BILL NO. 1310 By: McCortney
of the Senate
and
Sneed
of the House
An Act relating to state-sponsored employee
benefits; amending 63 O.S. 2021, Section 5003, which relates to powers and
duties of the Oklahoma Health Care Authority; directing the Authority to
administer state-sponsored benefits; amending 74 O.S. 2021, Sections 1306.2,
1306.5, 1318, 1321, and 1371, which relate to the administration of
state-sponsored plans; conforming language; removing requirement for certain
bid acceptance; updating statutory language; providing an effective date; and
declaring an emergency.
SUBJECT: State-sponsored employee benefits
BE IT ENACTED BY THE PEOPLE OF THE
STATE OF OKLAHOMA:
SECTION 1. AMENDATORY 63 O.S. 2021, Section 5003, is amended to
read as follows:
Section 5003. A. The
Legislature recognizes that the state is a major purchaser of health care
services, and the increasing costs of such health care services are posing and
will continue to pose a great financial burden on the state. It is the policy of the state to provide
comprehensive health care as an employer to state employees and officials and
their dependents and to those who are dependent on the state for necessary
medical care. It is imperative that the
state develop effective and efficient health care delivery systems and
strategies for procuring health care services in order for the state to
continue to purchase the most comprehensive health care possible.
B. It is therefore incumbent upon the
Legislature to establish the Oklahoma Health Care Authority whose purpose shall
be to:
1. Purchase state and education employees’
health care benefits and Medicaid benefits;
2. Study all state-purchased and
state-subsidized health care, alternative health care delivery systems and
strategies for the procurement of health care services in order to maximize
cost containment in these programs while ensuring access to quality health
care; and
3. Make recommendations aimed at minimizing the
financial burden which health care poses for the state, its employees and its
charges, while at the same time allowing the state to provide the most
comprehensive health care possible; and
4. Administer the state-sponsored health and
dental benefits plans known as HealthChoice and life insurance plans in
accordance with the Oklahoma Employees Insurance and Benefits Act and the State
Employees Flexible Benefits Act. The
Office of Management and Enterprise Services shall cause the transfer of all
necessary assets, data, records, and personnel necessary for the administration
of HealthChoice not later than the effective date of this act.
SECTION 2. AMENDATORY 74 O.S. 2021, Section 1306.2, is amended
to read as follows:
Section 1306.2. A. The
Director of the Office of Management and Enterprise Services Oklahoma
Health Care Authority shall submit to the Insurance Commissioner the
following information regarding utilization review performed by employees of
the Office Authority:
1. A utilization review plan that includes:
a. an adequate summary description of review
standards, protocol and procedures to be used in evaluating proposed or
delivered hospital and medical care,
b. assurances that the standards and criteria to
be applied in review determinations are established with input from health care
providers representing major areas of specialty and certified by the boards of
the various American medical specialties, and
c. the provisions by which patients or health
care providers may seek reconsideration or appeal of adverse decisions
concerning requests for medical evaluation, treatment or procedures;
2. The type and qualifications of the personnel
either employed or under contract to perform the utilization review;
3. The procedures and policies to ensure that an
employee of the Office Authority is reasonably accessible to
patients and health care providers five (5) days a week during normal business
hours, such procedures and policies to include as a requirement a toll-free
telephone number to be available during said such business hours;
4. The policies and procedures to ensure that
all applicable state and federal laws to protect the confidentiality of
individual medical records are followed;
5. The policies and procedures to verify the
identity and authority of personnel performing utilization review by telephone;
6. A copy of the materials designed to inform
applicable patients and health care providers of the requirements of the
utilization review plan;
7. The procedures for receiving and handling
complaints by patients, hospitals and health care providers concerning
utilization review; and
8. Procedures to ensure that after a request for
medical evaluation, treatment, or procedures has been rejected in whole or in
part and in the event a copy of the report on said such rejection
is requested, a copy of the report of the personnel performing utilization
review concerning the rejection shall be mailed by the insurer, postage
prepaid, to the ill or injured person, the treating health care provider,
hospital or to the person financially responsible for the patient’s bill within
fifteen (15) days after receipt of the request for the report.
B. The Office Authority shall pay
an annual fee to the Insurance Commissioner of Five Hundred Dollars ($500.00).
SECTION 3. AMENDATORY 74 O.S. 2021, Section 1306.5, is amended
to read as follows:
Section 1306.5. A network provider facility or physician
contract, or any part or section of it, may be amended at any time during the
term of the contract only by mutual written consent of duly authorized
representatives of the Office of Management and Enterprise Services Oklahoma
Health Care Authority and the facility or physician.
SECTION 4. AMENDATORY 74 O.S. 2021, Section 1318, is amended to
read as follows:
Section 1318. No former employee who is reemployed by a
participating entity within twenty-four (24) months after the date of
termination of previous employment shall be enrolled in the Oklahoma Employees
Insurance and Benefits Plan authorized by Sections 1301 through 1329.1 of this
title, for a greater amount of life insurance or life benefit than the amount
for which the life of the former employee was insured under the plan at the
date of termination of employment, except upon the former employee furnishing
evidence of insurability, satisfactory to the Office of Management and
Enterprise Services Oklahoma Health Care Authority, and any greater
amount of benefit or insurance provided the employee shall be at the former
employee’s cost.
SECTION 5. AMENDATORY 74 O.S. 2021, Section 1321, is amended to
read as follows:
Section 1321. A. The
Office of Management and Enterprise Services Oklahoma Health Care
Authority shall have the authority to determine all rates and life, dental and
health benefits for state-sponsored plans. All rates shall be compiled in a
comprehensive Schedule of Benefits. The
Schedule of Benefits shall be available for inspection during regular business
hours at the Office of Management and Enterprise Services Authority. The Office Authority shall have
the authority to annually adjust the rates and benefits based on claim
experience.
B.
The premiums for such insurance plans offered for the next plan year
shall be established as follows:
1.
For active employees and their dependents, the Office’s Authority’s
premium determination shall be made no later than the bid submission date for
health maintenance organizations set by the Oklahoma State Employees
Benefits Council Oklahoma Employees Insurance and Benefits Board,
which shall be set in August no later than the third Friday of that month; and
2.
For all other covered members and dependents, the Office’s Authority’s
and the health maintenance organizations’ premium determinations shall be no
later than the fourth Friday of September.
C.
The Office may approve a mid-year adjustment requested by the
Authority provided the need for an adjustment is substantiated by an
actuarial determination or more current experience rating. The only publication or notice requirements
that shall apply to the Schedule of Benefits shall be those requirements
provided in the Oklahoma Open Meeting Act and within this section. It is the intent of the Legislature that the
benefits provided not include cosmetic dental procedures except for certain
orthodontic procedures as adopted by the Director Chief Executive
Officer of the Authority.
SECTION 6. AMENDATORY 74 O.S. 2021, Section 1371, is amended to
read as follows:
Section 1371. A. All
participants mState
and Education Employees Group Insurance Board, a health maintenance
organization (HMO) or other vendors, shall meet the minimum
requirements set by the Board for the basic plan.
B.
The Board shall offer health, disability, life and dental coverage to
all participants and their dependents.
For health, dental, disability and life coverage, the Board shall offer
plans at the basic benefit level established by the Board, and in addition, may
offer benefit plans that provide an enhanced level of benefits. The Board shall be responsible for
determining the plan design and the benefit price for the plans that they
offer it offers. Effective
for the plan year beginning January 1, 2017, and for each plan year thereafter,
in setting health insurance premiums for active employees and for retirees
under sixty-five (65) years of age, the Board shall set the monthly premium for
active employees to be equal to the monthly premium for retirees under
sixty-five (65) years of age; except that the Board may offer retirees under
sixty-five (65) years of age the opportunity to voluntarily enroll in an
alternative plan of insurance at a rate that is between One Hundred Dollars
($100.00) less than the monthly premium for active employees and up to One
Hundred Dollars ($100.00) more than the monthly premium for active
employees. Retirees under the age of
sixty-five (65) who enroll in an alternative plan of insurance shall retain the
right to enroll in any other health insurance plan offered by the Board for
which they might be qualified during a subsequent open enrollment period.
Nothing in this subsection shall be
construed as prohibiting the Board from offering additional medical plans,
provided that any medical plan offered to participants shall meet or exceed the
benefits provided in the medical portion of the basic plan.
C.
In lieu of electing any of the preceding medical benefit plans, a
participant may elect medical coverage by any health maintenance organization
made available to participants by the Board.
The benefit price of any health maintenance organization shall be
determined on a competitive bid basis.
Contracts for said such plans shall not be subject to the
provisions of The the Oklahoma Central Purchasing Act. The Board shall promulgate rules establishing
appropriate competitive bidding criteria and procedures for contracts awarded
for flexible benefits plans. All
plans offered by health maintenance organizations meeting the bid requirements
as determined by the Board shall be accepted. The Board shall have the authority to reject
the bid or restrict enrollment in any health maintenance organization for which
the Board determines the benefit price to be excessive. The Board shall have the authority to reject
any plan that does not meet the bid requirements. All bidders shall submit along with their bid
a notarized, sworn statement as provided by Section 85.22 of this title. Effective for the plan year beginning
D.
Nothing in this section shall be construed as prohibiting the Board from
offering additional qualified benefit plans or currently taxable benefit plans.
E.
Each employee of a participating employer who meets the eligibility
requirements for participation in the flexible benefits plan shall make an
annual election of benefits under the plan during an enrollment period to be
held prior to the beginning of each plan year.
The enrollment period dates will be determined annually and will be
announced by the Board, providing; provided, the enrollment
period shall end no later than thirty (30) days before the beginning of the
plan year.
Each such employee shall make an
irrevocable advance election for the plan year or the remainder thereof
pursuant to such procedures as the Board shall prescribe. Any such employee who fails to make a proper
election under the plan shall, nevertheless, be a participant in the plan and
shall be deemed to have purchased the default benefits described in this
section.
F.
The Board shall prescribe the forms that participants will be required
to
G.
Any participant who, in the first year for which he or she is eligible
to participate in the plan, fails to make a proper election under the plan in
conformance with the procedures set forth in this section or as prescribed by
the Board shall be deemed automatically to have purchased the default
benefits. The default benefits shall be
the same as the basic plan benefits. Any
participant who, after having participated in the plan during the previo
H. Benefit plan contracts with the Board, health
maintenance organizations, and other third party third-party insurance
vendors shall provide for a risk adj
I.
1. For the plan year ending
a. that primary care physician was part of a
provider group that was offered to the individual at enrollment and later
removed from the network of the health maintenance organization, for reasons
other than for ca
b. the individual submits a request in writing
to the health maintenance organization to continue to have access to the
primary care physician.
2.
The primary care physician selected by the individual shall be required
to accept reimbursement for such health care services on a fee-for-service
basis only. The fee-for-service shall be
computed by the health maintenance organization based on the average of the
other fee-for-service contracts of the health maintenance organization in the
local community. The individual shall
only be required to pay the primary care physician those co-payments,
coinsurance and any applicable deductibles in accordance with the terms of the
agreement between the employer and the health maintenance organization and the
provider shall not balance bill the patient.
3.
Any network offered in Oklahoma City that is terminated prior to
SECTION
7. This act shall become effective July 1, 2024.
SECTION
8. It being immediately necessary for the
preservation of the public peace, health or safety, an emergency is hereby
declared to exist, by reason whereof this act shall take effect and be in full
force from and after its passage and approval.
Passed the Senate the 5th day of March, 2024.
Presiding Officer of the Senate
Passed the House of Representatives the 17th day of April, 2024.
Presiding Officer of the House
of Representatives
OFFICE OF THE GOVERNOR
Received by the Office of the Governor
this ____________________ day of ___________________, 20_______, at _______
o'clock _______ M.
By:
_________________________________
Approved by the Governor of the
State of Oklahoma this _________ day of ___________________, 20_______, at
_______ o'clock _______ M.
_________________________________
Governor
of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary
of State this __________ day of __________________, 20 _______, at _______
o'clock _______ M.
By:
_________________________________