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2024 Regular Session
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HB3587
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Oklahoma House Bill HB3587

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Oklahoma 2024 Regular Session

Oklahoma House Bill HB3587 Compare Versions

Only one version of the bill is available at this time.

Version 1 (Old)

Version 2 (New)

Old	New		Differences
1	1
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4	4		Req. No. 9486 Page 1 1
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53	53		STATE OF OKLAHOMA
54	54
55	55		2nd Session of the 59th Legislature (2024)
56	56
57	57		HOUSE BILL 3587 By: Strom
58	58
59	59
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63	63		AS INTRODUCED
64	64
65	65		An Act relating to state government; amending 74 O.S.
66	66		2021, Section 1304.1, which relates to Oklahoma
67	67		Employees Insurance and Benefits Board; modifying
68	68		certain duties and responsibilities ; adding external
69	69		review requirements; repealing 74 O.S. 2021, Section
70	70		1329.1, which relates to mut ual accountability
71	71		incentive pilot program ; repealing 74 O.S. 2021,
72	72		Sections 1381, 1382, 1383, and 1384, which relate to
73	73		the Wellness Program Act; and providing an effective
74	74		date.
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79	79		BE IT ENACTED BY THE PEOPL E OF THE STATE OF OKLAHOMA:
80	80		SECTION 1. AMENDATORY 74 O.S. 2021, Section 1304.1, is
81	81		amended to read as foll ows:
82	82		Section 1304.1 A. The State and Education Employees Group
83	83		Insurance Board and the Oklahoma State Employees Benefits Council
84	84		are hereby abolished. Wherever the State and Education Employees
85	85		Group Insurance Board and the Oklahoma State Employees Bene fits
86	86		Council are referenced in law, that reference shall be construed to
87	87		mean the Oklahoma Employees Insurance and Benefits Board.
88	88		B. There is hereby created the Oklahoma Employees Insurance and
89	89		Benefits Board.
90	90
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141	141		C. The chair and vice-chair shall be electe d by the Board
142	142		members at the first meeting of the Board and shall preside over
143	143		meetings of the Board and perform other duties as may be re quired by
144	144		the Board. Upon the resignation or expiration of the term of the
145	145		chair or vice-chair, the members shall el ect a chair or vice-chair.
146	146		The Board shall elect one of its members to serve as secretary.
147	147		D. The Board shall consist of seven (7) member s to be appointed
148	148		as follows:
149	149		1. The State Insurance Commissioner, or desi gnee;
150	150		2. Four members shall be appointed by the Governor;
151	151		3. One member shall be appointed by the Speaker of the Oklahoma
152	152		House of Representatives; and
153	153		4. One member shall be app ointed by the President Pro Tempore
154	154		of the Oklahoma State Senate.
155	155		E. The appointed members shall:
156	156		1. Have demonstrated professional experience in investment or
157	157		funds management, public funds management, public or private group
158	158		health or pension fund management, o r group health insurance
159	159		management;
160	160		2. Be licensed to practice law in thi s state and have
161	161		demonstrated professional experience in commercial matters; or
162	162		3. Be licensed by the Oklahoma Accountancy Board to practice in
163	163		this state as a public accountant or a certified public accountant.
164	164
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215	215		In making appointments that conform to the requirements of this
216	216		subsection, at least one but not more than three members shall be
217	217		appointed each from paragraphs 2 and 3 of this subsection by the
218	218		combined appointing authoriti es.
219	219		F. Each member of the Board shall serve a term of four (4)
220	220		years from the date of appointment.
221	221		G. Members of the Board shall be subject to the following:
222	222		1. The appointed members shall each receive compensation of
223	223		Five Hundred Dollars ($500.00) per month. Appointed members who
224	224		fail to attend a regularly scheduled meeting of the Board shall not
225	225		receive the related compensation;
226	226		2. The appointed members shall be reimbursed for their
227	227		expenses, according to the State Travel Reimbursement Act, as are
228	228		incurred in the performance of their duties, which shall be paid
229	229		from the Health Insurance Reserve Fund;
230	230		3. In the event an appointed member does not attend at least
231	231		seventy-five percent (75%) of the regularly scheduled meetings of
232	232		the Board during a calend ar year, the appointing authority may
233	233		remove the member;
234	234		4. A member may also be removed for any other caus e as provided
235	235		by law;
236	236		5. No Board member shall be individually or personally liable
237	237		for any action of the Board; and
238	238
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289	289		6. Participation on the Board is contingent upon maintaining
290	290		all necessary annual training as may be req uired through the Health
291	291		Insurance Portability and Accountability Act of 1996, Medicare
292	292		contracting requirements or other statutory or regulatory
293	293		guidelines.
294	294		H. The Board shall mee t as often as necessary to conduct
295	295		business, but shall meet no less than fou r times a year, with an
296	296		organizational meeting to be held prior to December 1, 2012. The
297	297		organizational meeting shall be called by the Insurance
298	298		Commissioner. A majority of the me mbers of the Board shall
299	299		constitute a quorum for the transaction of busines s, and any
300	300		official action of th e Board must have a favorable vote by a
301	301		majority of the members of the Board present.
302	302		I. Except as otherwise provided in this subsection, no member
303	303		of the Board shall be a lobbyist registered in this state as
304	304		provided by law, or be employed directly or in directly by any firm
305	305		or health care provider under contract to the State and Education
306	306		Employees Group Insurance Board, the Oklahoma State Employees
307	307		Benefits Council, or the Oklahoma Employees Insurance and Benefits
308	308		Board, or any benefit program under its jurisdiction, for any goods
309	309		or services whatsoever. Any physician member of the Board shall not
310	310		be subject to the provisions of this subsection.
311	311
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362	362		J. Any vacancy occurring on the Board shall be filled for the
363	363		unexpired term of office in the same manner as provided for in
364	364		subsection D of this section.
365	365		K. The Board shall act in accordance with the provisions of the
366	366		Oklahoma Open Meeting Act, the Oklahom a Open Records Act and the
367	367		Administrative Procedures Act.
368	368		L. The Administrative Director of the Courts sha ll designate
369	369		grievance panel members as shall be necessary. The members of the
370	370		grievance panel shall consist of two attorneys licensed to practice
371	371		law in this state and one state licensed health care professional or
372	372		health care administrator who has at le ast three (3) years practical
373	373		experience, has had or has admitting privileges to a hospital in
374	374		this state, has a working knowledge of prescription me dication, or
375	375		has worked in an administrative capacity at some point in thei r
376	376		career. The state health care professional shall be appointed by
377	377		the Governor. At the Governor 's discretion, one or more qualified
378	378		individuals may also be appointed as an altern ate to serve on the
379	379		grievance panel in the event the Governor 's primary appointee
380	380		becomes unable to serve.
381	381		M. The Office of Management and Enterprise Services shall have
382	382		the following duties, responsibilities and authority with respect to
383	383		the administration of the flexible benefits plan authorized pursuant
384	384		to the State Employees Flexible Benefits Act:
385	385
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436	436		1. To construe and interpret the plan, and decide all questions
437	437		of eligibility in accordance with the Oklahoma State Employees
438	438		Benefits Act and 26 U.S.C.A., Section 1 et seq.;
439	439		2. To select those benefits which shall be made availa ble to
440	440		participants under the pl an, according to the Oklahoma State
441	441		Employees Benefits Act, and other applicable laws and rules;
442	442		3. To prescribe procedures to be followed by partic ipants in
443	443		making elections and filing claims under the plan;
444	444		4. Beginning with the plan year which begins on January 1,
445	445		2013, to select and contract with one or more providers to offer a
446	446		group TRICARE Supplement product to eligible employees who are
447	447		eligible TRICARE beneficiaries. Any membership dues required to
448	448		participate in a group TRICARE Supplement produ ct offered pursuant
449	449		to this paragraph shall be paid by the employee. As used in this
450	450		paragraph, "TRICARE" means the Department of Defense health car e
451	451		program for active duty and retired service members and their
452	452		families;
453	453		5. To prepare and distribute inf ormation communicating and
454	454		explaining the plan to participating employers and participants.
455	455		Health Maintenance Organizations or other third -party insurance
456	456		vendors may be directly or indirectly involved in the distribution
457	457		of communicated information to pa rticipating state agency employers
458	458		and state employee participants subject to the following condition:
459	459
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510	510		the Board shall verify all marketing and comm unications information
511	511		for factual accuracy prior to distribution;
512	512		6. To receive from participating employ ers and participants
513	513		such information as shall be necessary for the proper administration
514	514		of the plan, and any of the benefits offered thereunder;
515	515		7. To furnish the participating employers and participants such
516	516		annual reports with respect to the administr ation of the plan as are
517	517		reasonable and appropriate;
518	518		8. To keep reports of benefit elections, claims and
519	519		disbursements for claims under the plan;
520	520		9. To negotiate for best and final offer through competitive
521	521		negotiation with the assistance and through the purchasing
522	522		procedures adopted by the Office of Management and Enterprise
523	523		Services, and contract with federally qualified health maintenance
524	524		organizations under the provisions of 42 U.S.C., Section 300e et
525	525		seq., or with Health Maintenance Organizations gra nted a certificate
526	526		of authority by the Insurance Commissioner pursuant to the Health
527	527		Maintenance Reform Act of 2003 for consideration by participants as
528	528		an alternative to the health plans offered by the Oklahoma Employees
529	529		Insurance and Benefits Board, and to transfer to the health
530	530		maintenance organizations such funds as may be approved for a
531	531		participant electing health maintenance organization alternati ve
532	532		services. The Board may also select and contract with a vendor to
533	533		offer a point-of-service plan. An HMO may offer coverage through a
534	534
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585	585		point-of-service plan, subject to the guidelines established by the
586	586		Board. However, if the Board chooses to offer a p oint-of-service
587	587		plan, then a vendor that offers both an HMO plan and a poin t-of-
588	588		service plan may choose to offer only its point-of-service plan in
589	589		lieu of offering its HMO plan. The Board may, however, renegotiate
590	590		rates with successful bidders after contr acts have been awarded if
591	591		there is an extraordinary circumstance. An extra ordinary
592	592		circumstance shall be limited to insolvency of a participating
593	593		health maintenance organization or point -of-service plan,
594	594		dissolution of a participating health maintenance o rganization or
595	595		point-of-service plan or withdrawal of another participating health
596	596		maintenance organizatio n or point-of-service plan at any time during
597	597		the calendar year. Nothing in this section of law shall be
598	598		construed to permit either party to unilater ally alter the terms of
599	599		the contract;
600	600		10. To retain as confidential inform ation the initial Request
601	601		For Proposal offers as well as any subsequent bid offers made by the
602	602		health plans prior to final contract awards as a part of the best
603	603		and final offer nego tiations process for the benefit plan;
604	604		11. To promulgate administrative ru les for the competitive
605	605		negotiation process;
606	606		12. To require vendors offering coverage to provide such
607	607		enrollment and claims data as is determined by the Board. The Board
608	608		shall be authorized to retain as confidential any proprietary
609	609
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660	660		information submitted in response to the Board 's Request For
661	661		Proposal. Provided, however, that any such information requested by
662	662		the Board from the vendors shall only be subject to the
663	663		confidentiality provision of this paragraph if it is clearly
664	664		designated in the Request For P roposal as being protected unde r this
665	665		provision. All requested information lacking such a designation in
666	666		the Request For Proposal shall be subject to Section 24A.1 et seq.
667	667		of Title 51 of the Oklahoma Statutes. From health maintenance
668	668		organizations, data provided shall include the curr ent Health Plan
669	669		Employer Data and Information Set (HEDIS);
670	670		13. To authorize the purchase of any insurance deemed necessary
671	671		for providing benefits und er the plan including indemnity dental
672	672		plans, provided that the only indemn ity health plan selected by the
673	673		Board shall be the indemnity plan offered by the Board, and to
674	674		transfer to the Board such funds as may be approved for a
675	675		participant electing a benef it plan offered by the Board. All
676	676		indemnity dental plans shall meet or exc eed the following
677	677		requirements:
678	678		a. they shall have a statewide provider network,
679	679		b. they shall provide benefits which shall reimburse the
680	680		expense for the following types of dental p rocedures:
681	681		(1) diagnostic,
682	682		(2) preventative,
683	683		(3) restorative,
684	684
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723	723		14
724	724		15
725	725		16
726	726		17
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728	728		19
729	729		20
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731	731		22
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733	733		24
734	734
735	735		(4) endodontic,
736	736		(5) periodontic,
737	737		(6) prosthodontics,
738	738		(7) oral surgery,
739	739		(8) dental implants,
740	740		(9) dental prosthetics, and
741	741		(10) orthodontics, and
742	742		c. they shall provide an annual benefit of not less than
743	743		One Thousand Five Hundred Dollars ($1,500.00) for all
744	744		services other than orthodontic services, and a
745	745		lifetime benefit of not less than One Thousand Five
746	746		Hundred Dollars ($1,500.00) for orthodontic services;
747	747		14. To communicate deferred compensation programs as provided
748	748		in Section 1701 of Title 74 of the Oklahoma Statutes this title;
749	749		15. To assess and c ollect reasonable fees from contracted
750	750		health maintenance organizations and third -party insurance vendors
751	751		to offset the costs of administration;
752	752		16. To accept, modify or reject elections under the plan in
753	753		accordance with the Oklahoma S tate Employees Benef its Act and 26
754	754		U.S.C.A., Section 1 et seq.;
755	755		17. To promulgate election and claim forms to be used by
756	756		participants;
757	757		18. To adopt rules requiring payment for med ical and dental
758	758		services and treatment rendered by duly licensed hospitals,
759	759
760	760
761	761		Req. No. 9486 Page 11 1
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809	809
810	810		physicians and dentists. Unless the Board has otherwise contracted
811	811		with the out-of-state health care provider, the Board shall
812	812		reimburse for medical services and treatment rendere d and charged by
813	813		an out-of-state health care provider at least at the same percentage
814	814		level as the network percentage level of the fee schedule
815	815		established by the Oklahoma Employees Insurance and Benefits Board
816	816		if the insured employee was referred to the o ut-of-state health care
817	817		provider by a physician or it was an emergency situ ation and the
818	818		out-of-state provider was the closest in proximity to the place of
819	819		residence of the employee which offers the type of health care
820	820		services needed. For purposes of thi s paragraph, health care
821	821		providers shall include, but not be limited to, ph ysicians,
822	822		dentists, hospitals and special care facilities;
823	823		19. To enter into a contract with out -of-state providers in
824	824		connection with any PPO or hospital or medical network plan w hich
825	825		shall include, but not be limited to, special care facilities and
826	826		hospitals outside the bo rders of the State of Oklahoma. The
827	827		contract for out-of-state providers shall be identical to the in -
828	828		state provider contracts. The Board may negotiate for disc ounts
829	829		from billed charges when the out -of-state provider is not a network
830	830		provider and the memb er sought services in an emergency situation,
831	831		when the services were not otherwise available in the State of
832	832		Oklahoma or when the Administrator appointed by the Board approved
833	833		the service as an exceptional circumstance;
834	834
835	835
836	836		Req. No. 9486 Page 12 1
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884	884
885	885		20. To create the establishment of a grievance procedure by
886	886		which a three-member grievance panel external appeals procedures for
887	887		complaints by insured employe es in the following manner :
888	888		a. independent review organizations, accredited by a
889	889		national accrediting body, shall act as an appeals
890	890		body bodies for complaints by insured employees
891	891		regarding the allowance and payment of claims,
892	892		eligibility, and other matters. Except for grievances
893	893		settled to the satisfaction of both parties prior to a
894	894		hearing, any person who requests in writing a hearing
895	895		before the grievance panel shall receive a hearing
896	896		before the panel adverse benefit determinations based
897	897		on:
898	898		(1) medical judgment,
899	899		(2) whether the insurer is complying with the
900	900		surprise billing and cost -sharing protections set
901	901		forth in Sections 2799A-1 and 2799A-2 of the
902	902		Public Health Services Act,
903	903		(3) a rescission in coverage, and
904	904		b. a three-member grievance panel, which shall a ct as an
905	905		appeals body for complaints by insured employees
906	906		regarding all other issues .
907	907		The grievance procedure appeals procedures provided by this
908	908		paragraph shall be the exclusive remedy remedies available to
909	909
910	910
911	911		Req. No. 9486 Page 13 1
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959	959
960	960		insured employees having complaints against the insurer. Such
961	961		grievance procedure The appeals procedures of the three -member
962	962		grievance panel shall be subject to the Oklaho ma Administrative
963	963		Procedures Act, including provisions thereof for review of agency
964	964		decisions by the district court. The grievance p anel shall schedule
965	965		a hearing regarding the allowance and payment of claims,
966	966		eligibility and other matters within sixty (60) days from the date
967	967		of properly submitted the grievance panel receives a written request
968	968		for a hearing application unless the panel orders a continuance for
969	969		good cause shown. Upon written request by the insured employee to
970	970		the grievance panel and received not less than ten (10) days before
971	971		the hearing date, the grievance panel shall cause a full
972	972		stenographic record of the proceedings to be made by a competent
973	973		court reporter at the insured employee 's expense; and
974	974		21. To intercept monies owing to plan parti cipants from other
975	975		state agencies, when those participants in turn owe money to the
976	976		Office of Management and Enterprise Services, and to ensure that the
977	977		participants are afforded due process of law.
978	978		N. Except for a breach of fiduciary obligation, a Board member
979	979		shall not be individually or personally responsible for any action
980	980		of the Board.
981	981		O. The Board shall operate in an advisory capacity to the
982	982		Office of Management and Enterprise Services.
983	983
984	984
985	985		Req. No. 9486 Page 14 1
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1033	1033
1034	1034		P. The members of the Board shall not accept gifts or
1035	1035		gratuities from an individual organization with a value in excess of
1036	1036		Ten Dollars ($10.00) per year. The provisions of this section shall
1037	1037		not be construed to prevent the mem bers of the Board from attending
1038	1038		educational seminars, conferences, meetings or similar fun ctions.
1039	1039		SECTION 2. REPEALER 74 O.S. 2021, Section 1329.1, is
1040	1040		hereby repealed.
1041	1041		SECTION 3. REPEALER 74 O.S. 2021, Sections 1381, 1382,
1042	1042		1383, and 1384, are hereby repealed.
1043	1043		SECTION 4. This act shall become effective November 1, 2024.
1044	1044
1045	1045		59-2-9486 TJ 01/12/24