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STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
COMMITTEE SUBSTITUTE
FOR
SENATE BILL 1703 By: Daniels
COMMITTEE SUBSTITUTE
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
and third-party administrators from denying claims on
specified grounds; requiring acceptance of certain
authorization; requiring response to certain inquiry
within specified time fram e; clarifying language; and
declaring an emergency .
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 reimburse 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, become s 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 cl aim from the Oklahoma
Health Care Authority, shall accept the state ’s right of recovery,
to process and, if appropriate, pay 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 pro vider 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 or third-party administrator, 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 or
third-party administrator. The insurer or third-party administrator
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 or third-party administrator
for such item or service.
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F. If the Authority submits an inquiry regarding a claim to an
insurer or third-party administrator not later than three (3) years
after the date of provision of the claimed item or service, the
insurer or third-party administrator 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. It being immediately necessary for the preservation
of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and
be in full force from and after its passage and approval.
59-2-3447 DC 2/29/2024 11:50:37 AM