Oklahoma 2024 Regular Session

Oklahoma House Bill HB3508 Compare Versions

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Version 2 (New)

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29		-	SENATE FLOOR VERSION
30		-	April 9, 2024
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33	28		ENGROSSED HOUSE
34	29		BILL NO. 3508 By: Sneed of the House
35	30
36	31		and
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38	33		McCortney of the Senate
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43	40		An Act relating to the Employee Group Insurance
44	41		Division; transferring the Employee Group Ins urance
45	42		Division from the Office of Management and Enterprise
46	43		Services to the Oklahoma Health Care Authority ;
47	44		amending 36 O.S. 2021, Section 6802, which relates to
48	45		definitions for the Oklahoma Telemedicine A ct;
49	46		transferring the Employee Group Insur ance Division
50	47		from the Office of Managemen t and Enterprise Services
51	48		to the Oklahoma Health Care Authority; amending 63
52	49		O.S. 2021, Section 2-309I, as amended by Section 1,
53	50		Chapter 257, O.S.L. 2022 (63 O.S . Supp. 2023, Section
54	51		2-309I), which relates to prescription r equirements
55	52		for opioids and benzodiazepines ; transferring the
56	53		Employee Group Insurance Division from the Office of
57	54		Management and Enterprise Services to the Oklahoma
58	55		Health Care Authority ; amending 74 O.S. 2021, Section
59	56		1304.1, which relates to Okla homa Employees Insurance
60	57		and Benefits Board; transferring the Emplo yee Group
61	58		Insurance Division from the Office of Management and
62	59		Enterprise Services to the Oklahoma Health Care
63	60		Authority; amending 85A O.S. 2021, Secti on 50, which
64	61		relates to employer required to provide prompt
65	62		medical treatment and fee schedule; transferring the
66	63		Employee Group Insurance Division from the Office of
67	64		Management and Enterprise Services to the Oklahoma
68	65		Health Care Authority ; providing for codification;
69	66		providing an effective date; and declaring an
70	67		emergency.
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75	72		BE IT ENACTED BY THE PEOP LE OF THE STATE OF OKLAHOMA:
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103	99		SECTION 1. NEW LAW A new section of law to be codified
104	100		in the Oklahoma Statutes as Sec tion 1304.2 of Title 74, unless there
105	101		is created a duplication in numbering, reads as follows:
106	102		Effective July 1, 2024 , the Employee Group Insurance Division of
107	103		the Office of Management and Enterprise Services shal l be
108	104		transferred to the Oklahoma Health Care Authority . All unexpended
109	105		funds, property, records, p ersonnel, and any outstanding financial
110	106		obligations or encumbrances of the Office of Management and
111	107		Enterprise Services which relate to the Emplo yee Group Division
112	108		Insurance Division are hereby transferred to the Oklahoma Health
113	109		Care Authority.
114	110		SECTION 2. AMENDATORY 36 O.S. 2021, Section 68 02, is
115	111		amended to read as follows:
116	112		Section 6802. As used in the Oklahoma Telemedicine Act:
117	113		1. "Distant site" means a site at which a health care
118	114		professional licensed to practice in this state is located while
119	115		providing health care services by means of t elemedicine;
120	116		2. a. "Health benefits plan" means any plan or arrangement
121	117		that:
122	118		(1) provides benefits for medical or surgical
123	119		expenses incurred as a resu lt of a health
124	120		condition, accident or illn ess, and
125	121		(2) is offered by any insurance company, group
126	122		hospital service corporation or health
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154	149		maintenance organiza tion that delivers or issues
155	150		for delivery an individual, gr oup, blanket or
156	151		franchise insurance poli cy or insurance
157	152		agreement, a group hospita l service contract or
158	153		an evidence of coverage, or, to the ext ent
159	154		permitted by the Employee Retirement Income
160	155		Security Act of 1974, 29 U.S.C., Section 1001 et
161	156		seq., by a multiple employer welfare arrangement
162	157		as defined in Section 3 of the Employee
163	158		Retirement Income Security Act of 1974, or any
164	159		other analogous benefit arrangement, whether the
165	160		payment is fixed or by indem nity,
166	161		b. Health benefits plan shall not include:
167	162		(1) a plan that provides coverage:
168	163		(a) only for a specified disease or diseases or
169	164		under an individual limited benefit policy,
170	165		(b) only for accidental de ath or dismemberment,
171	166		(c) only for dental or visi on care,
172	167		(d) for a hospital confinement indemnity policy,
173	168		(e) for disability income insurance or a
174	169		combination of accident-only and disability
175	170		income insurance, or
176	171		(f) as a supplement to liability insurance,
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204	198		(2) a Medicare supplemental policy as defined by
205	199		Section 1882(g)(1) of the Social Security Act (42
206	200		U.S.C., Section 1395ss),
207	201		(3) workers' compensation insurance coverage,
208	202		(4) medical payment insu rance issued as part of a
209	203		motor vehicle insurance policy,
210	204		(5) a long-term care policy including a nursing home
211	205		fixed indemnity polic y, unless a determination is
212	206		made that the policy provides benefit coverage so
213	207		comprehensive that the policy meets the
214	208		definition of a health benefits plan,
215	209		(6) short-term health insurance issued on a
216	210		nonrenewable basis with a duration of six (6)
217	211		months or less, or
218	212		(7) a plan offered by the Employ ees Group Insurance
219	213		Division of the Office of Management and
220	214		Enterprise Services Oklahoma Health Care
221	215		Authority;
222	216		3. "Health care professional " means a physician or other health
223	217		care practitioner licensed, accredited or certified to perform
224	218		specified health care services consistent with state law;
225	219		4. "Insurer" means any entity providin g an accident and health
226	220		insurance policy in this state inclu ding, but not limited to, a
227	221		licensed insurance company, a not-for-profit hospital service and
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255	248		medical indemnity corporation, a fraternal ben efit society, a
256	249		multiple employer welfare arrangement o r any other entity subject to
257	250		regulation by the Insurance Com missioner;
258	251		5. "Originating site" means a site at which a patient is
259	252		located at the time health care services are provided to him or her
260	253		by means of telemedicine, which may include, but shall not be
261	254		restricted to, a patient 's home, workplace or school;
262	255		6. "Remote patient monitoring services" means the delivery of
263	256		home health services using telecommunica tions technology to enhance
264	257		the delivery of home health care including monitoring of clinical
265	258		patient data such as weight, blood pressure, pulse, pulse oxim etry,
266	259		blood glucose and other condition-specific data, medication
267	260		adherence monitoring and interacti ve video conferencing with or
268	261		without digital image upload;
269	262		7. "Store and forward transfer " means the transmission of a
270	263		patient's medical information eithe r to or from an originating site
271	264		or to or from the health care professional at the distant site, but
272	265		does not require the patient being pres ent nor must it be in real
273	266		time; and
274	267		8. "Telemedicine" or "telehealth" means technology-enabled
275	268		health and care management and delivery systems that extend capacity
276	269		and access, which includes:
277	270		a. synchronous mechanisms, which may include live
278	271		audiovisual interaction between a patient and a health
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306	298		care professional or real-time provider-to-provider
307	299		consultation through live interactive audiovisual
308	300		means,
309	301		b. asynchronous mechanisms, which include store and
310	302		forward transfers, online exchange of health
311	303		information between a patient and a health care
312	304		professional and online exchange of health information
313	305		between health care professionals, but shall not
314	306		include the use of automated text messages or
315	307		automated mobile applicat ions that serve as the sole
316	308		interaction between a patient and a health care
317	309		professional,
318	310		c. remote patient monitoring, and
319	311		d. other electronic means that s upport clinical health
320	312		care, professional consultation, patient and
321	313		professional health-related education, public health
322	314		and health administration.
323	315		SECTION 3. AMENDATORY 63 O.S. 2021, Section 2-309I, as
324	316		amended by Section 1, Chapt er 257, O.S.L. 2022 (63 O.S. Supp. 2023,
325	317		Section 2-309I), is amended to read as follows:
326	318		Section 2-309I. A. A practitioner shall not issue an initial
327	319		prescription for an opioid drug in a quanti ty exceeding a seven-day
328	320		supply for treatment of acute pain . Any opioid prescription for
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356	347		acute pain shall be for th e lowest effective dose of an immed iate-
357	348		release drug.
358	349		B. Prior to issuing an initial prescription for an opioid drug
359	350		in a course of treatme nt for acute or chronic pain, a practitioner
360	351		shall:
361	352		1. Take and document the results of a thorough medical histor y,
362	353		including the experience of the pa tient with nonopioid medication
363	354		and nonpharmacological pain-management approaches and substance
364	355		abuse history;
365	356		2. Conduct, as appropriate, and document the results of a
366	357		physical examination;
367	358		3. Develop a treatment plan with particular attention focused
368	359		on determining the cause of pain of the patient;
369	360		4. Access relevant prescription monitoring information f rom the
370	361		central repository pursuant to Section 2-309D of this title;
371	362		5. Limit the supply of any opioid drug prescribed for acute
372	363		pain to a duration of no more than seven (7) days as determined by
373	364		the directed dosage and frequency of dosage; provided, howe ver, upon
374	365		issuing an initial prescription for acute pain pu rsuant to this
375	366		section, the practitioner may issue one (1) subsequent prescription
376	367		for an opioid drug in a quantity not to exceed seven (7) da ys if:
377	368		a. the subsequent prescription is due to a major surgical
378	369		procedure or "confined to home" status as defined in
379	370		42 U.S.C., Section 1395n(a),
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407	397		b. the practitioner provides the subsequent prescription
408	398		on the same day as the initial prescription,
409	399		c. the practitioner provides written instructions on the
410	400		subsequent prescription indicating the ea rliest date
411	401		on which the prescription may be filled, otherwise
412	402		known as a "do not fill until" date, and
413	403		d. the subsequent prescription is dispensed no more than
414	404		five (5) days after the "do not fill until" date
415	405		indicated on the prescription;
416	406		6. In the case of a patient under the age of eighteen (18)
417	407		years, enter into a patient-provider agreement with a parent or
418	408		guardian of the patient; and
419	409		7. In the case of a patien t who is a pregnant woman, enter into
420	410		a patient-provider agreement with the patient.
421	411		C. No less than seven (7) days after issuing the initial
422	412		prescription pursuant to subsection A of this section, the
423	413		practitioner, after consultation with the patient, may issue a
424	414		subsequent prescription for the drug to the patient in a quantity
425	415		not to exceed seven (7) days, provided that:
426	416		1. The subsequent prescription would not be deemed an initial
427	417		prescription under this section;
428	418		2. The practitioner determines the pres cription is necessary
429	419		and appropriate to the treatm ent needs of the patient and documents
430	420		the rationale for the issuance of the subsequent prescription; and
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458	447		3. The practitioner determines that issuance of the subsequent
459	448		prescription does not present an un due risk of abuse, addiction or
460	449		diversion and documents that determination.
461	450		D. Prior to issuing the initial prescription of an opioid drug
462	451		in a course of treatment for acute or chronic pain and again prior
463	452		to issuing the third prescription of the course o f treatment, a
464	453		practitioner shall discuss with th e patient or the parent or
465	454		guardian of the patient if the patient is under eighteen (18) years
466	455		of age and is not an emancipated minor, the risks associated w ith
467	456		the drugs being prescribed, including but not limited to:
468	457		1. The risks of addiction and overd ose associated with opioid
469	458		drugs and the dangers of taking opioid drugs with alcohol,
470	459		benzodiazepines and other central nervous system depressants;
471	460		2. The reasons why the prescription is necessary;
472	461		3. Alternative treatments that may be available; and
473	462		4. Risks associated with the use of the drugs being prescribed,
474	463		specifically that opioids are highly addictive, even when tak en as
475	464		prescribed, that there is a r isk of developing a physical or
476	465		psychological dependence on the controlled dangerous substance, and
477	466		that the risks of taking more opioids tha n prescribed or mixing
478	467		sedatives, benzodiazepines or alcohol with opioids can re sult in
479	468		fatal respiratory depressio n.
480	469		The practitioner shall include a note in the me dical record of
481	470		the patient that the patient or the parent or guardian of the
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509	497		patient, as applicable, has discussed with the practitioner the
510	498		risks of developing a physica l or psychological dependence on th e
511	499		controlled dangerous substance and alternative t reatments that may
512	500		be available. The applicable state licensing board of the
513	501		practitioner shall develop and make available to practitioners
514	502		guidelines for the discussion required pursuant to this subsectio n.
515	503		E. At the time of the issuance of the third pr escription for an
516	504		opioid drug, the practiti oner shall enter into a patient-provider
517	505		agreement with the patient.
518	506		F. When an opioid drug is continuously prescribed for thre e (3)
519	507		months or more for chronic pa in, the practitioner shall:
520	508		1. Review, at a minimum of every three (3) months, the course
521	509		of treatment, any new information about the etiolo gy of the pain,
522	510		and the progress of the patient toward treatment objectives and
523	511		document the results of that review ;
524	512		2. In the first year of the patient-provider agreement, assess
525	513		the patient prior to every renewal to determine whether the patient
526	514		is experiencing problems associated with an opioid use disorder as
527	515		defined by the Ameri can Psychiatric Association and document the
528	516		results of that assessment. Following one (1) year of compliance
529	517		with the patient-provider agreement, the practitioner shall asses s
530	518		the patient at a minimum of every six (6) months;
531	519		3. Periodically make reason able efforts, unless clinically
532	520		contraindicated, to either stop the use of the contro lled substance,
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560	547		decrease the dosage, try other drugs or treatment modalities in an
561	548		effort to reduce the potential for abuse or the development of an
562	549		opioid use disorder as defined by the American Psychiatri c
563	550		Association and document with specificity the ef forts undertaken;
564	551		4. Review the central repository information in accordance with
565	552		Section 2-309D of this title; and
566	553		5. Monitor compliance with the patient-provider agreement and
567	554		any recommendations that t he patient seek a referral.
568	555		G. 1. Any prescription for acute pain pursuant to this section
569	556		shall have the words "acute pain" notated on the face of the
570	557		prescription by the practitioner.
571	558		2. Any prescription for chronic pain pursuant to this section
572	559		shall have the words "chronic pain" notated on the face of the
573	560		prescription by the practitioner.
574	561		H. This section shall not apply to a prescriptio n for a
575	562		patient:
576	563		1. Who has sickle cell disease;
577	564		2. Who is in treatment for cancer or receiving aftercare cancer
578	565		treatment;
579	566		3. Who is receiving hospice care from a licensed hospice;
580	567		4. Who is receiving palliative care in conjunction with a
581	568		serious illness;
582	569		5. Who is a resident of a long-term care facility; or
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610	596		6. For any medications that are being prescribed for u se in the
611	597		treatment of substance abuse or opioid d ependence.
612	598		I. Every policy, contract or plan delive red, issued, executed
613	599		or renewed in this state, or approved for issuance or renewal in
614	600		this state by the Insurance Commissioner, and every contract
615	601		purchased by the Employees Group Insurance Division of t he Office of
616	602		Management and Enterprise Services Oklahoma Health Care Authority ,
617	603		on or after November 1, 2018, that provides coverage for
618	604		prescription drugs subject to a copayment, coinsurance or deductible
619	605		shall charge a copayment, coinsurance or deductible for an initial
620	606		prescription of an opioid drug prescri bed pursuant to this sect ion
621	607		that is either:
622	608		1. Proportional between the cost sharing for a thirty-day
623	609		supply and the amount of drugs the patient was prescribed; or
624	610		2. Equivalent to the cost sharing for a full thirty-day supply
625	611		of the drug, provided that no additional cost shari ng may be charged
626	612		for any additional prescriptions for the remainder of the thirty-day
627	613		supply.
628	614		J. Any practitioner authorized to prescribe an opioid drug
629	615		shall adopt and maintain a written policy or policies that include
630	616		execution of a written agreement t o engage in an informed consent
631	617		process between the prescribing practitioner and qualifying opioid
632	618		therapy patient. For the purposes of this section, "qualifying
633	619		opioid therapy patient" means:
634	620
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637	622		2
638	623		3
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643	628		8
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654	639		19
655	640		20
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657	642		22
658	643		23
659	644		24
660	645
661	646		1. A patient requiring opioid trea tment for more than three ( 3)
662	647		months;
663	648		2. A patient who is prescribed benzodiazepines and opioids
664	649		together for more than one twenty-four-hour period; or
665	650		3. A patient who is prescribed a dos e of opioids that exceeds
666	651		one hundred (100) morphine equivalent doses.
667	652		K. Nothing in the Anti-Drug Diversion Act shall be construed to
668	653		require a practitioner to limit or forcibly taper a patient on
669	654		opioid therapy. The standard of care requires effective and
670	655		individualized treatment for each patient as deemed appropr iate by
671	656		the prescribing practi tioner without an administrative or codified
672	657		limit on dose or quantity that is more restrictive than approved by
673	658		the Food and Drug Administration (FDA).
674	659		SECTION 4. AMENDATORY 74 O.S. 2021, Section 1304.1, is
675	660		amended to read as follows:
676	661		Section 1304.1 A. The State and Education Employees Group
677	662		Insurance Board and the Oklahoma State Employees Benefits Council
678	663		are hereby abolished. Wherever the State and Education Employees
679	664		Group Insurance Board and the Oklahoma State Employees Benefits
680	665		Council are referenced in la w, that reference shall be construed to
681	666		mean the Oklahoma Employees Insurance and Benefit s Board.
682	667		B. There is hereby created the Oklahoma Employees Insurance and
683	668		Benefits Board.
684	669
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687	671		2
688	672		3
689	673		4
690	674		5
691	675		6
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693	677		8
694	678		9
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697	681		12
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706	690		21
707	691		22
708	692		23
709	693		24
710	694
711	695		C. The chair and vice-chair shall be elected by the Board
712	696		members at the first meeting of the Board and shall preside over
713	697		meetings of the Board and perform other du ties as may be required by
714	698		the Board. Upon the resignation or expiration o f the term of the
715	699		chair or vice-chair, the members shall elect a chair or vice -chair.
716	700		The Board shall elect one of its members to serve as secretary.
717	701		D. The Board shall consist of seven (7) members to be appointed
718	702		as follows:
719	703		1. The State Insurance Comm issioner, or designee;
720	704		2. Four members shall be appointed by the Governor;
721	705		3. One member shall be appointed by the Speaker of the Oklahoma
722	706		House of Representatives; and
723	707		4. One member shall be appointed by the President Pro Tempore
724	708		of the Oklahoma State Senate.
725	709		E. The appointed members shall:
726	710		1. Have demonstrated professional experience in inve stment or
727	711		funds management, public funds management, p ublic or private group
728	712		health or pension fund management, or group health insuranc e
729	713		management;
730	714		2. Be licensed to practice law in this state and have
731	715		demonstrated professional experience in commercial matters; or
732	716		3. Be licensed by the Oklahoma Accountanc y Board to practice in
733	717		this state as a public accountant or a certified public acc ountant.
734	718
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737	720		2
738	721		3
739	722		4
740	723		5
741	724		6
742	725		7
743	726		8
744	727		9
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746	729		11
747	730		12
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749	732		14
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755	738		20
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759	742		24
760	743
761	744		In making appointments that conform to the requirements of this
762	745		subsection, at least one but not more than thre e members shall be
763	746		appointed each from paragraphs 2 an d 3 of this subsection by the
764	747		combined appointing authorities.
765	748		F. Each member of the Board shall serve a ter m of four (4)
766	749		years from the date of appointment.
767	750		G. Members of the Board shall be subject t o the following:
768	751		1. The appointed members shall each receive compensation of
769	752		Five Hundred Dollars ($500.00) per month. Appointed membe rs who
770	753		fail to attend a reg ularly scheduled meeting of the Board shall not
771	754		receive the related compensation;
772	755		2. The appointed members shall be reimbursed for their
773	756		expenses, according to the State Travel Reimburseme nt Act, as are
774	757		incurred in the performan ce of their duties, which s hall be paid
775	758		from the Health Insurance Reserve Fund;
776	759		3. In the event an appointed member doe s not attend at least
777	760		seventy-five percent (75%) of th e regularly scheduled meetings of
778	761		the Board during a calendar year, the appointing authority may
779	762		remove the member;
780	763		4. A member may also be removed for any other cause as provided
781	764		by law;
782	765		5. No Board member shall be individually or personally liable
783	766		for any action of the Board; and
784	767
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787	769		2
788	770		3
789	771		4
790	772		5
791	773		6
792	774		7
793	775		8
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807	789		22
808	790		23
809	791		24
810	792
811	793		6. Participation on the Board is contingent upon mai ntaining
812	794		all necessary annual training as may be required through the Health
813	795		Insurance Portability and Accountability Ac t of 1996, Medicare
814	796		contracting requirements or other statutory or regulatory
815	797		guidelines.
816	798		H. The Board shall meet as often as necessary to conduct
817	799		business but shall meet no less than four times a year, with an
818	800		organizational meeting to be held prior to D ecember 1, 2012. The
819	801		organizational meeting shall be called by the Insurance
820	802		Commissioner. A majority of the members of the Board shal l
821	803		constitute a quorum for t he transaction of business, and any
822	804		official action of the Board must have a favorable vote b y a
823	805		majority of the members of the Board present.
824	806		I. Except as otherwise provided in this subse ction, no member
825	807		of the Board shall be a lobbyist registered in thi s state as
826	808		provided by law, or be employed directly or indirectly by any firm
827	809		or health care provider under contract to the State and Education
828	810		Employees Group Insurance Board, the Oklahoma State Employees
829	811		Benefits Council, or th e Oklahoma Employees Insura nce and Benefits
830	812		Board, or any benefit program under its jurisdiction, for any goods
831	813		or services whatsoever. Any physician member of the Board sha ll not
832	814		be subject to the provisions of thi s subsection.
833	815
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836	817		2
837	818		3
838	819		4
839	820		5
840	821		6
841	822		7
842	823		8
843	824		9
844	825		10
845	826		11
846	827		12
847	828		13
848	829		14
849	830		15
850	831		16
851	832		17
852	833		18
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854	835		20
855	836		21
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857	838		23
858	839		24
859	840
860	841		J. Any vacancy occurring on the Board shall be fille d for the
861	842		unexpired term of office in the same manner as provided for in
862	843		subsection D of this section.
863	844		K. The Board shall act in accordance with t he provisions of the
864	845		Oklahoma Open Meeting Act, the Oklahoma Open Records Act and the
865	846		Administrative Procedur es Act.
866	847		L. The Administrative Director of the Courts shall designate
867	848		grievance panel members as shall be necessary. The members of the
868	849		grievance panel shall consist of two attorneys licen sed to practice
869	850		law in this state and on e state licensed health car e professional or
870	851		health care administrator who has at least three (3) years practical
871	852		experience, has had or has admitting privileges to a hospita l in
872	853		this state, has a working knowledge o f prescription medication, or
873	854		has worked in an administrative capac ity at some point in their
874	855		career. The state health care professional shall be appointed by
875	856		the Governor. At the Governor's discretion, one or mo re qualified
876	857		individuals may also be appoi nted as an alternate to serve on the
877	858		grievance panel in the event t he Governor's primary appointee
878	859		becomes unable to serve.
879	860		M. The Office of Management and Ent erprise Services Oklahoma
880	861		Health Care Authority shall have the following duties,
881	862		responsibilities and authority with respec t to the administration of
882	863		the flexible benefits plan authorized pursuan t to the State
883	864		Employees Flexible Benefits Act:
884	865
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887	867		2
888	868		3
889	869		4
890	870		5
891	871		6
892	872		7
893	873		8
894	874		9
895	875		10
896	876		11
897	877		12
898	878		13
899	879		14
900	880		15
901	881		16
902	882		17
903	883		18
904	884		19
905	885		20
906	886		21
907	887		22
908	888		23
909	889		24
910	890
911	891		1. To construe and interpret the plan, and decide all questions
912	892		of eligibility in accordance wi th the Oklahoma State Employees
913	893		Benefits Act and 26 U.S.C.A., Section 1 et seq.;
914	894		2. To select those benefits wh ich shall be made availa ble to
915	895		participants under the p lan, according to the Oklahoma State
916	896		Employees Benefits Act, and other applicable laws an d rules;
917	897		3. To prescribe procedures to be followed by participants in
918	898		making elections and filing claims under the plan;
919	899		4. Beginning with the plan year which begins on January 1,
920	900		2013, to select and contract with one or more providers to offer a
921	901		group TRICARE Supplement product to eligible em ployees who are
922	902		eligible TRICARE benefic iaries. Any membership dues req uired to
923	903		participate in a group TRICARE Supplement prod uct offered pursuant
924	904		to this paragraph shall be paid by the employee. As used in this
925	905		paragraph, "TRICARE" means the Department of Defense health care
926	906		program for active duty and retired service membe rs and their
927	907		families;
928	908		5. To prepare and distribute in formation communicating and
929	909		explaining the plan to participating employers and participan ts.
930	910		Health Maintenance Organizations or other third-party insurance
931	911		vendors may be directly or indirectly involv ed in the distribution
932	912		of communicated information to p articipating state agency employers
933	913		and state employee participants subject to the follow ing condition:
934	914
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937	916		2
938	917		3
939	918		4
940	919		5
941	920		6
942	921		7
943	922		8
944	923		9
945	924		10
946	925		11
947	926		12
948	927		13
949	928		14
950	929		15
951	930		16
952	931		17
953	932		18
954	933		19
955	934		20
956	935		21
957	936		22
958	937		23
959	938		24
960	939
961	940		the Board shall verify a ll marketing and communications informat ion
962	941		for factual accuracy prior t o distribution;
963	942		6. To receive from participating emplo yers and participants
964	943		such information as shall be necessary for the proper administratio n
965	944		of the plan, and any of the benefits o ffered thereunder;
966	945		7. To furnish the pa rticipating employers and partic ipants such
967	946		annual reports with respect to the administ ration of the plan as are
968	947		reasonable and appropriate;
969	948		8. To keep reports of benefit elec tions, claims and
970	949		disbursements for clai ms under the plan;
971	950		9. To negotiate for best and final offer through com petitive
972	951		negotiation with the assistance and through th e purchasing
973	952		procedures adopted by the Office of Management and Enterprise
974	953		Services Oklahoma Health Care Authority and contract with federally
975	954		qualified health maintenance organizations under the provi sions of
976	955		42 U.S.C., Section 300e et seq., or with Health Maintenance
977	956		Organizations granted a certificate of authority by the Insura nce
978	957		Commissioner pursuant to the Health Maintenance Reform Act of 2003
979	958		for consideration by participants as an alternative to the health
980	959		plans offered by the Oklahoma Employees Insurance and Benefits
981	960		Board, and to transfer to the health maintenance organiz ations such
982	961		funds as may be approved for a participant electing health
983	962		maintenance organization alternative services. The Bo ard may also
984	963		select and contract with a ve ndor to offer a point-of-service plan.
985	964
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988	966		2
989	967		3
990	968		4
991	969		5
992	970		6
993	971		7
994	972		8
995	973		9
996	974		10
997	975		11
998	976		12
999	977		13
1000	978		14
1001	979		15
1002	980		16
1003	981		17
1004	982		18
1005	983		19
1006	984		20
1007	985		21
1008	986		22
1009	987		23
1010	988		24
1011	989
1012	990		An HMO may offer coverage through a point -of-service plan, subject
1013	991		to the guidelines esta blished by the Board. However, if the Board
1014	992		chooses to offer a point-of-service plan, then a vendor that offers
1015	993		both an HMO plan and a point-of-service plan may choose to offer
1016	994		only its point-of-service plan in lieu of offering its HMO plan.
1017	995		The Board may, however, renegotiate rates with successful bidders
1018	996		after contracts have been award ed if there is an extraordinary
1019	997		circumstance. An extraordinary circumstance shall be limited to
1020	998		insolvency of a participating heal th maintenance organization or
1021	999		point-of-service plan, dissolution of a participating health
1022	1000		maintenance organization or point -of-service plan or withdrawal of
1023	1001		another participating health maintenance organization or point-of-
1024	1002		service plan at any time during the calendar year. Nothing in this
1025	1003		section of law shall be construed to permit eith er party to
1026	1004		unilaterally alter the terms of the contract;
1027	1005		10. To retain as confid ential information the initial Request
1028	1006		For Proposal offers as well as any subsequent bid offers made by the
1029	1007		health plans prior to final contract awards as a part of the best
1030	1008		and final offer negotiations process for the benefit plan;
1031	1009		11. To promulgate admi nistrative rules for the competitive
1032	1010		negotiation process;
1033	1011		12. To require vendors offerin g coverage to provide such
1034	1012		enrollment and claims data as is determined by the Board. The Board
1035	1013		shall be authorized to retain as confidential any proprietary
1036	1014
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1039	1016		2
1040	1017		3
1041	1018		4
1042	1019		5
1043	1020		6
1044	1021		7
1045	1022		8
1046	1023		9
1047	1024		10
1048	1025		11
1049	1026		12
1050	1027		13
1051	1028		14
1052	1029		15
1053	1030		16
1054	1031		17
1055	1032		18
1056	1033		19
1057	1034		20
1058	1035		21
1059	1036		22
1060	1037		23
1061	1038		24
1062	1039
1063	1040		information submitted in response to the Board's Request For
1064	1041		Proposal. Provided, however, that an y such information requested by
1065	1042		the Board from the vendors shall only be subject to t he
1066	1043		confidentiality provision of this par agraph if it is clearly
1067	1044		designated in the Request For Proposal as being protected under this
1068	1045		provision. All requested information lacking such a designation in
1069	1046		the Request For Proposal shall be subject to Section 24 A.1 et seq.
1070	1047		of Title 51 of the Oklahoma Statutes. From health maintenance
1071	1048		organizations, data provided shall include the current Health Plan
1072	1049		Employer Data and Information Set (HEDIS);
1073	1050		13. To authorize the purc hase of any insurance deemed necessary
1074	1051		for providing benefits under the plan includin g indemnity dental
1075	1052		plans, provided that th e only indemnity health plan selected by the
1076	1053		Board shall be the indemnity plan offered by the Board, and to
1077	1054		transfer to the Board such funds as may be approved for a
1078	1055		participant electing a benefit plan offered by t he Board. All
1079	1056		indemnity dental plans shal l meet or exceed the following
1080	1057		requirements:
1081	1058		a. they shall have a statewide provider netw ork,
1082	1059		b. they shall provide benefits whic h shall reimburse the
1083	1060		expense for the followi ng types of dental procedures:
1084	1061		(1) diagnostic,
1085	1062		(2) preventative,
1086	1063		(3) restorative,
1087	1064
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1090	1066		2
1091	1067		3
1092	1068		4
1093	1069		5
1094	1070		6
1095	1071		7
1096	1072		8
1097	1073		9
1098	1074		10
1099	1075		11
1100	1076		12
1101	1077		13
1102	1078		14
1103	1079		15
1104	1080		16
1105	1081		17
1106	1082		18
1107	1083		19
1108	1084		20
1109	1085		21
1110	1086		22
1111	1087		23
1112	1088		24
1113	1089
1114	1090		(4) endodontic,
1115	1091		(5) periodontic,
1116	1092		(6) prosthodontics,
1117	1093		(7) oral surgery,
1118	1094		(8) dental implants,
1119	1095		(9) dental prosthetics, and
1120	1096		(10) orthodontics, and
1121	1097		c. they shall provide an annual benefit of not less than
1122	1098		One Thousand Five Hundred Dollars ($1,500.00) for all
1123	1099		services other than orthodontic services, and a
1124	1100		lifetime benefit of not less than One Thous and Five
1125	1101		Hundred Dollars ($1,500.00) for orthodontic services;
1126	1102		14. To communicate de ferred compensation programs as provided
1127	1103		in Section 1701 of Title 74 of the Oklaho ma Statutes;
1128	1104		15. To assess and collect reasonable fees from contracted
1129	1105		health maintenance organizations and third-party insurance vendors
1130	1106		to offset the costs of administrati on;
1131	1107		16. To accept, modify or reject ele ctions under the plan in
1132	1108		accordance with the Oklahoma State Employees Benefits Act and 26
1133	1109		U.S.C.A., Section 1 et seq.;
1134	1110		17. To promulgate election and claim forms to be us ed by
1135	1111		participants;
1136	1112		18. To adopt rules requi ring payment for medical and dental
1137	1113		services and treatment rendered by duly licens ed hospitals,
1138	1114
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1141	1116		2
1142	1117		3
1143	1118		4
1144	1119		5
1145	1120		6
1146	1121		7
1147	1122		8
1148	1123		9
1149	1124		10
1150	1125		11
1151	1126		12
1152	1127		13
1153	1128		14
1154	1129		15
1155	1130		16
1156	1131		17
1157	1132		18
1158	1133		19
1159	1134		20
1160	1135		21
1161	1136		22
1162	1137		23
1163	1138		24
1164	1139
1165	1140		physicians and dentists. Unless the Board has otherwise contracted
1166	1141		with the out-of-state health care provider, the Board shall
1167	1142		reimburse for medical services a nd treatment rendered and charged by
1168	1143		an out-of-state health care provider at least at the same percentage
1169	1144		level as the network percentage level of the fee schedule
1170	1145		established by the Oklahoma Employees Insurance and Benefits Board
1171	1146		if the insured employee w as referred to the out-of-state health care
1172	1147		provider by a physician or it was an e mergency situation and the
1173	1148		out-of-state provider was the closest in proximity to the plac e of
1174	1149		residence of the employee which off ers the type of health care
1175	1150		services needed. For purposes of this paragraph, health care
1176	1151		providers shall include, but not be l imited to, physicians,
1177	1152		dentists, hospitals and special care facilities;
1178	1153		19. To enter into a contract with out-of-state providers in
1179	1154		connection with any PPO or hospital or me dical network plan which
1180	1155		shall include, but not be limited to, special care facili ties and
1181	1156		hospitals outside the borders of the State of Oklahoma. The
1182	1157		contract for out-of-state providers shall be identical to t he in-
1183	1158		state provider contracts. The Board ma y negotiate for discounts
1184	1159		from billed charges when the out-of-state provider is no t a network
1185	1160		provider and the member sought services in an emergency situation,
1186	1161		when the services were not otherwise available in the State of
1187	1162		Oklahoma or when the Administrat or appointed by the Board approved
1188	1163		the service as an exceptional circumstance;
1189	1164
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1196	1170		6
1197	1171		7
1198	1172		8
1199	1173		9
1200	1174		10
1201	1175		11
1202	1176		12
1203	1177		13
1204	1178		14
1205	1179		15
1206	1180		16
1207	1181		17
1208	1182		18
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1211	1185		21
1212	1186		22
1213	1187		23
1214	1188		24
1215	1189
1216	1190		20. To create the establishment of a grievance procedure by
1217	1191		which a three-member grievance panel shall act as an appeals body
1218	1192		for complaints by insured employees regarding the allowance and
1219	1193		payment of claims, eligibi lity, and other matters. Except for
1220	1194		grievances settled to the satisfaction of both parties prior to a
1221	1195		hearing, any person who requ ests in writing a hearing before the
1222	1196		grievance panel shall receive a hearing before t he panel. The
1223	1197		grievance procedure provi ded by this paragraph shall be the
1224	1198		exclusive remedy available to insured employees having complaints
1225	1199		against the insurer. Such gri evance procedure shall be subject to
1226	1200		the Oklahoma Administrative Procedures Act, incl uding provisions
1227	1201		thereof for review of a gency decisions by the district court. Th e
1228	1202		grievance panel shall schedule a hearing regarding the allowance and
1229	1203		payment of claims, eligibility and other matters within s ixty (60)
1230	1204		days from the date the grievance pa nel receives a written request
1231	1205		for a hearing unless the panel orders a continuance for good cause
1232	1206		shown. Upon written request by the insured employee to the
1233	1207		grievance panel and received not less than ten (10) d ays before the
1234	1208		hearing date, the grievance pa nel shall cause a full stenographic
1235	1209		record of the proceedings to be made by a comp etent court reporter
1236	1210		at the insured employee's expense; and
1237	1211		21. To intercept monies owin g to plan participants from other
1238	1212		state agencies, when those participants in turn owe money to the
1239	1213		Office of Management and E nterprise Services Oklahoma Health Care
1240	1214
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1251	1224		10
1252	1225		11
1253	1226		12
1254	1227		13
1255	1228		14
1256	1229		15
1257	1230		16
1258	1231		17
1259	1232		18
1260	1233		19
1261	1234		20
1262	1235		21
1263	1236		22
1264	1237		23
1265	1238		24
1266	1239
1267	1240		Authority, and to ensure that the participants are afforded due
1268	1241		process of law.
1269	1242		N. Except for a breach of fiduciary o bligation, a Board member
1270	1243		shall not be individually or personally responsible for any action
1271	1244		of the Board.
1272	1245		O. The Board shall operate in an advisory capacity to the
1273	1246		Office of Management and Enterprise Services Oklahoma Health Care
1274	1247		Authority.
1275	1248		P. The members of the Board shall not accept gifts or
1276	1249		gratuities from an indiv idual organization with a value in excess of
1277	1250		Ten Dollars ($10.00) per year. The provisions o f this section shall
1278	1251		not be construed to prevent the members of the Board from atten ding
1279	1252		educational seminars, conferences, meeti ngs or similar functions.
1280	1253		SECTION 5. AMENDATORY 85A O.S. 2021, Section 50, is
1281	1254		amended to read as foll ows:
1282	1255		Section 50. A. The employer shall promptly provide an injured
1283	1256		employee with medical, surgical, hospital, optometric, podiatric,
1284	1257		chiropractic and nursing ser vices, along with any medicine,
1285	1258		crutches, ambulatory devices, artificial limbs, eyeglasses, c ontact
1286	1259		lenses, hearing aids, and other apparatus as may be reasonably
1287	1260		necessary in connection with the injury r eceived by the employee.
1288	1261		The employer shall have th e right to choose the treating physician
1289	1262		or chiropractor.
1290	1263
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1293	1265		2
1294	1266		3
1295	1267		4
1296	1268		5
1297	1269		6
1298	1270		7
1299	1271		8
1300	1272		9
1301	1273		10
1302	1274		11
1303	1275		12
1304	1276		13
1305	1277		14
1306	1278		15
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1308	1280		17
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1312	1284		21
1313	1285		22
1314	1286		23
1315	1287		24
1316	1288
1317	1289		B. If the employer fails or neglec ts to provide medical
1318	1290		treatment within five (5) days after actual knowledge is recei ved of
1319	1291		an injury, the injur ed employee may select a physician or
1320	1292		chiropractor to provide medical treatment at the expense of the
1321	1293		employer; provided, however, that the injur ed employee, or another
1322	1294		in the employee's behalf, may obtain emergency treatment at the
1323	1295		expense of the employer where such emergency treatment is not
1324	1296		provided by the employer.
1325	1297		C. Diagnostic tests shall not be repeated sooner than six (6)
1326	1298		months from the date of the test unless agreed to by the parties or
1327	1299		ordered by the Commission for goo d cause shown.
1328	1300		D. Unless recommended by the treating doctor or chiropractor at
1329	1301		the time claimant reaches maximum medical improvement or by an
1330	1302		independent medical examiner, continuing medical maintenance shall
1331	1303		not be awarded by the Commission. The employe r or insurance carrier
1332	1304		shall not be responsible for continuing medical maintena nce or pain
1333	1305		management treatment that is outside the parameters established by
1334	1306		the Physician Advisory Committee or ODG. The employer or insurance
1335	1307		carrier shall not be responsib le for continuing medical m aintenance
1336	1308		or pain management treatment not previous ly ordered by the
1337	1309		Commission or approved in advance by the employer or insurance
1338	1310		carrier.
1339	1311		E. An employee claiming or entitled to benefits under the
1340	1312		Administrative Workers' Compensation Act, shall, if ord ered by the
1341	1313
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1347	1318		5
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1349	1320		7
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1351	1322		9
1352	1323		10
1353	1324		11
1354	1325		12
1355	1326		13
1356	1327		14
1357	1328		15
1358	1329		16
1359	1330		17
1360	1331		18
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1362	1333		20
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1365	1336		23
1366	1337		24
1367	1338
1368	1339		Commission or requested by the employer or insurance carrier, submit
1369	1340		himself or herself for medical examination. If an employee refu ses
1370	1341		to submit himself or herself to examination, his or her right to
1371	1342		prosecute any proceeding under the Adminis trative Workers'
1372	1343		Compensation Act shall be suspended , and no compensation shall be
1373	1344		payable for the period of such refusal.
1374	1345		F. For compensable in juries resulting in the use of a medical
1375	1346		device, ongoing service for the medical device shall be provided in
1376	1347		situations including, but not limited to, medical devi ce battery
1377	1348		replacement, ongoing medication refills related to the medical
1378	1349		device, medical device repair, or medical device replacement.
1379	1350		G. The employer shall reimburse the empl oyee for the actual
1380	1351		mileage in excess of twenty (20) miles round trip to and from the
1381	1352		employee's home to the location of a medical service provider for
1382	1353		all reasonable and n ecessary treatment, for an evaluation of an
1383	1354		independent medical examiner and for any evaluation made at the
1384	1355		request of the employer or insurance carrier. The rate of
1385	1356		reimbursement for such travel expense shall be the official
1386	1357		reimbursement rate as establi shed by the State Travel Reimbursement
1387	1358		Act. In no event shall the reimbursement of travel for medical
1388	1359		treatment or evaluation exceed six hundred (600) miles round trip.
1389	1360		H. Fee Schedule.
1390	1361		1. The Commission shall conduct a review and update of the
1391	1362		Current Procedural Terminology (CPT) in the Fee Schedule every two
1392	1363
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1396	1366		3
1397	1367		4
1398	1368		5
1399	1369		6
1400	1370		7
1401	1371		8
1402	1372		9
1403	1373		10
1404	1374		11
1405	1375		12
1406	1376		13
1407	1377		14
1408	1378		15
1409	1379		16
1410	1380		17
1411	1381		18
1412	1382		19
1413	1383		20
1414	1384		21
1415	1385		22
1416	1386		23
1417	1387		24
1418	1388
1419	1389		(2) years pursuant to the provisions of paragraph 14 of this
1420	1390		subsection. The Fee Schedule shall establi sh the maximum rates that
1421	1391		medical providers shall be reimbursed for medical care provided to
1422	1392		injured employees including, but not limited to, charges by
1423	1393		physicians, chiropractor s, dentists, counselors, ho spitals,
1424	1394		ambulatory and outpatient facilities, clini cal laboratory services,
1425	1395		diagnostic testing services, and ambulance services, and charges for
1426	1396		durable medical equipment, prosthetics, orthotics, and supplies.
1427	1397		The most current Fee Schedule established by the Administrator of
1428	1398		the Workers' Compensation Court prior to February 1, 2014, shall
1429	1399		remain in effect, unless or until the Legislature approves the
1430	1400		Commission's proposed Fee Schedule.
1431	1401		2. Reimbursement for medical care shall be prescribed and
1432	1402		limited by the Fee Schedule. The director of the Employees Gro up
1433	1403		Insurance Division of the Office of Management and Enterprise
1434	1404		Services Oklahoma Health Care Authority shall provide the Commission
1435	1405		such information as may be rel evant for the development o f the Fee
1436	1406		Schedule. The Commission shall develop the Fee Schedul e in a manner
1437	1407		in which quality of medical care is assured and maintained for
1438	1408		injured employees. The Commission shall give due consideration to
1439	1409		additional requireme nts for physicians treating an injured worker
1440	1410		under the Administrative Workers ' Compensation Act, including, but
1441	1411		not limited to, communication with claims representatives, ca se
1442	1412		managers, attorneys, and representatives of employers, and the
1443	1413
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1446	1415		2
1447	1416		3
1448	1417		4
1449	1418		5
1450	1419		6
1451	1420		7
1452	1421		8
1453	1422		9
1454	1423		10
1455	1424		11
1456	1425		12
1457	1426		13
1458	1427		14
1459	1428		15
1460	1429		16
1461	1430		17
1462	1431		18
1463	1432		19
1464	1433		20
1465	1434		21
1466	1435		22
1467	1436		23
1468	1437		24
1469	1438
1470	1439		additional time required to complete forms for the Commission,
1471	1440		insurance carriers, and employers.
1472	1441		3. In making adjustments to the Fee Sched ule, the Commission
1473	1442		shall use, as a benchmark, the reimbursement rate for each Current
1474	1443		Procedural Terminology (CPT) code provided fo r in the fee schedule
1475	1444		published by the Centers for Medicare and Medicaid Services of the
1476	1445		U.S. Department of Health and Human Services for use in Oklahoma
1477	1446		(Medicare Fee Schedu le) on the effective date of this section,
1478	1447		workers' compensation fee schedules emp loyed by neighboring states ,
1479	1448		the latest edition of "Relative Values for Physicians " (RVP), usual,
1480	1449		customary and reasonable m edical payments to workers' compensation
1481	1450		health care providers in the same trade area for comparable
1482	1451		treatment of a person with simi lar injuries, and all other data the
1483	1452		Commission deems relevant. For services not valued by CMS, the
1484	1453		Commission shall establ ish values based on the usual, customary and
1485	1454		reasonable medical payments to health care providers in the same
1486	1455		trade area for compara ble treatment of a person w ith similar
1487	1456		injuries.
1488	1457		a. No reimbursement shall be allowed for an y magnetic
1489	1458		resonance imaging (MR I) unless the MRI is provided by
1490	1459		an entity that meets Medicare requirements for the
1491	1460		payment of MRI services or is accredited by the
1492	1461		American College of Radiolo gy, the Intersocietal
1493	1462		Accreditation Commission or the Joint Commi ssion on
1494	1463
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1497	1465		2
1498	1466		3
1499	1467		4
1500	1468		5
1501	1469		6
1502	1470		7
1503	1471		8
1504	1472		9
1505	1473		10
1506	1474		11
1507	1475		12
1508	1476		13
1509	1477		14
1510	1478		15
1511	1479		16
1512	1480		17
1513	1481		18
1514	1482		19
1515	1483		20
1516	1484		21
1517	1485		22
1518	1486		23
1519	1487		24
1520	1488
1521	1489		Accreditation of Health care Organizations. For all
1522	1490		other radiology proce dures, the reimbursement rate
1523	1491		shall be the lesser of the reimbursement rate allowe d
1524	1492		by the 2010 Oklahoma Fee Schedule and two hundred
1525	1493		seven percent (207%) of the Medicare Fee Schedule.
1526	1494		b. For reimbursement of medical services for Evaluation
1527	1495		and Management of injured employees as defined in the
1528	1496		Fee Schedule adopted by the Commission, the
1529	1497		reimbursement rate shall n ot be less than one hundred
1530	1498		fifty percent (150%) of the Medicare Fee Schedule.
1531	1499		c. Any entity providing durable medical equipment,
1532	1500		prosthetics, orthotics or supplies shall be accredited
1533	1501		by a CMS-approved accreditation organization . If a
1534	1502		physician provides durable medical equipment,
1535	1503		prosthetics, orthotics, prescription d rugs, or
1536	1504		supplies to a patient a ncillary to the patient's
1537	1505		visit, reimbursement sha ll be no more than ten percent
1538	1506		(10%) above cost.
1539	1507		d. The Commission shall develop a reasonable stop-loss
1540	1508		provision of the Fee Schedule to provide for adequate
1541	1509		reimbursement for treatment for major burns, sev ere
1542	1510		head and neurological injuries, multiple syste m
1543	1511		injuries, and other catastrophic injuries requiring
1544	1512		extended periods of intensive care. An employer or
1545	1513
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1550	1517		4
1551	1518		5
1552	1519		6
1553	1520		7
1554	1521		8
1555	1522		9
1556	1523		10
1557	1524		11
1558	1525		12
1559	1526		13
1560	1527		14
1561	1528		15
1562	1529		16
1563	1530		17
1564	1531		18
1565	1532		19
1566	1533		20
1567	1534		21
1568	1535		22
1569	1536		23
1570	1537		24
1571	1538
1572	1539		insurance carrier shall have the right to audit the
1573	1540		charges and question the reasonableness and nece ssity
1574	1541		of medical treatment contained in a bill for treatment
1575	1542		covered by the stop-loss provision.
1576	1543		4. The right to recover charges fo r every type of medical car e
1577	1544		for injuries arising out of and in the course of covered employ ment
1578	1545		as defined in the Administr ative Workers' Compensation Act shall lie
1579	1546		solely with the Commission. When a medical care provider has
1580	1547		brought a claim to the Commi ssion to obtain payment for services, a
1581	1548		party who prevails in full on the claim shall be ent itled to
1582	1549		reasonable attorney fee s.
1583	1550		5. Nothing in this section shall prevent an em ployer, insurance
1584	1551		carrier, group self-insurance association, or certified workplac e
1585	1552		medical plan from contrac ting with a provider of medical care for a
1586	1553		reimbursement rate tha t is greater than or less than l imits
1587	1554		established by the Fee Schedule.
1588	1555		6. A treating physician may not charge more than Four Hundred
1589	1556		Dollars ($400.00) per hour for preparation for or testimo ny at a
1590	1557		deposition or appearance before the Commission in connect ion with a
1591	1558		claim covered by the Administrative Workers' Compensation Act.
1592	1559		7. The Commission's review of medical and treatment charges
1593	1560		pursuant to this section shal l be conducted pursuant to the Fee
1594	1561		Schedule in existence at the time the medical care or tre atment was
1595	1562		provided. The judgme nt approving the medical and treatment charges
1596	1563
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1600	1566		3
1601	1567		4
1602	1568		5
1603	1569		6
1604	1570		7
1605	1571		8
1606	1572		9
1607	1573		10
1608	1574		11
1609	1575		12
1610	1576		13
1611	1577		14
1612	1578		15
1613	1579		16
1614	1580		17
1615	1581		18
1616	1582		19
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1619	1585		22
1620	1586		23
1621	1587		24
1622	1588
1623	1589		pursuant to this section shall be enforceable by the Commission in
1624	1590		the same manner as provided in the Administra tive Workers'
1625	1591		Compensation Act for the enforcement of other compe nsation payments.
1626	1592		8. Charges for prescription drugs dispensed by a pharmacy shall
1627	1593		be limited to ninety percent (90%) of the average wholesale price of
1628	1594		the prescription, plus a dispensing fee of Five Dollars ($5.00) per
1629	1595		prescription. "Average wholesale pr ice" means the amount determined
1630	1596		from the latest publication designated by the Com mission.
1631	1597		Physicians shall prescribe and pharmacies shall dispense generic
1632	1598		equivalent drugs when available. If the National Drug Code, or
1633	1599		"NDC", for the drug product dispens ed is for a repackaged drug, the n
1634	1600		the maximum reimbursement shall be the lesser of the original
1635	1601		labeler's NDC and the lowest-cost therapeutic equivalent drug
1636	1602		product. Compounded medications shall be billed by the compounding
1637	1603		pharmacy at the ingredient lev el, with each ingredient identif ied
1638	1604		using the applicable NDC of the drug product, and the corresponding
1639	1605		quantity. Ingredients with no NDC area are not separately
1640	1606		reimbursable. Payment shall be based on a sum of the allowable fee
1641	1607		for each ingredient plus a dispensing fee of Five Dollars ($5.00)
1642	1608		per prescription.
1643	1609		9. When medical care i ncludes prescription drugs dispensed by a
1644	1610		physician or other medical care provider and the NDC for the drug
1645	1611		product dispensed is for a repackaged drug, then the maximum
1646	1612		reimbursement shall be the lesser of the original labeler's NDC and
1647	1613
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1657	1622		9
1658	1623		10
1659	1624		11
1660	1625		12
1661	1626		13
1662	1627		14
1663	1628		15
1664	1629		16
1665	1630		17
1666	1631		18
1667	1632		19
1668	1633		20
1669	1634		21
1670	1635		22
1671	1636		23
1672	1637		24
1673	1638
1674	1639		the lowest-cost therapeutic equivalent drug product. Payment shall
1675	1640		be based upon a sum of the allowable fee for each ingredient plus a
1676	1641		dispensing fee of Five Dollars ($5.00) per prescription. Compounded
1677	1642		medications shall be billed by the compounding pharmacy.
1678	1643		10. Implantables are paid in addition to procedural
1679	1644		reimbursement paid for medical or surgical services. A
1680	1645		manufacturer's invoice for the actual cost to a physician, hospital
1681	1646		or other entity of an implantable device s hall be adjusted by the
1682	1647		physician, hospital or oth er entity to reflect, at the time
1683	1648		implanted, all applicable discounts, rebates, co nsiderations and
1684	1649		product replacement programs and shall be provided to the payer by
1685	1650		the physician or hospital as a condition of payment for the
1686	1651		implantable device. If the ph ysician, or an entity in which the
1687	1652		physician has a financial interest other than a n ownership interest
1688	1653		of less than five percent (5%) in a publically traded company,
1689	1654		provides implantable devices, this relat ionship shall be disclosed
1690	1655		to patient, employer, i nsurance company, third-party commission,
1691	1656		certified workplace medical plan, case m anagers, and attorneys
1692	1657		representing claimant and defendant. If the physician, or an entity
1693	1658		in which the physician has a fin ancial interest other than an
1694	1659		ownership interest o f less than five percent (5%) in a publicly
1695	1660		traded company, buys and resells impla ntable devices to a hospita l
1696	1661		or another physician, the markup shall be limited to ten percen t
1697	1662		(10%) above cost.
1698	1663
1699		-	SENATE FLOOR VERSION - HB3508 SFLR Page 34
1700		-	(Bold face denotes Committee Amendments) 1
	1664	+	ENGR. H. B. NO. 3508 Page 34 1
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1725	1689		11. Payment for medical care as required by the Administrativ e
1726	1690		Workers' Compensation Act shall be due within forty-five (45) days
1727	1691		of the receipt by the employer or insura nce carrier of a complete
1728	1692		and accurate invoice, unless the employ er or insurance carrier has a
1729	1693		good-faith reason to request additional information about such
1730	1694		invoice. Thereafter, the Commission may assess a penalty up to
1731	1695		twenty-five percent (25%) for any amount due under the Fee Schedule
1732	1696		that remains unpaid on the find ing by the Commission that no go od-
1733	1697		faith reason existed for the delay in payment. If the Commission
1734	1698		finds a pattern of an employer or insurance carrier willfully and
1735	1699		knowingly delaying payme nts for medical care, the Commission may
1736	1700		assess a civil penalty o f not more than Five Thousand Do llars
1737	1701		($5,000.00) per occurrence.
1738	1702		12. If an employee fails to appear for a scheduled appointment
1739	1703		with a physician or chiropractor, the employer or insurance c ompany
1740	1704		shall pay to the physician or chiropractor a reasonable ch arge, to
1741	1705		be determined by the Co mmission, for the missed appointment. In the
1742	1706		absence of a good-faith reason for missing the appointment, the
1743	1707		Commission shall order the employee to reimburse the employer or
1744	1708		insurance company for the charge.
1745	1709		13. Physicians or chiropractors providing trea tment under the
1746	1710		Administrative Workers ' Compensation Act shall disclose under
1747	1711		penalty of perjury to the Commission, on a form prescr ibed by the
1748	1712		Commission, any ownership or interest in any health care facility,
1749	1713
1750		-	SENATE FLOOR VERSION - HB3508 SFLR Page 35
1751		-	(Bold face denotes Committee Amendments) 1
	1714	+	ENGR. H. B. NO. 3508 Page 35 1
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1776	1739		business, or diagnostic center that is not th e physician's or
1777	1740		chiropractor's primary place of b usiness. The disclosure shall
1778	1741		include any employee leasing arrangement between th e physician or
1779	1742		chiropractor and any health care facility that is not the
1780	1743		physician's or chiropractor's primary place of busi ness. A
1781	1744		physician's or chiropractor's failure to disclose as required by
1782	1745		this section shall be grounds for the Commission to disqua lify the
1783	1746		physician or chiropractor from providing treatment under the
1784	1747		Administrative Workers ' Compensation Act.
1785	1748		14. a. Beginning on May 28, 2019, the Commission shall
1786	1749		conduct an evaluation of the Fee Schedule, which shall
1787	1750		include an update of the list of C urrent Procedural
1788	1751		Terminology (CPT) codes, a line item adjustment or
1789	1752		renewal of all rates, a nd amendment as needed to the
1790	1753		rules applicable to the Fee Schedule.
1791	1754		b. The Commission shall contract with an external
1792	1755		consultant with knowledge of workers' compensation fee
1793	1756		schedules to review regional and nationwide
1794	1757		comparisons of Oklahoma 's Fee Schedule rates and date
1795	1758		and market for medical services. The consultant shall
1796	1759		receive written and oral comment from employers,
1797	1760		workers' compensation medical service and ins urance
1798	1761		providers, self-insureds, group self-insurance
1799	1762		associations of this state and the pub lic. The
1800	1763
1801		-	SENATE FLOOR VERSION - HB3508 SFLR Page 36
1802		-	(Bold face denotes Committee Amendments) 1
	1764	+	ENGR. H. B. NO. 3508 Page 36 1
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1827	1789		consultant shall submi t a report of its findings and a
1828	1790		proposed amended Fee Schedule to the Commission.
1829	1791		c. The Commission shall adopt the proposed amended Fee
1830	1792		Schedule in whole or i n part and make any additional
1831	1793		updates or adjustments. The Commi ssion shall submit a
1832	1794		proposed updated and adjusted Fee Schedule to the
1833	1795		President Pro Tempore of the Senate, the Speaker of
1834	1796		the House of Representatives and the Gove rnor. The
1835	1797		proposed Fee Schedule shall become effective on July 1
1836	1798		following the legislative session, if approved by
1837	1799		Joint Resolution of the Legislature during the session
1838	1800		in which a proposed Fee Schedule is submitted.
1839	1801		d. Beginning on May 28, 2019, an exter nal evaluation
1840	1802		shall be conducted and a proposed amended Fee Schedule
1841	1803		shall be submitted to the Legislature for approval
1842	1804		during the 2020 legislative session. Thereafter, an
1843	1805		external evaluation shall be conducted and a proposed
1844	1806		amended Fee Schedule shall b e submitted to the
1845	1807		Legislature for approval every two (2) years.
1846	1808		I. Formulary. The Commiss ion by rule shall adopt a closed
1847	1809		formulary. Rules adopted by the Commission shall allow an appeals
1848	1810		process for claims in which a treating doctor determines and
1849	1811		documents that a drug not incl uded in the formulary is necessary to
1850	1812		treat an injured employee 's compensable injury. The Commis sion by
1851	1813
1852		-	SENATE FLOOR VERSION - HB3508 SFLR Page 37
1853		-	(Bold face denotes Committee Amendments) 1
	1814	+	ENGR. H. B. NO. 3508 Page 37 1
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1878	1839		rule shall require the use of generic phar maceutical medications and
1879	1840		clinically appropriate over-the-counter alternatives to prescription
1880	1841		medications unless otherwise specified by the prescribing doctor, in
1881	1842		accordance with applicable state law.
1882	1843		SECTION 6. This act shall become eff ective July 1, 2024.
1883	1844		SECTION 7. It being immediately necessary fo r the preservation
1884	1845		of the public peace, health or safety, an emergency is hereby
1885	1846		declared to exist, by reason whereof thi s act shall take effect and
1886	1847		be in full force from and after its passage and approval.
1887		-	COMMITTEE REPORT BY: COMMITTEE ON RETIREMENT AND INSURANCE
1888		-	April 9, 2024 - DO PASS
	1848	+	Passed the House of Representatives the 13th day of March, 2024.
	1849	+
	1850	+
	1851	+
	1852	+
	1853	+	Presiding Officer of the House
	1854	+	of Representatives
	1855	+
	1856	+
	1857	+
	1858	+	Passed the Senate the ___ day of __________, 2024.
	1859	+
	1860	+
	1861	+
	1862	+
	1863	+	Presiding Officer of the Senate
	1864	+
	1865	+