claim before arbitration, all
652652 parties shall participate in an informal settlement teleconference
653653 no later than thirty (30) days after the date on which the
654654 arbitration is requested. A health benefit plan issuer or
655655 administrator, as applicable, shall make a reasonable effort to
656656 arrange the teleconference.
657657 H. The Commissioner shall promulgate rules providing
658658 requirements for submitting multiple claims to arbitration in one
659659 proceeding. The rules shall provide:
660660 1. The total amount in controversy for multiple claims in one
661661 proceeding shall not exceed Five Thousand Dollars ($5,000.00); and
662662 2. The multiple claims in one proceeding shall be limited to
663663 the same out-of-network provider or fa cility and health benefit plan
664664 issuer.
665665 I. Nothing in this section shall be construed to limit the
666666 amount in controversy for an individual claim in one arbitration
667667 proceeding.
668668 SECTION 12. NEW LAW A new section of law to be codified
669669 in the Oklahoma Statutes as Section 6060.71 of Title 36, unless
670670 there is created a duplication in numbering, reads as follows:
671671 A. The only issue the arbitrator may determine is the
672672 reasonable amount for the health care or medical services or
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699699 supplies provided to the enrollee by an out -of-network provider or
700700 out-of-network facility.
701701 B. The determination shall take into account:
702702 1. Whether there is a disparity between the fee billed by the
703703 out-of-network provider or out -of-network facility;
704704 2. Fees paid to the out-of-network provider or out -of-network
705705 facility;
706706 3. Level of training, education, and experience of the out -of-
707707 network provider;
708708 4. The out-of-network provider's or facility's usual billed
709709 charge for comparable services or supplies with regard to other
710710 enrollees for which the provider or facility is out -of-network;
711711 5. The circumstances and complexity of the enrollee's
712712 particular case, including the time and place of the provision of
713713 service or supply;
714714 6. Individual enrollee characteristics;
715715 7. Medical journals and peer -reviewed articles pertaining to
716716 medical necessity;
717717 8. Percentiles of out -of-network billed charges for the same
718718 service or supply performed by a health care provider or facility in
719719 the same or similar specialty and provided in th e same geozip as
720720 reported in a benchmarking database;
721721 9. The usual, customary, and reasonable rate as defined in
722722 Section 3 of this act;
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749749 10. The history of networking contracting between the parties;
750750 11. Historical data for percentiles; and
751751 12. An offer made during the informal settlement
752752 teleconference.
753753 SECTION 13. NEW LAW A new section of law to be codified
754754 in the Oklahoma Statutes as Section 6060.72 of Title 36, unless
755755 there is created a duplication in numbering, reads as follow s:
756756 A. An out-of-network provider, facility or health benefit plan
757757 issuer or administrator may not file suit for an out -of-network
758758 claim subject to the Oklahoma Out -of-Network Surprise Billing and
759759 Transparency Act until the conclusion of the arbitration on the
760760 issue of the amount to be paid in the out -of-network claim dispute.
761761 B. The arbitration conducted under the Oklahoma Out -of-Network
762762 Surprise Billing and Transparency Act is not subject to the Uniform
763763 Arbitration Act.
764764 SECTION 14. NEW LAW A new section of law to be codified
765765 in the Oklahoma Statutes as Section 6060.73 of Title 36, unless
766766 there is created a duplication in numbering, reads as follows:
767767 A. If parties are unable to mutually agree on an arbitrator
768768 within thirty (30) days after the date the arbitration is requested,
769769 the party requesting arbitration shall notify the Insurance
770770 Commissioner, and the Commissioner shall select an arbitrator from
771771 the Commissioner's list of approved arbitrators.
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798798 B. In selecting an arbitrator, th e Commissioner shall give
799799 preference to an arbitrator who is knowledgeable and experienced in
800800 applicable principles of contract and insurance law and the health
801801 care industry generally.
802802 C. In approving an individual as an arbitrator, the
803803 Commissioner shall ensure that the individual does not have a
804804 conflict of interest that would adversely impact the arbitrator's
805805 independence and impartiality in rendering a decision in an
806806 arbitration. A conflict of interest includes current or recent
807807 ownership or employme nt of the individual or a close family member
808808 as a health benefit issuer or administrator, physician, health care
809809 practitioner, or other health care provider.
810810 D. The Commissioner shall immediately terminate the approval of
811811 an arbitrator who no longer meet s the requirements adopted by the
812812 Commissioner.
813813 SECTION 15. NEW LAW A new section of law to be codified
814814 in the Oklahoma Statutes as Section 6060.74 of Title 36, unless
815815 there is created a duplication in numbering, reads as follows:
816816 A. The arbitrator shall set a date for submission of all
817817 information to be considered by the arbitrator.
818818 B. A party shall not engage in discovery in connection with the
819819 arbitration.
820820 C. On agreement of all parties, any deadline may be extended.
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847847 D. The party which is not awarded the amount submitted to
848848 arbitration shall pay all expenses and fees required by the
849849 arbitrator.
850850 E. Information submitted to the arbitrator is confidential and
851851 not public record.
852852 SECTION 16. NEW LAW A new sect ion of law to be codified
853853 in the Oklahoma Statutes as Section 6060.75 of Title 36, unless
854854 there is created a duplication in numbering, reads as follows:
855855 A. No later than fifty -one (51) days after the date the
856856 arbitration is requested, an arbitrator shall provide the parties
857857 with a written decision in which the arbitrator:
858858 1. Determines whether the health care provider or health care
859859 facility's charge is reasonable;
860860 2. Determines whether the usual, customary, and reasonable rate
861861 paid by an insurer is unre asonable; and
862862 3. Selects the amount determined to be the closest as the
863863 binding award.
864864 B. An arbitrator shall not modify the binding award amount.
865865 C. An arbitrator shall provide written notice in the form and
866866 manner prescribed by the Insurance Commissio ner rule of the
867867 reasonable amount for the services or supplies and the binding award
868868 amount. If the parties settle before a decision, the parties shall
869869 provide written notice in the form and manner prescribed by
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896896 Commissioner rule of the amount of settleme nt. The Oklahoma
897897 Insurance Department shall maintain a record of notices.
898898 SECTION 17. NEW LAW A new section of law to be codified
899899 in the Oklahoma Statutes as Section 6060.76 of Title 36, unless
900900 there is created a duplication in numb ering, reads as follows:
901901 A. An arbitrator's decision shall be binding.
902902 B. No later than forty -five (45) days after the date of an
903903 arbitrator's decision, a party not satisfied with the decision may
904904 file an action to determine the payment due.
905905 C. In an action filed, the court shall determine whether the
906906 arbitrator's decision is proper based on a substantial evidence
907907 review.
908908 D. No later than thirty (30) days after the date of an
909909 arbitrator's decision, a health benefit plan issuer or administrator
910910 shall pay the amount necessary to satisfy the binding award.
911911 E. Based on the arbitrator's binding award amount, the losing
912912 party shall be required to pay the arbitrator's fees and expenses.
913913 SECTION 18. NEW LAW A new section of law to be codi fied
914914 in the Oklahoma Statutes as Section 6060.77 of Title 36, unless
915915 there is created a duplication in numbering, reads as follows:
916916 A. The following constitutes bad faith participation in
917917 arbitration:
918918 1. Failing to participate in the informal settlement
919919 teleconference;
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946946 2. Failing to provide information the arbitrator believes
947947 necessary to facilitate a decision or agreement; or
948948 3. Failing to designate a representative participating in the
949949 arbitration with full authority to enter into any agreement.
950950 B. Failure to reach an agreement is not conclusive proof of bad
951951 faith participation.
952952 SECTION 19. NEW LAW A new section of law to be codified
953953 in the Oklahoma Statutes as Section 6060.78 of Title 36, unless
954954 there is created a duplication i n numbering, reads as follows:
955955 A. Bad faith participation or otherwise failing to comply with
956956 arbitration requirements is grounds for imposition of an
957957 administrative penalty by the regulatory agency that issued a
958958 license or certificate of authority to the party who committed the
959959 violation.
960960 B. Except for good cause shown, on a report of an arbitrator
961961 and appropriate proof of bad faith participation, the regulatory
962962 agency shall impose an administrative penalty.
963963 C. The Insurance Commissioner and the Oklahom a Board of Medical
964964 Licensure and Supervision or other regulatory agency, as
965965 appropriate, shall adopt rules regulating the investigation and
966966 review of a complaint filed that relates to the settlement of an
967967 out-of-network health benefit claim.
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994994 1. The rules adopted shall distinguish between complaints for
995995 out-of-network coverage or payment and give priority to
996996 investigating allegations of delayed health care or medical care;
997997 2. Develop a form for filing a complaint; and
998998 3. Ensure that a complaint is not dis missed without appropriate
999999 consideration.
10001000 D. The Oklahoma Insurance Department and State Board of Medical
10011001 Licensure and Supervision or other appropriate regulatory agency
10021002 shall maintain the following information on each complaint filed
10031003 that concerns a claim and arbitration:
10041004 1. The type of services or supplies that gave rise to the
10051005 dispute;
10061006 2. The type of specialty, if any, of the out -of-network
10071007 provider or facility who provided the out -of-network service or
10081008 supply;
10091009 3. The county and metropolitan area in which the health care or
10101010 medical service or supply was provided;
10111011 4. Whether the health care or medical service or supply was for
10121012 emergency care;
10131013 5. Any other information about the health benefit plan issuer
10141014 or administrator that the Commissioner by rule requires; or
10151015 6. The out-of-network provider or facility that the State Board
10161016 of Medical Licensure and Supervision or other appropriate regulatory
10171017 agency by rule requires.
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10441044 E. All information collected is public information and may not
10451045 include personally identifiable information.
10461046 SECTION 20. NEW LAW A new section of law to be codified
10471047 in the Oklahoma Statutes as Section 6060.79 of Title 36, unless
10481048 there is created a duplication in numbering, reads as follows:
10491049 A. The Oklahoma State I nsurance Department shall, each
10501050 biennium, conduct a study on the impacts of the Oklahoma Out -of-
10511051 Network Surprise Billing and Transparency Act and shall include:
10521052 1. Trends and changes in billed amounts;
10531053 2. Trends and changes in paid amounts;
10541054 3. Trends and changes in network participation;
10551055 4. Trends and changes in paid amounts to in -network providers
10561056 or facilities;
10571057 5. Trends and changes in paid amounts to out -of-network
10581058 providers or facilities; and
10591059 6. Number of complaints and results of claims that ente r
10601060 arbitration, including effectiveness of arbitration.
10611061 B. Beginning December 1, 2022, and no later than December 1 of
10621062 every other year thereafter, the Department shall prepare and submit
10631063 a written report on the results of the study to the Legislature and
10641064 appropriate committees.
10651065 SECTION 21. NEW LAW A new section of law to be codified
10661066 in the Oklahoma Statutes as Section 6060.80 of Title 36, unless
10671067 there is created a duplication in numbering, reads as follows:
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10941094 An insurer shall provide by written notice an explanation of
10951095 benefits provided to the insured and the physician or health care
10961096 provider in connection with a medical care or health care service or
10971097 supply provided by an out -of-network provider or facility. The
10981098 notice shall include a statement of the billing prohibition as
10991099 applicable to the Oklahoma Out -of-Network Surprise Billing and
11001100 Transparency Act that includes:
11011101 1. The total amount the health care provider or facility may
11021102 bill the insured under the insured' s health benefit plan and an
11031103 itemization of copayments, coinsurance, deductibles, and other
11041104 amounts included in the total;
11051105 2. An explanation of benefits provided to the health care
11061106 provider or facility with information required by rule advising the
11071107 health care provider or fac ility of the availability of arbitration,
11081108 as applicable under the Oklahoma Out -of-Network Surprise Billing and
11091109 Transparency Act; and
11101110 3. For elective services that are covered by an enrollee's
11111111 health benefit plan, if requested by an enrollee before a sched uled
11121112 service and explanation of benefits, the provider's average amounts
11131113 paid to comparable in -network health care providers or facilities
11141114 for covered services.
11151115 SECTION 22. AMENDATORY 12 O.S. 2011, Section 1854, is
11161116 amended to read as follows:
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11431143 Section 1854. A. The Uniform Arbitration Act governs an
11441144 agreement to arbitrate made on or after January 1, 2006.
11451145 B. The Uniform Arbitration Act governs an agreement to
11461146 arbitrate made before January 1, 2006, if all the parties to the
11471147 agreement or to the arbitration proceeding so agree in a record.
11481148 C. Beginning January 1, 2006, the Uniform Arbitration Act
11491149 governs an agreement to arbitrate whenever made.
11501150 D. The Uniform Arbitration Act shall not apply to the Oklahoma
11511151 Out-of-Network Surprise Bil ling and Transparency Act.
11521152 SECTION 23. This act shall become effective November 1, 2021.
11531153
11541154 58-1-6816 AB 12/29/20