Oklahoma 2024 Regular Session

Oklahoma House Bill HB1504 Compare Versions

Version 1 (Old)

Version 2 (New)

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1		-	An Act
2		-	ENROLLED HOUSE
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	30	+	April 4, 2023
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3	34		BILL NO. 1504 By: Sneed, Randleman,
4	35		O'Donnell, Luttrell,
5	36		Townley, Hardin, Osburn,
6	37		Humphrey, Manger, Olsen,
7	38		Williams, Pae, West
8	39		(Tammy), Cornwell,
9	40		Dobrinski, and Wolfley of
10	41		the House
11	42
12	43		and
13	44
14	45		Bullard of the Senate
15		-
16	46
17	47
18	48
19	49
20	50
21	51		An Act relating to he alth insurance; amending 36 O.S.
22	52		2021, Section 3624, which relates to ass ignability of
23	53		policies; updating statutory reference; amending 36
24	54		O.S. 2021, Section 6055, which relates to insurance
25	55		policies; modifying entities subject to certain
26	56		policies; requiring compensation of certain entities
27	57		in certain situations; creating liabi lity for damages
28	58		in certain cases; providing for certain
29	59		administrative fines; providing for an opportunity
30	60		for hearing; directing admin istrative fees to certain
31	61		funds; creating certa in policyholder rights; updating
32	62		statutory references; and providing an e ffective
33	63		date.
34	64
35	65
36	66
37	67
38		-	SUBJECT: Health insurance
39		-
40	68
41	69		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
42		-
43	70		SECTION 1. AMENDATORY 36 O.S . 2021, Section 3624, is
44	71		amended to read as follows:
45		-	ENR. H. B. NO. 1504 Page 2
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46	99		Section 3624. Except as provided in subsection D of Section
47	100		6055 of this title, a policy may be assignable or not assignable, as
48	101		provided by its terms. Subject to its terms relating to
49	102		assignability, any life or accident and health policy , whether
50	103		heretofore or hereafter issued, under the terms of which the
51	104		beneficiary may be c hanged upon the sole request of the insured, may
52	105		be assigned either by pledge or transfer of title, by an assignment
53	106		executed by the insured alone and delivered to t he insurer, whether
54	107		or not the pledgee or assignee is the insurer. Any such assignment
55	108		shall entitle the insurer to deal with the assignee as the owner or
56	109		pledgee of the policy in accordance with the terms of the
57	110		assignment, until the insurer has received at its home office
58	111		written notice of termination of the a ssignment or pledge, or
59	112		written notice by or on behalf of some other person claiming some
60	113		interest in the policy in conflict with the assignment.
61		-
62	114		SECTION 2. AMENDATORY 36 O.S. 2021, Section 6055, is
63	115		amended to read as follows:
64		-
65	116		Section 6055. A. Under any acciden t and health insurance
66	117		policy, hereafter renewed or issued for delivery from out of
67	118		Oklahoma or in Oklahoma by any insurer and c overing an Oklahoma
68	119		risk, the services and procedures may be performed by any
69	120		practitioner selected by the insured, or the paren t or guardian of
70	121		the insured if the insured is a minor, if the services and
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71	149		procedures fall within the licensed scope of practic e of the
72	150		practitioner providing the s ame.
73		-
74	151		B. An accident and health insurance policy may:
75		-
76	152		1. Exclude or limit coverage for a p articular illness, disease,
77	153		injury or condition; but, except for such exclusions or limits,
78	154		shall not exclude or limit particula r services or procedures that
79	155		can be provided for the diagnosis and treatment of a covered
80	156		illness, disease, injury or condition , if such exclusion or
81	157		limitation has the effect of discriminating against a particular
82	158		class of practitioner. However, such se rvices and procedures, in
83	159		order to be a covered medical expense, must:
84		-
85	160		a. be medically necessar y,
86		-
87	161		b. be of proven efficacy, and
88		-
89	162		c. fall within the licensed scope of practice of the
90		-	practitioner providing same; and ~~ENR. H. B. NO. 1504 Page 3~~
	163	+	practitioner providing same; and
91	164		2. Provide for the application of deducti bles and copayment
92	165		provisions, when equally applied to all covered charges for services
93	166		and procedures that can be provided by a ny practitioner for the
94	167		diagnosis and treatment of a covered illness, disease, injury or
95	168		condition.
96		-
97	169		C. 1. Paragraph 2 of subse ction B of this section shall not be
98	170		construed to prohibit differences in cost-sharing provisions such as
99	171		deductibles and copaym ent provisions between practitioners,
100	172		hospitals and, ambulatory surgical centers , home care agencies, or
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101	200		other health care provi ders or facilities that are licensed or
102	201		certified by the state who are participating preferred provider
103	202		organization providers a nd practitioners, hospitals and, ambulatory
104	203		surgical centers, home care agencies, or other health care providers
105	204		or facilities that are licensed or certified by the state who are
106	205		not participating in the preferred provider organization, subject to
107	206		the following limitations:
108		-
109	207		a. the amount of any annual deductible per covered person
110	208		or per family for treatment in a hospital or
111	209		ambulatory surgical center that is not a pr eferred
112	210		provider shall not exceed three times the amount o f a
113	211		corresponding annual deductib le for treatment in a
114	212		hospital or ambulatory surgical center that is a
115	213		preferred provider,
116		-
117	214		b. if the policy has no deductible fo r treatment in a
118	215		preferred provider h ospital or ambulatory surgical
119	216		center, the deductible for treatment in a hospital or
120	217		ambulatory surgical center that is not a preferred
121	218		provider shall not exceed One Thousand Dollars
122	219		($1,000.00) per covered -person visit,
123		-
124	220		c. the amount of any annual deducti ble per covered person
125	221		or per family treatment, other than inpatient
126	222		treatment, by a practi tioner that is not a preferred
127	223		practitioner shall not exceed three times the amount
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128	251		of a corresponding annual deductible for tre atment,
129	252		other than inpatient treatmen t, by a preferred
130	253		practitioner,
131		-
132	254		d. if the policy has no de ductible for treatment by a
133	255		preferred practitioner, the annual deductible for
134		-	treatment received from a practitioner that is not a ~~ENR. H. B. NO. 1504 Page 4~~
	256	+	treatment received from a practitioner that is not a
135	257		preferred practitioner shall n ot exceed Five Hundred
136	258		Dollars ($500.00) per covered person, and
137		-
138	259		e. the percentage amount of an y coinsurance to be paid by
139	260		an insured to a practitioner, hospital or ambulatory
140	261		surgical center that is not a preferred provider shall
141	262		not exceed by more than t hirty (30) percentage points
142	263		the percentage amount of any coinsurance payment to be
143	264		paid to a preferred provider.
144		-
145	265		2. The Commissioner has discretion to approve a cost-sharing
146	266		arrangement which does not satisfy the limitations imposed by this
147	267		subsection if the Commissioner finds that such cost-sharing
148	268		arrangement will provide a reduction in premium costs.
149		-
150	269		D. 1. A practitioner, ho spital or, ambulatory surgical center,
151	270		home care agency, or other health care provider or facility that is
152	271		licensed or certified by the state that is not a preferred provider
153	272		shall disclose to the insured, in writing, that the insured may be
154	273		responsible for:
	274	+	a. higher coinsurance and deductibles, and
155	275
156		-	a. higher coinsurance and deductibles, and
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157	301
158	302		b. practitioner, hospital or ambulatory surgical center
159	303		charges which exceed the a llowable charges of a
160	304		preferred provider, and
161		-
162	305		c. a good-faith estimate of the total cost to the
163	306		insured.
164		-
165	307		2. When a referral is made to a nonparticipating hospital or
166	308		ambulatory surgical center, the referring practitioner must disclose
167	309		in writing to the in sured, any ownership interest in the
168	310		nonparticipating hospital or ambulatory surgical center.
169		-
170	311		E. Upon submission of a clai m by a practitioner, hospital, home
171	312		care agency, or ambulatory surgical center , or other health care
172	313		provider or facility that is lic ensed or certified by the state to
173	314		an insurer on a unif orm health care claim form adopted by th e
174	315		Insurance Commissioner pur suant to Section 6581 of this title, the
175	316		insurer shall provide a timely explanation of benefits to the
176	317		practitioner, hospital, home c are agency, or ambulatory surgical
177	318		center, or other health care provider or facility that is li censed
178	319		or certified by the s tate regardless of the network participation
179		-	status of such person or entity. ~~ENR. H. B. NO. 1504 Page 5~~
	320	+	status of such person or entity.
180	321		F. Benefits available under an accident and health ins urance
181	322		policy, at the option of the insured, shall be a ssignable to a
182	323		practitioner, hospital, h ome care agency or, ambulatory surgical
183	324		center, or other health care provider or facility that is licensed
184	325		or certified by the state who has provided services an d procedures
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185	353		which are covered under the policy. A pra ctitioner, hospital, home
186	354		care agency or, ambulatory surgical center , or other health care
187	355		provider or facility that is licensed or certified by the state
188	356		shall be compensated directly by an insurer fo r services and
189	357		procedures which have been provided when the following conditions
190	358		are met:
191		-
192	359		1. Benefits available under a po licy have been assigned in
193	360		writing by an insured to the practitioner, hospital, home care
194	361		agency or, ambulatory surgical center , or other health care provider
195	362		or facility that is licensed or certified by the state ;
196		-
197	363		2. A copy of the assignment has been pro vided by the
198	364		practitioner, hospital, home care agency or, ambulatory surgical
199	365		center, or other health care provider or facility that is licensed
200	366		or certified by the state to the insurer;
201		-
202	367		3. A claim has been submitted by the pra ctitioner, hospital,
203	368		home care agency, or ambulatory surgical center, or other health
204	369		care provider or facility that is licensed or certified by the state
205	370		to the insurer on a uniform health insurance claim form adopt ed by
206	371		the Insurance Commissioner pursuan t to Section 6581 of this ti tle;
207	372		and
208		-
209	373		4. A copy of the claim has and the estimate required in
210	374		subparagraph c of paragraph 1 of subsection D of this section have
211	375		been provided by the practitioner, hospital, home care agency or,
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212	403		ambulatory surgical center, or other health care provider or
213	404		facility that is licensed or certified by the s tate to the insured.
214		-
215	405		G. The provisions of subsection F of this section shall not
216	406		apply to:
217		-
218	407		1. Any preferred provider organization (PPO) , as defined by
219	408		generally accepted indus try standards, that contracts with
220	409		practitioners that agree to accept the reimb ursement available under
221	410		the PPO agreement as payment in full and agree not to bal ance bill
222	411		the insured; or
223		-
224		-	2. Any statewide provider ne twork which: ENR. H. B. NO. 1504 Page 6
	412	+	2. Any statewide provider ne twork which:
225	413		a. provides that a practiti oner, hospital, home care
226	414		agency or, ambulatory surgical center, or other health
227	415		care provider or facility that is licensed or
228	416		certified by the state who joins the provider network
229	417		shall be compensated directly by th e insurer,
230		-
231	418		b. does not have any terms or conditions which have the
232	419		effect of discriminating against a particular class of
233	420		practitioner,
234		-
235	421		c. allows any practitioner, hospital, home care agency ,
236	422		or ambulatory surgical center, or other health care
237	423		provider or facility that is licensed or certified b y
238	424		the state, except a practitioner who has a prior
239	425		felony conviction, to become a network provider if
240	426		said the hospital or practitioner is willing to comply
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241	454		with the terms and conditions of a standard network
242	455		provider contract, and
243		-
244	456		d. contracts with practi tioners that agree to accept the
245	457		reimbursement available under the network agre ement as
246	458		payment in full and agree not to balance bill the
247	459		insured.
248		-
249	460		The provisions of this section shall not be deemed to prohibit a
250	461		policyholder from assigning benefits availab le pursuant to an
251	462		accident and health insurance policy, provided that the benefi ts of
252	463		such policy include out -of-network provisions and are being assigned
253	464		to an out-of-network practitioner, hospital, home care agency ,
254	465		ambulatory surgical center, or other h ealth care provider or
255	466		facility that is licensed or certified by the state. The
256	467		assignability of an accident and health insurance policy related to
257	468		out-of-network care shall only be subject to the terms and
258	469		conditions specified in subsection F of this sec tion.
259		-
260	470		H. A nonparticipating p ractitioner, hospital or ambulatory
261	471		surgical center may request from an insurer and the insurer shall
262	472		supply a good-faith estimate of the allowable fee for a procedure to
263	473		be performed upon an insured based upon information reg arding the
264	474		anticipated medical needs of the insured provided to the insurer by
265	475		the nonparticipating practitioner.
266		-
267	476		I. A practitioner shall be equally compensated for covered
268	477		services and procedures provided to an ins ured on the basis of
269		-	charges prevailing in the same geographical area or in similar sized ENR. H. B. NO. 1504 Page 7
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	505	+	charges prevailing in the same geographical area or in similar sized
270	506		communities for similar servic es and procedures provided to
271	507		similarly ill or injured persons regardless of the branch of the
272	508		healing arts to which the practitioner ma y belong, if:
273		-
274	509		1. The practitioner does not authorize or permit false and
275	510		fraudulent advertising regarding the services and procedures
276	511		provided by the practitioner; and
277		-
278	512		2. The practitioner does not ai d or abet the insured to violate
279	513		the terms of the polic y.
280		-
281	514		J. Nothing in the Health Care Freedo m of Choice Act shall
282	515		prohibit an insurer from establishing a preferred provider
283	516		organization and a standard participating provider contract
284	517		therefor, specifying the terms and conditions, including, but not
285	518		limited to, provider qualifications, and alternat ive levels or
286	519		methods of payment that must be met by a practitioner selected by
287	520		the insurer as a participating preferred provider organization
288	521		provider.
289		-
290	522		K. A preferred provider organization, in executing a contract,
291	523		shall not, by the terms and conditions of the contract or internal
292	524		protocol, discriminate within its network of practit ioners with
293	525		respect to participation and reimbursement as it relates to any
294	526		practitioner who is acting within the scope of the practitio ner's
295	527		license under the law solely on th e basis of such license.
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296	554
297	555		L. Decisions by an insurer or a preferred provider org anization
298	556		(PPO) to authorize or deny coverage for an emergency service shall
299	557		be based on the patient presenting symptoms arising from an y injury,
300	558		illness, or condition manifest ing itself by acute symptoms o f
301	559		sufficient severity, including severe pain, such that a reasonable
302	560		and prudent layperson could expect the absence of medical atte ntion
303	561		to result in serious:
304		-
305	562		1. Jeopardy to the health of the patient;
306		-
307	563		2. Impairment of bodily function; or
308		-
309	564		3. Dysfunction of any bodily organ or part.
310		-
311	565		M. An insurer or preferred provider organization (PPO) shall
312	566		not deny an otherwise covered emergen cy service based solely upon
313		-	lack of notification to the i nsurer or PPO. ~~ENR. H. B. NO. 1504 Page 8~~
	567	+	lack of notification to the i nsurer or PPO.
314	568		N. An insurer or a prefe rred provider organization (PP O) shall
315	569		compensate a provider for patient screeni ng, evaluation, and
316	570		examination services that are reasonably calculated to assist the
317	571		provider in determining whether the condition of t he patient
318	572		requires emergency service. If the provider determines tha t the
319	573		patient does not require emergency service, coverage for services
320	574		rendered subsequent to that determination shall be go verned by the
321	575		policy or PPO contract.
322		-
323	576		O. Nothing in this act the Health Care Freedom of Choice Act
324	577		shall be construed as prohib iting an insurer, preferred provider
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325	605		organization or other network from determining the adequacy of the
326	606		size of its network.
327		-
328	607		P. An insurer or a preferred provider organization shall not
329	608		unilaterally remove a provider from the ne twork solely because the
330	609		provider informs an enrollee of the full range of physi cians and
331	610		providers available to the enrollee , including out-of-network
332	611		providers. Nothing in this act the Health Care Freedom of Choic e
333	612		Act prohibits any insurer from allowin g a contract to expire b y its
334	613		own terms or negotiating a new contract with the p rovider at the end
335	614		of the contract term. A provider agreement shall not, as a
336	615		condition of the agreement, prohibit, penalize, terminate , or
337	616		otherwise restrict a preferred prov ider from referring to an out-of-
338	617		network provider; provided, the insured signs a n acknowledgment of
339	618		referral that the insured may be responsible for:
340		-
341	619		1. Higher coinsurance and deductibles; and
342		-
343	620		2. Charges which exce ed the allowable charges of a preferred
344	621		provider.
345		-
346	622		SECTION 3. This act shall become effective November 1, 2023.
347		-	ENR. H. B. NO. 1504 Page 9
348		-	Passed the House of Representatives the 20th day of March, 2023.
349		-
350		-
351		-
352		-
353		-	Presiding Officer of the House
354		-	of Representatives
355		-
356		-
357		-
358		-	Passed the Senate the 26th day of April, 2023.
359		-
360		-
361		-
362		-
363		-	Presiding Officer of the Senate
364		-
365		-
366		-	OFFICE OF THE GOVERNOR
367		-	Received by the Office of the Governor this ____________________
368		-	day of ___________________, 20_______, at _______ o'clock _______ M.
369		-	By: _________________________________
370		-	Approved by the Governor of the State of Oklahoma this _____ ____
371		-	day of ___________________, 20_______, at _______ o'clock _______ M.
372		-
373		-
374		-	_________________________________
375		-	Governor of the State of Oklahoma
376		-
377		-	OFFICE OF THE SECRETARY OF STATE
378		-	Received by the Office of the Secretary of State this __________
379		-	day of ___________________, 20_______, at _______ o'clock _______ M.
380		-	By: _________________________________
	623	+	COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
	624	+	April 4, 2023 - DO PASS