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SENATE FLOOR VERSION
February 8, 2024
COMMITTEE SUBSTITUTE
FOR
SENATE BILL NO. 1588 By: Hall
An Act relating to state and education employee
benefits; amending 63 O.S. 2021, Section 5003, which
relates to powers and duties of the Oklahoma Health
Care Authority; directing the Authority to administer
state-sponsored benefits; amending 74 O.S. 2021,
Sections 1306.2, 1306.5, 1318, and 1321, which relate
to the administration of state -sponsored plans;
conforming language; providing an ef fective date; and
declaring an emergency .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, Section 5003, is
amended to read as follows:
Section 5003. A. The Legislature recognizes that the state is
a major purchaser of health care s ervices, and the increasing costs
of such health care services ar e posing and will continue to pose a
great financial burden on the state. It is the policy of the state
to provide comprehensive health care as an employer to state
employees and officials and their dependents and to those who are
dependent on the state for necessary medical care. It is imperative
that the state develop effective and efficient h ealth care delivery
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systems and strategies for procuring health care services in order
for the state to continue to purchase the most comprehensive health
care possible.
B. It is therefore incumbent upon the Legislature to establish
the Oklahoma Health Care Authority whose purpose shall be to:
1. Purchase state and education employees’ health care benefits
and Medicaid benefits;
2. Study all state-purchased and state-subsidized health care,
alternative health care delivery systems and strategies for the
procurement of health care service s in order to maximize cost
containment in these programs while ensuring access to quality
health care; and
3. Make recommendati ons aimed at minimizing the financial
burden which health care poses for the state, its employees and its
charges, while at the same time allowing the state to provide the
most comprehensive health care possible ; and
4. Administer the state-sponsored health and dental benefits
plans known as HealthChoice and life insurance plans in accordance
with the Oklahoma Employees Insurance and Benefits Act and the State
Employees Flexible Benefits Act. The Office of Management and
Enterprise Services shall cause transfer of all necessary assets,
data, records, and personnel necessary for the administ ration of
HealthChoice not later than the effective date of this act .
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SECTION 2. AMENDATORY 74 O.S. 2021, Section 1306.2, is
amended to read as follows:
Section 1306.2. A. The Director of the Office of Management
and Enterprise Services Oklahoma Health Care Authority shall submit
to the Insurance Commissioner the following inf ormation regarding
utilization review performed by employees of the Office Authority:
1. A utilization review plan that includes:
a. an adequate summary description of rev iew standards,
protocol and procedures to be used i n evaluating
proposed or delivered hospital and medical care,
b. assurances that the standards and criter ia to be
applied in review determinations are establishe d with
input from health care provid ers representing major
areas of specialty and certified by the b oards of the
various American medical specialties, and
c. the provisions by which patients or health care
providers may seek reconsideration or appeal of
adverse decisions concerning requests for medi cal
evaluation, treatment or procedures;
2. The type and qualifications of the personnel either employed
or under contract to perf orm the utilization revie w;
3. The procedures and policies to ensure that an emp loyee of
the Office Authority is reasonably accessible to patients and health
care providers five (5 ) days a week during normal business hours,
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such procedures and policies to include as a requirement a toll -free
telephone number to be available during said such business hours;
4. The policies and procedures to ensure that all applicable
state and federal laws to protect the confidentiality of individual
medical records are fo llowed;
5. The policies and procedures to verify the identity and
authority of personnel performing utilizati on review by telephone;
6. A copy of the materials designed to inform applicable
patients and health care providers of the r equirements of the
utilization review plan;
7. The procedures for receiving and handling complaints by
patients, hospitals and health care provid ers concerning utilization
review; and
8. Procedures to ensure that after a re quest for medical
evaluation, treatment, or procedur es has been rejected in whole or
in part and in the event a copy of the report on said such rejection
is requested, a copy of the report of the personnel performing
utilization review concerning the rejection shall be mailed by the
insurer, postage prepaid, to the ill or injured person, the treating
health care provider, hospital or to the person financially
responsible for the patient’s bill within fifteen (15) days after
receipt of the request for the re port.
B. The Office Authority shall pay an annual f ee to the
Insurance Commissioner of Five Hundred Dollars ($500.00).
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SECTION 3. AMENDATORY 74 O.S. 2021, Se ction 1306.5, is
amended to read as follows:
Section 1306.5. A network provider facility or physician
contract, or any part or section of it, may be amended at any time
during the term of the contract only by mutual written consent of
duly authorized representatives of the Office of Management and
Enterprise Services Oklahoma Health Care Authority and the facility
or physician.
SECTION 4. AMENDATORY 74 O .S. 2021, Section 1318, is
amended to read as follows:
Section 1318. No former employee who is reemployed by a
participating entity within twenty-four (24) months after the date
of termination of previous employment shall be enrolled in the
Oklahoma Employees Insurance and Benefits Plan authorized by
Sections 1301 through 1329.1 of this title, for a greater amount of
life insurance or life benefit than the amount for which the life of
the former employee was insured under the plan at the date of
termination of employment, except upon the former employee
furnishing evidence of insurability, satisfactory to the Office of
Management and Enterprise Services Oklahoma Health Care Authority ,
and any greater amount of benefit or insurance provided the e mployee
shall be at the former employee ’s cost.
SECTION 5. AMENDATORY 74 O.S. 2021, Section 1321 , is
amended to read as follows:
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Section 1321. A. The Office of Management and Enterprise
Services Oklahoma Health Care Authority shall have the authority to
determine all rates and life, dental and health benefits for state-
sponsored plans. All rates shall be compiled in a comprehensive
Schedule of Benefits . The Schedule of Benefits shall be avai lable
for inspection during regular business hours at the Office of
Management and Enterprise Services Authority. The Office Authority
shall have the authority to annually adj ust the rates and benefits
based on claim experience.
B. The premiums for su ch insurance plans offered for the next
plan year shall be established as follows:
1. For active employees and their dependents, the Office’s
Authority’s premium determination sh all be made no later than the
bid submission date for health maintenance organizations set by the
Oklahoma State Employees Benefits Council Oklahoma Employees
Insurance and Benefits Board , which shall be set in August no later
than the third Friday of that month; and
2. For all other covered members and dependents, the Office’s
Authority’s and the health maintenance organi zations’ premium
determinations shall be no later than the fourth Friday of
September.
C. The Office may approve a mid-year adjustment requested by
the Authority provided the need for an adjustment is substa ntiated
by an actuarial determination or more current expe rience rating.
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The only publication or notice require ments that shall apply to the
Schedule of Benefits shall be those requir ements provided in the
Oklahoma Open Meeting Act and within this section. It is the intent
of the Legislature that the benefits provided not include cosmetic
dental procedures except for certain orthodontic procedures as
adopted by the Director Chief Executive Officer of the Authority.
SECTION 6. This act shall become effective July 1, 2024.
SECTION 7. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason wh ereof this act shall take effect and
be in full force from and after its passage and approval.
COMMITTEE REPORT BY: COMMITTEE ON HEALTH AND HUMAN SERVICES
February 8, 2024 - DO PASS AS AMENDED BY CS