Oklahoma 2024 Regular Session

Oklahoma House Bill HB3369 Compare Versions

Version 1 (Old)

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1		-	An Act
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3	34		BILL NO. 3369 By: McEntire of the House
4	35
5	36		and
6	37
7	38		Garvin of the Senate
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14	43		An Act relating to state government; amending 74 O.S.
15	44		2021, Section 1304.1, which relates to the Oklahoma
16	45		Employees Insurance a nd Benefits Act; modifying
17	46		certain duties and responsibilities; adding external
18	47		review requirements; and providing an effective date .
19	48
20	49
21		-	SUBJECT: State government
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23	53		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
24		-
25	54		SECTION 1. AMENDATORY 74 O.S. 2021, S ection 1304.1, is
26	55		amended to read as follows:
27		-
28		-	Section 74-1304.1 A. The State and Education Employees Group
	56	+	Section 1304.1 A. The State and Education Employees Group
29	57		Insurance Board and the Oklahoma State Employees Benefits Council
30	58		are hereby abolished. Wherever the State and Education Employees
31	59		Group Insurance Board and the Oklahoma State Employees Benefits
32	60		Council are referenced in law, that reference shall be construed to
33	61		mean the Oklahoma Employees Insurance and Benefits Board.
34		-
35	62		B. There is hereby created the Oklahoma Employees Insurance and
36	63		Benefits Board.
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38	91		C. The chair and vice-chair shall be elected by the Board
39	92		members at the first meeting of the Board and shall preside over
40	93		meetings of the Board and perform other duties as may be required by
41	94		the Board. Upon the resignation or expiration of the term of the
42	95		chair or vice-chair, the members shall elect a chair or vice -chair.
43	96		The Board shall elect one of its members to serve as secretary.
44		-	ENR. H. B. NO. 3369 Page 2
45	97		D. The Board shall consist of seven (7) members to be appointed
46	98		as follows:
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48	99		1. The State Insurance Commissioner, or desig nee;
49		-
50	100		2. Four members shall be appointed by the Governor;
51		-
52	101		3. One member shall be appointed by the Speaker of the Oklahoma
53	102		House of Representatives; and
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55	103		4. One member shall be appointed by the President Pro Tempore
56	104		of the Oklahoma State Senate.
57		-
58	105		E. The appointed members shall:
59		-
60	106		1. Have demonstrated professional experience in investment or
61	107		funds management, public funds management, publ ic or private group
62	108		health or pension fund management, or group health insurance
63	109		management;
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65	110		2. Be licensed to practice la w in this state and have
66	111		demonstrated professional experience in commercial matters; or
67		-
68	112		3. Be licensed by the Oklahoma Accountancy Board to practice in
69	113		this state as a public accountant or a certified public accountant.
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71	141		In making appointments that conform to the requirements of this
72	142		subsection, at least one but not more than three members shall be
73	143		appointed each from paragraphs 2 and 3 of this subsection by the
74	144		combined appointing authorities.
75		-
76	145		F. Each member of the Board shall serve a term of four (4)
77	146		years from the date of appointment.
78		-
79	147		G. Members of the Board shall be subject to the following:
80		-
81	148		1. The appointed members shall each receive compensation of
82	149		Five Hundred Dollars ($500.00) per month. Appointed members who
83	150		fail to attend a regularly scheduled meeting of the Board shall not
84	151		receive the related compensation;
85		-
86	152		2. The appointed members shall be reimbursed for their
87	153		expenses, according to the State Travel Reimbursement Act, as are
88	154		incurred in the performance of their duties, which shall be paid
89		-	from the Health Insurance Reserve Fund; ENR. H. B. NO. 3369 Page 3
90		-
	155	+	from the Health Insurance Reserve Fund;
91	156		3. In the event an appointed member does not attend at least
92	157		seventy-five percent (75%) of the regularly scheduled meetings of
93	158		the Board during a calendar year, the appointing authority may
94	159		remove the member;
95		-
96	160		4. A member may also be removed for any other cause as provided
97	161		by law;
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99	162		5. No Board member shall be individually or personally liable
100	163		for any action of the Board; and
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102	191		6. Participation on the Board is contingent upon maintaining
103	192		all necessary annual training as ma y be required through the Health
104	193		Insurance Portability and Accountability Act of 1996, Medicare
105	194		contracting requirements or other statutory or regulatory
106	195		guidelines.
107		-
108	196		H. The Board shall meet as often as necessary to conduct
109	197		business but shall meet no less than four times a year, with an
110	198		organizational meeting to be held prior to December 1, 2012. The
111	199		organizational meeting shall be cal led by the Insurance
112	200		Commissioner. A majority of the members of the Board shall
113	201		constitute a quorum for the transaction of business, and any
114	202		official action of the Board must have a favorable vote by a
115	203		majority of the members of the Board present.
116		-
117	204		I. Except as otherwise provided in this subsection, no member
118	205		of the Board shall be a lobbyist registered in this state as
119	206		provided by law, or be employed directly or indirectly by any firm
120	207		or health care provider under contract to the State and Education
121	208		Employees Group Insurance Board, the Oklahoma State Employees
122	209		Benefits Council, or the Oklahoma Employees Insurance and Benefits
123	210		Board, or any benefit program under its jurisdiction, for any goods
124	211		or services whatsoever. Any physician member of the Board shall not
125	212		be subject to the provisions of this subsection.
126	213
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127	240		J. Any vacancy occurring on the Board shall be filled for the
128	241		unexpired term of office in the same manner as provided for in
129	242		subsection D of this section.
130		-
131	243		K. The Board shall act in accordance with the provisions of the
132	244		Oklahoma Open Meeting Act, the Oklahoma Open Records Act and the
133	245		Administrative Procedures Act.
134		-	ENR. H. B. NO. 3369 Page 4
135	246		L. The Administrative Director of the Courts shall designate
136	247		grievance panel members as shall be necessary. The members of the
137	248		grievance panel shall consist of two attorneys licensed to practice
138	249		law in this state and one state -licensed health care professional or
139	250		health care administrator who has at least three (3) years practical
140	251		experience, has had or has admitting privileges to a hospital i n
141	252		this state, has a working knowledge of prescription medication, or
142	253		has worked in an administrative capacity at some point in their his
143	254		or her career. The state health care professional shall be
144	255		appointed by the Governor. At the Governor 's discretion, one or
145	256		more qualified individuals may also be appointed as an alternate to
146	257		serve on the grievance panel in the event the Gov ernor's primary
147	258		appointee becomes unable to serve.
148		-
149	259		M. The Office of Management and Enterprise Services shall have
150	260		the following duties, responsibilities and authority with respect to
151	261		the administration of the flexible benefits plan authorized pursuant
152	262		to the State Employees Flexible Benefits Act:
153	263
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154	290		1. To construe and interpret the plan, and decide all questions
155	291		of eligibility in accordance with the Oklahoma State Employees
156	292		Benefits Act and 26 U.S.C.A., Section 1 et seq.;
157		-
158	293		2. To select those benefits which s hall be made available to
159	294		participants under the plan, according to the Oklahoma State
160	295		Employees Benefits Act, and other applicable l aws and rules;
161		-
162	296		3. To prescribe procedures to be followed by participants in
163	297		making elections and filing claims under the p lan;
164		-
165	298		4. Beginning with the plan year which begins on January 1,
166	299		2013, to select and contract with one or more providers to offer a
167	300		group TRICARE Supplement product to eligible employees who are
168	301		eligible TRICARE beneficiaries. Any membership dues required to
169	302		participate in a group TRICARE Supplement product offered pursuant
170	303		to this paragraph shall be paid by the employee. As used in t his
171	304		paragraph, "TRICARE" means the Department of Defense health care
172	305		program for active duty and retired service members an d their
173	306		families;
174		-
175	307		5. To prepare and distribute information communicating and
176	308		explaining the plan to participating employers and participants.
177	309		Health Maintenance Organizations or other third -party insurance
178	310		vendors may be directly or indirectly involved i n the distribution
179		-	of communicated information to participating state agency employers ~~ENR. H. B. NO. 3369 Page 5~~
	311	+	of communicated information to participating state agency employers
180	312		and state employee participants subject to the following condition:
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181	340		the Board shall verify all marketing and communications information
182	341		for factual accuracy prior to di stribution;
183		-
184	342		6. To receive from participating employers and participants
185	343		such information as shall be necessary for the proper administration
186	344		of the plan, and any of the benefits offered thereunder;
187		-
188	345		7. To furnish the participating employers and participan ts such
189	346		annual reports with respect to the administration of the plan as are
190	347		reasonable and appropriate;
191		-
192	348		8. To keep reports of benef it elections, claims and
193	349		disbursements for claims under the plan;
194		-
195	350		9. To negotiate for best and final offer through competi tive
196	351		negotiation with the assistance and through the purchasing
197	352		procedures adopted by the Office of Management and Enterprise
198	353		Services and contract with federally qualified health maintenance
199	354		organizations under the provisions of 42 U.S.C., Section 300e et
200	355		seq., or with Health Maintenance Organizations granted a certificate
201	356		of authority by the Insurance Commissioner pursuant to the Heal th
202	357		Maintenance Reform Act of 2003 for consideration by participants as
203	358		an alternative to the health plans offered by the Ok lahoma Employees
204	359		Insurance and Benefits Board, and to transfer to the health
205	360		maintenance organizations such funds as may be approved for a
206	361		participant electing health maintenance organization alternative
207	362		services. The Board may also select and contract wi th a vendor to
208	363		offer a point-of-service plan. An HMO may offer coverage through a
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209	391		point-of-service plan, subject to the guidelines e stablished by the
210	392		Board. However, if the Board chooses to offer a point -of-service
211	393		plan, then a vendor that offers both an HMO plan and a point -of-
212	394		service plan may choose to offer only its point -of-service plan in
213	395		lieu of offering its HMO plan. The Board may, however, renegotiate
214	396		rates with successful bidders after contracts have been awarded if
215	397		there is an extraordinary cir cumstance. An extraordinary
216	398		circumstance shall be limited to insolvency of a participating
217	399		health maintenance organization or point -of-service plan,
218	400		dissolution of a participating health maintenance organization or
219	401		point-of-service plan or withdrawal of a nother participating health
220	402		maintenance organization or point -of-service plan at any time during
221	403		the calendar year. Nothing in this section of law shall be
222	404		construed to permit either party to unilaterally alter the terms of
223	405		the contract;
224		-	ENR. H. B. NO. 3369 Page 6
225	406		10. To retain as confidential information the initial Request
226	407		For Proposal offers as well as any subsequent bid offers made by the
227	408		health plans prior to final contract awards as a part of the best
228	409		and final offer negotiations process for the benefit plan;
229		-
230	410		11. To promulgate administrative rules for the competitive
231	411		negotiation process;
232		-
233	412		12. To require vendors offering coverage to provide such
234	413		enrollment and claims data as is determined by the Board. The Board
235	414		shall be authorized to retain as confidential any proprietary
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236	442		information submitted in response to the Board 's Request For
237	443		Proposal. Provided, however, that any such information requested by
238	444		the Board from the vendors shall only be subject to the
239	445		confidentiality provision of this paragraph if it is clearly
240	446		designated in the Request For Proposal as being protected under this
241	447		provision. All requested information lacking such a designation in
242	448		the Request For Proposal shall be subject to Section 24A.1 et seq.
243	449		of Title 51 of the Oklahoma Statutes. From health maintenance
244	450		organizations, data provided shall include the current Health Plan
245	451		Employer Data and Information Set (HEDIS);
246		-
247	452		13. To authorize the p urchase of any insurance deemed necessary
248	453		for providing benefits under the plan including indemnity dental
249	454		plans, provided that the only indemnity health plan selected by the
250	455		Board shall be the indemnity plan offered by the Board, and to
251	456		transfer to the Board such funds as may be approved for a
252	457		participant electing a benefit plan offered by the Board. All
253	458		indemnity dental pla ns shall meet or exceed the following
254	459		requirements:
255		-
256	460		a. they shall have a statewide provider network,
257		-
258	461		b. they shall provide benefits w hich shall reimburse the
259	462		expense for the following types of dental procedures:
260		-
261	463		(1) diagnostic,
262		-
263	464		(2) preventative,
264		-
265	465		(3) restorative,
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267	493		(4) endodontic,
268		-
269		-	(5) periodontic, ENR. H. B. NO. 3369 Page 7
270		-
	494	+	(5) periodontic,
271	495		(6) prosthodontics,
272		-
273	496		(7) oral surgery,
274		-
275	497		(8) dental implants,
276		-
277	498		(9) dental prosthetics, and
278		-
279	499		(10) orthodontics, and
280		-
281	500		c. they shall provide an annual benefit of not less than
282	501		One Thousand Five Hundred Dollars ($1,500.00) for all
283	502		services other than orthodontic services, and a
284	503		lifetime benefit of not less than One Thousand Five
285	504		Hundred Dollars ($1,500.00) for orthodontic services;
286		-
287	505		14. To communicate deferred compensation programs as provided
288	506		in Section 1701 of Title 74 of the Oklahoma Statutes this title;
289		-
290	507		15. To assess and collect reasonable fees from contracted
291	508		health maintenance organizations and third -party insurance vendors
292	509		to offset the costs of administration;
293		-
294	510		16. To accept, modify or reject elections under the plan in
295	511		accordance with the Oklahoma State Employees Benefits Act and 26
296	512		U.S.C.A., Section 1 et seq.;
297		-
298	513		17. To promulgate election and claim forms to be used by
299	514		participants;
300		-
301	515		18. To adopt rules requiring payment for medical and dental
302	516		services and treatment rende red by duly licensed hospitals,
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303	544		physicians and dentists. Unless the Board has otherwise contracted
304	545		with the out-of-state health care provider, the Board shall
305	546		reimburse for medical services and treatment rendered and charged by
306	547		an out-of-state health care provider at least at the same percentage
307	548		level as the network percentage level of the fee schedule
308	549		established by the Oklahoma Emplo yees Insurance and Benefits Board
309	550		if the insured employee was referred to the out -of-state health care
310	551		provider by a physic ian or it was an emergency situation and the
311	552		out-of-state provider was the closest in proximity to the place of
312	553		residence of the employee which offers the type of health care
313		-	services needed. For purposes of this paragraph, health care ~~ENR. H. B. NO. 3369 Page 8~~
	554	+	services needed. For purposes of this paragraph, health care
314	555		providers shall include, but not be limited to, physicians,
315	556		dentists, hospitals and special care facilities;
316		-
317	557		19. To enter into a contract with out -of-state providers in
318	558		connection with any PPO or hospital or medical network plan which
319	559		shall include, but not be limited to, s pecial care facilities and
320	560		hospitals outside the borders of the State of Oklahoma. The
321	561		contract for out-of-state providers shall be identical to the in -
322	562		state provider contracts. The Board may negotiate for discounts
323	563		from billed charges when the out -of-state provider is not a network
324	564		provider and the member sought services in an emergency situation,
325	565		when the services were not otherwise available in the State of
326	566		Oklahoma or when the Administrator appointed by the Board approved
327	567		the service as an exceptional circumstance;
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329	595		20. To create the establishment of a grievance procedure by
330	596		which a three-member grievance panel external appeals procedures for
331	597		complaints by insured employees in the two following manners :
332		-
333	598		a. independent review organizations, accredited b y a
334	599		national accrediting body, shall act as an appeals
335	600		body bodies for complaints by insured employees
336	601		regarding the allowance and pa yment of claims,
337	602		eligibility, and other matters. Except for grievances
338	603		settled to the satisfaction of both parties prior t o a
339	604		hearing, any person who requests in writing a hearing
340	605		before the grievance panel shall receive a hearing
341	606		before the panel. adverse benefit determinations based
342	607		on:
343		-
344	608		(1) medical judgment,
345		-
346	609		(2) whether the insurer is complying with the
347	610		surprise billing and cost-sharing protections set
348	611		forth in Sections 2799A-1 and 2799A-2 of the
349	612		Public Health Services Act, 42 U.S.C. 201 et
350	613		seq., and
351		-
352	614		(3) a recission in coverage,
353		-
354	615		b. a three-member grievance panel, which shall act as an
355	616		appeals body for complaints by insured e mployees
356	617		regarding all other issues.
357		-	ENR. H. B. NO. 3369 Page 9
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358	645		The grievance procedure appeals procedures provided by this
359	646		paragraph shall be the exclusive remedy remedies available to
360	647		insured employees having complaints against the insurer. Such
361	648		grievance procedure The appeals procedures of the three -member
362	649		grievance panel shall be subject to the Oklahoma Administrative
363	650		Procedures Act, including provisions the reof for review of agency
364	651		decisions by the district court. The grievance panel shall schedule
365		-	a hearing regarding the allowance and payment of claims,
366		-	eligibility and other matters within sixty (60) days from the date
367		-	the grievance panel receives a written request for a hearing unless
368		-	the panel orders a continuance for good cause shown. Upon written
369		-	request by the insured employee to the grievance panel and rec eived
370		-	not less than ten (10) days before the hearing date, the grievance
371		-	panel shall cause a full stenographic record of the proc eedings to
372		-	be made by a competent court reporter at the insured employee's
373		-	expense; and
374		-
	652	+	a hearing regarding the allowance and payment of claims, eligibility
	653	+	and other matters within sixty (60) days from the date the grievance
	654	+	panel receives a written request for a hearing unless the panel
	655	+	orders a continuance for good cause shown. Upon written request by
	656	+	the insured employee to the grievance panel and received not less
	657	+	than ten (10) days before the hearing date, the grievance panel
	658	+	shall cause a full stenographic record of the proceedings to be made
	659	+	by a competent court reporter at the insured employee 's expense; and
375	660		21. To intercept monies owing to plan participants from other
376	661		state agencies, when those participants in turn owe money to the
377	662		Office of Management and Enterprise Services, and to ensure that the
378	663		participants are afforded due process of law.
379		-
380	664		N. Except for a breach of fiduciary obligation, a Board member
381	665		shall not be individually or personally responsible for any action
382	666		of the Board.
383		-
384	667		O. The Board shall operate in an advisory capacity to the
385	668		Office of Management and Enterprise Services.
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386	695
387	696		P. The members of th e Board shall not accept gifts or
388	697		gratuities from an individual organization with a value in excess of
389	698		Ten Dollars ($10.00) per year. The provisions of this section shall
390	699		not be construed to prevent the members of the Board from attending
391	700		educational seminars, conferences, meetings or similar functions.
392		-
393	701		SECTION 2. This act shall become effective November 1, 2024.
394		-	ENR. H. B. NO. 3369 Page 10
395		-	Passed the House of Representatives the 12th day of March, 2024.
396		-
397		-
398		-
399		-
400		-	Presiding Officer of the House
401		-	of Representatives
402		-
403		-
404		-
405		-	Passed the Senate the 25th day of April, 2024.
406		-
407		-
408		-
409		-
410		-	Presiding Officer of the Senate
411		-
412		-
413		-	OFFICE OF THE GOVERNOR
414		-	Received by the Office of the Governor this ____________________
415		-	day of ___________________, 20_______, at _______ o'clock _______ M.
416		-	By: _________________________________
417		-	Approved by the Governor of the State of Oklahoma this _____ ____
418		-	day of ___________________, 20_______, at _______ o'clock _______ M.
419		-
420		-
421		-	_________________________________
422		-	Governor of the State of Oklahoma
423		-
424		-	OFFICE OF THE SECRETARY OF STATE
425		-	Received by the Office of the Secretary of State this __________
426		-	day of ___________________, 20_______, at _______ o'clock _______ M.
427		-	By: _________________________________
428		-	ENR. H. B. NO. 3369 Page 11
429		-
	702	+	COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
	703	+	April 2, 2024 - DO PASS