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HOUSE OF REPRESENTATIVES - FLOOR VERSION
STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
HOUSE BILL 1398 By: Lepak
AS INTRODUCED
An Act relating to emergency medical services;
defining term; providing for unfair method of
competition or unfair or deceptive act or pra ctice
for certain purposes; prohibiting distinction in
health care coverage related to network sta tus of
emergency care providers or facilities; prohibiting
construction of statutory provisions with respect to
cost-sharing amounts; imposing requirements re lated
to emergency care claims; prescribing procedures for
utilization review process; providing for statutory
construction with respect to utilization review;
providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PE OPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 4420 of Title 36, unless there
is created a duplication in numberi ng, reads as follows:
A. As used in this section, "emergency care" means health care
services provided in a general medical surgical hospita l, critical
access hospital, or emergency hospital, as such terms are defined in
Section 1-701 of Title 63 of the O klahoma Statutes, that is licensed
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by the State Department of Health, to evaluate and stabilize medical
conditions of a recent and onset seve rity, including severe pain,
regardless of the final diagnosis that is given, that would lead a
prudent layperson possessing an average knowledge of medicine and
health to believe that the individual 's condition, sickness, or
injury is of such a nature tha t failure to get immediate medical
care could:
1. Place the individual 's health in serious jeopardy;
2. Result in serious impairment to bodily function;
3. Result in serious disfunction of a bodily organ or part;
4. Result in serious disfigurement; or
5. For pregnant women, result in serious jeopardy to the health
of the fetus.
Nothing in this section shall be con strued as providing licensure
of, or applying to, facilities providing emergency care that are not
licensed as, or affiliated with, a hospita l as defined in Section 1-
701 of Title 63 of the Oklahoma Statutes.
B. It shall be an unfair method of competition or an unfair or
deceptive act or practice in the business of insurance for an
insurer or an individual or entity acting on behalf of an insu rer
to:
1. Deter enrollees from seeking care consistent with the
prudent layperson standard for emergency care; or
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2. Engage in a pattern of wrongful denia ls of claims for
emergency care.
C. If an individual's health insurance coverage includes any
benefits for emergency care, there shall be no distinction made in
regard to network status of an emergency care provid er or facility.
An enrollee's cost-sharing amount shall not be greater tha n that
which would be imposed if the services were pro vided in-network for
emergency care.
D. This section shall not be construed to prohibit an insurer
from imposing a different cost-sharing amount for out -of-network
services so long as the services provided are not related to the
evaluation and stabilization of an emer gency medical care situation.
E. Utilization review of an emergency care claim must be
performed by a physician bo ard-certified in emergency medicine . A
utilization review agent:
1. May not make an adverse determin ation for the emergency care
claim based on the final diagnosis that is given, including the
classification under a Current Procedural Terminology or
International Classification of Diseases co de; and
2. Must review the enrollee 's medical records before making an
adverse determination.
F. Nothing in this section may be co nstrued as authorizing
utilization review of emergency care when otherwise prohibited by
law.
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SECTION 2. This act shall become effective November 1, 2023.
COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 02/23/2023 - DO
PASS.