OK
Oklahoma Senate Bill SB1323

Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB1323 Compare Versions

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4-
5-An Act
6-ENROLLED SENATE
7-BILL NO. 1323 By: Garvin of the Senate
28+ENGROSSED HOUSE AMENDME NT
29+ TO
30+ENGROSSED SENATE BILL NO . 1323 By: Garvin of the Senate
831
932 and
1033
1134 McEntire of the House
1235
1336
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16-An Act relating to the state Medicaid program;
17-authorizing Insurance Department to recognize certain
18-self-funded or self-insured health care plan as
19-health care plan under specified conditions; amending
20-56 O.S. 2021, Section 1010.1, which relates to
21-premium assistance program; allowing certain self -
22-funded or self-insured health care plan to
39+
40+[ state Medicaid program - recognize certain self-
41+funded or self-insured health care pla n as health
42+care plan under specified conditions - codification -
43+effective date ]
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48+AMENDMENT NO. 1. Strike the stricken title, enacting clause, and
49+entire bill and insert:
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51+
52+"An Act relating to the state Medicaid program;
53+authorizing Insurance Department to recognize
54+certain self-funded or self-insured health care plan
55+as health care plan under specified conditions;
56+amending 56 O.S. 2021, Section 1010.1, which relates
57+to premium assistance program; allowing certain
58+self-funded or self-insured health care plan to
2359 participate in premium assistanc e program under
2460 specified conditions; updating statutory language;
2561 updating statutory reference; providing for
2662 codification; and providin g an effective date.
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31-SUBJECT: Medicaid
3267
3368 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
34-
3569 SECTION 1. NEW LAW A new section of law to be codified
3670 in the Oklahoma Statutes as Section 6012 of Title 36, unless there
3771 is created a duplication in numbering, reads as follows:
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3998 A health care plan recognized by the Insurance Department that
4099 participates in the premium assistance program created under Section
41100 1010.1 of Title 56 of the Oklahoma Statutes as of the effective date
42101 of this act that at a lat er date becomes a self-funded or self-
43102 insured health care plan may continue to be recognized by the
44103 Insurance Department as a health care plan if such plan meets the
45104 requirements under subsection J of Se ction 1010.1 of Title 56 of the
46105 Oklahoma Statutes. The health care plan shall only be considered a
47106 health care plan for the exc lusive purposes of the premium
107+assistance program created under Section 1010.1 of Title 56 of the
108+Oklahoma Statutes.
109+SECTION 2. AMENDATORY 56 O.S. 2021, Se ction 1010.1, is
110+amended to read as follows:
111+Section 1010.1 A. Section 1010.1 et seq. of this title shall
112+be known and may be cited as the "Oklahoma Medicaid Pr ogram Reform
113+Act of 2003".
114+B. Recognizing that many Oklahomans do not have health care
115+benefits or health care coverage, that many small bu sinesses cannot
116+afford to provide health care benefits to their em ployees, and that,
117+under federal law, barriers exi st to providing Medicaid benefits to
118+the uninsured, the Oklahoma Legislature hereby establish es
119+provisions to lower the number of uninsured, assist businesses in
120+their ability to afford health care benefits and coverage for their
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147+employees, and eliminate b arriers to providing health coverage to
148+eligible enrollees under federal law.
149+C. Unless otherwise provided by law, the Oklahoma Health Care
150+Authority shall provide coverage under the state Medicaid program to
151+children under the age of eighteen (18) years whose family incomes
152+do not exceed one hundred eighty-five percent (185%) of the federal
153+poverty level.
154+D. 1. The Authority is directed to apply for a waiver or
155+waivers to the Centers for Medicaid Medicare and Medicare Medicaid
156+Services (CMS) that will a ccomplish the purposes out lined in
157+subsection B of this section. The Authority is further di rected to
158+negotiate with CMS to include in the waiver authority provisions to:
159+a. increase access to health care for Oklahomans,
160+b. reform the Oklahoma Medicaid Pr ogram to promote
161+personal responsibility for health care services and
162+appropriate utilization of health care benefits
163+through the use of pub lic-private cost sharing,
164+c. enable small employers, and/or employ ed, uninsured
165+adults with or without children to p urchase employer-
166+sponsored, state-approved private, or state -sponsored
167+health care coverage t hrough a state premium
168+assistance payment plan. If by January 1, 2012, the
169+Employer/Employee Partnership for Ins urance Coverage
170+Premium Assistance Program is not consuming more than
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197+seventy-five percent (75%) of its dedicated source of
198+funding, then the program will be expanded to include
199+parents of children eligible for Medicaid, and
200+d. develop flexible health care benefit packages based
201+upon patient need and cost .
202+2. The Authority may ph ase in any waiver or waivers it receives
203+based upon available fundi ng.
204+3. The Authority is authorized to develop and implement a
205+premium assistance plan to assist small businesses and/or their
206+eligible employees to purchase emplo yer-sponsored insurance or "buy-
207+in" to a state-sponsored benefit plan.
208+4. a. The Authority is authorized to seek from the Centers
209+for Medicare and Medicaid Services any waivers or
210+amendments to existing wai vers necessary to accomplish
211+an expansion of the p remium assistance program to:
212+(1) include for-profit employers with two hundred
213+fifty employees or less up to any level supported
214+by existing funding resources, and
215+(2) include not-for-profit employers with five
216+hundred employees or less up to any level
217+supported by existing fundin g resources.
218+b. Foster parents employed by employers with greater t han
219+two hundred fifty employees shall be exempt from the
220+qualifying employer requirement p rovided for in this
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247+paragraph and shall be eligible to qualify for the
248+premium assistance program p rovided for in this
249+section if supported by existing funding.
250+E. For purposes of this paragraph, "for-profit employer" shall
251+mean an entity which is not exe mpt from taxation pursu ant to the
252+provisions of Section 501(c)(3) of the Internal Revenue Code and
253+"not-for-profit employer" shall mean an entity which is exempt from
254+taxation pursuant to the provisions of Section 501(c)(3) of the
255+Internal Revenue Code.
256+F. The Authority is auth orized to seek from the Centers for
257+Medicare and Medicaid Services any waive rs or amendments to existing
258+waivers necessary to accomplish an ext ension of the premium
259+assistance program to inc lude qualified employees whose family
260+income does not exceed two h undred fifty percent (250%) of the
261+federal poverty level, subject to the lim it of federal financial
262+participation.
263+G. The Authority is authori zed to create as part of the premium
264+assistance program an option to purchase a high -deductible health
265+insurance plan that is compatible with a health savings acco unt.
266+H. 1. There is here by created in the State Treasury a
267+revolving fund to be designated the "Health Employee and Economy
268+Improvement Act (HEEIA) Revolving Fund ".
269+2. The fund shall be a continuing fund , not subject to fiscal
270+year limitations, and shal l consist of:
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297+a. all monies received by the Authority pursuant to this
298+section and otherwise specified or authorized by law,
299+b. monies received by the Authority due to federal
300+financial participation pursua nt to Title XIX of the
301+Social Security Act, and
302+c. interest attributable to investment of money in the
303+fund.
304+3. All monies accruing to the cre dit of the fund are hereby
305+appropriated and sha ll be budgeted and expended by the Authorit y to
306+implement a premium assistance plan and to fund the state share for
307+the Oklahoma Medicaid prog ram on or after the effective date of this
308+act July 1, 2020, unless otherwise provided by law.
309+I. 1. The Authority shall establish a procedure for verifying
310+an applicant’s individual income by utilizing available Oklahoma Tax
311+Commission records, new hire report data collected by the Oklahoma
312+Employment Security Commissi on, and child support payment data
313+collected by the Department of Human Services in accordance with
314+federal and state law.
315+2. The Oklahoma Tax Commission, Oklahom a Employment Security
316+Commission, and Department of Human Services shall cooperate in
317+accordance with federal and state law with the Authority to
318+establish procedures for the secure electronic tra nsmission of an
319+applicant’s individual income data to the Au thority.
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346+3. The Department of Public Safety shall cooperate in
347+accordance with federal and s tate law with the Authority to
348+establish procedures for the secure electronic transmission of an
349+applicant’s individual identification data to the Authority.
350+J. A health care plan participating in the premium assistance
351+program created under this section as of the effective date of this
352+act that at a later date becomes a self-funded or self-insured
353+health care plan may continue to participate in the premium
354+assistance program if:
355+1. The health care plan has continuously participated in the
356+premium assistance program without interruption up to the date it
357+becomes a self-funded or self-insured health care plan;
358+2. The self-funded or self-insured health care plan continues
359+to be recognized as a health care plan by the Insurance Department
360+under Section 1 of this act;
361+3. The self-funded or self-insured health care plan continues
362+to cover all essential health benefits as required by the Centers
363+for Medicare and Medicaid Services; and
364+4. The Authority receives the necessary federal appr oval for
365+self-funded or self-insured health care plans to participate in the
366+premium assistance program.
367+SECTION 3. This act shall become effective November 1, 2022."
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396+Passed the House of Representatives the 28th day of April, 2022.
397+
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400+
401+
402+Presiding Officer of the House of
403+ Representatives
404+
405+
406+Passed the Senate the ____ day of _______ ___, 2022.
407+
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412+Presiding Officer of the Senate
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440+ENGROSSED SENATE
441+BILL NO. 1323 By: Garvin of the Senate
442+
443+ and
444+
445+ McEntire of the House
446+
447+
448+
449+
450+[ state Medicaid program - recognize certain self-
451+funded or self-insured health care pla n as health
452+care plan under specified conditions - codification -
453+effective date ]
454+
455+
456+
457+
458+BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
459+SECTION 4. NEW LAW A new section of law to be codified
460+in the Oklahoma Statutes as Section 6012 of Title 36, unless there
461+is created a duplication in numbering, reads as follows:
462+A health care plan recognized by the Insurance Department that
463+participates in the premium assistance progr am created under Section
464+1010.1 of Title 56 of the Oklahoma Statutes as of the effective date
465+of this act that at a lat er date becomes a self-funded or self-
466+insured health care plan may continue to be recognized by the
467+Insurance Department as a health care plan if such plan meets the
468+requirements under subsection J of Se ction 1010.1 of Title 56 of the
469+Oklahoma Statutes. The health care plan shall only be considered a
470+health care plan for the exc lusive purposes of the premium
50471 assistance program creat ed under Section 1010.1 of Title 56 of the
51472 Oklahoma Statutes.
52473
53-SECTION 2. AMENDATORY 56 O.S. 2021, Se ction 1010.1, is
474+ENGR. S. B. NO. 1323 Page 2 1
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499+SECTION 5. AMENDATORY 56 O.S. 2021, Se ction 1010.1, is
54500 amended to read as follows:
55-
56501 Section 1010.1. A. Section 1010.1 et seq. of this title shall
57-be known and may be cited as the "Oklahoma Medicaid Pr ogram Reform
58-Act of 2003".
59-
502+be known and may be cited as the “Oklahoma Medicaid Pr ogram Reform
503+Act of 2003”.
60504 B. Recognizing that many Oklahomans do not have health care
61505 benefits or health care coverage, that many small bus inesses cannot
62506 afford to provide health care benefits to their em ployees, and that,
63507 under federal law, barriers exi st to providing Medicaid benefits to
64508 the uninsured, the Oklahoma Legislature hereby establish es
65509 provisions to lower the number of uninsured, assist businesses in
66510 their ability to afford health care benefits and coverage for their
67511 employees, and eliminate b arriers to providing health coverage to
68512 eligible enrollees under federal law.
69-
70513 C. Unless otherwise provided by law, the Oklahoma Health Care
71514 Authority shall provide coverage under the state Medicaid program to
72515 children under the age of eighteen (18) years whose family incomes
73516 do not exceed one hundred eighty-five percent (185%) of the federal
74517 poverty level.
75-
76518 D. 1. The Authority is directed to apply for a waiver or
77519 waivers to the Centers for Medicaid Medicare and Medicare Medicaid
78520 Services (CMS) that will a ccomplish the purposes out lined in
79521 subsection B of this section. The Authority is further di rected to
80522 negotiate with CMS to include in the w aiver authority provisions to:
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82549 a. increase access to health care for Oklahomans,
83-
84550 b. reform the Oklahoma Medicaid Pr ogram to promote
85551 personal responsibility for health care services and
86552 appropriate utilization of health care benefits
87553 through the use of publ ic-private cost sharing,
88-
89554 c. enable small employers, and/or employ ed, uninsured
90555 adults with or without children to p urchase employer-
91556 sponsored, state-approved private, or state -sponsored
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93-ENR. S. B. NO. 1323 Page 3
94557 health care coverage t hrough a state premium
95558 assistance payment plan. If by January 1, 2012, the
96559 Employer/Employee Partnership for Ins urance Coverage
97560 Premium Assistance Program is not consuming more than
98561 seventy-five percent (75%) of its dedicated source of
99562 funding, then the program will be expanded to include
100563 parents of children eligible for Medicaid, and
101-
102564 d. develop flexible health care benefit packages based
103565 upon patient need and cost .
104-
105566 2. The Authority may ph ase in any waiver or waivers it receives
106567 based upon available fundi ng.
107-
108568 3. The Authority is authorized to develop a nd implement a
109569 premium assistance plan to assist small businesses and/or their
110-eligible employees to purchase emplo yer-sponsored insurance or "buy-
111-in" to a state-sponsored benefit plan.
570+eligible employees to purchase emplo yer-sponsored insurance or “buy-
571+in” to a state-sponsored benefit plan.
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113598 4. a. The Authority is authorized to seek from the Centers
114599 for Medicare and Medicaid Services any waivers or
115600 amendments to existing wai vers necessary to accomplish
116601 an expansion of the p remium assistance program to:
117-
118602 (1) include for-profit employers with two hundred
119603 fifty employees or less up to any level supported
120604 by existing funding resources, and
121-
122605 (2) include not-for-profit employers with five
123606 hundred employees or less up to any level
124607 supported by existing fundin g resources.
125-
126608 b. Foster parents employed by employers with greater t han
127609 two hundred fifty employees shall be exempt from the
128610 qualifying employer requirement p rovided for in this
129611 paragraph and shall be eligible to qualify for the
130612 premium assistance program p rovided for in this
131613 section if supported by existing funding.
132-
133-E. For purposes of this paragraph, "for-profit employer" shall
614+E. For purposes of this paragraph, “for-profit employer” shall
134615 mean an entity which is not exe mpt from taxation pursu ant to the
135616 provisions of Section 501(c)(3) of the Internal Revenue Code and
136-
137-ENR. S. B. NO. 1323 Page 4
138-"not-for-profit employer" shall mean an entity which is exempt from
617+“not-for-profit employer” shall mean an entity which is exempt from
139618 taxation pursuant to the provisions of Section 501(c)(3) of the
140619 Internal Revenue Code.
141-
142620 F. The Authority is auth orized to seek from the Centers for
143621 Medicare and Medicaid Services any waive rs or amendments to existing
622+
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144648 waivers necessary to accomplish an ext ension of the premium
145649 assistance program to incl ude qualified employees whose family
146650 income does not exceed two h undred fifty percent (250%) of the
147651 federal poverty level, subject to the lim it of federal financial
148652 participation.
149-
150653 G. The Authority is authori zed to create as part of the premium
151654 assistance program an option to purchase a high -deductible health
152655 insurance plan that is compatible with a health savings acco unt.
153-
154656 H. 1. There is here by created in the State Treasury a
155-revolving fund to be designated the "Health Employee and Economy
156-Improvement Act (HEEIA) Revolving Fund ".
157-
657+revolving fund to be designated the “Health Employee and Economy
658+Improvement Act (HEEIA) Revolving Fund ”.
158659 2. The fund shall be a continuing fund , not subject to fiscal
159660 year limitations, and shal l consist of:
160-
161661 a. all monies received by the Authority pursuant to this
162662 section and otherwise specified or authorized by law,
163-
164663 b. monies received by the Authority due to federal
165664 financial participation pursua nt to Title XIX of the
166665 Social Security Act, and
167-
168666 c. interest attributable to investment of money in the
169667 fund.
170-
171668 3. All monies accruing to the cre dit of the fund are hereby
172669 appropriated and shal l be budgeted and expended by the Authorit y to
173670 implement a premium assistance plan and to fund the state share for
671+
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174697 the Oklahoma Medicaid prog ram on or after the effective date of this
175698 act July 1, 2020, unless otherwise provided by law.
176-
177699 I. 1. The Authority shall establish a procedure for verifying
178700 an applicant’s individual income by utilizing available Oklahoma Tax
179701 Commission records, new hire report data collected by the Oklahoma
180-
181-ENR. S. B. NO. 1323 Page 5
182702 Employment Security Commissi on, and child support payment data
183703 collected by the Department of Human Services in accordance with
184704 federal and state law.
185-
186705 2. The Oklahoma Tax Commission, Oklahom a Employment Security
187706 Commission, and Department of Human Services shall cooperate in
188707 accordance with federal and state law with the Authority to
189708 establish procedures for the secure electronic tra nsmission of an
190709 applicant’s individual income data to the Au thority.
191-
192710 3. The Department of Public Safety shall cooperate in
193711 accordance with federal and s tate law with the Authority to
194712 establish procedures for the secure electronic transmission of an
195713 applicant’s individual identification data to the Authority.
196-
197714 J. A health care plan participating in the premium assistance
198715 program created under this section as of the effective date of this
199716 act that at a later date becomes a self-funded or self-insured
200717 health care plan may continue to participate in the premium
201718 assistance program if:
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203745 1. The health care plan has continuously participated in the
204746 premium assistance program without interruption up to the date it
205747 becomes a self-funded or self-insured health care plan;
206-
207748 2. The self-funded or self-insured health care plan continues
208749 to be recognized as a health care plan by the Insurance Department
209750 under Section 1 of this act;
210-
211751 3. The self-funded or self-insured health care plan continues
212752 to cover all essential health benefits as required by the Centers
213753 for Medicare and Medicaid Services; and
214-
215754 4. The Authority receives the necessary federal appr oval for
216755 self-funded or self-insured health care plans to participate in the
217756 premium assistance program.
218-
219-SECTION 3. This act shall become effective November 1, 2022.
220-
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224-ENR. S. B. NO. 1323 Page 6
225-Passed the Senate the 16th day of May, 2022.
757+SECTION 6. This act shall become effective November 1, 2022.
758+Passed the Senate the 21st day of March, 2022.
226759
227760
228761
229762 Presiding Officer of the Senate
230763
231764
232-Passed the House of Representatives the 28th day of April, 2022.
765+Passed the House of Representatives the ____ day of __________,
766+2022.
233767
234768
235769
236770 Presiding Officer of the House
237771 of Representatives
238772
239-OFFICE OF THE GOVERNOR
240-Received by the Office of the Governor this _______ _____________
241-day of _________________ __, 20_______, at _______ o'clock _______ M.
242-By: _______________________________ __
243-Approved by the Governor of the State of Oklahoma this _____ ____
244-day of _________________ __, 20_______, at _______ o'clock _______ M.
245773
246- _________________________________
247- Governor of the State of Oklahoma
248-
249-
250-OFFICE OF THE SECRETARY OF STATE
251-Received by the Office of the Secretary of State this _______ ___
252-day of __________________, 20 _______, at _______ o'clock _______ M.
253-By: _______________________________ __