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ENGROSSED HOUSE AMENDME NTS
TO
ENGROSSED SENATE BILL NO . 1703 By: Daniels of the Senate
and
McEntire of the House
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 denyin g claims on
specified grounds; requiring acceptance of certain
authorization; requiring response to certain inquiry
within specified time frame; clarifying language; and
declaring an emergency.
AMENDMENT NO. 1. Page 1, Lines 6 through 9.5, strike title to read
"[ state Medicaid program – recovery of expenses –
insurers – third-party administrators – denial of
claims - acceptance of authorization – inquiry
response –
emergency ]"
AMENDMENT NO. 2. Page 1, Line 12, strike the enacting clause
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Passed the House of Representatives the 25th day of April, 2024.
Presiding Officer of the House of
Representatives
Passed the Senate the ____ day of _______ ___, 2024.
Presiding Officer of the Senate
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ENGROSSED SENATE
BILL NO. 1703 By: Daniels of the Senate
and
McEntire of the House
An Act relating to the state Medicaid program;
amending 63 O.S. 2021, Section 5051.2, which relates
to recovery of expenses; prohibiting cer tain insurers
and third-party administrators from denying claims on
specified grounds; requiring acceptance of certain
authorization; requiring response to certain inquiry
within specified time frame; clarifying language; and
declaring an emergency .
BE IT ENACTED BY THE PEO PLE 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 r enders medical service s, 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 the Oklahoma Health Care
Authority, upon noti ce to the insurer or other pa rty obligated as a
matter of law or agreement to reimburse the provider on behalf of
the patient.
B. Upon the assignment, the Authority, for purposes of the
claim for reimbursement, becomes a provider of medical services.
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C. The assignment of the right t o 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 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 provider of services. Insurer The
insurer shall not deny the Authorit y 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 Aut hority claims solely on the
basis that a claimed item or service did not receive prior
authorization under the rules or coverage policies of the insurer or
third-party administrator. The insurer or third -party administrator
shall accept an authorization p rovided 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.
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
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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 t he service was furnished. An y 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, heal th 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.
Passed the Senate the 12th day of March, 2024.
Presiding Officer of the Senate
Passed the House of Representatives the ____ day of __________,
2024.
Presiding Officer of the House
of Representatives