An Act
ENROLLED SENATE
BILL NO. 442 By: Montgomery of the Senate
and
Sneed and Munson of the
House
An Act relating to health benefit plan directories;
defining terms; directing plans to publish ce rtain
provider directories on certain website; describin g
information to be included in directory; requiring
directory to be publicly accessible; directing plan
to publish certain criteria; providing for
accessibility of certain directories; requiring
certain disclosure; providing for reporting
procedure; requiring plan response to report by
certain date; requiring annual audit of certain
information; requiring notice to be provided to
certain providers by plan ; directing plan to remove
certain providers af ter certain time period;
directing plan to submit certai n information to
Insurance Commissioner; establishing procedure for
certain use of inaccurate information by insured;
requiring reimbursement by plan und er certain
circumstances for care provided by o ut-of-network
provider; authorizing Commissioner to prom ulgate
rules; providing for codification; and providing an
effective date.
SUBJECT: Health benefit plan directories
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
ENR. S. B. NO. 442 Page 2
SECTION 1. NEW LAW A new section o f 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:
A. As used in this section:
1. “Health benefit plan” means a plan as defined pursuant 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 def ined
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 provider directory for each of
its network plans, to be updated every sixty (60) 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
directory shall include the following information:
1. For health care professionals:
a. name,
b. contact information, including a website address,
physical address, and phone number, and
c. specialty, if applicable;
2. For hospitals:
ENR. S. B. NO. 442 Page 3
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.
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 n umber.
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 criteria used to build its provider
network; and
2. If applicable:
ENR. S. B. NO. 442 Page 4
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 network 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. Provider directories, whether in electronic or, if
offered, print format, shall be accessible to individuals with
disabilities and individuals with limite d English proficiency as
defined in 45 C.F.R. Sections 92.201 and 155.205.
2. The plan shall include a disclosure in any print directory
issued under this subsection that the informati on in the directory
is accurate as of the date of printing and that an insured or
prospective insured should consult the electronic provider direct ory
on the website of the plan 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 , if offered, a clearly identifiable telephone
number, email address, or l ink to a webpage which an insured or the
general public may use to r eport 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
two (2) days following the receipt of such report, either verify the
accuracy of the information or update the information.
2. A plan shall take appropriate steps to en sure the accuracy
of the information concerning eac h provider listed in the provider
directory. 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 audit should be focus ed on the top
four utilized specialties to include at least one specialty related
ENR. S. B. NO. 442 Page 5
to mental health. Alternatively, plans may audit based on a
reasonable sample size of providers, as long as the sample size
includes behavioral health p roviders. The plan shall retain
documentation of any audit conducted under this paragraph to be made
available to the Insu rance Commissioner. Based on the results of a
given audit, the plan shall ver ify and attest to th e accuracy of the
information or update the infor mation.
G. An insurer of a health benefit plan shall, by certified
mail, return receipt requested, or by electronic mail, read receipt
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 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:
1. The number of reports received pursuant to subsection F of
this section, the ti meliness of the response from the plan, and the
corrective action or actions taken; and
2. All auditing reports conducted by the plan pursuant to
subsection F of this section.
I. If an insured reasonably relies upon materially inaccurate
information contained in a provider directory of a plan, the
Commissioner may require the plan to provide coverage for all
covered health care services provided to the insured and to
reimburse the insured f or 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 car e providers to report changes to their
information prior to requiring any reimbursement to an insured. In
the event that the Commissioner finds that the p rovider has not
ENR. S. B. NO. 442 Page 6
provided updated information for the network directory of the
insurer of a health ben efit 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 were covered services under
the insured’s network plan. If the services satisfy requirements of
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 may promulgate rules to effectuate the
provisions of this section.
SECTION 2. This act shall become effective November 1, 2023.
ENR. S. B. NO. 442 Page 7
Passed the Senate the 6th day of March, 2023.
Presiding Officer of the Senate
Passed the House of Representatives the 25th day of April, 2023.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of _________________ __, 20_______, at _______ o'clock _______ M.
By: _______________________________ __
Approved by the Governor of the State of Oklahoma this _____ ____
day of _________________ __, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this _______ ___
day of __________________, 20 _______, at _______ o'clock _______ M.
By: _______________________________ __