Oklahoma Senate Bill SB756

Oklahoma 2024 Regular Session

• Introduced: 2/6/23
• Refer: 2/7/23

Caption

Medicaid; prohibiting prior authorization process by contracted entity when provider meets criteria for certain exemption; stipulating certain procedures. Emergency.

Impact

If enacted, SB756 will alter the interaction between participating providers and Medicaid managed care organizations. The bill establishes a structured means for providers to maintain exemptions from prior authorization requirements, thus allowing them to deliver timely services without unnecessary bureaucratic delays. It aims to bolster provider autonomy, potentially improving patient access to necessary healthcare services. Furthermore, the bill emphasizes clear communication by requiring contracted entities to notify providers of exemptions and any rescissions, thereby enhancing transparency in the authorization process.

Summary

Senate Bill 756 proposes significant changes to the prior authorization process for Medicaid services in Oklahoma. The bill mandates that a contracted entity cannot require prior authorization for a health care service if a participating provider has previously had at least 90% of their authorization requests approved over the past six months. This automatic exemption aims to streamline the process for health care providers and reduce barriers to patient care when they consistently meet approval thresholds. Continued exemptions can be granted without re-evaluation, easing the administrative burden on providers who demonstrate high compliance rates.

Contention

While SB756 has garnered support for its potential to ease access to care, it has also sparked concerns over the possibility of unintended consequences. Critics argue that the bill may lead to abuses or over-utilization of services without adequate oversight, although safeguards are included in the legislation. The framework for rescinding exemptions is defined, requiring retrospective reviews based on a sample of prior claims. This aspect of the bill is crucial, as it seeks to balance provider flexibility with the need for constant monitoring of healthcare quality and compliance with medical necessity standards.