Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB1310 Compare Versions

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Version 2 (New)

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4		-	An Act
5		-	ENROLLED SENATE
	29	+	HOUSE OF REPRESENTATIVES - FLOOR VERSION
	30	+
	31	+	STATE OF OKLAHOMA
	32	+
	33	+	2nd Session of the 59th Legislature (2024)
	34	+
	35	+	ENGROSSED SENATE
6	36		BILL NO. 1310 By: McCortney of the Senate
7	37
8	38		and
9	39
10	40		Sneed of the House
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15	45		An Act relating to state -sponsored employee benefits;
16	46		amending 63 O.S. 2021, Section 5003, which relates to
17	47		powers and duties of the Oklahoma Health Care
18	48		Authority; directing the Authority to administer
19	49		state-sponsored benefits; amending 74 O.S. 2021,
20	50		Sections 1306.2, 1306.5, 1318, 1321, and 1371, which
21	51		relate to the administration of state -sponsored
22	52		plans; conforming language; removing requirement for
23	53		certain bid acceptance; updating statutory language;
24	54		providing an effective date; and declaring an
25	55		emergency.
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30		-	SUBJECT: State-sponsored employee benefits
31	60
32	61		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAH OMA:
33		-
34	62		SECTION 1. AMENDATORY 63 O.S. 2021, Section 5003, is
35	63		amended to read as fo llows:
36		-
37	64		Section 5003. A. The Legislature recognizes that the state is
38	65		a major purchaser of health care services, and the increasing costs
39	66		of such health care services are posing and will continue to pose a
40	67		great financial burden on the state. It is the p olicy of the state
41	68		to provide comprehensive health care as an employer to state
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42	96		employees and officials and their dependents and to those who are
43	97		dependent on the state for necessary medical care. It is imperative
44	98		that the state develop effective and effi cient health care delivery
45	99		systems and strategies for procuring health care services in order
46		-
47		-	ENR. S. B. NO. 1310 Page 2
48	100		for the state to continue to purchase the most comprehens ive health
49	101		care possible.
50		-
51	102		B. It is therefore incumbent upon the Legislature to establish
52	103		the Oklahoma Health Care Authority whose purpose shall be to:
53		-
54	104		1. Purchase state and education employees ’ health care benefits
55	105		and Medicaid benefits;
56		-
57	106		2. Study all state-purchased and state-subsidized health care,
58	107		alternative health care delivery systems and strategies f or the
59	108		procurement of health care services in order to maximize cost
60	109		containment in these programs while ensuring access to quality
61	110		health care; and
62		-
63	111		3. Make recommendations aimed at minimizing the financial
64	112		burden which health care poses for the state, it s employees and its
65	113		charges, while at the same time allowing the state to provide the
66	114		most comprehensive health care possible ; and
67		-
68	115		4. Administer the s tate-sponsored health and dental benefits
69	116		plans known as HealthChoice and life insurance plans in accorda nce
70	117		with the Oklahoma Employees Insurance and Benefits Act and the State
71	118		Employees Flexible Benefits Act. The Office of Management and
72	119		Enterprise Services shall cause the transfer of all necessary
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73	147		assets, data, records, and personnel necessary for the
74	148		administration of HealthChoice not later than the effective date of
75	149		this act.
76		-
77	150		SECTION 2. AMENDATORY 74 O.S. 2021, Section 1306.2 , is
78	151		amended to read as follows:
79		-
80	152		Section 1306.2. A. The Director of the Office of Management
81	153		and Enterprise Services Oklahoma Health Care Authority shall submit
82	154		to the Insurance Commissioner the following information regarding
83	155		utilization review performe d by employees of the Office Authority:
84		-
85	156		1. A utilization review plan that includes:
86		-
87	157		a. an adequate summary description of review standards,
88	158		protocol and procedures to be used in evaluating
89	159		proposed or delivered hospital and medical care,
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91		-	ENR. S. B. NO. 1310 Page 3
92		-
93	160		b. assurances that the standards and criteria to be
94	161		applied in review determinations are established with
95	162		input from health care providers representing major
96	163		areas of specialty and certified by the boards of the
97	164		various American medical specialties, and
98		-
99	165		c. the provisions by which patients or health care
100	166		providers may seek reconsideration or appeal of
101	167		adverse decisions concern ing requests for medical
102	168		evaluation, treatment or procedures;
103		-
104	169		2. The type and qualifications of the personnel either employed
105	170		or under contract to per form the utilization review;
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106	197
107	198		3. The procedures and policies to ensure that an employee of
108	199		the Office Authority is reasonably accessible to patients and health
109	200		care providers five (5) days a week during normal business hours,
110	201		such procedures and policies t o include as a requirement a toll -free
111	202		telephone number to be available during said such business hours;
112		-
113	203		4. The policies and procedures to ensure that all applicable
114	204		state and federal laws to protect the confidentiality of individual
115	205		medical records are f ollowed;
116		-
117	206		5. The policies and procedures to verify the identity and
118	207		authority of personnel performing uti lization review by telephone;
119		-
120	208		6. A copy of the materials designed to inform applicable
121	209		patients and health care providers of the requirements of the
122	210		utilization review plan;
123		-
124	211		7. The procedures for receiving and handling complaints by
125	212		patients, hospitals a nd health care providers concerning utilization
126	213		review; and
127		-
128	214		8. Procedures to ensure that after a request for medical
129	215		evaluation, treatment, or procedu res has been rejected in whole or
130	216		in part and in the event a copy of the report on said such rejection
131	217		is requested, a copy of the report of the personnel performing
132	218		utilization review concerning the rejection shall be mailed by the
133	219		insurer, postage prepai d, to the ill or injured person, the treating
	220	+	health care provider, hospital or to the person financially
134	221
135		-	ENR. S. B. NO. 1310 Page 4
136		-	health care provider, hospital or to the person financially
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137	248		responsible for the patient ’s bill within fifteen (15) days after
138	249		receipt of the request for th e report.
139		-
140	250		B. The Office Authority shall pay an annual fee to the
141	251		Insurance Commissioner of Five Hundred Dollars ($500.00).
142		-
143	252		SECTION 3. AMENDATORY 74 O.S. 2021, Section 1306.5, is
144	253		amended to read as follows:
145		-
146	254		Section 1306.5. A network provider facility or physician
147	255		contract, or any par t or section of it, may be amended at any time
148	256		during the term of the contract only by mutual written con sent of
149	257		duly authorized representatives of the Office of Management and
150	258		Enterprise Services Oklahoma Health Care Authority and the facility
151	259		or physician.
152		-
153	260		SECTION 4. AMENDATORY 74 O.S. 2021, Section 1318, is
154	261		amended to read as foll ows:
155		-
156	262		Section 1318. No former employee who is reemployed by a
157	263		participating entity within twenty -four (24) months after the date
158	264		of termination of prev ious employment shall be enrolled in the
159	265		Oklahoma Employees Insurance and Benefits Plan authorized by
160	266		Sections 1301 through 1329.1 of this title, for a greater amount of
161	267		life insurance or life benefit than the amount for which the life of
162	268		the former employee was insured under the plan at the date of
163	269		termination of employment, except upon the former employee
164	270		furnishing evidence of insurability, satisfactory to the Office of
165	271		Management and Enterprise Services Oklahoma Health Care Authority ,
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166	299		and any greater amount of benefit or insurance provided the employee
167	300		shall be at the former employee ’s cost.
168		-
169	301		SECTION 5. AMENDATORY 74 O.S. 2021, Section 1321, is
170	302		amended to read as follows:
171		-
172	303		Section 1321. A. The Office of Management and Enterprise
173	304		Services Oklahoma Health Care Authority shall have the authority to
174	305		determine all rates and life, dental and health benefits for state-
175	306		sponsored plans. All rates shall be compiled in a comprehensive
176	307		Schedule of Benefits. The Schedule of Benefits shall b e available
177	308		for inspection during regular business hours at the Office of
178		-
179		-	ENR. S. B. NO. 1310 Page 5
180	309		Management and Enterprise Servi ces Authority. The Office Authority
181	310		shall have the authority to annually adjust the rates and b enefits
182	311		based on claim experience.
183		-
184	312		B. The premiums for such insurance plans offered for the next
185	313		plan year shall be established as follows:
186		-
187	314		1. For active employees and their dependents, the Office’s
188	315		Authority’s premium determination shall be made no later than the
189	316		bid submission date for health maintenance o rganizations set by the
190	317		Oklahoma State Employees Benefits Council Oklahoma Employees
191	318		Insurance and Benefi ts Board, which shall be set in August no later
192	319		than the third Friday of that month; and
193		-
194	320		2. For all other covered members and dependents, the Office’s
195	321		Authority’s and the health maintenance organizations ’ premium
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196	349		determinations shall be no later than the fourth Friday of
197	350		September.
198		-
199	351		C. The Office may approve a mid -year adjustment requested by
200	352		the Authority provided the need for an adjustment is substant iated
201	353		by an actuarial determination or more current experience rating.
202	354		The only publication or notice re quirements that shall apply to the
203	355		Schedule of Benefits shall be those requirements provided in the
204	356		Oklahoma Open Meeting Act and within this section . It is the intent
205	357		of the Legislature that the benefits provided not include cosmetic
206	358		dental procedures ex cept for certain orthodontic procedures as
207	359		adopted by the Director Chief Executive Officer of the Authority .
208		-
209	360		SECTION 6. AMENDATORY 74 O.S. 2021, Section 1371, is
210	361		amended to read as follows:
211		-
212	362		Section 1371. A. All participants must purchase at least the
213	363		basic plan unless, to the extent that it is consistent with federal
214	364		law, the participant is a person who has retired from a bran ch of
215	365		the United States military and has been provided with health
216	366		coverage through a federal plan and th at participant provides proof
217	367		of that coverage, or the participant has opted out of the state ’s
218	368		basic plan according to the provisions in Section 1308. 3 of this
219	369		title. On or before January 1 of the plan year beginning July 1,
220	370		2001, and July 1 of any plan year beginning after January 1, 2002,
221	371		the Oklahoma Employees Insurance and Benefits Board shall design the
	372	+	basic plan for the next plan year to ensure that the basic plan
222	373
223		-	ENR. S. B. NO. 1310 Page 6
224		-	basic plan for the next plan year to ensure that the basic plan
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225	400		provides adequate coverage to all participants. All benefit plans,
226	401		whether offered by the State and Education Employees Group Insurance
227	402		Board, a health maintenance organization (HMO) or other vendors,
228	403		shall meet the minimum requirement s set by the Board for the basic
229	404		plan.
230		-
231	405		B. The Board shall offer health, disability, life and dental
232	406		coverage to all participants and their dependents. For health,
233	407		dental, disability and life coverage , the Board shall offer plans at
234	408		the basic benefit leve l established by the Board, and in addition,
235	409		may offer benefit plans that provide an enhanced level of be nefits.
236	410		The Board shall be responsible for determining the plan design and
237	411		the benefit price for the plans that they offer it offers.
238	412		Effective for the plan year beginning January 1, 2017, and for each
239	413		plan year thereafter, in setting health insurance pr emiums for
240	414		active employees and for retirees under sixty -five (65) years of
241	415		age, the Board shall set the monthly premium for active employees to
242	416		be equal to the monthly premium for retirees under sixty -five (65)
243	417		years of age; except that the Board may offe r retirees under sixty -
244	418		five (65) years of age the opportunity to voluntarily enroll in an
245	419		alternative plan of insurance at a rate that is between One H undred
246	420		Dollars ($100.00) less than the monthly premium for active employees
247	421		and up to One Hundred Dollars ($100.00) more than the monthly
248	422		premium for active employees. Retirees under the age of sixty -five
249	423		(65) who enroll in an alternative plan of insuranc e shall retain the
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250	451		right to enroll in any other health insurance plan offered by the
251	452		Board for which they might be qualified during a subsequent open
252	453		enrollment period.
253		-
254	454		Nothing in this subsection shall be construed as prohibiting the
255	455		Board from offering ad ditional medical plans, provided that any
256	456		medical plan offered to participants shall meet or exceed the
257	457		benefits provided in the medical portion of the basic plan.
258		-
259	458		C. In lieu of electing any of the pr eceding medical benefit
260	459		plans, a participant may elect medical coverage by any health
261	460		maintenance organization made available to participants by the
262	461		Board. The benefit price of any health maintenance organization
263	462		shall be determined on a competitive bid basis. Contracts for said
264	463		such plans shall not be subje ct to the provisions of The the
265	464		Oklahoma Central Purchasing Act. The Board shall promulgate rules
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267		-	ENR. S. B. NO. 1310 Page 7
268	465		establishing appropriate competitive bidding criteria and procedures
269	466		for contracts awarded for flexibl e benefits plans. All plans
270	467		offered by health maintena nce organizations meeting the bid
271	468		requirements as determined by the Board shall be accepted. The
272	469		Board shall have the authority to reject the bid or restrict
273	470		enrollment in any health maintenance organization for which the
274	471		Board determines the benefit pric e to be excessive. The Board shall
275	472		have the authority to reject any plan that does not meet the bid
276	473		requirements. All bidders shall submit along with their bid a
277	474		notarized, sworn statement as provide d by Section 85.22 of this
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278	502		title. Effective for the pl an year beginning January 1, 2007, and
279	503		for each plan year thereafter, in setting health insurance premium s
280	504		for active employees and for retirees under sixty -five (65) years of
281	505		age, HMOs, self-insured organizations and prepaid plans shall set
282	506		the monthly premium for active employees to be equal to the monthly
283	507		premium for retirees under sixty -five (65) years of age.
284		-
285	508		D. Nothing in this section shall be construed as prohibiting
286	509		the Board from offering addi tional qualified benefit plans or
287	510		currently taxable ben efit plans.
288		-
289	511		E. Each employee of a participating employer who meets the
290	512		eligibility requirements for part icipation in the flexible benefits
291	513		plan shall make an annual election of benefits under the plan during
292	514		an enrollment period to be held prior to the be ginning of each plan
293	515		year. The enrollment period dates will be determined annually and
294	516		will be announced by the Board, providing; provided, the enrollment
295	517		period shall end no later than thirty (30) da ys before the beginning
296	518		of the plan year.
297		-
298	519		Each such employee shall make an irrevocable advance election
299	520		for the plan year or the remainder thereof pursuant to s uch
300	521		procedures as the Board shall prescribe. Any such employee who
301	522		fails to make a proper election under the plan shall, nevertheless,
302	523		be a participant in the plan and shall be deemed to have purchased
303	524		the default benefits described in this section.
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305	552		F. The Board shall prescribe the forms that participants will
306	553		be required to use in making their ele ctions, and may prescribe
307	554		deadlines and other procedure s for filing the elections.
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311	555		G. Any participant who, in the first year for which he or she
312	556		is eligible to participate in the plan, fails to make a proper
313	557		election under the plan in conformance with the procedures set forth
314	558		in this section or as prescribed by the Board shall be deemed
315	559		automatically to have purchased the default benefits. The default
316	560		benefits shall be the same as the basic plan benefits. Any
317	561		participant who, after having participated in the plan during the
318	562		previous plan year, fails to make a proper election under the plan
319	563		in conformance with the procedures set forth in this section or
320	564		prescribed by the Board, shall be deemed automatically to have
321	565		purchased the same benefits which the participant purchased in the
322	566		immediately preceding plan ye ar, except that the participant shall
323	567		not be deemed to have elected coverage under the health care
324	568		reimbursement account plan or the dependent care reimbursement
325	569		account plan.
326		-
327	570		H. Benefit plan contract s with the Board, health maintenance
328	571		organizations, and other third party third-party insurance vendors
329	572		shall provide for a risk adjustment factor for adverse s election
330	573		that may occur, as determined by the Board, based on generally
331	574		accepted actuarial principles.
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332	601
333	602		I. 1. For the plan year ending December 31, 20 04, employees
334	603		covered or eligible to be covered under the State and Education
335	604		Employees Group Insurance A ct and the State Employees Flexible
336	605		Benefits Act who are enrolled in a health maintenance organi zation
337	606		offering a network in Oklahoma City, shall have the option of
338	607		continuing care with a primary care physician for the remainder of
339	608		the plan year if:
340		-
341	609		a. that primary care physician was part of a provider
342	610		group that was offered to the individual at enrollment
343	611		and later removed from the network of the health
344	612		maintenance organization, for reasons other than for
345	613		cause, and
346		-
347	614		b. the individual submits a request in w riting to the
348	615		health maintenance organization to continue to have
349	616		access to the primary care phy sician.
350		-
351	617		2. The primary care physician selected by the individual shall
352	618		be required to accept reimbursement for such health care services on
353		-
354		-	ENR. S. B. NO. 1310 Page 9
355	619		a fee-for-service basis only. The fee-for-service shall be computed
356	620		by the health maintenance organization based on the average of the
357	621		other fee-for-service contracts of the health maintenance
358	622		organization in the local community. The individual shall only be
359	623		required to pay the primary care physician those co -payments,
360	624		coinsurance and any applicable deductibles in ac cordance with the
361	625		terms of the agreement between the em ployer and the health
	626	+
	627	+	SB1310 HFLR Page 13
	628	+	BOLD FACE denotes Committee Amendments. 1
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362	653		maintenance organization and the provider shall not balance bill the
363	654		patient.
364		-
365	655		3. Any network offered in Oklahoma City that is terminated
366	656		prior to July 1, 2004, shall notify the health maintenance
367	657		organization, and Oklahoma Employees Insurance and Benefits Board by
368	658		June 11, 2004, of the network ’s intentions to continue providing
369	659		primary care services as described in paragraph 2 of this subsection
370	660		offered by the health maintenance o rganization to state and public
371	661		employees.
372		-
373	662		SECTION 7. This act shall become effective July 1, 2024.
374		-
375	663		SECTION 8. It being immediately necessary for the preservation
376	664		of the public peace, health or safety, an emergency is hereby
377	665		declared to exist, by reason whereof this act shall take effect and
378	666		be in full force from and after its passage and approval.
379	667
380		-
381		-	ENR. S. B. NO. 1310 Page 10
382		-	Passed the Senate the 5th day of March, 2024.
383		-
384		-
385		-
386		-	Presiding Officer of the Senate
387		-
388		-
389		-	Passed the House of Representatives the 17th day of April, 2024.
390		-
391		-
392		-
393		-	Presiding Officer of the House
394		-	of Representatives
395		-
396		-	OFFICE OF THE GOVERNOR
397		-	Received by the Office of the Governor this _______ _____________
398		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
399		-	By: _________________________________
400		-	Approved by the Governor of the State of Oklahom a this _________
401		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
402		-
403		-	_________________________________
404		-	Governor of the State of Oklahoma
405		-
406		-
407		-	OFFICE OF THE SECRETARY OF STATE
408		-	Received by the Office of the Secretary of State this _______ ___
409		-	day of _________________ _, 20 _______, at _______ o'clock _______ M.
410		-	By: _________________________________
	668	+	COMMITTEE REPORT BY: COMMITTEE ON GENERAL GOVERNMENT, dated
	669	+	04/09/2024 - DO PASS.