1| STATE OF OKLAHOMA | | | 2| 2nd Session of the 60th Legislature (2026) | | | 3|COMMITTEE SUBSTITUTE | |FOR | 4|HOUSE BILL NO. 4453 By: Newton | | | 5| | | | 6| | | | 7| COMMITTEE SUBSTITUTE | | | 8| An Act relating to health insurance; creating the | | Oklahoma Health Care Cost Transparency Board; | 9| providing purpose for the Board; directing Board to | | oversee operation and reporting of the All Payer | 10| Claims Database; providing membership of Board; | | directing for members to serve staggered terms; | 11| clarifying members shall serve without compensation | | but may receive travel reimbursement; directing Board | 12| to meet at least quarterly; permitting Board to | | create technical working groups; directing the | 13| Department to establish and maintain an All Payer | | Claims Database; directing to the Database to collect | 14| and analyze health care costs, utilization, and | | spending data; directing the Database to include | 15| certain data; directing for collected data to be used | | for certain purposes; granting Insurance Department | 16| rule-making authority; permitting publication of | | deidentified, aggregated data; directing the Oklahoma | 17| Health Care Authority to maintain and update state | | primary care spend methodology and definitions; | 18| directing all regulated commercial health insurers | | measure annual primary care spending; directing | 19| commercial health insurers to submit annual reports; | | directing commercial health insurers to achieve | 20| minimum percentage of total medical spending devoted | | to primary care by certain date; directing the Board | 21| to establish benchmarks; directing the Insurance | | Department to compile annual analyses of primary care | 22| spending levels; granting the Insurance Commissioner | | exclusive authority to determine and implement | 23| enforcement mechanisms and incentives; granting | | certain authority related to benchmark goals to the | 24| Commissioner; allowing Board to make advisory | | recommendations to Commissioner; directing the | Req. No. 16673 Page 1 ___________________________________________________________________________
1| Insurance Department to coordinate with the Oklahoma | | Health Care Authority and other agencies; directing | 2| Board to prepare an annual report; directing for | | report to be published to Insurance Department | 3| website; providing for codification; and providing an | | effective date. | 4| | | | 5| | | | 6| | | | 7|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 8| SECTION 1. NEW LAW A new section of law to be codified | | | 9|in the Oklahoma Statutes as Section 8000 of Title 36, unless there | | | 10|is created a duplication in numbering, reads as follows: | | | 11| A. There is hereby created within the Oklahoma Insurance | | | 12|Department, the Oklahoma Health Care Cost Transparency Board, | | | 13|hereinafter referred to as the Board. | | | 14| B. The purpose of the Board is to: | | | 15| 1. Measure statewide health care cost growth and primary care | | | 16|investment trends across commercial insurance, Medicaid, and | | | 17|Medicare; | | | 18| 2. Ensure consistent statewide evaluation of total health | | | 19|expenditures and primary care spending; and | | | 20| 3. Foster transparency and accountability in Oklahoma's health | | | 21|care system. | | | 22| C. The Board shall oversee the operation and reporting | | | 23|functions of the All Payer Claims Database (APCD) established under | | | 24|Section 3 of this act. | | | Req. No. 16673 Page 2 ___________________________________________________________________________
1| SECTION 2. NEW LAW A new section of law to be codified | | | 2|in the Oklahoma Statutes as Section 8001 of Title 36, unless there | | | 3|is created a duplication in numbering, reads as follows: | | | 4| A. The Health Care Cost Transparency Board shall consist of | | | 5|fourteen (14) members, as follows: | | | 6| 1. The Insurance Commissioner, or designee, who shall serve as | | | 7|chair; | | | 8| 2. The Chief Executive Officer of the Oklahoma Health Care | | | 9|Authority (OHCA), or designee; | | | 10| 3. The Commissioner of Health, or designee; | | | 11| 4. One representative of a licensed commercial health insurer, | | | 12|appointed by the Insurance Commissioner; | | | 13| 5. One representative of employers or large purchasers of | | | 14|health care, appointed by the Governor; | | | 15| 6. One representative of a hospital or health system, appointed | | | 16|by the Speaker of the Oklahoma Hospital Association; | | | 17| 7. One representative of a rural health organization, appointed | | | 18|by the Healthcare Workforce Training Commission; | | | 19| 8. One representative recommended by the Oklahoma Academy of | | | 20|Family Physicians (OAFP); | | | 21| 9. One representative recommended by the Oklahoma Chapter of | | | 22|the American Academy of Pediatrics (OKAAP); | | | 23| 10. One independent primary care provider practicing in | | | 24|Oklahoma; | | | Req. No. 16673 Page 3 ___________________________________________________________________________
1| 11. One consumer advocate, appointed by the Governor; | | | 2| 12. One health care economist or data analytics expert, | | | 3|appointed by the Speaker of the Oklahoma House of Representatives; | | | 4| 13. One behavioral health care provider, appointed by the | | | 5|President Pro Tempore of the Oklahoma State Senate; and | | | 6| 14. One primary care provider practicing in Oklahoma | | | 7|recommended by the Oklahoma Primary Care Association. | | | 8| B. 1. The first class of members shall serve terms as follows: | | | 9| a. paragraphs 4, 11, and 12 of subsection A of this | | | 10| section shall serve an initial one-year term, | | | 11| b. paragraphs 5, 7, and 10 of subsection A of this | | | 12| section shall serve an initial two-year term, and | | | 13| c. paragraphs 6, 8, 9, and 13 of subsection A of this | | | 14| section shall serve an initial three-year term. | | | 15| 2. All members, with the exception of paragraphs 1, 2, and 3 of | | | 16|subsection A of this section following the first class shall serve | | | 17|three-year terms. | | | 18| 3. All members, with the exception of paragraphs 1, 2, and 3 of | | | 19|subsection A of this section shall be reappointed only once. | | | 20| C. Members shall serve without compensation but may receive | | | 21|reimbursement for travel under the State Travel Reimbursement Act. | | | 22| D. The Board shall meet at least quarterly and may create | | | 23|technical working groups for data, transparency, and performance | | | 24|evaluation. | | | Req. No. 16673 Page 4 ___________________________________________________________________________
1| SECTION 3. NEW LAW A new section of law to be codified | | | 2|in the Oklahoma Statutes as Section 8002 of Title 36, unless there | | | 3|is created a duplication in numbering, reads as follows: | | | 4| A. The State Coordinator for the Health Information Exchange, | | | 5|created in Section 1-132.1 of Title 63 of the Oklahoma Statutes, | | | 6|shall establish and maintain an All Payer Claims Database (APCD) to | | | 7|collect and analyze health care costs, utilization, and spending | | | 8|data from all payer types operating within this state. | | | 9| B. The APCD shall, to the extent permitted by law, include data | | | 10|from: | | | 11| 1. Commercial health insurers and third-party administrators; | | | 12| 2. The Oklahoma Health Care Authority, covering all Medicaid | | | 13|programs; and | | | 14| 3. The Centers for Medicare and Medicaid Services, providing | | | 15|Medicare data under applicable data use agreements. | | | 16| C. Data collected shall be used to: | | | 17| 1. Measure statewide health care cost trends and cost growth; | | | 18| 2. Determine rates of investment in primary care across all | | | 19|payer segments; and | | | 20| 3. Support public transparency and policy evaluation. | | | 21| D. The Department shall adopt rules setting standards for data | | | 22|submission, validation, and confidentiality consistent with federal | | | 23|and state privacy laws. | | | 24| | | | Req. No. 16673 Page 5 ___________________________________________________________________________
1| E. The Department may publish de-identified, aggregated data | | | 2|through regular public reports and dashboards. | | | 3| SECTION 4. NEW LAW A new section of law to be codified | | | 4|in the Oklahoma Statutes as Section 8003 of Title 36, unless there | | | 5|is created a duplication in numbering, reads as follows: | | | 6| A. The Oklahoma Health Care Authority (OHCA) shall maintain and | | | 7|periodically update the state primary care spending methodology and | | | 8|definitions originally established for Medicaid, which shall serve | | | 9|as the uniform statewide standard for measuring primary care | | | 10|expenditures under this act. | | | 11| B. All commercial health insurers regulated under Title 36 of | | | 12|the Oklahoma Statutes shall: | | | 13| 1. Measure their annual primary care spending using the | | | 14|OHCA-approved methodology; and | | | 15| 2. Submit annual reports of primary care and total medical | | | 16|expenditures to the Insurance Department. | | | 17| C. The Oklahoma Health Care Cost Transparency Board, in | | | 18|consultation with OHCA, shall establish interim benchmarks for the | | | 19|years 2027 through 2029 and monitor progress toward the 2030 goal. | | | 20| D. The Insurance Department shall compile annual analyses of | | | 21|primary care spending levels across all payer types and publish a | | | 22|statewide transparency report. | | | 23| | | | 24| | | | Req. No. 16673 Page 6 ___________________________________________________________________________
1| SECTION 5. NEW LAW A new section of law to be codified | | | 2|in the Oklahoma Statutes as Section 8004 of Title 36, unless there | | | 3|is created a duplication in numbering, reads as follows: | | | 4| A. The Insurance Commissioner shall have exclusive authority to | | | 5|determine and implement enforcement mechanisms and incentive | | | 6|programs under this act. | | | 7| B. The Commissioner may: | | | 8| 1. Require commercial insurers not meeting progress benchmarks | | | 9|to submit corrective action plans; | | | 10| 2. Impose administrative penalties not to exceed Five Thousand | | | 11|Dollars ($5,000.00) per day for willful noncompliance with data | | | 12|reporting or benchmark requirements; | | | 13| 3. Develop incentive programs or recognition designations for | | | 14|insurers demonstrating sustained investment in primary care, | | | 15|achievement of benchmarks, or innovations in value-based care; and | | | 16| 4. Consider primary care investment performance when conducting | | | 17|rate, form, or network adequacy reviews. | | | 18| C. The Board may make advisory recommendations to the | | | 19|Commissioner, but all enforcement and incentive actions shall be | | | 20|determined and administered solely by the Insurance Commissioner's | | | 21|Office. | | | 22| SECTION 6. NEW LAW A new section of law to be codified | | | 23|in the Oklahoma Statutes as Section 8005 of Title 36, unless there | | | 24|is created a duplication in numbering, reads as follows: | | | Req. No. 16673 Page 7 ___________________________________________________________________________
1| A. The Insurance Department shall promulgate rules as necessary | | | 2|to carry out the provisions of this act, including specifications | | | 3|for data submission, risk adjustment, benchmark evaluation, and | | | 4|public reporting. | | | 5| B. The Department shall coordinate with the Oklahoma Health | | | 6|Care Authority (OHCA) and other agencies to ensure consistent | | | 7|application of methodologies and efficient use of existing data | | | 8|infrastructure. | | | 9| SECTION 7. NEW LAW A new section of law to be codified | | | 10|in the Oklahoma Statutes as Section 8006 of Title 36, unless there | | | 11|is created a duplication in numbering, reads as follows: | | | 12| A. The Oklahoma Health Care Cost Transparency Board shall | | | 13|prepare an annual report for the Governor, the President Pro Tempore | | | 14|of the Oklahoma State Senate, and the Speaker of the Oklahoma House | | | 15|of Representatives describing: | | | 16| 1. Statewide health care cost growth trends; | | | 17| 2. Primary care spending levels across commercial, Medicaid, | | | 18|and Medicare payers; | | | 19| 3. Commercial insurer performance relative to interim and final | | | 20|benchmarks; and | | | 21| 4. Policy recommendations to promote value and affordability in | | | 22|the health care system. | | | 23| | | | 24| | | | Req. No. 16673 Page 8 ___________________________________________________________________________
1| B. The report shall be published annually on the Insurance | | | 2|Department website and made available to the public. The initial | | | 3|report shall be published no later than December 31, 2027. | | | 4| SECTION 8. This act shall become effective November 1, 2026. | | | 5| | | | 6| 60-2-16673 TKR 02/24/26 | | | 7| | | | 8| | | | 9| | | | 10| | | | 11| | | | 12| | | | 13| | | | 14| | | | 15| | | | 16| | | | 17| | | | 18| | | | 19| | | | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | Req. No. 16673 Page 9