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| 3 | - | ENGR. S. A. TO ENGR. H. B. NO. 1522 Page 1 1 | |
| 3 | + | SENATE FLOOR VERSION - HB1522 SFLR Page 1 | |
| 4 | + | (Bold face denotes Committee Amendments) 1 | |
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| 28 | - | ENGROSSED SENATE AMENDMENT | |
| 29 | - | TO | |
| 30 | - | ENGROSSED HOUSE | |
| 31 | - | BILL NO. 1522 By: Sims, Randleman, Sneed, and | |
| 29 | + | SENATE FLOOR VERSION | |
| 30 | + | April 9, 2024 | |
| 31 | + | ||
| 32 | + | ||
| 33 | + | COMMITTEE SUBSTITUTE | |
| 34 | + | FOR ENGROSSED | |
| 35 | + | HOUSE BILL NO. 1522 By: Sims, Randleman, Sneed, and | |
| 32 | 36 | Sterling of the House | |
| 33 | 37 | ||
| 34 | 38 | and | |
| 35 | 39 | ||
| 36 | 40 | Bullard of the Senate | |
| 37 | - | ||
| 38 | 41 | ||
| 39 | 42 | ||
| 40 | 43 | ||
| 41 | 44 | ||
| 42 | 45 | [ insurance - definitions - shared savings incentive | |
| 43 | 46 | programs - short title - savings incentive program - | |
| 44 | 47 | effective date ] | |
| 45 | 48 | ||
| 46 | 49 | ||
| 47 | 50 | ||
| 48 | 51 | ||
| 49 | - | AMENDMENT NO. 1. Page 1, strike the stricken title, enacting clause | |
| 50 | - | and entire bill and insert | |
| 51 | - | ||
| 52 | - | ||
| 53 | - | “[ insurance - definitions - shared savings incentive | |
| 54 | - | programs - short title - savings incentive program - | |
| 55 | - | effective date ] | |
| 56 | - | ||
| 57 | - | ||
| 58 | 52 | ||
| 59 | 53 | BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | |
| 60 | 54 | SECTION 1. AMENDATORY Section 1, Chapter 151, O.S.L. | |
| 61 | 55 | 2022 (36 O.S. Supp. 2023, Section 6060.40), is amended to read as | |
| 62 | 56 | follows: | |
| 63 | 57 | Section 6060.40. This act shall be known and may be cited as | |
| 64 | 58 | the “Oklahoma Right to Shop Consumer Health Choice Empowerment Act”. | |
| 59 | + | SECTION 2. AMENDATORY Section 2, Chapter 151, O.S.L. | |
| 60 | + | 2022 (36 O.S. Supp. 2023, Section 6060.41 ), is amended to read as | |
| 61 | + | follows: | |
| 62 | + | Section 6060.41. As used in the Oklahoma Right to Shop Consumer | |
| 63 | + | Health Choice Empowerment Act: | |
| 65 | 64 | ||
| 66 | - | ENGR. S. A. TO ENGR. H. B. NO. 1522 Page 2 1 | |
| 65 | + | SENATE FLOOR VERSION - HB1522 SFLR Page 2 | |
| 66 | + | (Bold face denotes Committee Amendments) 1 | |
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| 91 | - | SECTION 2. AMENDATORY Section 2, Chapter 151, O.S.L. | |
| 92 | - | 2022 (36 O.S. Supp. 2023, Section 6060.41), is amended to read as | |
| 93 | - | follows: | |
| 94 | - | Section 6060.41. As used in the Oklahoma Right to Shop Consumer | |
| 95 | - | Health Choice Empowerment Act: | |
| 96 | 91 | 1. “Allowed amount” means the contractually agreed -upon amount | |
| 97 | 92 | paid by a carrier to a health care entity participating in the | |
| 98 | 93 | network of the carrier; | |
| 99 | 94 | 2. “Average allowed amount ” means the mean of all allowed | |
| 100 | 95 | amounts paid for a comparable health care service; | |
| 101 | 96 | 3. “Comparable health care service ” means any covered | |
| 102 | 97 | nonemergency health care service or bundle of services. The | |
| 103 | 98 | Insurance Commissioner may limit what is considered a comparable | |
| 104 | 99 | health care service if an insurance carrier can demonstrate allowed | |
| 105 | 100 | amount variation among network providers is less than Fifty Dollars | |
| 106 | 101 | ($50.00); | |
| 107 | 102 | 3. 4. “Health benefit plan” means any plan as def ined in | |
| 108 | 103 | subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes | |
| 109 | 104 | this title; | |
| 110 | 105 | 4. 5. “Insurance carrier” or “carrier” means an insurance | |
| 111 | 106 | company that issues policies of accident and health insurance and is | |
| 112 | 107 | licensed to sell insurance in this state ; | |
| 113 | 108 | 5. 6. “Shared savings incentive ” means a voluntary and optional | |
| 114 | 109 | financial incentive that an insurance carrier may shall provide to | |
| 110 | + | an enrollee for choosing certain health care services under a shared | |
| 111 | + | savings incentive program; and | |
| 112 | + | 6. 7. “Shared savings incentive program” means a voluntary and | |
| 113 | + | optional an incentive program established by an insurance carrier | |
| 114 | + | pursuant to this act the Consumer Health Choice Empowerment Act . | |
| 115 | 115 | ||
| 116 | - | ENGR. S. A. TO ENGR. H. B. NO. 1522 Page 3 1 | |
| 116 | + | SENATE FLOOR VERSION - HB1522 SFLR Page 3 | |
| 117 | + | (Bold face denotes Committee Amendments) 1 | |
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| 141 | - | an enrollee for choosing certain health care services under a shared | |
| 142 | - | savings incentive program; and | |
| 143 | - | 6. 7. “Shared savings incentive program” means a voluntary and | |
| 144 | - | optional an incentive program established by an insurance carrier | |
| 145 | - | pursuant to this act the Consumer Health Choice Empowerment Act . | |
| 146 | 142 | SECTION 3. AMENDATORY Section 3, Chapter 151, O.S.L. | |
| 147 | 143 | 2022 (36 O.S. Supp. 2023, Section 6060.42), is amended to read as | |
| 148 | 144 | follows: | |
| 149 | 145 | Section 6060.42. A. An insurance carrier may shall offer a | |
| 150 | - | shared savings incentive program to provide incentives to an | |
| 151 | - | enrollee when the enrollee obtains a comparable health care service | |
| 152 | - | that is covered by the carrier from providers that charge les s than | |
| 153 | - | the average allowed amount paid by that carrier to network providers | |
| 154 | - | for that, comparable health care service. If the allowed amount of | |
| 155 | - | a provider is less than the average allowed amount paid by the | |
| 156 | - | carrier, the provider shall not participate in th e shared savings | |
| 157 | - | incentive program unless the provider agrees to accept an amount | |
| 158 | - | less than the allowed amount. | |
| 159 | - | B. If an enrollee of a health benefit plan elects to receive a | |
| 160 | - | covered comparable health care service from a provider who is not | |
| 161 | - | participating in the network of the carrier and agrees to accept an | |
| 162 | - | amount less than the average allowed amount, the carrier shall | |
| 163 | - | ensure that: | |
| 164 | - | ||
| 165 | - | ENGR. S. A. TO ENGR. H. B. NO. 1522 Page 4 1 | |
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| 190 | - | 1. The financial liability of the enrollee is no greater than | |
| 191 | - | the in-network deductible, copay, and coinsurance amounts as | |
| 192 | - | dictated in the health benefit plan contract; and | |
| 193 | - | 2. Calculation of coinsurance liability is based on the amount | |
| 194 | - | negotiated by the enrollee and his or her provider, provided that it | |
| 195 | - | is an amount less than the average allowed amount. | |
| 196 | - | C. Incentives may shall be calculated as a percentage of the | |
| 197 | - | difference in allowed amounts to the average , as a flat dollar | |
| 198 | - | amount, or by any other reasonable methodology approved by the | |
| 199 | - | Insurance Department allowed amount paid by a carrier for a | |
| 200 | - | comparable health care service. If an enrollee elects to receive a | |
| 201 | - | covered comparable health care service from a provider who is not | |
| 202 | - | participating in the network of the carrier, the incentive shall be | |
| 203 | - | calculated as a percentage of the difference in the average allowed | |
| 204 | - | amount to the amount agreed upon between the enrollee and provider, | |
| 205 | - | provided that the amount is less than the average allowed amount . | |
| 206 | - | The carrier shall provide the incentive as a cash payment to the | |
| 207 | - | enrollee or credit toward the annual in -network deductible and out - | |
| 208 | - | of-pocket limit of the enrollee. Carriers may allow enrollees to | |
| 209 | - | select which method the enrollee prefers to receive the incentive. | |
| 210 | - | C. D. An insurance carrier that offers a shared savings | |
| 211 | - | incentive program shall: | |
| 212 | - | 1. Establish the program as a component part of the policy or | |
| 213 | - | certificate of insurance provided by the carrier and notify the | |
| 214 | - | ||
| 215 | - | ENGR. S. A. TO ENGR. H. B. NO. 1522 Page 5 1 | |
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| 240 | - | enrollees and the Insurance Department at least thirty (30) days | |
| 241 | - | before program termination; | |
| 242 | - | 2. File a description of the program on a form prescribed by | |
| 243 | - | the Insurance Commissi oner. The Insurance Department shall review | |
| 244 | - | the filing and determine whether the program complies with the | |
| 245 | - | provisions of this section; | |
| 246 | - | 3. Notify an enrollee, annually or at the time of renewal, of | |
| 247 | - | the availability of the shared savings incentive program and the | |
| 248 | - | procedures to participate in the program; | |
| 249 | - | 4. Publish on the website of the insurance carrier, easily | |
| 250 | - | accessible to enrollees and applicants for insurance, a list of | |
| 251 | - | comparable health care services and health care providers and the | |
| 252 | - | shared savings incentive amount applicable for each service. A | |
| 253 | - | shared savings incentive shall not be less than twenty -five percent | |
| 254 | - | (25%) of the savings generated by the participation of the enrollee | |
| 255 | - | in any shared savings incentive program offered by the insurance | |
| 256 | - | carrier. The baseline for the savings calculation shall be the | |
| 257 | - | average in-network amount paid for that service in the most recent | |
| 258 | - | twelve-month period or any other methodology established by the | |
| 259 | - | insurance carrier and approved by the Insurance Department ; | |
| 260 | - | 5. Upon request by an enrollee, provide the average allowed | |
| 261 | - | amount for a covered comparable health care service; | |
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| 263 | - | ENGR. S. A. TO ENGR. H. B. NO. 1522 Page 6 1 | |
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| 288 | - | 6. At least quarterly, credit , deposit or make a cash payment | |
| 289 | - | to an enrollee of the shared savings incentive amount pursuant to | |
| 290 | - | participation in the shared savings incentive program; and | |
| 291 | - | 6. 7. Submit an annual report to the Insurance Department | |
| 292 | - | within ninety (90) days after the close of each health benefit plan | |
| 293 | - | year. At a minimum, the report shall include the following | |
| 294 | - | information: | |
| 295 | - | a. the number of enrollees who participated in the | |
| 296 | - | program during the health benefit plan year and the | |
| 297 | - | number of instances of participation, | |
| 298 | - | b. the total cost of services provided as a part of the | |
| 299 | - | program, and | |
| 300 | - | c. the total value of the shared savings incentive | |
| 301 | - | payments made to enrollees participating in the | |
| 302 | - | program and the values distributed as cash or credit | |
| 303 | - | toward the annual in -network deductible and out -of- | |
| 304 | - | pocket limit of an enrollee. | |
| 305 | - | D. E. An enrollee shall not be required to participate in a | |
| 306 | - | shared savings incentive pr ogram. | |
| 307 | - | F. The provisions of this act shall only be applicable to | |
| 308 | - | enrollees of a health benefit plan that elect to receive a covered | |
| 309 | - | comparable health care service in a county with a population of no | |
| 310 | - | more than Five Hundred Thousand (500,000). | |
| 311 | - | SECTION 4. This act shall become effective November 1, 2024. ” | |
| 312 | - | ||
| 313 | - | ENGR. S. A. TO ENGR. H. B. NO. 1522 Page 7 1 | |
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| 338 | - | Passed the Senate the 25th day of April, 2024. | |
| 339 | - | ||
| 340 | - | ||
| 341 | - | ||
| 342 | - | Presiding Officer of the Senate | |
| 343 | - | ||
| 344 | - | ||
| 345 | - | Passed the House of Representatives the ____ day of __________, | |
| 346 | - | 2024. | |
| 347 | - | ||
| 348 | - | ||
| 349 | - | ||
| 350 | - | Presiding Officer of the Ho use | |
| 351 | - | of Representatives | |
| 352 | - | ||
| 353 | - | ENGR. H. B. NO. 1522 Page 1 1 | |
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| 378 | - | ENGROSSED HOUSE | |
| 379 | - | BILL NO. 1522 By: Sims, Randleman, Sneed, and | |
| 380 | - | Sterling of the House | |
| 381 | - | ||
| 382 | - | and | |
| 383 | - | ||
| 384 | - | Bullard of the Senate | |
| 385 | - | ||
| 386 | - | ||
| 387 | - | ||
| 388 | - | ||
| 389 | - | ||
| 390 | - | [ insurance - definitions - shared savings incentive | |
| 391 | - | programs - short title - savings incentive program - | |
| 392 | - | effective date ] | |
| 393 | - | ||
| 394 | - | ||
| 395 | - | ||
| 396 | - | ||
| 397 | - | BE IT ENACTED BY THE PEOPLE OF THE S TATE OF OKLAHOMA: | |
| 398 | - | SECTION 5. AMENDATORY Section 1, Chapter 151, O.S.L. | |
| 399 | - | 2022 (36 O.S. Supp. 2023, Section 6060.40), is amended to read as | |
| 400 | - | follows: | |
| 401 | - | Section 6060.40 This act shall be known and may be c ited as the | |
| 402 | - | "Oklahoma Right to Shop Consumer Health Choice Empowerment Act". | |
| 403 | - | SECTION 6. AMENDATORY Section 2, Chapter 151, O.S.L. | |
| 404 | - | 2022 (36 O.S. Supp. 2023, Section 6060.41 ), is amended to read as | |
| 405 | - | follows: | |
| 406 | - | Section 6060.41 As used in the Oklahoma Right to Shop Consumer | |
| 407 | - | Health Choice Empowerment Act: | |
| 408 | - | ||
| 409 | - | ENGR. H. B. NO. 1522 Page 2 1 | |
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| 434 | - | 1. "Allowed amount" means the contractually agreed -upon amount | |
| 435 | - | paid by a carrier to a health care entity participating in the | |
| 436 | - | network of the carrier; | |
| 437 | - | 2. "Average allowed amount" means the mean of all allowed | |
| 438 | - | amounts paid for a comparable health care service; | |
| 439 | - | 3. "Comparable health care service " means any covered | |
| 440 | - | nonemergency health care service or bundle of services. The | |
| 441 | - | Insurance Commissioner may limit what is considered a comparable | |
| 442 | - | health care service if an insuran ce carrier can demonstrate allowed | |
| 443 | - | amount variation among network providers is less than Fifty Dol lars | |
| 444 | - | ($50.00); | |
| 445 | - | 3. 4. "Health benefit plan" means any plan as defined in | |
| 446 | - | subsection C of Section 6060 .4 of Title 36 of the Oklahoma Statutes | |
| 447 | - | this title; | |
| 448 | - | 4. 5. "Insurance carrier" or "carrier" means an insurance | |
| 449 | - | company that issues policies of accident and health insurance and is | |
| 450 | - | licensed to sell insurance in this state; | |
| 451 | - | 5. 6. "Shared savings incentive " means a voluntary and optional | |
| 452 | - | financial incentive that a n insurance carrier may shall provide to | |
| 453 | - | an enrollee for choosing certain health care services und er a shared | |
| 454 | - | savings incentive program; and | |
| 455 | - | 6. 7. "Shared savings incentive program " means a voluntary and | |
| 456 | - | optional an incentive program established by an insurance carrier | |
| 457 | - | pursuant to this act the Consumer Health Choice Empowerment Act. | |
| 458 | - | ||
| 459 | - | ENGR. H. B. NO. 1522 Page 3 1 | |
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| 483 | - | ||
| 484 | - | SECTION 7. AMENDATORY Section 3, Chapter 151, O.S.L. | |
| 485 | - | 2022 (36 O.S. Supp. 2023, Section 6060.42), is amended to read as | |
| 486 | - | follows: | |
| 487 | - | Section 6060.42 A. An insurance carrier may shall offer a | |
| 488 | 146 | shared savings incentive program to provide incentives to an | |
| 489 | 147 | enrollee when the enrollee obtains a comparable health care servi ce | |
| 490 | 148 | that is covered by the carrier from providers that charge less than | |
| 491 | 149 | the average allowed amount paid by that carrier to network providers | |
| 492 | 150 | for that, comparable health care service. If the allowed amount of | |
| 493 | 151 | a provider is less than the average allowed amou nt paid by the | |
| 494 | 152 | carrier, the provider shall not pa rticipate in the shared savings | |
| 495 | 153 | incentive program unless the provider agrees to accept an amount | |
| 496 | 154 | less than the allowed amount. | |
| 497 | 155 | B. If an enrollee of a health benefit plan elects to receive a | |
| 498 | 156 | covered comparable health care service from a provider who is not | |
| 499 | 157 | participating in the network of the carrier and agrees to accept an | |
| 500 | 158 | amount less than the average allowed amount, the carrier shall | |
| 501 | 159 | ensure that: | |
| 502 | 160 | 1. The financial liability of the enrollee is no greater than | |
| 503 | 161 | the in-network deductible, copay, and coinsuranc e amounts as | |
| 504 | 162 | dictated in the health benefit plan contract; and | |
| 505 | 163 | 2. Calculation of coinsurance liability is based on the amount | |
| 506 | 164 | negotiated by the enrollee and his or her provider, provided that it | |
| 507 | 165 | is an amount less than the average allowed amount. | |
| 508 | 166 | ||
| 509 | - | ENGR. H. B. NO. 1522 Page 4 1 | |
| 167 | + | SENATE FLOOR VERSION - HB1522 SFLR Page 4 | |
| 168 | + | (Bold face denotes Committee Amendments) 1 | |
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| 534 | 193 | C. Incentives may shall be calculated as a percentage of the | |
| 535 | 194 | difference in allowed amounts to the average , as a flat dollar | |
| 536 | 195 | amount, or by any other reasonable methodology approved by the | |
| 537 | 196 | Insurance Department allowed amount paid by a carrier for a | |
| 538 | 197 | comparable health care service. If an enrollee elects to receive a | |
| 539 | 198 | covered comparable health care service from a provider who is not | |
| 540 | 199 | participating in the network of the carrier, the incentive shall be | |
| 541 | 200 | calculated as a percen tage of the difference in the average allowed | |
| 542 | 201 | amount to the amount agreed upon between the enrollee and provider, | |
| 543 | 202 | provided that the amount is less than the average allowed amount . | |
| 544 | 203 | The carrier shall provide the incentive as a cash payment to the | |
| 545 | 204 | enrollee or credit toward the annual in -network deductible and out- | |
| 546 | 205 | of-pocket limit of the enrollee. Carriers may allow enrollees to | |
| 547 | 206 | select which method the enrollee prefers to receive the incentive. | |
| 548 | 207 | C. D. An insurance carrier that offers a shared savings | |
| 549 | 208 | incentive program shall: | |
| 550 | 209 | 1. Establish the program as a component part of the policy or | |
| 551 | 210 | certificate of insurance provided by the carrier and notify the | |
| 552 | 211 | enrollees and the Insurance Department at least thirty (30) days | |
| 553 | 212 | before program termination; | |
| 554 | 213 | 2. File a descripti on of the program on a form prescribed by | |
| 555 | 214 | the Insurance Commissioner. The Insurance Department shall review | |
| 556 | 215 | the filing and determine whether the program complies with the | |
| 557 | 216 | provisions of this section; | |
| 558 | 217 | ||
| 559 | - | ENGR. H. B. NO. 1522 Page 5 1 | |
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| 584 | 244 | 3. Notify an enrollee, annually or at the time of renew al, of | |
| 585 | 245 | the availability of the shared savings incentive program and the | |
| 586 | 246 | procedures to participate in the program; | |
| 587 | 247 | 4. Publish on the website of the insurance carrier, easily | |
| 588 | 248 | accessible to enrollees and applicants for insurance, a list of | |
| 589 | 249 | comparable health care services and health care providers and the | |
| 590 | 250 | shared savings incentive amount applicable for each service. A | |
| 591 | 251 | shared savings incentive shall not be less than twenty -five percent | |
| 592 | 252 | (25%) of the savings generated by the participation of the enrollee | |
| 593 | 253 | in any shared savings incentive program offered by the insurance | |
| 594 | 254 | carrier. The baseline for the savings calculation shall be the | |
| 595 | 255 | average in-network amount paid for that service in the most recent | |
| 596 | 256 | twelve-month period or any other methodology established by the | |
| 597 | 257 | insurance carrier and approved by the Insurance Depar tment; | |
| 598 | 258 | 5. Upon request by an enrollee, provide the average allowed | |
| 599 | 259 | amount for a covered comparable health care service; | |
| 600 | 260 | 6. At least quarterly, credit , deposit or make a cash payment | |
| 601 | 261 | to an enrollee of the s hared savings incentive amount pursuant to | |
| 602 | 262 | participation in the shared savings incentive program; and | |
| 603 | 263 | 6. 7. Submit an annual report to the Insurance Department | |
| 604 | 264 | within ninety (90) days after the close of each health benefit plan | |
| 605 | 265 | year. At a minimum, the re port shall include the following | |
| 606 | 266 | information: | |
| 607 | 267 | ||
| 608 | - | ENGR. H. B. NO. 1522 Page 6 1 | |
| 268 | + | SENATE FLOOR VERSION - HB1522 SFLR Page 6 | |
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| 633 | 294 | a. the number of enrollees who participated in the | |
| 634 | 295 | program during the health benefit plan year and the | |
| 635 | 296 | number of instances of participation, | |
| 636 | 297 | b. the total cost of services provided as a part of the | |
| 637 | 298 | program, and | |
| 638 | 299 | c. the total value of the shared savings incentive | |
| 639 | 300 | payments made to enrollees participating in the | |
| 640 | 301 | program and the values distributed as cash or credit | |
| 641 | 302 | toward the annual in -network deductible and out -of- | |
| 642 | 303 | pocket limit of an enrollee. | |
| 643 | 304 | D. E. An enrollee shall not be required to participate in a | |
| 644 | 305 | shared savings incentive program. | |
| 645 | - | SECTION 8. This act shall become effective November 1, 2024. | |
| 646 | - | Passed the House of Representatives the 14th day of March, 2024. | |
| 647 | - | ||
| 648 | - | ||
| 649 | - | ||
| 650 | - | ||
| 651 | - | Presiding Officer of the House | |
| 652 | - | of Representatives | |
| 653 | - | ||
| 654 | - | ||
| 655 | - | Passed the Senate the ___ day of __________, 2024. | |
| 656 | - | ||
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| 659 | - | ||
| 660 | - | Presiding Officer of the Senate | |
| 661 | - | ||
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| 306 | + | F. The provisions of this act shall only be applicable to | |
| 307 | + | enrollees of a health benefit plan that elect to receive a covered | |
| 308 | + | comparable health care service in a county with a populatio n of no | |
| 309 | + | more than Five Hundred Thousand (500,000). | |
| 310 | + | SECTION 4. This act shall become effective November 1, 2024. | |
| 311 | + | COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE | |
| 312 | + | April 9, 2024 - DO PASS AS AMENDED BY CS |