Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB1588 Compare Versions

Version 1 (Old)

Version 2 (New)

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29		-	SENATE FLOOR VERSION
30		-	February 8, 2024
	28	+	STATE OF OKLAHOMA
31	29
	30	+	2nd Session of the 59th Legislature (2024)
32	31
33	32		COMMITTEE SUBSTITUTE
34	33		FOR
35		-	SENATE BILL ~~NO.~~ 1588 By: Hall
	34	+	SENATE BILL 1588 By: Hall
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	39	+
	40	+	COMMITTEE SUBSTITUTE
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41	42		An Act relating to state and education employee
42	43		benefits; amending 63 O.S. 2021, Section 5003, which
43	44		relates to powers and duties of the Oklahoma Health
44	45		Care Authority; directing the Authority to administer
45	46		state-sponsored benefits; amending 74 O.S. 2021,
46	47		Sections 1306.2, 1306.5, 1318, and 1321, which relate
47	48		to the administration of state -sponsored plans;
48	49		conforming language; providing an ef fective date; and
49	50		declaring an emergency .
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55	56		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
56	57		SECTION 1. AMENDATORY 63 O.S. 2021, Section 5003, is
57	58		amended to read as follows:
58	59		Section 5003. A. The Legislature recognizes that the state is
59	60		a major purchaser of health care s ervices, and the increasing costs
60	61		of such health care services ar e posing and will continue to pose a
61	62		great financial burden on the state. It is the policy of the st ate
62	63		to provide comprehensive health care as an employer to state
63	64		employees and officia ls and their dependents and to those who are
64	65		dependent on the state for necessary medical care. It is imperative
65		-	that the state develop effective and efficient h ealth care delivery
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	92	+	that the state develop effective and efficient h ealth care delivery
93	93		systems and strategies for procuring health care services in order
94	94		for the state to continue to purchase the most comprehensive health
95	95		care possible.
96	96		B. It is therefore incumbent upon the Legislature to establish
97	97		the Oklahoma Health Care Autho rity whose purpose shall be to:
98	98		1. Purchase state and education employees ’ health care benefits
99	99		and Medicaid benefits;
100	100		2. Study all state-purchased and state-subsidized health care,
101	101		alternative health care delivery systems and strategies for the
102	102		procurement of health care service s in order to maximize cost
103	103		containment in these programs while ensuring access to quality
104	104		health care; and
105	105		3. Make recommendati ons aimed at minimizing the financial
106	106		burden which health care poses for the state, its employees and its
107	107		charges, while at the same time allowing the state to provide the
108	108		most comprehensive health care possible; and
109	109		4. Administer the state-sponsored health and dental benefits
110	110		plans known as HealthChoice and life insurance plans in accordance
111	111		with the Oklahoma Employees Insurance and Benefits Act and the State
112	112		Employees Flexible Benefits Act. The Office of Management and
113	113		Enterprise Services shall cause transfer of all necessary assets,
114	114		data, records, and personnel necessary for the administ ration of
115	115		HealthChoice not later than the effective date of this act .
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143	142		SECTION 2. AMENDATORY 7 4 O.S. 2021, Section 1306.2, is
144	143		amended to read as follows:
145	144		Section 1306.2. A. The Director of the Office of Management
146	145		and Enterprise Services Oklahoma Health Care Authority shall submit
147	146		to the Insurance Commiss ioner the following inf ormation regarding
148	147		utilization review performed by employees of the Office Authority:
149	148		1. A utilization review plan that includes:
150	149		a. an adequate summary description of r eview standards,
151	150		protocol and procedures to be used i n evaluating
152	151		proposed or delivered hospital and medi cal care,
153	152		b. assurances that the standards and criter ia to be
154	153		applied in review determinations are establishe d with
155	154		input from health care provid ers representing major
156	155		areas of specialty and certified by the boards of the
157	156		various American medical specialties, and
158	157		c. the provisions by which patients or health care
159	158		providers may seek reconsideration or appeal of
160	159		adverse decisions concerning requests for me dical
161	160		evaluation, treatment or procedures;
162	161		2. The type and qualifications of the personnel either employ ed
163	162		or under contract to perf orm the utilization revie w;
164	163		3. The procedures and policies to ensure that an emp loyee of
165	164		the Office Authority is reasonably accessible to patients and health
166	165		care providers five (5) days a week durin g normal business hours,
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194	192		such procedures and policies to include as a requirement a toll -free
195	193		telephone number to be available during said such business hours;
196	194		4. The policies and procedures to ensure that all applicable
197	195		state and federal laws to protect the confidentiality of indiv idual
198	196		medical records are fo llowed;
199	197		5. The policies and procedures to verify the identity and
200	198		authority of personnel performing utilizati on review by telephone;
201	199		6. A copy of the materials designed to inform applicable
202	200		patients and health care providers of the r equirements of the
203	201		utilization review plan;
204	202		7. The procedures for receiving and handling complaints by
205	203		patients, hospitals and health care prov iders concerning utilization
206	204		review; and
207	205		8. Procedures to ensure that after a request for medical
208	206		evaluation, treatment, or procedur es has been rejected in whole or
209	207		in part and in the event a copy of the report on said such rejection
210	208		is requested, a copy of the report of the personnel performing
211	209		utilization review concerning the rejection shall be mailed by the
212	210		insurer, postage prepaid, to the ill or injured person, the treating
213	211		health care provider, hospital or to the person financially
214	212		responsible for the patient’s bill within fifteen (15) days after
215	213		receipt of the request for the report.
216	214		B. The Office Authority shall pay an annual f ee to the
217	215		Insurance Commissioner of Five Hundred Dollars ($500.00).
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245	242		SECTION 3. AMENDATORY 74 O.S. 2021, Section 1306.5, is
246	243		amended to read as follows:
247	244		Section 1306.5. A network provider facility or physician
248	245		contract, or any part or section of it, may be amended at any time
249	246		during the term of the contract only by mutual written consent of
250	247		duly authorized representatives of the Office of Management and
251	248		Enterprise Services Oklahoma Health Care Authority and the facility
252	249		or physician.
253	250		SECTION 4. AMENDATORY 74 O .S. 2021, Section 1318, is
254	251		amended to read as follows:
255	252		Section 1318. No former employee who is reemployed by a
256	253		participating entity within twenty -four (24) months after the date
257	254		of termination of previous employment shall be enrolled in the
258	255		Oklahoma Employees Insurance and Benefits Plan authorized by
259	256		Sections 1301 through 1329.1 of this title, for a greater amount of
260	257		life insurance or life benefit than the amount for which th e life of
261	258		the former employee was insured under the plan at the date of
262	259		termination of employment, except upon the former employee
263	260		furnishing evidence of insurability, satisfactory to the Office of
264	261		Management and Enterprise Services Oklahoma Health Care Authority ,
265	262		and any greater amount of benefit or insurance provided the e mployee
266	263		shall be at the former employee ’s cost.
267	264		SECTION 5. AMENDATORY 74 O.S. 2021, Section 1321 , is
268	265		amended to read as follows:
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296	292		Section 1321. A. The Office of Management and Enterprise
297	293		Services Oklahoma Health Care Authority shall have the authority to
298	294		determine all rates and life, dental and health benefit s for state-
299	295		sponsored plans. All rates shall be compiled in a comprehensive
300	296		Schedule of Benefits . The Schedule of Benefits shall be avai lable
301	297		for inspection during regular business hours at the Office of
302	298		Management and Enterprise Services Authority. The Office Authority
303	299		shall have the authority to annually adjust the rates an d benefits
304	300		based on claim exper ience.
305	301		B. The premiums for su ch insurance plans offered for the next
306	302		plan year shall be established as follows:
307	303		1. For active employees and their dep endents, the Office’s
308	304		Authority’s premium determination shall be made no later than the
309	305		bid submission date for health maintenance organizations set by the
310	306		Oklahoma State Employees Benefits Council Oklahoma Employees
311	307		Insurance and Benefits Board , which shall be set in August no later
312	308		than the third Friday of that month; and
313	309		2. For all other covered members a nd dependents, the Office’s
314	310		Authority’s and the health maintenance organi zations’ premium
315	311		determinations shall be no later than the fourth Friday of
316	312		September.
317	313		C. The Office may approve a mid-year adjustment requested by
318	314		the Authority provided the need for an adjustment is substa ntiated
319	315		by an actuarial determination or more current expe rience rating.
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347	342		The only publication or notice require ments that shall apply to the
348	343		Schedule of Benefits shall be those requirem ents provided in the
349	344		Oklahoma Open Meeting Ac t and within this section. It is the intent
350	345		of the Legislature that the benefits provided not include cosmetic
351	346		dental procedures except for certain or thodontic procedures as
352	347		adopted by the Director Chief Executive Officer of the Authority.
353	348		SECTION 6. This act shall become effective July 1, 2024.
354	349		SECTION 7. It being immediately necessary for the preservation
355	350		of the public peace, health or safety, an emergency is hereby
356	351		declared to exist, by reason whereof this act shall tak e effect and
357	352		be in full force from and after its passage and approval.
358		-	~~COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES~~
359		-	~~February~~ 8, 2024 ~~- DO PASS AS AMENDED BY CS~~
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	354	+	59-2-3466 RD 2/8/2024 12:04:04 PM