Bill Text For HB3190 - Engrossed

 1|ENGROSSED HOUSE                                                        |
  |BILL NO. 3190                        By: Newton, Boles, Manger,        |
 2|                                         Munson, Humphrey, Burns,      |
  |                                         McDugle, McBride,             |
 3|                                         Rosecrants, Schreiber,        |
  |                                         Caldwell (Chad), Hasenbeck,   |
 4|                                         Dollens, West (Kevin),        |
  |                                         Talley, Deck, Moore, West     |
 5|                                         (Rick), May, Pfeiffer,        |
  |                                         Ford, West (Tammy), Osburn    |
 6|                                         of the House                  |
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 7|                                         and                           |
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 8|                                         Garvin of the Senate          |
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 9|                                                                       |
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10|                                                                       |
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11|       [ health insurance - Ensuring Transparency in Prior             |
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12|         Authorization Act  definitions - disclosure and               |
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13|         review of prior authorization - adverse                       |
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14|         determinations - consultation - reviewing                     |
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15|         physicians - obligations - utilization review                 |
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16|         entity - retrospective denial - length of prior               |
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17|         authorization - continuity of care  severability              |
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18|         noncodification  codification - effective date ]              |
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19|                                                                       |
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20|                                                                       |
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21|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:                  |
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22|    SECTION 1.     NEW LAW     A new section of law not to be          |
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23|codified in the Oklahoma Statutes reads as follows:                    |
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24|                                                                       |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 1
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 1|    This act shall be known and may be cited as the "Ensuring          |
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 2|Transparency in Prior Authorization Act".                              |
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 3|    SECTION 2.     NEW LAW     A new section of law to be codified     |
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 4|in the Oklahoma Statutes as Section 6570.1 of Title 36, unless there   |
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 5|is created a duplication in numbering, reads as follows:               |
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 6|    As used in this act:                                               |
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 7|    1.  "Adverse determination" means a determinization by a health    |
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 8|carrier or its designee utilization review entity that an admission,   |
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 9|availability of care, continued stay, or other health care service     |
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10|that is a covered benefit has been reviewed and, based upon the        |
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11|information provided, does not meet the health carrier's               |
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12|requirements for medical necessity, appropriateness, health care       |
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13|setting, level of care, or effectiveness, and the requested service    |
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14|or payment for the service is therefore denied, reduced, or            |
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15|terminated as defined by Section 6475.3 of Title 36 of the Oklahoma    |
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16|Statutes;                                                              |
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17|    2.  "Chronic condition" means a condition that lasts one (1)       |
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18|year or more and requires ongoing medical attention or limits          |
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19|activities of daily living or both;                                    |
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20|    3.  "Clinical criteria" means the written policies, written        |
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21|screening procedures, determination rules, determination abstracts,    |
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22|clinical protocols, practice guidelines, medical protocols, and any    |
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23|other criteria or rationale used by the utilization review entity to   |
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24|determine the necessity and appropriateness of health care services;   |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 2
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 1|    4.  "Emergency health care services", with respect to an           |
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 2|emergency medical condition as defined in 42 U.S.C.A., Section         |
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 3|300gg-111, means:                                                      |
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 4|         a.    a medical screening examination, as required under      |
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 5|              Section 1867 of the Social Security Act, 42 U.S.C.,      |
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 6|              Section 1395dd, or as would be required under such       |
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 7|              section if such section applied to an independent,       |
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 8|              freestanding emergency department, that is within the    |
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 9|              capability of the emergency department, of a hospital    |
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10|              or of an independent, freestanding emergency             |
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11|              department, as applicable, including ancillary           |
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12|              services routinely available to the emergency            |
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13|              department to evaluate such emergency medical            |
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14|              condition, and                                           |
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15|         b.    within the capabilities of the staff and facilities     |
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16|              available at the hospital or the independent,            |
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17|              freestanding emergency department, as applicable, such   |
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18|              further medical examination and treatment as are         |
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19|              required under Section 1395dd of the Social Security     |
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20|              Act, or as would be required under such section if       |
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21|              such section applied to an independent, freestanding     |
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22|              emergency department, to stabilize the patient,          |
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23|              regardless of the department of the hospital in which    |
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24|                                                                       |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 3
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 1|              such further examination or treatment is furnished, as   |
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 2|              defined by 42 U.S.C.A., Section 300gg-111;               |
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 3|    5.  "Emergency Medical Treatment and Active Labor Act" or          |
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 4|"EMTALA" means Section 1867 of the Social Security Act and             |
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 5|associated regulations;                                                |
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 6|    6.  "Enrollee" means an individual who is enrolled in a health     |
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 7|care plan, including covered dependents, as defined by Section         |
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 8|6592.1 of Title 36 of the Oklahoma Statutes;                           |
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 9|    7.  "Health care provider" means any person or other entity who    |
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10|is licensed pursuant to the provisions of Title 59 or Title 63 of      |
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11|the Oklahoma Statutes, or pursuant to the definition in Section        |
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12|1-1708.1C of Title 63 of the Oklahoma Statutes;                        |
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13|    8.  "Health care services" means any services provided by a        |
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14|health care provider, or by an individual working for or under the     |
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15|supervision of a health care provider, that relate to the diagnosis,   |
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16|assessment, prevention, treatment, or care of any human illness,       |
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17|disease, injury, or condition, as defined by Section 1-1708.1C.2 of    |
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18|Title 63 of the Oklahoma Statutes.                                     |
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19|The term also includes the provision of mental health and substance    |
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20|use disorder services, as defined by Section 6060.10 of Title 36 of    |
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21|the Oklahoma Statutes, and the provision of durable medical            |
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22|equipment.  The term does not include the provision, administration,   |
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23|or prescription of pharmaceutical products or services;                |
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24|    9.  "Licensed mental health professional" means:                   |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 4
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 1|         a.    a psychiatrist who is a diplomate of the American       |
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 2|              Board of Psychiatry and Neurology,                       |
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 3|         b.    a psychiatrist who is a diplomate of the American       |
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 4|              Osteopathic Board of Neurology and Psychiatry,           |
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 5|         c.    a physician licensed pursuant to the Oklahoma           |
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 6|              Allopathic Medical and Surgical Licensure and            |
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 7|              Supervision Act or the Oklahoma Osteopathic Medicine     |
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 8|              Act,                                                     |
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 9|         d.    a clinical psychologist who is duly licensed to         |
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10|              practice by the State Board of Examiners of              |
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11|              Psychologists,                                           |
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12|         e.    a professional counselor licensed pursuant to the       |
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13|              Licensed Professional Counselors Act,                    |
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14|         f.    a person licensed as a clinical social worker           |
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15|              pursuant to the provisions of the Social Worker's        |
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16|              Licensing Act,                                           |
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17|         g.    a licensed marital and family therapist as defined in   |
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18|              the Marital and Family Therapist Licensure Act,          |
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19|         h.    a licensed behavioral practitioner as defined in the    |
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20|              Licensed Behavioral Practitioner Act,                    |
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21|         i.    an advanced practice nurse as defined in the Oklahoma   |
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22|              Nursing Practice Act,                                    |
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23|         j.    a physician assistant who is licensed in good           |
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24|              standing in this state, or                               |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 5
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 1|         k.    a licensed alcohol and drug counselor/mental health     |
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 2|              (LADC/MH) as defined in the Licensed Alcohol and Drug    |
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 3|              Counselors Act;                                          |
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 4|    10.  "Medically necessary" means services or supplies provided     |
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 5|by a health care provider that are:                                    |
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 6|         a.    appropriate for the symptoms and diagnosis or           |
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 7|              treatment of the enrollee's condition, illness,          |
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 8|              disease, or injury,                                      |
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 9|         b.    in accordance with standards of good medical            |
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10|              practice,                                                |
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11|         c.    not primarily for the convenience of the enrollee or    |
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12|              the enrollee's health care provider, and                 |
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13|         d.    the most appropriate supply or level of service that    |
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14|              can safely be provided to the enrollee as defined by     |
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15|              Section 6592 of Title 36 of the Oklahoma Statutes;       |
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16|    11.  "Notice" means communication delivered either                 |
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17|electronically or through the United States Postal Service or common   |
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18|carrier;                                                               |
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19|    12.  "Physician" means an allopathic or osteopathic physician      |
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20|licensed by the State of Oklahoma or another state to practice         |
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21|medicine;                                                              |
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22|    13.  "Prior authorization" means the process by which              |
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23|utilization review entities determine the medical necessity and        |
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24|medical appropriateness of otherwise covered health care services      |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 6
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 1|prior to the rendering of such health care services.  The term shall   |
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 2|include "authorization", "pre-certification", and any other term       |
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 3|that would be a reliable determination by a health benefit plan.       |
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 4|The term shall not be construed to include or refer to such            |
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 5|processes as they may pertain to pharmaceutical services;              |
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 6|    14.  "Urgent health care service" means a health care service      |
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 7|with respect to which the application of the time periods for making   |
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 8|an urgent care determination, which, in the opinion of a physician     |
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 9|with knowledge of the enrollee's medical condition:                    |
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10|         a.    could seriously jeopardize the life or health of the    |
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11|              enrollee or the ability of the enrollee to regain        |
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12|              maximum function, or                                     |
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13|         b.    in the opinion of a physician with knowledge of the     |
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14|              claimant's medical condition, would subject the          |
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15|              enrollee to severe pain that cannot be adequately        |
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16|              managed without the care or treatment that is the        |
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17|              subject of the utilization review; and                   |
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18|    15.  "Utilization review entity" means an individual or entity     |
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19|that performs prior authorization for a health benefit plan as         |
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20|defined by Section 6060.4 of Title 36 of the Oklahoma Statutes, but    |
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21|shall not include any health plan offered by a contracted entity       |
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22|defined in Section 4002.2 of Title 56 of the Oklahoma Statutes that    |
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23|provides coverage to members of the state Medicaid program or other    |
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24|insurance subject to the Long Term Care Insurance Act.                 |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 7
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 1|    SECTION 3.     NEW LAW     A new section of law to be codified     |
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 2|in the Oklahoma Statutes as Section 6570.2 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 utilization review entity shall make any current prior           |
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 5|authorization requirements and restrictions, including written         |
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 6|clinical criteria, readily accessible on its website to enrollees      |
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 7|and health care providers.  Prior authorization requirements shall     |
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 8|be described in detail but also in easily understandable language.     |
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 9|    If a utilization review entity intends either to implement a new   |
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10|prior authorization requirement or restriction, or amend an existing   |
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11|requirement or restriction, the utilization review entity shall        |
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12|ensure that the new or amended requirement or restriction is not       |
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13|implemented unless the utilization review entity's website has been    |
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14|updated to reflect the new or amended requirement or restriction.      |
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15|    If a utilization review entity intends either to implement a new   |
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16|prior authorization requirement or restriction, or amend an existing   |
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17|requirement or restriction, the utilization review entity shall        |
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18|provide contracted health care providers credentialed to perform the   |
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19|service, or enrollees who have a chronic condition and are already     |
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20|receiving the service for which the prior authorization changes will   |
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21|impact, notice of the new or amended requirement or restriction no     |
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22|less than sixty (60) days before the requirement or restriction is     |
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23|implemented.                                                           |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 8
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 1|    SECTION 4.     NEW LAW     A new section of law to be codified     |
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 2|in the Oklahoma Statutes as Section 6570.3 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 utilization review entity shall ensure that all adverse          |
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 5|determinations are made by a physician or licensed mental health       |
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 6|professional.  The physician or licensed mental health professional    |
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 7|shall:                                                                 |
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 8|    1.  Possess a current and valid nonrestricted license in any       |
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 9|United States jurisdiction;                                            |
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10|    2.  Have the appropriate training, knowledge, or expertise to      |
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11|apply appropriate clinical guidelines to the health care service       |
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12|being requested; and                                                   |
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13|    3.  Make the adverse determination under the clinical direction    |
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14|of one of the utilization review entity's medical directors who is     |
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15|responsible for the provision of reviewing health care services to     |
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16|enrollees of Oklahoma.  All such medical directors must be             |
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17|physicians licensed in any United States jurisdiction.                 |
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18|    SECTION 5.     NEW LAW     A new section of law to be codified     |
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19|in the Oklahoma Statutes as Section 6570.4 of Title 36, unless there   |
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20|is created a duplication in numbering, reads as follows:               |
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21|    A utilization review entity shall ensure that all appeals are      |
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22|reviewed by a physician or licensed mental health professional.  The   |
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23|physician or licensed mental health professional shall:                |
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24|                                                                       |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 9
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 1|    1.  Possess a current and valid unrestricted license in any        |
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 2|United States jurisdiction;                                            |
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 3|    2.  Be of the same or similar specialty as a physician or          |
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 4|licensed mental health professional who typically manages the          |
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 5|medical condition or disease, which means that the physician either    |
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 6|maintains board certification for the same or similar specialty as     |
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 7|the medical condition in question or whose training and experience:    |
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 8|         a.    includes treating the condition,                        |
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 9|         b.    includes treating complications that may result from    |
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10|              the service or procedure, and                            |
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11|         c.    is sufficient for the physician or licensed mental      |
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12|              health professional to determine if the service or       |
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13|              procedure is medically necessary or clinically           |
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14|              appropriate,                                             |
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15|except for appeals coming from a licensed mental health                |
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16|professional, which may be conducted by another licensed mental        |
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17|health professional as opposed to a physician;                         |
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18|    3.  Not have been directly involved in making the adverse          |
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19|determination;                                                         |
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20|    4.  Not have any financial interest in the outcome of the          |
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21|appeal; and                                                            |
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22|    5.  Consider all known clinical aspects of the health care         |
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23|service under review, including, but not limited to, a review of       |
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24|those medical records which are pertinent and relevant to the active   |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 10
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 1|condition provided to the utilization review entity by the             |
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 2|enrollee's health care provider, or a health care facility, and any    |
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 3|pertinent medical literature provided to the utilization review        |
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 4|entity by the health care provider.                                    |
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 5|    SECTION 6.     NEW LAW     A new section of law to be codified     |
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 6|in the Oklahoma Statutes as Section 6570.5 of Title 36, unless there   |
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 7|is created a duplication in numbering, reads as follows:               |
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 8|    A.  For plan years beginning on or after January 1, 2027, a        |
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 9|health benefit plan must implement and maintain a Prior                |
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10|Authorization Application Programming Interface (API), as described    |
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11|in 45 C.F.R. Part 156.                                                 |
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12|    B.  By July 1, 2027, health care providers must have electronic    |
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13|health records or practice management systems that are compatible      |
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14|with the API.                                                          |
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15|    C.  As of the effective date of this act, a utilization review     |
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16|entity must provide health care providers with the following           |
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17|opportunities for communication during the prior authorization         |
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18|process:                                                               |
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19|    1.  Make staff available at least eight (8) hours a day during     |
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20|normal business hours for inbound telephone calls regarding prior      |
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21|authorization issues;                                                  |
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22|    2.  Allow staff to receive inbound communication regarding prior   |
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23|authorization issues after normal business hours; and                  |
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24|                                                                       |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 11
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 1|    3.  Provide a treating provider with the opportunity to discuss    |
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 2|a prior authorization denial with an appropriate reviewer.             |
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 3|    SECTION 7.     NEW LAW     A new section of law to be codified     |
  |                                                                       |
 4|in the Oklahoma Statutes as Section 6570.6 of Title 36, unless there   |
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 5|is created a duplication in numbering, reads as follows:               |
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 6|    A.  If a utilization review entity requires prior authorization    |
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 7|of a health care service, the utilization review entity must make a    |
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 8|prior authorization or adverse determination and notify the enrollee   |
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 9|and the enrollee's health care provider of the prior authorization     |
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10|or adverse determination in accordance with the time frames set        |
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11|forth below:                                                           |
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12|    1.  For purposes of approving prior authorization for urgent       |
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13|health care services, within seventy-two (72) hours of obtaining all   |
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14|necessary information to make the prior authorization or adverse       |
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15|determination; or                                                      |
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16|    2.  For purposes of approving prior authorization for non-urgent   |
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17|health care services, within seven (7) days of obtaining all           |
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18|necessary information to make the prior authorization or adverse       |
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19|determination.                                                         |
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20|    For purposes of this section, "necessary information" includes,    |
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21|but is not limited to, the results of any face-to-face clinical        |
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22|evaluation or second opinion that may be required.                     |
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23|    B.  For those health care providers that submit all necessary      |
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24|information through the utilization review entity's authorized prior   |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 12
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 1|authorization system, health care services are deemed authorized if    |
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 2|a utilization review entity fails to comply with the deadlines set     |
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 3|forth in this section.                                                 |
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 4|    C.  In the notification to the health care provider that a prior   |
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 5|authorization has been approved, the utilization review entity shall   |
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 6|include in such notification the duration of the prior authorization   |
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 7|or the date by which the prior authorization will expire.              |
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 8|    SECTION 8.     NEW LAW     A new section of law to be codified     |
  |                                                                       |
 9|in the Oklahoma Statutes as Section 6570.7 of Title 36, unless there   |
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10|is created a duplication in numbering, reads as follows:               |
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11|    A.  A utilization review entity shall not require prior            |
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12|authorization for pre-hospital transportation, for the provision of    |
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13|emergency health care services, or for transfers between facilities    |
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14|as required by the Emergency Medical Treatment and Active Labor Act.   |
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15|    B.  A utilization review entity shall allow an enrollee and the    |
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16|enrollee's health care provider a minimum of twenty-four (24) hours    |
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17|following an emergency admission or provision of emergency health      |
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18|care services for the enrollee or health care provider to notify the   |
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19|utilization review entity of the admission or provision of health      |
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20|care services.  If the admission or health care service occurs on a    |
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21|holiday or weekend, a utilization review entity cannot require         |
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22|notification until the next business day after the admission or        |
  |                                                                       |
23|provision of the health care services.                                 |
  |                                                                       |
24|                                                                       |
  |                                                                       |
arsid2845662 ENGR. H. B. NO. 3190                                  Page 13
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 1|    C.  A utilization review entity shall cover emergency health       |
  |                                                                       |
 2|care services in accordance with the requirements of Section 6907 of   |
  |                                                                       |
 3|Title 36 of the Oklahoma Statutes.                                     |
  |                                                                       |
 4|    SECTION 9.     NEW LAW     A new section of law to be codified     |
  |                                                                       |
 5|in the Oklahoma Statutes as Section 6570.8 of Title 36, unless there   |
  |                                                                       |
 6|is created a duplication in numbering, reads as follows:               |
  |                                                                       |
 7|    A.  A health benefit plan may not revoke, limit, condition, or     |
  |                                                                       |
 8|restrict a prior authorization if care is provided within forty-five   |
  |                                                                       |
 9|(45) business days from the date the health care provider received     |
  |                                                                       |
10|the prior authorization unless the enrollee was no longer eligible     |
  |                                                                       |
11|for care on the day care was provided.                                 |
  |                                                                       |
12|    B.  A health benefit plan must pay a contracted health care        |
  |                                                                       |
13|provider at the contracted payment rate for a health care service      |
  |                                                                       |
14|provided by the health care provider per a prior authorization,        |
  |                                                                       |
15|unless:                                                                |
  |                                                                       |
16|    1.  The health care provider knowingly and materially              |
  |                                                                       |
17|misrepresented the health care service in the prior authorization      |
  |                                                                       |
18|request with the specific intent to deceive and obtain an unlawful     |
  |                                                                       |
19|payment from a utilization review entity;                              |
  |                                                                       |
20|    2.  The health care service was no longer a covered benefit on     |
  |                                                                       |
21|the day it was provided;                                               |
  |                                                                       |
22|    3.  The health care provider was no longer contracted with the     |
  |                                                                       |
23|patient's health benefit plan on the date the care was provided;       |
  |                                                                       |
24|                                                                       |
  |                                                                       |
arsid2845662 ENGR. H. B. NO. 3190                                  Page 14
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 1|    4.  The health care provider failed to meet the utilization        |
  |                                                                       |
 2|review entity's timely filing requirements; or                         |
  |                                                                       |
 3|    5.  The patient was no longer eligible for health care coverage    |
  |                                                                       |
 4|on the day the care was provided.                                      |
  |                                                                       |
 5|    SECTION 10.     NEW LAW     A new section of law to be codified    |
  |                                                                       |
 6|in the Oklahoma Statutes as Section 6570.9 of Title 36, unless there   |
  |                                                                       |
 7|is created a duplication in numbering, reads as follows:               |
  |                                                                       |
 8|    A.  If a prior authorization is required for a health care         |
  |                                                                       |
 9|service, other than for inpatient care, for the treatment of a         |
  |                                                                       |
10|chronic condition of an enrollee, then the prior authorization shall   |
  |                                                                       |
11|remain valid for at least six (6) months from the date the health      |
  |                                                                       |
12|care provider receives the prior authorization approval, unless        |
  |                                                                       |
13|clinical criteria changes and notice of the change in clinical         |
  |                                                                       |
14|criteria is provided as stipulated in this act.                        |
  |                                                                       |
15|    B.  If a prior authorization is required for inpatient acute       |
  |                                                                       |
16|care for the treatment of a chronic condition of an enrollee, then     |
  |                                                                       |
17|the prior authorization shall remain valid for at least fourteen       |
  |                                                                       |
18|(14) calendar days from the date the health care provider receives     |
  |                                                                       |
19|the prior authorization approval.                                      |
  |                                                                       |
20|    1.  If an enrollee requires inpatient care beyond the length of    |
  |                                                                       |
21|stay that was previously approved by the utilization review entity,    |
  |                                                                       |
22|then the utilization review entity shall evaluate any prior            |
  |                                                                       |
23|authorization requests for the continuation of inpatient care          |
  |                                                                       |
24|according to the provisions of this act.  A utilization review         |
  |                                                                       |
arsid2845662 ENGR. H. B. NO. 3190                                  Page 15
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 1|entity shall not use any stricter criteria to determine medical        |
  |                                                                       |
 2|necessity and appropriateness of the continuation of inpatient care    |
  |                                                                       |
 3|as the utilization review entity used to evaluate the initial          |
  |                                                                       |
 4|request for authorization of inpatient care.  A utilization review     |
  |                                                                       |
 5|entity shall review any relevant and pertinent literature or data      |
  |                                                                       |
 6|provided by the health care provider to determine the medical          |
  |                                                                       |
 7|necessity and appropriateness of the requested length of stay and/or   |
  |                                                                       |
 8|continuation of inpatient care.  A prior authorization for the         |
  |                                                                       |
 9|continuation of inpatient care shall remain valid for a maximum of     |
  |                                                                       |
10|fourteen (14) calendar days from the date the health care provider     |
  |                                                                       |
11|receives the prior authorization approval.                             |
  |                                                                       |
12|    2.  If a utilization review entity fails to respond to a health    |
  |                                                                       |
13|care provider's timely prior authorization request for the             |
  |                                                                       |
14|continuation of inpatient acute care before the termination of the     |
  |                                                                       |
15|previously approved length of stay, then the health benefit plan       |
  |                                                                       |
16|shall continue to compensate the health care provider at the           |
  |                                                                       |
17|contracted rate for inpatient care provided until the utilization      |
  |                                                                       |
18|review entity issues its determination on the prior authorization      |
  |                                                                       |
19|request.                                                               |
  |                                                                       |
20|    For the purposes of this section, a timely request for             |
  |                                                                       |
21|continuation of inpatient care means a request that is submitted at    |
  |                                                                       |
22|least seventy-two (72) hours prior to the termination of the           |
  |                                                                       |
23|previously approved prior authorization and includes all necessary     |
  |                                                                       |
24|                                                                       |
  |                                                                       |
arsid2845662 ENGR. H. B. NO. 3190                                  Page 16
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 1|information for the utilization review entity to make a                |
  |                                                                       |
 2|determination.                                                         |
  |                                                                       |
 3|    3.  If a utilization review entity issues an adverse               |
  |                                                                       |
 4|determination to a health care provider's prior authorization          |
  |                                                                       |
 5|request for continuation of inpatient acute care and the health care   |
  |                                                                       |
 6|provider appeals the adverse determination according to the            |
  |                                                                       |
 7|provisions of this act, then the health benefit plan shall continue    |
  |                                                                       |
 8|to compensate the health care provider at the contracted rate for      |
  |                                                                       |
 9|inpatient care provided until the appeal has been finalized.           |
  |                                                                       |
10|    C.  This section does not require a health benefit plan to cover   |
  |                                                                       |
11|care, treatment, or services for a health condition that the terms     |
  |                                                                       |
12|of coverage otherwise completely exclude from the policy's covered     |
  |                                                                       |
13|benefits without regard for whether the care, treatment, or services   |
  |                                                                       |
14|are medically necessary.                                               |
  |                                                                       |
15|    SECTION 11.     NEW LAW     A new section of law to be codified    |
  |                                                                       |
16|in the Oklahoma Statutes as Section 6570.10 of Title 36, unless        |
  |                                                                       |
17|there is created a duplication in numbering, reads as follows:         |
  |                                                                       |
18|    A.  On receipt of information documenting a prior authorization    |
  |                                                                       |
19|from the enrollee or from the enrollee's health care provider, a       |
  |                                                                       |
20|utilization review entity shall honor a prior authorization granted    |
  |                                                                       |
21|to an enrollee from a previous utilization review entity for at        |
  |                                                                       |
22|least the initial sixty (60) days of an enrollee's coverage under a    |
  |                                                                       |
23|new health plan.                                                       |
  |                                                                       |
24|                                                                       |
  |                                                                       |
arsid2845662 ENGR. H. B. NO. 3190                                  Page 17
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 1|    B.  During the time period described in subsection A of this       |
  |                                                                       |
 2|section, a utilization review entity may perform its own review to     |
  |                                                                       |
 3|grant a prior authorization or make an adverse determination.          |
  |                                                                       |
 4|    C.  A utilization review entity shall continue to honor a prior    |
  |                                                                       |
 5|authorization it has granted to an enrollee when the enrollee          |
  |                                                                       |
 6|changes products under the same health insurance company for the       |
  |                                                                       |
 7|initial sixty (60) days of an enrollee's coverage under the new        |
  |                                                                       |
 8|product unless the service is no longer a covered service under the    |
  |                                                                       |
 9|new product.                                                           |
  |                                                                       |
10|    SECTION 12.     NEW LAW     A new section of law to be codified    |
  |                                                                       |
11|in the Oklahoma Statutes as Section 6570.11 of Title 36, unless        |
  |                                                                       |
12|there is created a duplication in numbering, reads as follows:         |
  |                                                                       |
13|    If any provision of this act or the application thereof to any     |
  |                                                                       |
14|person or circumstance is held invalid, such invalidity shall not      |
  |                                                                       |
15|affect other provisions or applications of the act which can be        |
  |                                                                       |
16|given effect without the invalid provision or application, and to      |
  |                                                                       |
17|this end, the provisions of this act are declared to be severable.     |
  |                                                                       |
18|    SECTION 13.  This act shall become effective January 1, 2025.      |
  |                                                                       |
19|    Passed the House of Representatives the 13th day of March, 2024.   |
  |                                                                       |
20|                                                                       |
  |                                                                       |
21|                                                                       |
  |                                     Presiding Officer of the House    |
22|                                                 of Representatives    |
  |                                                                       |
23|                                                                       |
  |                                                                       |
24|    Passed the Senate the ___ day of __________, 2024.                 |
  |                                                                       |
arsid2845662 ENGR. H. B. NO. 3190                                  Page 18
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 2|                                                                       |
  |                                    Presiding Officer of the Senate    |
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 6|                                                                       |
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 9|                                                                       |
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10|                                                                       |
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11|                                                                       |
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12|                                                                       |
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13|                                                                       |
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14|                                                                       |
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15|                                                                       |
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16|                                                                       |
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17|                                                                       |
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18|                                                                       |
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19|                                                                       |
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20|                                                                       |
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21|                                                                       |
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22|                                                                       |
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23|                                                                       |
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arsid2845662 ENGR. H. B. NO. 3190                                  Page 19
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