1|ENGROSSED SENATE AMENDMENT |
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2|ENGROSSED HOUSE |
|BILL NO. 1712 By: Marti and McDugle of the |
3| House |
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5| Garvin of the Senate |
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8| An Act relating to health insurance; defining terms; |
| prohibiting insurers from refusing coverage to an |
9| insured under certain circumstances; providing for an |
| insured to seek care from an out-of-network provider |
10| under certain circumstances; requiring out-of-network |
| providers to be reimbursed for covered services at |
11| the same rate as in-network providers; providing for |
| codification; and declaring an emergency. |
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14|AMENDMENT NO. 1. Page 1, strike the title, enacting clause and |
| entire bill and insert |
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16| "An Act relating to health insurance; defining terms; |
| prohibiting insurers from refusing coverage to an |
17| insured under certain circumstances; providing for an |
| insured to seek care from an out-of-network provider |
18| under certain circumstances; requiring out-of-network |
| providers to be reimbursed for covered services at |
19| the same rate as in-network providers; providing for |
| codification; and declaring an emergency. |
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22|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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1| SECTION 1. NEW LAW A new section of law to be codified |
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2|in the Oklahoma Statutes as Section 6981 of Title 36, unless there |
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3|is created a duplication in numbering, reads as follows: |
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4| A. As used in this section: |
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5| 1. "Durable medical equipment" means equipment as defined |
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6|pursuant to Section 375.2 of Title 59 of the Oklahoma Statutes; |
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7| 2. "Health benefit plan" means a health benefit plan as defined |
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8|pursuant to Section 6060.4 of Title 36 of the Oklahoma Statutes, but |
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9|shall not include any health benefit plan offered by a contracted |
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10|entity as defined in Section 4002.2 of Title 56 of the Oklahoma |
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11|Statutes that provides coverage to members of the state Medicaid |
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12|program; |
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13| 3. "Health care provider" means a provider as defined pursuant |
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14|to Section 6571 of Title 36 of the Oklahoma Statutes; |
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15| 4. "Health maintenance organization" or "HMO" means a health |
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16|maintenance organization as defined pursuant to Section 6902 of |
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17|Title 36 of the Oklahoma Statutes, but shall not include any health |
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18|benefit plan offered by a contracted entity as defined in Section |
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19|4002.2 of Title 56 of the Oklahoma Statutes that provides coverage |
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20|to members of the state Medicaid program; and |
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21| 5. "Preferred provider organization" or "PPO" means a preferred |
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22|provider organization as defined pursuant to Section 6054 of Title |
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23|36 of the Oklahoma Statutes. |
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1| B. No health benefit plan, HMO, PPO, or other provider network |
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2|authorized to administer health care coverage in this state shall |
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3|refuse coverage to an insured for durable medical equipment and |
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4|supplies as prescribed by a health care provider, regardless of |
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5|whether they are in-network or out-of-network, unless there is an |
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6|Oklahoma-licensed in-network provider within a fifteen-mile radius |
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7|of the patient's home address that can provide in-person evaluation |
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8|for durable medical equipment, supplies, and related services. |
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9| C. If a health care provider deems it necessary that an insured |
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10|receive covered durable medical equipment or supplies within |
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11|twenty-four (24) hours, the insured shall not be subject to |
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12|drop-shipped orders and may seek such equipment and supplies from |
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13|any health care provider who can provide the necessary services and |
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14|supplies within the requested time frame. |
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15| D. When an insured utilizes an out-of-network health care |
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16|provider, as described in subsection B of this section, the |
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17|out-of-network provider shall be reimbursed at the same rate and |
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18|benefit level for the provided services as an in-network provider |
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19|for the health benefit plan, HMO, PPO, or other provider network |
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20|authorized to administer health care coverage in this state. |
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21| SECTION 2. It being immediately necessary for the preservation |
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22|of the public peace, health or safety, an emergency is hereby |
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23|declared to exist, by reason whereof this act shall take effect and |
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24|be in full force from and after its passage and approval." |
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1| Passed the Senate the 19th day of March, 2024. |
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| Presiding Officer of the Senate |
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5| Passed the House of Representatives the ____ day of __________, |
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6|2024. |
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| Presiding Officer of the House |
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