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STATE OF OKLAHOMA
1st Session of the 59th Legislature (2023)
SENATE BILL 442 By: Montgomery
AS INTRODUCED
An Act relating to health benefit plan directories;
defining terms; directing plans to publish certain
provider directories on certain website; describing
information to be included in directory; requiring
directory to be publicly accessible; directing plan
to publish certain criteria ; requiring print copy of
directory be provided to an insured upon request;
providing for accessibility of certain directories;
requiring certain disclosure; providing for reporting
procedure; requiring plan response to report by
certain date; directing plan to mainta in and update
directory; requiring annual audit of certain
information; requiring notice to be provided to
certain providers by plan; directing plan to remov e
certain providers after certain time period;
directing plan to submit certain information to
Insurance Commissioner; establishing pro cedure for
certain use of inaccurate information by insu red;
requiring reimbursement by plan under certain
circumstances for care provided by out-of-network
provider; directing Commissioner to promulgate rules;
providing for codification; and providing an
effective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6971 of Title 36, unless there
is created a duplication in numb ering, reads as follows:
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A. As used in this section:
1. “Health benefit plan” means a plan as defined pur suant to
Section 6060.4 of Title 36 of the Oklahoma Statutes;
2. “Health care facility” means a facility as defined pursuant
to Section 1-725.2 of Title 63 of the Oklahoma Statutes;
3. “Health care professional” means a professional as defined
pursuant to Section 6802 of Title 36 of the Oklahoma Statutes;
4. “Hospital” means a hospital as defined pursuant to Section
1-701 of Title 63 of the Oklahoma Statutes; and
5. “Provider” means a health care provider as defined pursuant
to Section 6571 of Title 36 of the Okl ahoma Statutes.
B. Any insurer of a health benefit plan that is offered,
issued, or renewed in this state on or after the effective date o f
this act shall publish an electronic and printed provider directory
for each of its network plans , to be updated every thirty (30) days.
The insurer shall make clear the provider directory that applies to
each network plan as marketed and issued in this state. The
electronic directory shall be published on an easily accessible
website in a standardized, downloadable, and searchable format. The
electronic and printed directory shall include the following
information:
1. For health care professionals:
a. name,
b. gender,
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c. contact information, including a website address,
d. participating office locati on or locations,
e. specialty, if applicable,
f. board certifications,
g. medical group affiliations,
h. participating facility affiliations,
i. languages spoken other than English by the
professional or clinical staff, if applicable, and
j. whether they are acceptin g new patients;
2. For hospitals:
a. hospital name,
b. hospital type, including, but not limited to, acute,
rehabilitation, children ’s, or cancer,
c. participating hospital location,
d. hospital accreditation status,
e. customer service telephone number, and
f. website address; and
3. For health care facilities other than hospitals:
a. facility name,
b. facility type,
c. types of services performed,
d. participating facility location or loca tions,
e. customer service telephone number, and
f. website address.
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C. Any insurer of a health benefit plan that publishes a
provider directory pursuant to this section shall ensure that the
general public is able to view all of the current providers for a
network plan, through a clearly identifiable hyperlink or website
tab, without requiring any person to create or sign into an account
or submit a policy or contract number.
D. For each network plan published, an insurer of a health
benefit plan shall in clude in plain language the following
information:
1. A description of the criteri a used to build its provider
network; and
2. If applicable:
a. a description of the criteria used to tier providers,
b. how the plan designates the different provider ti ers
or levels, including, but not limited to, by name,
symbols, or grouping, in the net work and for each
specific provider in the network, which tier each is
placed for an insured or a prospective insured to be
able to identify the provider tier , and
c. a notice that authorization or ref erral may be
required to access some providers.
E. 1. An insurer of a health benefit plan shall, upon written
request by an insured or prospective insured, provide a print copy
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of the most up-to-date provider directory or a copy of any requested
provider information from the directory.
2. Provider directories, whether in electronic or print format,
shall be accessible to individuals with disabilities and individuals
with limited English proficiency as defined in 45 C.F.R. Sections
92.201 and 155.205.
3. The plan shall inclu de a disclosure in any print directory
issued under this subsection that the information in the directory
is accurate as of the date of printing and that an insured or
prospective insured should consult the plan’s electronic provider
directory on its website or call the listed customer service
telephone number to obtain current provider directory information.
F. 1. The health benefit plan shall in clude in both its online
and print directories a cl early identifiable telephone number, email
address, or link to a webpage by wh ich an insured or the general
public may use to report to the plan inaccurate information listed
in the provider directory. Whenever a plan receives a report, it
shall promptly investigate the report and, not later than thirty
(30) days following the receip t of such report, either verify the
accuracy of the information or up date the information.
2. A plan shall take appropriate steps to en sure the accuracy
of the information concerning eac h provider listed in the plan ’s
provider directory and shall, no later than January 1, 2024, review
and update the entire provider directory for each network pla n
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offered. The plan shall contact providers as necessary to ensure
that the information provided in the directory is up to date.
3. The plan shall, at least annually, audit its provider
directories for accurac y. The plan shall retain documentation of
any audit conducted under this paragraph to be made available to the
Insurance Commissioner. Based on the results of a given audit, the
plan shall verify and attest to th e accuracy of the information or
update the information.
G. An insurer of a health benefit plan shall , by certified
mail, return receipt requested, or by electronic mail, read recei pt
requested, notify any provider of its removal from the network if
the provider has not submitted claims to the plan or otherwise
communicated intent to continue participation in the plan’s network
within a twelve-month period. If the provisions of the contract
entered between the plan and the provider provides notice terms, the
notice shall be provided in accordance with such terms. If the plan
does not receive a response from the provider within thirty (30)
days of such notification, the plan shall remove the provider from
the network.
H. In accordance with any timeframes and requirements that may
be established by the Commissioner , an insurer of a health benefit
plan shall report to the Commissi oner the following:
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1. The number of reports received pursuant to subsection F of
this section, the ti meliness of the plan ’s response, and the
corrective action or actions taken; and
2. All auditing reports conducted b y the plan pursuant to
subsection F of this section.
I. If an insured reasonably relies upon materially inaccurate
information contained in a plan’s provider directory, the
Commissioner may require the plan to provide coverage for all
covered health care services provided to the insured and to
reimburse the insured for any amount that he or she would have to
pay if the services would have been delivered by an in -network
provider under the network plan. Provided, the Commissioner shall
take into consideration that health benefit plan insurers are
relying on health care providers to report changes to their
information prior to requiring any reimbursement to an insured. In
the event that the Commissioner finds that the provider has not
provided updated information for the network directory of the
insurer of a health benefit plan, the Commissioner may require that
the provider be reimbursed at the assignment of benefits rate for
the service if it were conducted in -network. Prior to requiring
reimbursement under this subsection, the Commissioner shal l conclude
that the services received by the plan w ere covered services under
the insured’s network plan. If the services satisfy requirements of
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this subsection, a pla n shall not deny reimbursement to an insured
based on the provider of the services bein g out-of-network.
J. The Commissioner shall promul gate rules to effectuate the
provisions of this section.
SECTION 2. This act shall become effective November 1, 2023.
59-1-515 RD 1/17/2023 9:33:27 AM