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ENGROSSED HOUSE
BILL NO. 1712 By: Marti and McDugle of the
House
and
Garvin of the Senate
An Act relating to health insurance; defining terms;
prohibiting insurers from refusing coverage to an
insured under certain c ircumstances; providing for an
insured to seek care from an out-of-network provider
under certain circumstances; requiring out-of-network
providers to be reimbursed for covered services at
the same rate as in-network providers; providing for
codification; and declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKL AHOMA:
SECTION 1. NEW LAW A new se ction of law to be codified
in the Oklahoma Statutes as Section 6971 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. As used in this section:
1. "Durable medical equipment" means equipment as defined
pursuant to paragraph 2 of Section 375.2 of Title 59 of the Oklahoma
Statutes;
2. "Health benefit plan" means a health benefit plan as def ined
pursuant to subsection C of Section 6060.4 of Title 36 of the
Oklahoma Statutes;
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3. "Health care provider" means a provider as defined pursuant
to Section 6571 of Title 36 of the Oklahoma Statutes ;
4. "Health maintenance organization" or "HMO" means a health
maintenance organization as defined pursuant to paragraph 12 of
Section 6902 of Title 36 of the Oklahoma Statutes; and
5. "Preferred provider organization" or "PPO" means a preferred
provider organization as defined pursuant to paragraph 8 of Section
6054 of Title 36 of the Oklahoma Statutes.
B. No health benefit plan , HMO, PPO, or other provider network
authorized to admini ster health care coverage in this state shall
refuse coverage to an insured for durable medical equipment and
supplies as prescribed by a health care provider, regardless of
whether they are in-network or out-of-network, unless there is an
Oklahoma-licensed in-network provider within a fifteen-mile radius
of the patient's five-digit ZIP code that can provide in-person
evaluation for medical equipment, supplies, and related services .
C. If a health care provider deems it necessary that an insured
receive covered medical equip ment or supplies within twenty-four
(24) hours, the insured shall not be subject to drop-shipped orders
and may seek such equipment and supplies from any health care
provider who can provide the nec essary services and supplies within
the requested timeframe.
D. When an insured utilizes an out-of-network health care
provider, as described in subsection B of this section, the out-of-
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network provider shall be reimbursed at the same rate and benefit
level for the provided services as an in-network provider for t he
health benefit plan, HMO, PPO, or other provider network authorized
to administer health care coverage in this state.
SECTION 2. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
Passed the House of Representatives the 20th day of March, 2023.
Presiding Officer of the House
of Representatives
Passed the Senate the ___ day of __________, 2023.
Presiding Officer of the Senate