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53	53	STATE OF OKLAHOMA
54	54
55	55	1st Session of the 59th Legislature (2023)
56	56
57	57	SENATE BILL 912 By: Seifried
58	58
59	59
60	60
61	61
62	62
63	63	AS INTRODUCED
64	64
65	65	An Act relating to the Oklahoma Right to Shop Act;
66	66	amending Section 2, Chapter 151, O.S.L. 2022 and
67	67	Section 3, Chapter 151, O.S.L. 2022 (36 O.S. Supp.
68	68	2022, Sections 6060.41 and 6060.42), which relate to
69	69	definitions and shared savings incent ive program;
70	70	defining term; establishing provisions of program;
71	71	conforming language; updating statutory reference;
72	72	providing for codification; and pro viding an
73	73	effective date.
74	74
75	75
76	76
77	77	BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
78	78	SECTION 1. AMENDATORY Section 2, Chapter 151, O.S.L .
79	79	2022 (36 O.S. Supp. 2022 , Section 6060.41), is amended to read as
80	80	follows:
81	81	Section 6060.41. As used in the Oklahoma Right to Shop Act:
82	82	1. “Allowed amount” means the contractually agreed-upon amount
83	83	paid by a carrier to a health care enti ty participating in the
84	84	network of the carrier;
85	85	2. “Comparable health care service” means any covered
86	86	nonemergency health care service or bundle of services. The
87	87	Insurance Commissioner may li mit what is considered a comparable
88	88	health care service if an i nsurance carrier can demonstrate allowed
89	89
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140	140	amount variation among network providers is less than Fifty Dollars
141	141	($50.00);
142	142	3. “Health benefit plan” means any plan as defined in
143	143	subsection C of Section 6060.4 of Title 36 of the Oklahoma Statutes
144	144	this title;
145	145	4. “Health care entity” means a physician, hospital,
146	146	pharmaceutical company, pharmacist, laboratory, or other provider of
147	147	health care services that is licensed in this state;
148	148	5. “Insurance carrier” or “carrier” means an insurance company
149	149	that issues policies of accident and health insurance and is
150	150	licensed to sell insurance in this state;
151	151	5. 6. “Shared savings incentive” means a voluntary and optional
152	152	financial incentive that an insurance ca rrier may provide to an
153	153	enrollee for choosing certain h ealth care services under a shared
154	154	savings incentive program; and
155	155	6. 7. “Shared savings incentive program ” or “program” means a
156	156	voluntary and optional in centive program established by an insura nce
157	157	carrier pursuant to this act.
158	158	SECTION 2. AMENDATORY Section 3, Chapte r 151, O.S.L.
159	159	2022 (36 O.S. Supp. 2022, Section 6060.42), is amended to read as
160	160	follows:
161	161	Section 6060.42. A. An insurance carrier, offering a health
162	162	benefit plan in this state in the individual or group insurance
163	163	market, except plans w here enrollees receive a premium subsidy under
164	164
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215	215	the federal Patient Protection and Affordable Car e Act, may offer a
216	216	shared savings incentive program to provide incentives to an
217	217	enrollee when the enrollee obtains a comparable health care service
218	218	that is covered by the carrier from providers that charge less than
219	219	the average allowed amount paid by that carrier to network providers
220	220	for that, comparable health care service .
221	221	B. Incentives may be calculated as a percentage of the
222	222	difference in allowed amounts to the average, as a flat dollar
223	223	amount, or by any other reasonable methodology approved by the
224	224	Insurance Department. The carrier shall provide the incentive as a
225	225	cash payment to the enrollee or credit toward the annual in-network
226	226	deductible and out-of-pocket limit of the enrollee. Carriers may
227	227	allow enrollees to select which method the enrollee prefers to
228	228	receive the incentive.
229	229	C. An insurance carrier that offers a shared s avings incentive
230	230	program shall:
231	231	1. Establish the program as a component part of the policy or
232	232	certificate of insurance provided by the carrier and notify the
233	233	enrollees and the Insurance Department at least thirty (30) days
234	234	before program termination ;
235	235	2. File a description of the program on a form prescribed by
236	236	the Insurance Commissio ner. The Insurance Department s hall review
237	237	the filing and determine whether the program complies with the
238	238	provisions of this section;
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290	290	3. Notify an enrollee, annually or at the time of renewal, of
291	291	the availability of the shared savings incentive program a nd the
292	292	procedures to participate in the program;
293	293	4. Publish on the website of the insurance carrier, easily
294	294	accessible to enrollees and applicants for insurance, a list o f
295	295	comparable health care services and health care providers and the
296	296	shared savings incentive amount applicable for ea ch service. A
297	297	shared savings incentive shall not be less than twenty-five percent
298	298	(25%) of the savings generated by the participation of the enrollee
299	299	in any shared savings incentive program offered by the insurance
300	300	carrier. The baseline for the savings c alculation shall be the
301	301	average in-network amount paid for that service in the most recent
302	302	twelve-month period or any other methodology est ablished by the
303	303	insurance carrier and approved by the Insurance Department;
304	304	5. At least quarterly, credit, deposit o r make a cash payment
305	305	to an enrollee of the shared savings incentive amount pursuant to
306	306	participation in the shared savings incentive prog ram; and
307	307	6. Submit an annual report to the Insurance Department within
308	308	ninety (90) days after the close of each health benefit plan year.
309	309	At a minimum, the report shall include the following information:
310	310	a. the number of enrollees who participated in t he
311	311	program during the health benefit plan year and the
312	312	number of instances of participat ion,
313	313
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364	364	b. the total cost of servic es provided as a part of the
365	365	program, and
366	366	c. the total value of the shared savings incentive
367	367	payments made to enrollees participating in the
368	368	program and the values distributed as cash or credit
369	369	toward the annual in-network deductible and out-of-
370	370	pocket limit of an enrollee.
371	371	D. An enrollee shall not be required to participate in a shared
372	372	savings incentive program.
373	373	SECTION 3. This act shall become effective November 1, 2023.
374	374
375	375	59-1-1577 RD 1/19/2023 10:36:03 AM

Oklahoma 2024 Regular Session

Oklahoma Senate Bill SB912 Compare Versions