1| SENATE FLOOR VERSION | | April 17, 2025 | 2| | | | 3|COMMITTEE SUBSTITUTE | |FOR ENGROSSED | 4|HOUSE BILL NO. 1853 By: Schreiber, Lepak, Sneed, | | and Wolfley of the House | 5| | | and | 6| | | Frix of the Senate | 7| | | | 8| | | | 9| An Act relating to health care services; defining | | terms; authorizing certain enrollee to send certain | 10| documentation to certain carrier; requiring certain | | health care provider to accept certain enrollee's | 11| payment as payment in full; prohibiting certain | | health care provider from billing certain enrollee or | 12| health benefit plan for certain amount; requiring | | certain carrier to count certain amount toward | 13| certain enrollee's deductible and out-of-pocket | | expense on certain occasion; directing certain costs | 14| to be attributed to certain deductible; prohibiting | | certain amount from exceeding certain total amount; | 15| providing for codification; and providing an | | effective date. | 16| | | | 17| | | | 18|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 19| SECTION 1. NEW LAW A new section of law to be codified | | | 20|in the Oklahoma Statutes as Section 6060.51 of Title 36, unless | | | 21|there is created a duplication in numbering, reads as follows: | | | 22| As used in this section: | | | 23| 1. "Health benefit plan" means group hospital coverage, | | | 24|individual and group medical insurance coverage, a not-for-profit | | | arsid14305566 SENATE FLOOR VERSION - HB1853 SFLR Page 1 ___________________________________________________________________________
1|hospital or medical service or indemnity plan, a prepaid health | | | 2|plan, a health maintenance organization plan, a preferred provider | | | 3|organization plan, the Oklahoma Employees Insurance Plan, and | | | 4|coverage provided by a multiple employer welfare arrangement. The | | | 5|term shall not include: | | | 6| a. a plan that provides coverage: | | | 7| (1) only for a specified disease or diseases or | | | 8| under an individual limited benefit policy, | | | 9| (2) only for accidental death or dismemberment, | | | 10| (3) only for dental or vision care, | | | 11| (4) for a hospital confinement indemnity policy, | | | 12| (5) for disability income insurance or a combination | | | 13| of accident-only and disability income insurance, | | | 14| or | | | 15| (6) as a supplement to liability insurance, | | | 16| b. any health plan offered by a contracted entity, as | | | 17| defined in Section 4002.2 of Title 56 of the Oklahoma | | | 18| Statutes, that provides coverage to members of the | | | 19| state Medicaid program, | | | 20| c. a Medicare supplemental policy as defined by Section | | | 21| 1882(g)(1) of the Social Security Act (42 U.S.C., | | | 22| Section 1395ss), | | | 23| d. workers' compensation insurance coverage, | | | 24| | | | arsid14305566 SENATE FLOOR VERSION - HB1853 SFLR Page 2 ___________________________________________________________________________
1| e. medical payment insurance issued as part of a motor | | | 2| vehicle insurance policy, | | | 3| f. a long-term care policy, including a nursing home | | | 4| fixed indemnity policy, unless a determination is made | | | 5| that the policy provides benefit coverage so | | | 6| comprehensive that the policy meets the definition of | | | 7| a health benefit plan, or | | | 8| g. short-term health insurance issued on a nonrenewable | | | 9| basis with a duration of six (6) months or less; | | | 10| 2. "Health care provider" means the same as defined in Section | | | 11|1219.6 of Title 36 of the Oklahoma Statutes; and | | | 12| 3. "Health care service" means any service provided by a health | | | 13|care provider, or by an individual working for or under the | | | 14|supervision of a health care provider, that relates to the | | | 15|diagnosis, assessment, prevention, treatment, or care of any human | | | 16|illness, disease, injury, or condition. | | | 17| The term shall also include mental health and substance use | | | 18|disorder services, as defined by Section 6060.10 of Title 36 of the | | | 19|Oklahoma Statutes, and durable medical equipment as defined by | | | 20|Section 375.2 of Title 59 of the Oklahoma Statutes. The term shall | | | 21|not include the administration or prescription of pharmaceutical | | | 22|products or services. | | | 23| | | | 24| | | | arsid14305566 SENATE FLOOR VERSION - HB1853 SFLR Page 3 ___________________________________________________________________________
1| SECTION 2. NEW LAW A new section of law to be codified | | | 2|in the Oklahoma Statutes as Section 6060.52 of Title 36, unless | | | 3|there is created a duplication in numbering, reads as follows: | | | 4| A. An enrollee may choose to pay out of pocket for a health | | | 5|care service from a health care provider. If an enrollee obtains a | | | 6|medically necessary health care service covered by his or her health | | | 7|benefit plan and negotiates for a price lower than the average | | | 8|allowed amount established by the health benefit plan and provided | | | 9|to the enrollee upon request, and the enrollee pays out of pocket | | | 10|for the health care service, the enrollee may electronically send | | | 11|documentation to the carrier that provides the following: | | | 12| 1. The health care service the enrollee or patient received and | | | 13|the name of the health care provider and contact information; | | | 14| 2. If an order by the health care provider is required by the | | | 15|policy, the order from the health care provider given to the | | | 16|enrollee or patient and the final bill or statement for the health | | | 17|care service; and | | | 18| 3. The negotiated cost of the health care service that the | | | 19|enrollee received and that: | | | 20| a. the enrollee paid out of pocket for the health care | | | 21| services received, and | | | 22| b. the health care entity is not making a claim against | | | 23| the carrier for payment for the health care service | | | 24| provided to the enrollee or patient. | | | arsid14305566 SENATE FLOOR VERSION - HB1853 SFLR Page 4 ___________________________________________________________________________
1| B. The health care provider shall accept the payment from the | | | 2|enrollee as payment in full and shall not bill the enrollee or the | | | 3|health benefit plan for any balance between the amount collected | | | 4|from the enrollee and the billed charge for the service by the | | | 5|provider. | | | 6| C. A carrier that receives the documentation described in | | | 7|subsection A of this section shall count the full amount that the | | | 8|enrollee paid out of pocket toward the deductible and annual maximum | | | 9|out-of-pocket expense if: | | | 10| 1. The health care service is covered under the health benefit | | | 11|plan of the enrollee; and | | | 12| 2. The enrollee negotiated for a lower cost for the health care | | | 13|service than the average allowed amount established by his or her | | | 14|health benefit plan for that covered health care service. | | | 15| D. The amount of the out-of-pocket cost shall be attributed to | | | 16|the in-network deductible and annual maximum out-of-pocket expense | | | 17|if the provider was an in-network provider, and to the | | | 18|out-of-network deductible and annual maximum out-of-pocket expense | | | 19|if the provider was an out-of-network provider. | | | 20| E. The amount counted toward an applicable out-of-pocket | | | 21|deductible and annual maximum out-of-pocket expense shall not exceed | | | 22|the total amount that the enrollee is required to pay out of pocket | | | 23|during a contractually agreed upon period of time for health care | | | 24|services that are included under the health benefit plan of the | | | arsid14305566 SENATE FLOOR VERSION - HB1853 SFLR Page 5 ___________________________________________________________________________
1|enrollee, and shall not carry over once a new contract or agreement | | | 2|period for the plan begins. | | | 3| SECTION 3. This act shall become effective November 1, 2025. | | | 4|COMMITTEE REPORT BY: COMMITTEE ON BUSINESS AND INSURANCE | |April 17, 2025 - DO PASS AS AMENDED BY CS | 5| | | | 6| | | | 7| | | | 8| | | | 9| | | | 10| | | | 11| | | | 12| | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | arsid14305566 SENATE FLOOR VERSION - HB1853 SFLR Page 6