Old	New	Differences
1	1
2	2
3	3
4	4	Req. No. 2861 Page 1 1
5	5	2
6	6	3
7	7	4
8	8	5
9	9	6
10	10	7
11	11	8
12	12	9
13	13	10
14	14	11
15	15	12
16	16	13
17	17	14
18	18	15
19	19	16
20	20	17
21	21	18
22	22	19
23	23	20
24	24	21
25	25	22
26	26	23
27	27	24
28	28	1
29	29	2
30	30	3
31	31	4
32	32	5
33	33	6
34	34	7
35	35	8
36	36	9
37	37	10
38	38	11
39	39	12
40	40	13
41	41	14
42	42	15
43	43	16
44	44	17
45	45	18
46	46	19
47	47	20
48	48	21
49	49	22
50	50	23
51	51	24
52	52
53	53	STATE OF OKLAHOMA
54	54
55	55	2nd Session of the 58th Legislature (2022)
56	56
57	57	SENATE BILL 1812 By: Pugh
58	58
59	59
60	60
61	61
62	62
63	63	AS INTRODUCED
64	64
65	65	An Act relating to insurance; creating the Okla homa
66	66	Right to Shop Act; defining terms; a uthorizing
67	67	insurance carriers to create certain program;
68	68	establishing requirements of program; providing for
69	69	calculation and method of distribution of incentives;
70	70	requiring insurer to provide certain notification an d
71	71	filings; requiring insurer to publish c ertain
72	72	information on website; providing methodology for
73	73	calculating minimum required savings incentive;
74	74	requiring insurer to make certain payments; requiring
75	75	certain report within specified time period; stating
76	76	contents of report; specifying participation in
77	77	program is optional; directing the I nsurance
78	78	Department to promulgate rules; requiring Office of
79	79	Management and Enterprise Services to conduct
80	80	analysis; requiring certain program be implemented;
81	81	requiring Office to provide certain report to
82	82	Legislature; providing for codification; and
83	83	providing an effective date.
84	84
85	85
86	86
87	87
88	88
89	89	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
90	90	SECTION 1. NEW LAW A new section of law to be codified
91	91	in the Oklahoma Statutes a s Section 6060.40 of Title 36, unless
92	92	there is created a duplication in numbering, reads as follows:
93	93	This act shall be known and may be cited as the “Oklahoma Right
94	94	to Shop Act”.
95	95
96	96
97	97	Req. No. 2861 Page 2 1
98	98	2
99	99	3
100	100	4
101	101	5
102	102	6
103	103	7
104	104	8
105	105	9
106	106	10
107	107	11
108	108	12
109	109	13
110	110	14
111	111	15
112	112	16
113	113	17
114	114	18
115	115	19
116	116	20
117	117	21
118	118	22
119	119	23
120	120	24
121	121	1
122	122	2
123	123	3
124	124	4
125	125	5
126	126	6
127	127	7
128	128	8
129	129	9
130	130	10
131	131	11
132	132	12
133	133	13
134	134	14
135	135	15
136	136	16
137	137	17
138	138	18
139	139	19
140	140	20
141	141	21
142	142	22
143	143	23
144	144	24
145	145
146	146	SECTION 2. NEW LAW A new section of law to be codified
147	147	in the Oklahoma Statutes as Section 6060.41 of Title 36, unless
148	148	there is created a duplication in numbering, reads as follows:
149	149	As used in the Oklahoma Right to Shop Act:
150	150	1. “Allowed amount” means the contractually agreed-upon amount
151	151	paid by a carrier to a health care e ntity participating in the
152	152	network of the carrier;
153	153	2. “Comparable health care service ” means any covered
154	154	nonemergency health care service or bundle of services. The
155	155	Insurance Commissioner may limit what is considered a comparable
156	156	health care service if a n insurance carrier can demonstrate allowed
157	157	amount variation among network providers is less than Fifty Dollars
158	158	($50.00);
159	159	3. “Health benefit plan” means any plan as defined in
160	160	subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes;
161	161	4. “Insurance carrier” or “carrier” means an insurance compa ny
162	162	that issues policies of accident and health insurance and is
163	163	licensed to sell insurance in this state;
164	164	5. “Shared savings incentive ” means a voluntary and optional
165	165	financial incentive that an insurance carrier may provide to an
166	166	enrollee for choosing ce rtain health care services under a shared
167	167	savings incentive program; and
168	168
169	169
170	170	Req. No. 2861 Page 3 1
171	171	2
172	172	3
173	173	4
174	174	5
175	175	6
176	176	7
177	177	8
178	178	9
179	179	10
180	180	11
181	181	12
182	182	13
183	183	14
184	184	15
185	185	16
186	186	17
187	187	18
188	188	19
189	189	20
190	190	21
191	191	22
192	192	23
193	193	24
194	194	1
195	195	2
196	196	3
197	197	4
198	198	5
199	199	6
200	200	7
201	201	8
202	202	9
203	203	10
204	204	11
205	205	12
206	206	13
207	207	14
208	208	15
209	209	16
210	210	17
211	211	18
212	212	19
213	213	20
214	214	21
215	215	22
216	216	23
217	217	24
218	218
219	219	6. “Shared savings incentive program ” means a voluntary and
220	220	optional incentive program established by an insurance carrier
221	221	pursuant to this act.
222	222	SECTION 3. NEW LAW A new section of law to be codified
223	223	in the Oklahoma Statutes as Section 6060.42 of Title 36, unless
224	224	there is created a duplication in numbering, rea ds as follows:
225	225	A. An insurance carrier may offer a shared savings incentive
226	226	program to provide ince ntives to an enrollee when the enrollee
227	227	obtains a comparable health care service that is covered by the
228	228	carrier from providers that charge less than the ave rage allowed
229	229	amount paid by that carrier to networ k providers for that comparable
230	230	health care service.
231	231	B. Incentives may be calculated as a percentage of the
232	232	difference in allowed amounts to the average, as a flat dollar
233	233	amount, or by any other reasonabl e methodology approved by the
234	234	Insurance Department . The carrier shall provide the incentive as a
235	235	cash payment to the enrollee or credit toward the annual in -network
236	236	deductible and out-of-pocket limit of the enrollee. Carriers may
237	237	allow enrollees to selec t which method the enrollee prefers to
238	238	receive the incentive.
239	239	C. An insurance carrier that offers a shared savings incentive
240	240	program shall:
241	241	1. Establish the program as a component part of the policy or
242	242	certificate of insurance provided by the carrier and notify the
243	243
244	244
245	245	Req. No. 2861 Page 4 1
246	246	2
247	247	3
248	248	4
249	249	5
250	250	6
251	251	7
252	252	8
253	253	9
254	254	10
255	255	11
256	256	12
257	257	13
258	258	14
259	259	15
260	260	16
261	261	17
262	262	18
263	263	19
264	264	20
265	265	21
266	266	22
267	267	23
268	268	24
269	269	1
270	270	2
271	271	3
272	272	4
273	273	5
274	274	6
275	275	7
276	276	8
277	277	9
278	278	10
279	279	11
280	280	12
281	281	13
282	282	14
283	283	15
284	284	16
285	285	17
286	286	18
287	287	19
288	288	20
289	289	21
290	290	22
291	291	23
292	292	24
293	293
294	294	enrollees and the Insurance Department at least thirty (30) days
295	295	before program terminati on;
296	296	2. File a description of the program on a form prescribed by
297	297	the Insurance Commissioner. The Insurance Department shall review
298	298	the filing and determi ne whether the program complies with the
299	299	provisions of this section;
300	300	3. Notify an enrollee annually or at the time of renewal of the
301	301	availability of the shared savings incentive program and the
302	302	procedures to participate in the program;
303	303	4. Publish on the website of the insurance carrier, easily
304	304	accessible to enrollees and applicants for insurance, a list of
305	305	comparable health care services and health care providers and the
306	306	shared savings incentive amount applicable for each service. A
307	307	shared savings incentive shall not be less than twenty -five percent
308	308	(25%) of the savings generated by the participation of the enrollee
309	309	in any shared savings incentive program offered by the insurance
310	310	carrier. The baseline for the savings calculation shall be the
311	311	average in-network amount paid for that service in the most recent
312	312	twelve-month period or any other methodology e stablished by the
313	313	insurance carrier and approved by the Insurance Department;
314	314	5. At least quarterly, credit, deposit , or make a cash payment
315	315	to an enrollee of the shared savings incentive amount pursuant to
316	316	participation in the shared savings incentive pr ogram; and
317	317
318	318
319	319	Req. No. 2861 Page 5 1
320	320	2
321	321	3
322	322	4
323	323	5
324	324	6
325	325	7
326	326	8
327	327	9
328	328	10
329	329	11
330	330	12
331	331	13
332	332	14
333	333	15
334	334	16
335	335	17
336	336	18
337	337	19
338	338	20
339	339	21
340	340	22
341	341	23
342	342	24
343	343	1
344	344	2
345	345	3
346	346	4
347	347	5
348	348	6
349	349	7
350	350	8
351	351	9
352	352	10
353	353	11
354	354	12
355	355	13
356	356	14
357	357	15
358	358	16
359	359	17
360	360	18
361	361	19
362	362	20
363	363	21
364	364	22
365	365	23
366	366	24
367	367
368	368	6. Submit an annual report to the Insurance Department within
369	369	ninety (90) days after the close of each health benefit plan year.
370	370	At a minimum, the report shall include the following informati on:
371	371	a. the number of enrollees who participated in t he
372	372	program during the health benefit plan year and the
373	373	number of instances of participation,
374	374	b. the total cost of services provided as a part of the
375	375	program, and
376	376	c. the total value of the shared savings i ncentive
377	377	payments made to enrollees participating in the
378	378	program and the values distributed as cash or credit
379	379	toward the annual in -network deductible and out -of-
380	380	pocket limit of an enrollee.
381	381	D. An enrollee shall not be required to participate in a shared
382	382	savings incentive program.
383	383	SECTION 4. NEW LAW A new section of law to be codified
384	384	in the Oklahoma Statutes as Section 6060.43 of Title 36, unless
385	385	there is created a duplication in numbering, reads as follows:
386	386	The Insurance Departme nt shall promulgate necessary rules for
387	387	the implementation of the Oklahoma Right to Shop Act.
388	388	SECTION 5. NEW LAW A new section of law to be codified
389	389	in the Oklahoma Statutes as Section 6060.44 of Title 36, unless
390	390	there is created a duplication in numbering, reads as follows:
391	391
392	392
393	393	Req. No. 2861 Page 6 1
394	394	2
395	395	3
396	396	4
397	397	5
398	398	6
399	399	7
400	400	8
401	401	9
402	402	10
403	403	11
404	404	12
405	405	13
406	406	14
407	407	15
408	408	16
409	409	17
410	410	18
411	411	19
412	412	20
413	413	21
414	414	22
415	415	23
416	416	24
417	417	1
418	418	2
419	419	3
420	420	4
421	421	5
422	422	6
423	423	7
424	424	8
425	425	9
426	426	10
427	427	11
428	428	12
429	429	13
430	430	14
431	431	15
432	432	16
433	433	17
434	434	18
435	435	19
436	436	20
437	437	21
438	438	22
439	439	23
440	440	24
441	441
442	442	The Office of Management and Enterprise Services shall conduct
443	443	an analysis no later than November 1, 202 3, of the cost-
444	444	effectiveness of implementing a shared savings incentive program, as
445	445	defined in paragraph 6 of Section 2 of this act, for current
446	446	enrollees of the Oklahoma Employees Insurance Plan created pursuant
447	447	to the Oklahoma Employees Insurance and Benefits Act. If a program
448	448	is found to be cost-effective, it shall be implemented as part of
449	449	the next open enrollment. The Office shall communicate the
450	450	rationale for its decision to the President Pro Tempore of the
451	451	Senate, the Speaker of the House of Representatives, and the chairs
452	452	of the relevant legislative committees in writing.
453	453	SECTION 6. This act shall become effective November 1, 202 2.
454	454
455	455	58-2-2861 RJ 1/20/2022 7:53:17 PM

Oklahoma 2022 Regular Session

Oklahoma Senate Bill SB1812 Compare Versions