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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
SENATE BILL 1703 By: Daniels
AS INTRODUCED
An Act relating to the state Medicaid program;
amending 63 O.S. 2021, Section 5051.2 , which relates
to recovery of expenses; prohibiting certain insurers
from denying claims on specified grounds ; requiring
insurer to accept certain authorization; requiring
insurer to respond to certain in quiry within
specified time frame; clarifying language; and
providing an effective date .
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, Section 5051.2, is
amended to read as follows:
Section 5051.2. A. Whenever the Oklahoma Health Care Authority
pays for medical services or renders medical services, for or on
behalf of a person who has been injured or suffered an illness or
disease, the right of the provider of the services to reimbursement
shall be automatically assigned to t he Oklahoma Health Care
Authority, upon notice to the insurer or other party obligated as a
matter of law or agreement to r eimburse the provider on behalf of
the patient.
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B. Upon the assignment, the Authority, f or purposes of the
claim for reimbursement, becomes a provider of medical services.
C. The assignment of the right to reimbursement shall be
applied and considered valid against any employer or insurer under
the Administrative Workers’ Compensation Act in this state.
D. Each insurer, upon receiving a claim from the Ok lahoma
Health Care Authority, shall accept the state ’s right of recovery,
to process and, if appropriate, pa y the claim to the same extent
that the plan would have been liable if it had been billed at the
point of sale or by the original provider of services. Insurer The
insurer shall not deny the Authority claims on the basis of the date
of submission, the format of the claim, or for failure to present
proper documentation of coverage at the point of sale.
E. An insurer, except a Medicare Advantage plan, shall not deny
the Authority claims solely on the basis that a claimed item or
service did not receive prio r authorization under the rules or
coverage policies of the insurer. The insurer shall accept an
authorization provided by the Authority for an item or service
covered under the state Medicaid program or under a home- and
community-based services waiver for such individual as if such
authorization was made by the insurer for such item or service.
F. If the Authority submits a n inquiry regarding a claim to an
insurer not later than three (3) years after the date of provision
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of the claimed item or service, the insurer shall respond to the
inquiry within sixty (60) days of receiving the inquiry.
G. Insurer An insurer shall make appropriate payments to the
Authority as long as the claim is submitted for consideration within
three (3) years from the date the service was furnished. Any action
by the Authority to enforce the payment of the claim shall be
commenced within six (6) years of the submission of the claim by the
Authority.
SECTION 2. This act shall become effective November 1, 2024.
59-2-2724 DC 1/16/2024 4:43:12 PM