Req. No. 3596 Page 1 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
STATE OF OKLAHOMA
2nd Session of the 59th Legislature (2024)
COMMITTEE SUBSTITUTE
FOR
SENATE BILL 1752 By: Garvin
COMMITTEE SUBSTITUTE
An Act relating to the state Medicaid program;
amending Section 1, Chapter 309, O.S.L. 2022 (36 O.S.
Supp. 2023, Section 6012) , which relates to health
care plan recognition ; modifying certain authority of
the Insurance Department; requiring the Department to
recognize certain health care plans for specified
purpose; modifying conditions for recognition;
amending 56 O.S. 2021, Section 1010.1, as amended by
Section 2, Chapter 309, O.S.L. 2022 (56 O.S. Supp.
2023, Section 1010.1), which relates to premium
assistance program; modifying certain deadline and
conditions for participation by certain health care
plans; imposing additional conditions for
participation; updating statutory language; updating
statutory reference; providing an effective date; and
declaring an emergency.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY Section 1, Chapter 309, O.S.L.
2022 (36 O.S. Supp. 2023, Section 6012), is ame nded to read as
follows:
Section 6012. A health care plan recognized by the The
Insurance Department that participates shall recognize self-funded
or self-insured health care plan s for the exclusive purpose of
Req. No. 3596 Page 2 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
participation in the premium assistance program created under
Section 1010.1 of Title 56 of the Oklahoma Statutes as of the
effective date of this act that at a lat er date becomes a self-
funded or self-insured health care plan may continue to be
recognized by the Insurance Department as a health care plan if such
plan meets if such plans meet the requirements under subsection J of
Section 1010.1 of Title 56 of the Oklahoma Statutes . The A self-
funded or self-insured health care plan recognized by the Department
under this section shall only be considered a health care plan for
the exclusive purposes of the premium assistance program created
under Section 1010.1 of Title 56 of the Oklahoma Statutes.
SECTION 2. AMENDATORY 56 O.S. 2021, Section 1010.1, as
amended by Section 2, C hapter 309, O.S.L. 2022 (56 O.S. Supp. 2023,
Section 1010.1), is amended to read as follows:
Section 1010.1. A. Section 1010.1 et seq. of this title shall
be known and may be cited as the “Oklahoma Medicaid Program Reform
Act of 2003”.
B. Recognizing that many Oklahomans do not have health care
benefits or health care coverage, that many small bu sinesses cannot
afford to provide health care benefits to their employees, and that,
under federal law, barriers exi st to providing Medicaid benefits to
the uninsured, the Legislature hereby establish es provisions to
lower the number of uninsur ed, assist businesses in the ir ability to
afford health care benefit s and coverage for their employees, and
Req. No. 3596 Page 3 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
eliminate barriers to providing health coverage to eligible
enrollees under federal law.
C. Unless otherwise provided by law, the Oklahoma Health Care
Authority shall provide coverage under the state Medicaid program to
children under the age of eighteen (18) years whose family incomes
do not exceed one hundred eighty-five percent (185%) of the federal
poverty level.
D. 1. The Authority is directed to apply for a waiver or
waivers to the Centers for Medicare and Medicaid Services (CMS) that
will accomplish the purposes outlined in subsection B of this
section. The Authority is further directed to negotiate with CMS to
include in the waiver authority provisions to:
a. increase access to health care for Oklahomans,
b. reform the Oklahoma Medicaid Pr ogram to promote
personal responsibility for health care services and
appropriate utilization of health care benefits
through the use of pub lic-private cost sharing,
c. enable small employers, and/or employ ed, uninsured
adults with or without children to p urchase employer-
sponsored, state-approved private, or state-sponsored
health care coverage through a state premium
assistance payment plan. If by January 1, 2012, the
Oklahoma Employer/Employee Partnership for Insurance
Coverage Premium Assistance Program premium assistance
Req. No. 3596 Page 4 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
program is not consuming more than sevent y-five
percent (75%) of its dedicated source of funding, then
the program will be expanded to include parents of
children eligible for Medicaid, and
d. develop flexible health care benefit packages based
upon patient need and cost .
2. The Authority may phase in any waiver or waivers it receives
based upon available fun ding.
3. The Authority is authorized to develop and implement a
premium assistance plan to assist small businesses and/or their
eligible employees to purcha se employer-sponsored insurance or “buy-
in” to a state-sponsored benefit plan.
4. a. The Authority is authorized to seek from the Centers
for Medicare and Medicaid Services any waivers or
amendments to existing waivers necessary to accomplish
an expansion of the premium assistance program to:
(1) include for-profit employers with two hundred
fifty employees or less up to any level supported
by existing funding resources, and
(2) include not-for-profit employers with five
hundred employees or less up to any level
supported by existing fundin g resources.
b. Foster parents employed by employers with greater t han
two hundred fifty employees shall be exempt from the
Req. No. 3596 Page 5 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
qualifying employer requirement p rovided for in this
paragraph and shall be eligible to qualify for the
premium assistance program provided for in this
section if supported by existing funding.
E. For purposes of this paragraph, “for-profit employer” shall
mean an entity which is not exe mpt from taxation pursuant to the
provisions of Section 501(c)(3) of the Internal Revenue Code and
“not-for-profit employer” shall mean an entity which is exempt from
taxation pursuant to the provisions of Section 501(c)(3) of the
Internal Revenue Code.
F. The Authority is authorized to seek from the Centers for
Medicare and Medicaid Services any waivers or amendments to existing
waivers necessary to accomplish an e xtension of the premium
assistance program to inc lude qualified employees whose family
income does not exceed two hundred fifty percent (250%) of the
federal poverty level, subject to the lim it of federal financial
participation.
G. The Authority is authori zed to create as part of the premium
assistance program an option to purchase a high -deductible health
insurance plan that is compatible with a health savings account.
H. 1. There is hereby created in the State Treasury a
revolving fund to be designate d the “Health Employee and Economy
Improvement Act (HEEIA) Revolving Fund ”.
Req. No. 3596 Page 6 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
2. The fund shall be a continuing fund, not subject to fiscal
year limitations, and shall consist of:
a. all monies received by the Authority pursuant to this
section and otherwise specified or authorized by law,
b. monies received by the Authority due to federal
financial participation pursuant to Title XIX of the
Social Security Act, and
c. interest attributable to investment of money in the
fund.
3. All monies accruing to the c redit of the fund are hereby
appropriated and sha ll be budgeted and expend ed by the Authority to
implement a premium assistance plan and to fund the state share for
the Oklahoma Medicaid program Program on or after July 1, 2020,
unless otherwise provided by law.
I. 1. The Authority shall establish a procedure for verifying
an applicant’s individual income by utilizing available Oklahoma Tax
Commission records, new hire report data collected by the Oklahoma
Employment Security Commission, and child support payment data
collected by the Department of Human Services in accordance with
federal and state law.
2. The Oklahoma Tax Commission, Oklaho ma Employment Security
Commission, and Department of Human Services shall cooperate in
accordance with federal and state law with the Authority to
Req. No. 3596 Page 7 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
establish procedures for the secure elec tronic transmission of an
applicant’s individual income data to the Au thority.
3. The Department of Public Safety shall cooperate in
accordance with federal and state law with the Authority to
establish procedures for the secure electronic transmission of an
applicant’s individual identification data to the Authority.
J. A health care plan An employer participating in the premium
assistance program created unde r this section as of the effective
date of this act that at a later date becomes May 1, 2024, may
utilize a self-funded or self-insured health care plan may continue
to participate in the premium assistance p rogram as a participating
health care plan if:
1. The health care plan has continuously participated in the
premium assistance program without interruption up to the date it
becomes a self-funded or self-insured health care plan;
2. The self-funded or self-insured health care plan continues
to be recognized as a health care plan is recognized by the
Insurance Department under Section 1 of this act Section 6012 of
Title 36 of the Oklahoma Statutes ;
3. 2. The self-funded or self-insured health care plan
continues to cover covers all essential health benefits as required
by the Centers for Medicare and Medicaid Services Authority and all
other health benefits required under applicable federal laws;
Req. No. 3596 Page 8 1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
3. The self-funded or self-insured health care plan otherwise
complies with all applicable federal laws including but not limited
to the Employee Retirement Income Security Act of 1974 (ERISA );
4. The self-funded or self-insured health care plan assesses a
monthly premium on members and maintains a rate schedule for
provider reimbursement ;
5. The self-funded or self-insured health care plan meets
actuarial standards for the premium assistance program as determined
by the Authority and the employer submits an attestation to the
Insurance Department that the self -funded or self-insured health
care plan meets such actuarial standards ; and
4. 6. The Authority receives the necessary federal appr oval for
self-funded or self-insured health care plans to participate in the
premium assistance program.
SECTION 3. This act shall become effective July 1, 2024.
SECTION 4. It being immediately necessary for the preservation
of the public peace, health or saf ety, 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.
59-2-3596 DC 2/29/2024 11:51:40 AM