Oklahoma 2023 Regular Session

Oklahoma Senate Bill SB442 Compare Versions

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
2	2
	3	+	SB442 HFLR Page 1
	4	+	BOLD FACE denotes Committee Amendments. 1
	5	+	2
	6	+	3
	7	+	4
	8	+	5
	9	+	6
	10	+	7
	11	+	8
	12	+	9
	13	+	10
	14	+	11
	15	+	12
	16	+	13
	17	+	14
	18	+	15
	19	+	16
	20	+	17
	21	+	18
	22	+	19
	23	+	20
	24	+	21
	25	+	22
	26	+	23
	27	+	24
3	28
4		-	An Act
5		-	ENROLLED SENATE
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
	30	+
	31	+	STATE OF OKLAHOMA
	32	+
	33	+	1st Session of the 59th Legislature (2023)
	34	+
	35	+	ENGROSSED SENATE
6	36		BILL NO. 442 By: Montgomery of the Senate
7	37
8	38		and
9	39
10		-	Sneed and Munson of the
11		-	House
	40	+	Sneed of the House
12	41
13	42
14	43
15	44
16	45		An Act relating to health benefit plan directories;
17	46		defining terms; directing plans to publish ce rtain
18	47		provider directories on certain website; describing
19	48		information to be included in directory; requiring
20	49		directory to be publicly accessible; directing plan
21	50		to publish certain criteria; providing for
22	51		accessibility of certain directories; requiring
23	52		certain disclosure; providing for reporting
24	53		procedure; requiring plan response to report by
25	54		certain date; requiring annual audit of certain
26	55		information; requiring notice to be provided to
27	56		certain providers by plan ; directing plan to remove
28	57		certain providers af ter certain time period;
29	58		directing plan to submit certain information to
30	59		Insurance Commissioner; establishing procedure for
31	60		certain use of inaccurate information by insured;
32	61		requiring reimbursement by plan und er certain
33	62		circumstances for care provided by o ut-of-network
34	63		provider; authorizing Commissioner to promu lgate
35	64		rules; providing for codification; and providing an
36	65		effective date.
37	66
38	67
39	68
40		-
41		-	SUBJECT: Health benefit plan directories
42		-
43	69		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
44		-
45		-
46		-	ENR. S. B. NO. 442 Page 2
47	70		SECTION 1. NEW LAW A new section o f law to be codified
48	71		in the Oklahoma Statutes as Section 6971 of Title 36, unless there
49	72		is created a duplication in numb ering, reads as follows:
50	73
	74	+	SB442 HFLR Page 2
	75	+	BOLD FACE denotes Committee Amendments. 1
	76	+	2
	77	+	3
	78	+	4
	79	+	5
	80	+	6
	81	+	7
	82	+	8
	83	+	9
	84	+	10
	85	+	11
	86	+	12
	87	+	13
	88	+	14
	89	+	15
	90	+	16
	91	+	17
	92	+	18
	93	+	19
	94	+	20
	95	+	21
	96	+	22
	97	+	23
	98	+	24
	99	+
51	100		A. As used in this section:
52		-
53	101		1. “Health benefit plan” means a plan as defined pursuant to
54	102		Section 6060.4 of Title 36 of the Oklahoma Statutes;
55		-
56	103		2. “Health care facility” means a facility as defined pursuant
57	104		to Section 1-725.2 of Title 63 of the Oklahoma Statutes;
58		-
59	105		3. “Health care professional” means a professional as def ined
60	106		pursuant to Section 6802 of Title 36 of the Oklahoma Statutes;
61		-
62	107		4. “Hospital” means a hospital as defined pursuant to Section
63	108		1-701 of Title 63 of the Oklahoma Statutes; and
64		-
65	109		5. “Provider” means a health care provider as defined pursuant
66	110		to Section 6571 of Title 36 of the Oklahoma Statutes.
67		-
68	111		B. Any insurer of a health benefit plan that is offered,
69	112		issued, or renewed in this state on or after the effective date o f
70	113		this act shall publish an electronic provider directory for each of
71	114		its network plans, to be updated every sixty (60) days. The insurer
72	115		shall make clear the provider directory that applies to each network
73	116		plan as marketed and issued in this state. The electronic directory
74	117		shall be published on an easily accessible website in a
75	118		standardized, downloadable, and searchable format. The electronic
76	119		directory shall include the following information:
77		-
78	120		1. For health care professionals:
79		-
80	121		a. name,
81		-
82	122		b. contact information, including a website address,
83	123		physical address, and phone number, and
84	124
	125	+	SB442 HFLR Page 3
	126	+	BOLD FACE denotes Committee Amendments. 1
	127	+	2
	128	+	3
	129	+	4
	130	+	5
	131	+	6
	132	+	7
	133	+	8
	134	+	9
	135	+	10
	136	+	11
	137	+	12
	138	+	13
	139	+	14
	140	+	15
	141	+	16
	142	+	17
	143	+	18
	144	+	19
	145	+	20
	146	+	21
	147	+	22
	148	+	23
	149	+	24
	150	+
85	151		c. specialty, if applicable;
86		-
87	152		2. For hospitals:
88		-
89		-
90		-	ENR. S. B. NO. 442 Page 3
91	153		a. hospital name,
92		-
93	154		b. hospital type, including, but not limited to, acute,
94	155		rehabilitation, children’s, or cancer,
95		-
96	156		c. participating hospital location,
97		-
98	157		d. hospital accreditation status,
99		-
100	158		e. customer service telephone number, and
101		-
102	159		f. website address; and
103		-
104	160		3. For health care facilities other than hospitals:
105		-
106	161		a. facility name,
107		-
108	162		b. facility type,
109		-
110	163		c. types of services performed,
111		-
112	164		d. participating facility location or loca tions,
113		-
114	165		e. customer service telephone number, and
115		-
116	166		f. website address.
117		-
118	167		C. Any insurer of a health benefit plan th at publishes a
119	168		provider directory pursuant to this section shall ensure that the
120	169		general public is able to view all of the current providers for a
121	170		network plan, through a clearly identifiable hyperlink or website
122	171		tab, without requiring any person to create or sign into an account
123	172		or submit a policy or contract n umber.
124	173
	174	+	SB442 HFLR Page 4
	175	+	BOLD FACE denotes Committee Amendments. 1
	176	+	2
	177	+	3
	178	+	4
	179	+	5
	180	+	6
	181	+	7
	182	+	8
	183	+	9
	184	+	10
	185	+	11
	186	+	12
	187	+	13
	188	+	14
	189	+	15
	190	+	16
	191	+	17
	192	+	18
	193	+	19
	194	+	20
	195	+	21
	196	+	22
	197	+	23
	198	+	24
	199	+
125	200		D. For each network plan published, an insurer of a health
126	201		benefit plan shall in clude in plain language the following
127	202		information:
128		-
129	203		1. A description of the criteria used to build its provider
130	204		network; and
131		-
132	205		2. If applicable:
133		-
134		-	ENR. S. B. NO. 442 Page 4
135		-
136	206		a. a description of the criteria used to tier providers,
137		-
138	207		b. how the plan designates the different provider ti ers
139	208		or levels, including, but not limited to, by name,
140	209		symbols, or grouping, in the network and for each
141	210		specific provider in the network, which tier each is
142	211		placed for an insured or a prospective insured to be
143	212		able to identify the provider tier , and
144		-
145	213		c. a notice that authorization or ref erral may be
146	214		required to access some providers.
147		-
148	215		E. 1. Provider directories, whether in electronic or, if
149	216		offered, print format, shall be accessible to individuals with
150	217		disabilities and individuals with limite d English proficiency as
151	218		defined in 45 C.F.R. Sections 92.201 and 155.205.
152		-
153	219		2. The plan shall include a disclosure in any print directory
154	220		issued under this subsection that the informati on in the directory
155	221		is accurate as of the date of printing and that an insured or
156	222		prospective insured should consult the electronic provider direct ory
	223	+
	224	+	SB442 HFLR Page 5
	225	+	BOLD FACE denotes Committee Amendments. 1
	226	+	2
	227	+	3
	228	+	4
	229	+	5
	230	+	6
	231	+	7
	232	+	8
	233	+	9
	234	+	10
	235	+	11
	236	+	12
	237	+	13
	238	+	14
	239	+	15
	240	+	16
	241	+	17
	242	+	18
	243	+	19
	244	+	20
	245	+	21
	246	+	22
	247	+	23
	248	+	24
	249	+
157	250		on the website of the plan or call the listed customer service
158	251		telephone number to obtain current provider directory information.
159		-
160	252		F. 1. The health benefit plan shall in clude in both its online
161	253		and print directories , if offered, a clearly identifiable telephone
162	254		number, email address, or link to a webpa ge which an insured or the
163	255		general public may use to r eport to the plan inaccurate information
164	256		listed in the provider directory. Whenever a plan receives a
165	257		report, it shall promptly investigate the report and, not later than
166	258		two (2) days following the rec eipt of such report, either verify the
167	259		accuracy of the information or update the information.
168		-
169	260		2. A plan shall take appropriate steps to en sure the accuracy
170	261		of the information concerning eac h provider listed in the provider
171	262		directory. The plan shall contact providers as necessary to ensure
172	263		that the information provided in the directory is up to date.
173		-
174	264		3. The plan shall, at least annually, audit its provider
175	265		directories for accurac y. The audit should be focus ed on the top
176	266		four utilized specialties to inclu de at least one specialty related
177		-
178		-	ENR. S. B. NO. 442 Page 5
179	267		to mental health. Alternatively, plans may audit based on a
180	268		reasonable sample size of providers, as long as the sample size
181	269		includes behavioral health p roviders. The plan shall retain
182	270		documentation of any audit conducted under this paragraph to be made
183	271		available to the Insu rance Commissioner. Based on the results of a
184	272		given audit, the plan shall ver ify and attest to th e accuracy of the
185	273		information or update the infor mation.
	274	+
	275	+	SB442 HFLR Page 6
	276	+	BOLD FACE denotes Committee Amendments. 1
	277	+	2
	278	+	3
	279	+	4
	280	+	5
	281	+	6
	282	+	7
	283	+	8
	284	+	9
	285	+	10
	286	+	11
	287	+	12
	288	+	13
	289	+	14
	290	+	15
	291	+	16
	292	+	17
	293	+	18
	294	+	19
	295	+	20
	296	+	21
	297	+	22
	298	+	23
	299	+	24
186	300
187	301		G. An insurer of a health benefit plan shall , by certified
188	302		mail, return receipt requested, or by electronic mail, read receipt
189	303		requested, notify any provider of its removal from the network if
190	304		the provider has not submitted claims to the plan or otherwise
191	305		communicated intent to continue participation in the plan network
192	306		within a twelve-month period. If the provisions of the contract
193	307		entered between the plan and the provider provides notice terms, the
194	308		notice shall be provided in accordance with such terms. If the plan
195	309		does not receive a response from the provider within thirty (30)
196	310		days of such notification, the plan shall remove the provider from
197	311		the network.
198		-
199	312		H. In accordance with any timeframes and requirements that may
200	313		be established by the Commissioner , an insurer of a health benefit
201	314		plan shall report to the Commissi oner the following:
202		-
203	315		1. The number of reports received pursuant to subsection F of
204	316		this section, the ti meliness of the response from the plan, and the
205	317		corrective action or actions taken; and
206		-
207	318		2. All auditing reports conducted by the plan pursuant to
208	319		subsection F of this section.
209		-
210	320		I. If an insured reasonably relies upon materially inaccurate
211	321		information contained in a provider directory of a plan, the
212	322		Commissioner may require the plan to provide coverage for all
213	323		covered health care servic es provided to the insured and to
214	324		reimburse the insured f or any amount that he or she would have to
	325	+
	326	+	SB442 HFLR Page 7
	327	+	BOLD FACE denotes Committee Amendments. 1
	328	+	2
	329	+	3
	330	+	4
	331	+	5
	332	+	6
	333	+	7
	334	+	8
	335	+	9
	336	+	10
	337	+	11
	338	+	12
	339	+	13
	340	+	14
	341	+	15
	342	+	16
	343	+	17
	344	+	18
	345	+	19
	346	+	20
	347	+	21
	348	+	22
	349	+	23
	350	+	24
	351	+
215	352		pay if the services would have been delivered by an in -network
216	353		provider under the network plan. Provided, the Commissioner shall
217	354		take into consideration that health benefit plan insurers are
218	355		relying on health car e providers to report changes to their
219	356		information prior to requiring any reimbursement to an insured. In
220	357		the event that the Commissioner finds that the p rovider has not
221		-
222		-	ENR. S. B. NO. 442 Page 6
223	358		provided updated information for the network directory of the
224	359		insurer of a health ben efit plan, the Commissioner may require that
225	360		the provider be reimbursed at the assignment of benefits rate for
226	361		the service if it were conducted in -network. Prior to requiring
227	362		reimbursement under this subsection, the Commissioner shal l conclude
228	363		that the services received by the plan were covered services under
229	364		the insured’s network plan. If the services satisfy requirements of
230	365		this subsection, a pla n shall not deny reimbursement to an insured
231	366		based on the provider of the services bein g out-of-network.
232		-
233	367		J. The Commissioner may promulgate rules to effectuate the
234	368		provisions of this section.
235		-
236	369		SECTION 2. This act shall become effective November 1, 2023.
237	370
238		-
239		-	ENR. S. B. NO. 442 Page 7
240		-	Passed the Senate the 6th day of March, 2023.
241		-
242		-
243		-
244		-	Presiding Officer of the Senate
245		-
246		-
247		-	Passed the House of Representatives the 25th day of April, 2023.
248		-
249		-
250		-
251		-	Presiding Officer of the House
252		-	of Representatives
253		-
254		-	OFFICE OF THE GOVERNOR
255		-	Received by the Office of the Governor this ____________________
256		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
257		-	By: _______________________________ __
258		-	Approved by the Governor of the State of Oklahoma this _____ ____
259		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
260		-
261		-	_________________________________
262		-	Governor of the State of Oklahoma
263		-
264		-
265		-	OFFICE OF THE SECRETARY OF STATE
266		-	Received by the Office of the Secretary of State this _______ ___
267		-	day of __________________, 20 _______, at _______ o'clock _______ M.
268		-	By: _______________________________ __
	371	+	COMMITTEE REPORT BY: COMMITTEE ON INSURANCE, dated 04/04/2023 - DO
	372	+	PASS.