Oklahoma 2023 Regular Session

Oklahoma House Bill HB1658 Compare Versions

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Version 2 (New)

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1		-	An Act
2		-	ENROLLED HOUSE
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	3	+	ENGR. S. A. TO ENGR. H. B. NO. 1658 Page 1 1
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	28	+	ENGROSSED SENATE AMENDMENT
	29	+	TO
	30	+	ENGROSSED HOUSE
3	31		BILL NO. 1658 By: McEntire of the House
4	32
5	33		and
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7	35		Rosino of the Senate
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12		-	An Act relating to poor persons; amending 56 O.S.
13		-	2021, Section 4002.5, as amended by Secti on 9,
14		-	Chapter 395, O.S.L. 2022 (56 O.S. Supp. 2022, Section
15		-	4002.5), which relates to ensuring access to Medicaid
16		-	Act; requiring contracted entity to obtain
17		-	certificate of authority; requiring entity to obtain
18		-	certain certificate of authority as a health
19		-	maintenance organization; requiring entity to obtain
20		-	certain certificate of authority as an accident and
21		-	health insurer or as a prepaid dental plan
22		-	organization; and declaring an emer gency.
	40	+	An Act relating to poor persons; 56 O.S. 2021,
	41	+	Section 4002.5, as amended by Secti on 9, Chapter 395,
	42	+	O.S.L. 2022 (56 O.S. Supp. 2022, Section 4002.5),
	43	+	which relates to ensuring access to Medicaid Act;
	44	+	adding when an entity shall obtain a certificate of
	45	+	authority; health maintenance organization; a ccident
	46	+	and health insurer; prepaid dent al plan organization;
	47	+	providing an effective date; and declaring an
	48	+	emergency.
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26		-	SUBJECT: Poor persons
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	53	+
	54	+	AMENDMENT NO. 1. Page 5, line 3, delete Section 2
	55	+
	56	+	and renumber the subsequent section
	57	+
	58	+	and amend the title to conform
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	63	+	ENGR. S. A. TO ENGR. H. B. NO. 1658 Page 2 1
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	88	+	Passed the Senate the 18th day of April, 2023.
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	92	+	Presiding Officer of the Senate
	93	+
	94	+
	95	+	Passed the House of Representatives the ____ day of __________,
	96	+	2023.
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	100	+	Presiding Officer of the House
	101	+	of Representatives
	102	+
	103	+	ENGR. H. B. NO. 1658 Page 1 1
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	128	+	ENGROSSED HOUSE
	129	+	BILL NO. 1658 By: McEntire of the House
	130	+
	131	+	and
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	133	+	Rosino of the Senate
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	138	+	An Act relating to poor persons; 56 O.S. 2021,
	139	+	Section 4002.5, as amended by Secti on 9, Chapter 395,
	140	+	O.S.L. 2022 (56 O.S. Supp. 2022, Section 4002.5),
	141	+	which relates to ensuring access to Medicaid Act;
	142	+	adding when an entity shall obtain a certificate of
	143	+	authority; health maintenance organization; a ccident
	144	+	and health insurer; prepaid dent al plan organization;
	145	+	providing an effective date; and declaring an
	146	+	emergency.
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27	151
28	152		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
29		-
30	153		SECTION 1. AMENDATORY 56 O.S. 2021, Section 4002.5, as
31	154		amended by Section 9, Chapter 395, O.S.L. 2022 (56 O.S. Supp. 2022,
32	155		Section 4002.5), is amended to rea d as follows:
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34	156		Section 4002.5 A. A contracted entity shall be responsible for
35	157		all administrative functions for members enrolled in its plan
36	158		including, but not limited to, claims processing, authorization of
37	159		health services, care and case management, grievances and appeals,
38	160		and other necessary administrative services.
39		-
40	161		B. A contracted entity selected by the Oklahoma Health Care
41	162		Authority under Section 4 of this ac t shall obtain a certificate of
42	163		authority as a health maintenance organization issued by the
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	165	+	ENGR. H. B. NO. 1658 Page 2 1
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43	190		Insurance Department prior Prior to the execution of the a contract
44	191		between the a contracted entity and the Oklahoma Health Care
45	192		Authority, the contracted entity s hall obtain the appropr iate
46		-	certificate of authority issued by the In surance Department. ENR. H. B. NO. 1658 Page 2
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	193	+	certificate of authority issued by the In surance Department.
48	194		1. A contracted entity shall obtain a certificate of authority
49	195		issued by the Insurance Department to operate as a health
50	196		maintenance organization when the contracted services to be
51	197		delivered include physical health services, behav ioral health
52	198		services, and prescription drug services.
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54	199		2. A contracted entity shall obtain a certificate of authority
55	200		issued by the Insurance Dep artment to operate as an a ccident and
56	201		health insurer or as a prepai d dental plan organization when the
57	202		contracted services to be deliver ed include dental services.
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59	203		C. 1. To ensure providers have a voice in the direction and
60	204		operation of the contracted entities selected by the Oklahoma Health
61	205		Care Authority under Section 4 4002.3b of this act title, each
62	206		contracted entity shall have a shared governance structure that
63	207		includes:
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65	208		a. representatives of local Oklahoma provider
66	209		organizations who are Medicaid providers,
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68	210		b. essential community providers, and
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70	211		c. a representative from a teaching hospital owned,
71	212		jointly owned, or affiliated with and designated by
72	213		the University Hospitals Authority, University
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73	240		Hospitals Trust, Oklahoma State University Med ical
74	241		Authority, or Oklahoma State University Medical Trust.
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76	242		2. No less than one-third (1/3) of the contracted entity's
77	243		local governing body shall be comprised of representatives of local
78	244		Oklahoma provider organizations.
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80	245		3. No less than two members of the contracted entity's clinical
81	246		and quality committees shall be representatives of local Oklahoma
82	247		provider organizations, and the committees shall be chaired or co-
83	248		chaired by a representative of a local Oklahoma provider
84	249		organization.
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86	250		D. A contracted entity shall promptly notify the Authority of
87	251		all material changes affecting the delivery of care or the
88	252		administration of its program.
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90	253		E. A contracted entity shall have a medical loss ratio that
91		-	meets the standards provided by 42 C.F.R., Section 438.8. ENR. H. B. NO. 1658 Page 3
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	254	+	meets the standards provided by 42 C.F.R., Section 438.8.
93	255		F. A contracted entity shall provide patient data to a provider
94	256		upon request to the exte nt allowed under federal or state laws,
95	257		rules or regulations including, but not limited to, the Health
96	258		Insurance Portability and Accountability Act of 1996.
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98	259		G. A contracted entity or a subcontractor of a contracted
99	260		entity shall not enforce a policy or contract term with a provider
100	261		that requires the provider to contract for all products that are
101	262		currently offered or t hat may be offered in the future by the
102	263		contracted entity or subcontractor.
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104	290		H. Nothing in this act or in a contract between the Authority
105	291		and a contracted entity shall prohibit the contracted entity from
106	292		contracting with a statewide or regional accounta ble care
107	293		organization.
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109	294		I. Nothing in this act, in a contract between the Authority and
110	295		a contracted entity, or in a contract between a contracted entity
111	296		and a provider shall prohibit any provider from contracting with
112	297		more than one contracted entity.
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114	298		J. A contracted entity shall not withhold, fail to offer, or
115	299		make impracticable a contract with a provider on the basis of
116	300		independent practice or lack of hospital system affiliation.
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118	301		K. All contracted entities shall:
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120	302		1. Use the same drug formulary, which shall be established by
121	303		the Authority; and
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123	304		2. Ensure broad access to pharmacies including, but not limited
124	305		to, pharmacies contracted with covered entities under Section 340B
125	306		of the Public Health Service Act. Such access shall, at a minimum,
126	307		meet the requirements of the Patient's Right to Pharmacy Choice Act,
127	308		Section 6958 et seq. of Title 36 of the Oklahoma Statutes.
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129	309		L. Each contracted entity and each participating provider shall
130	310		submit data through the state-designated entity for health
131	311		information exchange to ensure effective systems and connectivity to
132	312		support clinical coordination of care, the exchange of information,
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133	339		and the availability of data to the Authority to manage the state
134	340		Medicaid program.
135		-	~~ENR~~. ~~H. B. NO. 1658 Page 4~~
136		-	SECTION 2. It being immediately neces sary for the preservation
	341	+	SECTION 2. This act shall become effec tive July 1, 2023.
	342	+	SECTION 3. It being immediately neces sary for the preservation
137	343		of the public peace, health or safety, an emergency is hereby
138	344		declared to exist, by reason whereof this act shall t ake effect and
139	345		be in full force from and a fter its passage and approval.
140		-	ENR. H. B. NO. 1658 Page 5
141		-	Passed the House of Representatives the 10th day of May, 2023.
	346	+	Passed the House of Representatives the 13th day of March, 2023.
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146	351		Presiding Officer of the House
147	352		of Representatives
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151		-	Passed the Senate the ~~18th~~ day of ~~April~~, 2023.
	356	+	Passed the Senate the ___ day of __________, 2023.
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156	361		Presiding Officer of the Senate
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160		-	OFFICE OF THE GOVERNOR
161		-	Received by the Office of the Governor this ____________________
162		-	day of ___________________, 20_______, at _______ o'clock _______ M.
163		-	By: _________________________________
164		-	Approved by the Governor of the State of Oklahoma this _____ ____
165		-	day of __________________ _, 20_______, at _______ o'clock _______ M.
166		-
167		-
168		-	_________________________________
169		-	Governor of the State of O klahoma
170		-
171		-	OFFICE OF THE SECRETARY OF STATE
172		-	Received by the Office of the Secretary of State this __________
173		-	day of ___________________, 20_______, at _______ o'clock _______ M.
174		-	By: _________________________________