Oklahoma 2023 Regular Session

Oklahoma House Bill HB1398 Compare Versions

Version 1 (Old)

Version 2 (New)

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3		-	ENGR. H. B. NO. 1398 Page 1 1
	3	+	HB1398 HFLR Page 1
	4	+	BOLD FACE denotes Committee Amend ments. 1
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28		-	ENGROSSED HOUSE
29		-	BILL NO. 1398 By: Lepak, Sims, Sneed, Olsen,
30		-	Caldwell (Trey), Humphrey,
31		-	Randleman, Sterling, and
32		-	Wolfley of the House
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
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34		-	~~and~~
	31	+	STATE OF OKLAHOMA
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36		-	Jett of the Senate
	33	+	1st Session of the 59th Legislature (2023)
	34	+
	35	+	HOUSE BILL 1398 By: Lepak
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	41	+	AS INTRODUCED
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44	43		An Act relating to emergency medical services;
45		-	defining term; ~~defining certain actions as~~ unfair
46		-	~~methods of~~ competition or unfair or deceptive act s or
47		-	~~practices~~ for certain purposes; prohibiting
48		-	~~distinction in~~ health care coverage related to
49		-	~~network status of~~ emergency care providers or
50		-	~~facilities; prohibiting~~ construction of ~~st atutory~~
51		-	~~provisions with respect to~~ cost-sharing amounts;
52		-	~~imposing requirements re lated~~ to emergency care
53		-	~~claims; prescribing procedures for~~ utilization review
54		-	~~process; providing for statutory~~ construction with
55		-	~~respect to utilization review;~~ providing for
56		-	~~codification; and providing an~~ effective date.
	44	+	defining term; providing for unfair method of
	45	+	competition or unfair or deceptive act or pra ctice
	46	+	for certain purposes; prohibiting distinction in
	47	+	health care coverage related to network sta tus of
	48	+	emergency care providers or facilities; prohibiting
	49	+	construction of statutory provisions with respect to
	50	+	cost-sharing amounts; imposing requirements re lated
	51	+	to emergency care claims; prescribing procedures for
	52	+	utilization review process; providing for statutory
	53	+	construction with respect to utilization review;
	54	+	providing for codification; and providing an
	55	+	effective date.
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62	61		BE IT ENACTED BY THE PE OPLE OF THE STATE OF OKLAHOMA:
63	62		SECTION 1. NEW LAW A new section of law to be codified
64	63		in the Oklahoma Statutes as Section 4420 of Title 36, unless there
65	64		is created a duplication in numberi ng, reads as follows:
66	65		A. As used in this section, "emergency care" means health care
67	66		services provided in a general medical surgical hospita l, critical
68	67		access hospital, or emergency hospital, as such terms are defined in
	68	+	Section 1-701 of Title 63 of the O klahoma Statutes, that is licensed
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70		-	ENGR. H. B. NO. 1398 Page 2 1
	70	+	HB1398 HFLR Page 2
	71	+	BOLD FACE denotes Committee Amend ments. 1
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95		-	Section 1-701 of Title 63 of the O klahoma Statutes, that is licensed
96	96		by the State Department of Health, to evaluate and stabilize medical
97	97		conditions of a recent and onset seve rity, including severe pain,
98	98		regardless of the final diagnosis that is given, that would lead a
99	99		prudent layperson possessing an average knowledge of medicine and
100	100		health to believe that the individual 's condition, sickness, or
101	101		injury is of such a nature tha t failure to get immediate medical
102	102		care could:
103	103		1. Place the individual 's health in serious jeopardy;
104	104		2. Result in serious impairment to bodily function;
105	105		3. Result in serious disfunction of a bodily organ or part;
106	106		4. Result in serious disfigurement; or
107	107		5. For pregnant women, result in serious jeopardy to the health
108	108		of the fetus.
109	109		Nothing in this section shall be con strued as providing licensure
110	110		of, or applying to, facilities providing emergency care that are not
111	111		licensed as, or affiliated with, a hospita l as defined in Section 1-
112	112		701 of Title 63 of the Oklahoma Statutes.
113	113		B. It shall be an unfair method of competition or an unfair or
114	114		deceptive act or practice in the business of insurance for an
115	115		insurer or an individual or entity acting on behalf of an insu rer
116	116		to:
117	117		1. Deter enrollees from seeking care consistent with the
118	118		prudent layperson standard for emergency care; or
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120		-	ENGR. H. B. NO. 1398 Page 3 1
	120	+	HB1398 HFLR Page 3
	121	+	BOLD FACE denotes Committee Amend ments. 1
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145	146		2. Engage in a pattern of wrongful denia ls of claims for
146	147		emergency care.
147	148		C. If an individual's health insurance coverage includes any
148	149		benefits for emergency care, there shall be no distinction made in
149	150		regard to network status of an emergency care provid er or facility.
150	151		An enrollee's cost-sharing amount shall not be greater tha n that
151	152		which would be imposed if the services were pro vided in-network for
152	153		emergency care.
153	154		D. This section shall not be construed to prohibit an insurer
154	155		from imposing a different cost-sharing amount for out -of-network
155	156		services so long as the services provided are not related to the
156	157		evaluation and stabilization of an emer gency medical care situation.
157	158		E. Utilization review of an emergency care claim must be
158	159		performed by a physician bo ard-certified in emergency medicine . A
159	160		utilization review agent:
160	161		1. May not make an adverse determin ation for the emergency care
161	162		claim based on the final diagnosis that is given, including the
162	163		classification under a Current Procedural Terminology or
163	164		International Classification of Diseases co de; and
164	165		2. Must review the enrollee 's medical records before making an
165	166		adverse determination.
166	167		F. Nothing in this section may be co nstrued as authorizing
167	168		utilization review of emergency care when otherwise prohibited by
168	169		law.
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170		-	ENGR. H. B. NO. 1398 Page 4 1
	171	+	HB1398 HFLR Page 4
	172	+	BOLD FACE denotes Committee Amend ments. 1
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195	197		SECTION 2. This act shall become effective November 1, 2023.
196		-	Passed the House of Representatives the 22nd day of March, 2023.
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201		-	Presiding Officer of the House
202		-	of Representatives
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205		-	Passed the Senate the ___ day of __________, 2023.
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210		-	Presiding Officer of the Senate
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	199	+	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 02/23/2023 - DO
	200	+	PASS.