Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB1631 Compare Versions

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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. 1631 By: Coleman of the Senate
7	37
8	38		and
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10	40		Tedford of the House
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15	45		An Act relating to insurance; amending 36 O.S. 2021,
16	46		Section 4405.1, which relates to credentialing or
17	47		recredentialing of health care providers; requiring
18	48		certain notice following credential application
19	49		determination; updating statutory language; updating
20	50		statutory reference; and providing an effective date .
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25		-	SUBJECT: Health insurance
26		-
27	55		BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
28		-
29	56		SECTION 1. AMENDATORY 36 O.S. 2021, Section 4405.1, is
30	57		amended to read as follows:
31		-
32	58		Section 4405.1. A. As used in this section:
33		-
34	59		1. a. “Health benefit plan” or “plan” means:
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36	60		(1) group hospital or medical insurance coverages,
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38	61		(2) not-for-profit hospital or medical service or
39	62		indemnity plans,
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41	63		(3) prepaid health plans,
42		-
43	64		(4) health maintenance organizations,
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45	65		(5) preferred provider plans,
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48		-	ENR. S. B. NO. 1631 Page 2
49	93		(6) Multiple Employer Welfare Arrangement s multiple
50	94		employer welfare arrangements (MEWA), or
51		-
52	95		(7) employer self-insured plans that are not exempt
53	96		pursuant to the federal Employee Retirement
54	97		Income Security Act of 1974 (ERISA) provisions,
55	98		and
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57	99		b. the term “health benefit plan” health benefit plan
58	100		shall not include:
59		-
60	101		(1) individual plans,
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62	102		(2) plans that only provide coverage for a specified
63	103		disease, accidental death, or dismemberment for
64	104		wages or payments in lieu of wages for a period
65	105		during which an employee is absent from work
66	106		because of sickness or injury or as a supplement
67	107		to liability insurance,
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69	108		(3) Medicare supplemental policies as defined in
70	109		Section 1882(g)(1) of the federal Social Security
71	110		Act (42 U.S.C., Section 1395ss),
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73	111		(4) workers’ compensation insurance coverage,
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75	112		(5) medical payment insurance iss ued as a part of a
76	113		motor vehicle insurance policy, or
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78	114		(6) long-term care policies, including nursing home
79	115		fixed indemnity policies, unless the Insurance
80	116		Commissioner determines that the policy provides
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81	144		comprehensive benefit coverage sufficient to meet
82	145		the definition of a health benefit plan; and
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84	146		2. “Credentialing” or “recredentialing”, as applied to
85	147		physicians and other health care providers, means the process of
86	148		accessing and validating the qualifications of such persons to
87	149		provide health care services to the beneficiaries of a health
88	150		benefit plan. Credentialing or recredentialing may include, but is
89	151		not limited to, an evaluation of licensure status, education,
90	152		training, experience, competence and professional judgment.
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92		-	ENR. S. B. NO. 1631 Page 3
93		-
94	153		Credentialing or recredentiali ng is a prerequisite to the final
95	154		decision of a health benefit plan to permit initial or continued
96	155		participation by a physician or other health care provider.
97		-
98	156		B. 1. Any health benefit plan that is offered, issued or
99	157		renewed in this state shall provide for cre dentialing and
100	158		recredentialing of physicians and other health care providers based
101	159		on criteria provided i n the uniform credentialing application
102	160		required by Section 1 -106.2 of Title 63 of the Oklahoma Statutes.
103		-
104	161		2. Health benefit plans shall make info rmation on such criteria
105	162		available to physician and other health care provider applicants,
106	163		participating physicians, and other participating health care
107	164		providers and shall provide applicants with a checklist of materials
108	165		required in the application process.
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110	166		3. Physicians or other health care providers under
111	167		consideration to provide health care services under a h ealth benefit
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112	195		plan in this state shall apply for credentialing or recredentialing
113	196		on the uniform credentialing application and shall provide the
114	197		documentation as outlined in the plan ’s checklist of materials
115	198		required in the application process.
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117	199		C. A health benefit plan shall determine whether a
118	200		credentialing or recredentialing application is complete. If an
119	201		application is determined to be incomplete, t he plan shall notify
120	202		the applicant in writing within ten (10) calendar days of receipt of
121	203		the application. The written notice shall specify the portion of
122	204		the application that is causing a delay in processing and explain
123	205		any additional information or corrections needed.
124		-
125	206		D. 1. In reviewing the application, the health benefit plan
126	207		shall evaluate each applica tion according to the plan ’s checklist of
127	208		required materials that accompanies the application.
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129	209		2. When an application is deemed complete, the plan sha ll
130	210		initiate requests for primary source verification and malpractice
131	211		history within seven (7) calendar da ys.
132		-
133	212		3. A malpractice carrier shall have twenty -one (21) calendar
134	213		days within which to respond after receipt of an inquiry from a
135		-
136		-	ENR. S. B. NO. 1631 Page 4
137	214		health benefit plan. Any malpractice carrier that fails to respond
138	215		to an inquiry within the time frame may be assessed an
139	216		administrative penalty by the Insurance Commissioner.
140		-
141	217		E. 1. Upon receipt of primary source verification and
142	218		malpractice history by the plan, the plan sh all determine if the
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143	246		application is a clean application. If the application is deemed
144	247		clean, a plan shall have forty-five (45) calendar days within which
145	248		to credential or recredential a physician or other health care
146	249		provider. As used in this paragr aph, “clean application” means an
147	250		application that has no defect, misstatement of facts,
148	251		improprieties, includ ing a lack of any required substantiating
149	252		documentation, or particular circumstance requiring special
150	253		treatment that impedes prompt credentialing or re credentialing.
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152	254		2. If a plan is unable to credential or recredential a
153	255		physician or other health care pro vider due to an application’s
154	256		application not being clean, the plan may extend the credentialing
155	257		or recredentialing process for sixty (60) calenda r days. At the end
156	258		of sixty (60) calendar days, if the plan is awaiting documentation
157	259		to complete the applica tion, the physician or other health care
158	260		provider shall be notified of the reason for the delay by certified
159	261		mail. The physician or other health care provider may extend the
160	262		sixty-day period upon written notice to the plan within ten (10)
161	263		calendar days; otherwise the application shall be deemed withdrawn.
162	264		In no event shall the entire credentialing or recredentialing
163	265		process exceed one hundred eigh ty (180) calendar days.
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165	266		3. If an application for credentialing or recredentialing is
166	267		denied, the plan shall n otify the applicant in writing the reason
167	268		for the denial and what corrective actions the applicant may
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168	296		consider within ten (10) calendar days of the de termination to deny
169	297		the application.
170		-
171	298		4. A health benefit plan shall be prohibited from solely basing
172	299		a denial of an application for credentialing or recredentialing on
173	300		the lack of board certification or board eligibility and from adding
174	301		new requirements solely for the purpose of delaying an application.
175		-
176	302		4. 5. Any health benefit plan that violates the provis ions of
177	303		this section may be assessed an administrative penalty by the
178	304		Commissioner.
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180		-	ENR. S. B. NO. 1631 Page 5
181		-
182	305		F. Within thirty-one (31) days after a provider has been
183	306		credentialed by a health benefit plan following the completion of
184	307		the credentialing or recredentialing process pur suant to this
185	308		section, the health benefit plan shall consider the provider in -
186	309		network for purposes of reimbursement.
187		-
188	310		SECTION 2. This act shall become effective November 1, 2024.
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191		-	ENR. S. B. NO. 1631 Page 6
192		-	Passed the Senate the 5th day of March, 2024.
193		-
194		-
195		-
196		-	Presiding Officer of the Senate
197		-
198		-
199		-	Passed the House of Representatives the 24th day of April, 2024.
200		-
201		-
202		-
203		-	Presiding Officer of the House
204		-	of Representatives
205		-
206		-	OFFICE OF THE GOVERNOR
207		-	Received by the Office of the Governor this _______ _____________
208		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
209		-	By: _________________________________
210		-	Approved by the Governor of the State of Oklahoma this _______ __
211		-	day of _________________ __, 20_______, at _______ o'clock _______ M.
212		-
213		-	_________________________________
214		-	Governor of the State of Oklahoma
215		-
216		-
217		-	OFFICE OF THE SECRETARY OF STATE
218		-	Received by the Office of the Secretary of State this _______ ___
219		-	day of _________________ _, 20 _______, at _______ o'clock ___ ____ M.
220		-	By: _________________________________
	312	+	COMMITTEE REPORT BY: COMMITTEE ON RULES, dated 04/09/2024 - DO PASS.