1| STATE OF OKLAHOMA |
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2| 2nd Session of the 60th Legislature (2026) |
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3|COMMITTEE SUBSTITUTE |
|FOR |
4|SENATE BILL 1566 By: Stanley of the Senate |
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5| and |
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6| Stinson of the House |
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8| |
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9| COMMITTEE SUBSTITUTE |
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10| An Act relating to the state Medicaid program; |
| amending 56 O.S. 2021, Section 1011.12, which relates |
11| to applied behavior analysis treatment of autism |
| spectrum disorder; updating statutory language; |
12| requiring medical necessity criteria to include |
| certain diagnosis by specified health care provider; |
13| prohibiting imposition of certain policy; providing |
| certain construction; specifying certain requirements |
14| for provision of applied behavior analysis services; |
| authorizing use of telehealth for services and |
15| supervision under certain conditions; and providing |
| an effective date. |
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18|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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19| SECTION 1. AMENDATORY 56 O.S. 2021, Section 1011.12, is |
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20|amended to read as follows: |
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21| Section 1011.12. A. The Oklahoma Health Care Authority, in |
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22|conjunction with the Department of Mental Health and Substance Abuse |
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23|Services, the State Department of Health and the State Department of |
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24|Education shall examine the feasibility of a state plan amendment to |
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Req. No. 3609 Page 1
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1|the Oklahoma Medicaid Program state Medicaid program for applied |
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2|behavior analysis treatment of autism spectrum disorders disorder. |
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3| B. On or before December 31, 2016, the Authority and partnering |
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4|agencies shall submit a report to the President Pro Tempore of the |
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5|Senate, the Speaker of the House of Representatives and the Governor |
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6|estimating the potential costs to the state, clinical findings, |
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7|reviews of pilot projects and research from other states on the |
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8|effects of applied behavioral analysis treatment on autism spectrum |
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9|disorders disorder. |
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10| C. Beginning July 1, 2017, and subject to the availability of |
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11|funding, the Authority and partnering agencies shall draft a state |
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12|plan amendment for applied behavior analysis treatment of autism |
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13|spectrum disorders disorder. The provisions of this subsection |
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14|shall only apply if the report required by subsection B of this |
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15|section demonstrates applied behavioral analysis treatment to be |
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16|evidence-based and essential to qualifying participants in the |
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17|Oklahoma Medicaid Program state Medicaid program. |
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18| D. The medical necessity criteria for applied behavior analysis |
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19|services covered under the state Medicaid program shall include a |
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20|definitive diagnosis of an autism spectrum disorder by one of the |
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21|following health care providers, who shall be licensed in this state |
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22|and who shall be trained in the diagnosis of autism: |
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23| 1. Pediatric neurologist or neurologist; |
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24| 2. Developmental pediatrician; |
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1| 3. Psychologist which may include, but is not limited to, a |
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2|psychologist working in a school; |
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3| 4. Psychiatrist or neuropsychiatrist; |
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4| 5. Other licensed physician experienced in the diagnosis and |
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5|treatment of autism spectrum disorder; or |
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6| 6. Interdisciplinary team composed of a licensed psychologist, |
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7|physician, physician assistant (PA), or Advanced Practice Registered |
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8|Nurse (APRN). |
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9| E. The Authority or a contracted entity shall not impose a |
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10|general policy that requires all Medicaid members receiving covered |
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11|applied behavior analysis services to be re-diagnosed with or |
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12|receive subsequent clinical assessments for autism spectrum disorder |
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13|as a condition of continuation of coverage after the member has |
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14|already been diagnosed with autism spectrum disorder by a health |
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15|care provider as described in subsection D of this section. An |
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16|initial diagnosis of autism spectrum disorder shall remain accepted |
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17|indefinitely unless otherwise clinically indicated including, but |
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18|not limited to, by a significant behavioral or developmental change. |
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19| Nothing in this subsection shall be construed to prohibit a member |
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20|or member's parent or legal guardian from requesting a subsequent |
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21|assessment or a qualified provider from conducting a subsequent |
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22|assessment if he or she deems it necessary. |
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1| F. 1. All applied behavior analysis services provided by a |
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2|contracted provider to a Medicaid member shall be performed by duly |
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3|qualified professionals as determined by the Authority. |
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4| 2. A registered behavior technician (RBT), board-certified |
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5|assistant behavior analyst (BCABA), or other professional whose |
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6|credentials are less than a board-certified behavior analyst (BCBA), |
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7|as determined by the Authority, may only provide applied behavior |
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8|analysis services to members in person. |
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9| 3. A BCBA may use telehealth to provide applied behavior |
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10|analysis services to members or to supervise the provision of |
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11|applied behavior analysis services by a BCABA or other professional |
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12|described in paragraph 2 of this subsection. The Authority or a |
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13|contracted entity shall not require a BCBA to be located in this |
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14|state or within a certain distance of the state border to perform |
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15|such services or supervision; provided, however, the BCBA shall be |
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16|licensed in this state under Section 1928 of Title 59 of the |
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17|Oklahoma Statutes or licensed or credentialed in his or her state of |
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18|residence. |
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19| G. As used in this section: |
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20| 1. "Applied behavior analysis" means the design, implementation |
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21|and evaluation of environmental modifications, using behavioral |
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22|stimuli and consequences, to produce socially significant |
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23|improvement in human behavior, including the use of direct |
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1|observation, measurement and functional analysis of the relationship |
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2|between environment and behavior; |
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3| 2. "Autism spectrum disorder" means any of the pervasive |
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4|developmental disorders or autism spectrum disorders as defined by |
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5|the most recent edition of the Diagnostic and Statistical Manual of |
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6|Mental Disorders (DSM) or the edition that was in effect at the time |
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7|of diagnosis; |
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8| 3. "Behavioral health treatment" means counseling and treatment |
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9|programs, including applied behavior analysis, that are: |
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10| a. necessary to develop, maintain or restore, to the |
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11| maximum extent practicable, the functioning of an |
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12| individual, and |
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13| b. provided by a board-certified behavior analyst or by |
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14| a licensed doctoral-level psychologist so long as the |
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15| services performed are commensurate with the |
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16| psychologist's university training and supervised |
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17| experience; and |
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18| 4. "Treatment for autism spectrum disorder" means |
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19|evidence-based care and related equipment prescribed or ordered for |
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20|an individual diagnosed with an autism spectrum disorder by a |
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21|licensed physician or a licensed doctoral-level psychologist who |
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22|determines the care to be medically necessary, including, but not |
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23|limited to: |
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24| a. behavioral health treatment, |
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1| b. pharmacy care, |
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2| c. psychiatric care, |
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3| d. psychological care, and |
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4| e. therapeutic care. |
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5| SECTION 2. This act shall become effective November 1, 2026. |
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7| 60-2-3609 DC 2/16/2026 5:09:44 PM |
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Req. No. 3609 Page 6
