1| STATE OF OKLAHOMA |
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2| 2nd Session of the 60th Legislature (2026) |
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3|SENATE BILL 1654 By: Frix |
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4| |
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5| |
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6| AS INTRODUCED |
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7| An Act relating to mobile integrated healthcare; |
| defining terms; requiring certain reimbursement by |
8| health care benefit plan; amending 63 O.S. 2021, |
| Section 1-2503, as amended by Section 1, Chapter 276, |
9| O.S.L. 2022 (63 O.S. Supp. 2025, Section 1-2503), |
| which relates to the Oklahoma Emergency Response |
10| Systems Development Act; defining terms; amending 63 |
| O.S. 2021, Section 1-2511, which relates to powers |
11| and duties; directing establishment of mobile |
| integrated healthcare program; updating statutory |
12| language; updating statutory reference; providing for |
| promulgation of rules; defining terms; directing the |
13| Oklahoma Health Care Authority to establish certain |
| reimbursement methodology; requiring certain |
14| reimbursement by the Authority or contracted entity; |
| providing for codification; and providing an |
15| effective date. |
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16| |
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17|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: |
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18| SECTION 1. NEW LAW A new section of law to be codified |
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19|in the Oklahoma Statutes as Section 6050.4 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. As used in this section: |
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22| 1. "Health care benefit plan" has the same meaning as provided |
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23|in Section 6050.2 of Title 36 of the Oklahoma Statutes; and |
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24| |
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Req. No. 2364 Page 1
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1| 2. "Mobile integrated health care" (MIH) and "mobile integrated |
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2|health care (MIH) supplier" have the same meanings as provided in |
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3|Section 1-2503 of Title 63 of the Oklahoma Statutes. |
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4| B. Any encounter between a mobile integrated healthcare (MIH) |
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5|supplier and an enrollee that results in a treatment without |
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6|transport of the enrollee shall be reimbursed by a health care |
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7|benefit plan at a rate not less than the minimum allowable |
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8|reimbursement rate under the methodology established for the state |
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9|Medicaid program by the Oklahoma Health Care Authority under Section |
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10|4 of this act. |
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11| C. When an MIH supplier triages, treats, and transports an |
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12|enrollee to an alternative destination in accordance with an |
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13|approved MIH program protocol, reimbursement by a health care |
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14|benefit plan shall be at a rate not less than the minimum allowable |
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15|reimbursement rate for basic life support (BLS) services or advanced |
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16|life support (ALS) services, as appropriate based on the condition |
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17|of the patient, including mileage from the scene to the alternative |
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18|destination. |
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19| SECTION 2. AMENDATORY 63 O.S. 2021, Section 1-2503, as |
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20|amended by Section 1, Chapter 276, O.S.L. 2022 (63 O.S. Supp. 2025, |
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21|Section 1-2503), is amended to read as follows: |
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22| Section 1-2503. As used in the Oklahoma Emergency Response |
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23|Systems Development Act: |
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24| |
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Req. No. 2364 Page 2
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1| 1. "Ambulance" means any ground, air or water vehicle which is |
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2|or should be approved by the State Commissioner of Health, designed |
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3|and equipped to transport a patient or patients and to provide |
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4|appropriate on-scene and en route patient stabilization and care as |
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5|required. Vehicles used as ambulances shall meet such standards as |
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6|may be required by the Commissioner for approval, and shall display |
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7|evidence of such approval at all times; |
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8| 2. "Ambulance authority" means any public trust or nonprofit |
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9|corporation established by the state or any unit of local government |
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10|or combination of units of government for the express purpose of |
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11|providing, directly or by contract, emergency medical services in a |
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12|specified area of the state; |
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13| 3. "Ambulance patient" or "patient" means any person who is or |
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14|will be transported in a reclining position to or from a health care |
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15|facility in an ambulance; |
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16| 4. "Ambulance service" means any private firm or governmental |
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17|agency which is or should be licensed by the State Department of |
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18|Health to provide levels of medical care based on certification |
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19|standards promulgated by the Commissioner; |
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20| 5. "Ambulance service district" means any county, group of |
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21|counties or parts of counties formed together to provide, operate |
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22|and finance emergency medical services as provided by Section 9C of |
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23|Article X of the Oklahoma Constitution or Sections 1201 through 1221 |
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24|of Title 19 of the Oklahoma Statutes; |
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1| 6. "Board" means the State Board of Health; |
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2| 7. "Certified emergency medical responder" means an individual |
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3|certified by the Department to perform emergency medical services in |
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4|accordance with the Oklahoma Emergency Response Systems Development |
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5|Act and in accordance with the rules and standards promulgated by |
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6|the Commissioner; |
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7| 8. "Certified emergency medical response agency" means an |
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8|organization of any type certified by the Department to provide |
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9|emergency medical care and limited transport in an emergency vehicle |
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10|as defined in Section 1-103 of Title 47 of the Oklahoma Statutes. A |
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11|certified emergency medical response agency shall only provide |
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12|transport upon approval by the appropriate online medical control at |
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13|the time of transport. Certified emergency medical response |
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14|agencies may utilize certified emergency medical responders or |
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15|licensed emergency medical personnel; provided, however, that all |
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16|personnel so utilized shall function under the direction of and |
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17|consistent with guidelines for medical control; |
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18| 9. "Classification" means an inclusive standardized |
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19|identification of stabilizing and definitive emergency services |
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20|provided by each hospital that treats emergency patients; |
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21| 10. "CoAEMSP" means the Committee on Accreditation of |
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22|Educational Programs for the Emergency Medical Services Professions; |
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23| 11. "Commissioner" means the State Commissioner of Health; |
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24| |
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1| 12. "Council" means the Trauma and Emergency Response Advisory |
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2|Council created in Section 1-103a.1 of this title; |
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3| 13. "Critical care paramedic" or "CCP" means a licensed |
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4|paramedic who has successfully completed critical care training and |
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5|testing requirements in accordance with the Oklahoma Emergency |
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6|Response Systems Development Act and in accordance with the rules |
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7|and standards promulgated by the Commissioner; |
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8| 14. "Department" means the State Department of Health; |
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9| 15. "Emergency medical services system" means a system which |
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10|provides for the organization and appropriate designation of |
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11|personnel, facilities and equipment for the effective and |
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12|coordinated local, regional and statewide delivery of health care |
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13|services primarily under emergency conditions; |
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14| 16. "Letter of review" means the official designation from |
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15|CoAEMSP to a paramedic program that is in the "becoming accredited" |
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16|process; |
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17| 17. "Licensed emergency medical personnel" means an emergency |
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18|medical technician (EMT), an intermediate emergency medical |
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19|technician (IEMT), an advanced emergency medical technician (AEMT), |
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20|or a paramedic licensed by the Department to perform emergency |
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21|medical services in accordance with the Oklahoma Emergency Response |
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22|Systems Development Act and the rules and standards promulgated by |
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23|the Commissioner; |
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24| |
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1| 18. "Licensure" means the licensing of emergency medical care |
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2|providers and ambulance services pursuant to rules and standards |
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3|promulgated by the Commissioner at one or more of the following |
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4|levels: |
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5| a. basic life support, |
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6| b. intermediate life support, |
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7| c. paramedic life support, |
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8| d. advanced life support, |
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9| e. stretcher van, and |
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10| f. specialty care, which shall be used solely for |
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11| interhospital transport of patients requiring |
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12| specialized en route medical monitoring and advanced |
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13| life support which exceed the capabilities of the |
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14| equipment and personnel provided by paramedic life |
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15| support. |
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16| Requirements for each level of care shall be established by the |
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17|Commissioner. Licensure at any level of care includes a license to |
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18|operate at any lower level, with the exception of licensure for |
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19|specialty care; provided, however, that the highest level of care |
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20|offered by an ambulance service shall be available twenty-four (24) |
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21|hours each day, three hundred sixty-five (365) days per year. |
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22| Licensure shall be granted or renewed for such periods and under |
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23|such terms and conditions as may be promulgated by the Commissioner; |
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24| |
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1| 19. "Medical control" means local, regional or statewide |
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2|medical direction and quality assurance of health care delivery in |
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3|an emergency medical service system. Online medical control is the |
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4|medical direction given to licensed emergency medical personnel, |
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5|certified emergency medical responders and stretcher van personnel |
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6|by a physician via radio or telephone. Off-line medical control is |
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7|the establishment and monitoring of all medical components of an |
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8|emergency medical service system, which is to include stretcher van |
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9|service including, but not limited to, protocols, standing orders, |
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10|educational programs, and the quality and delivery of online |
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11|control; |
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12| 20. "Medical director" means a physician, fully licensed |
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13|without restriction, who acts as a paid or volunteer medical advisor |
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14|to a licensed ambulance service and who monitors and directs the |
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15|care so provided. Such physicians shall meet such qualifications |
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16|and requirements as may be promulgated by the Commissioner; |
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17| 21. "Mobile integrated healthcare" (MIH) means a |
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18|patient-centered model of care that: |
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19| a. utilizes licensed emergency medical services |
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20| personnel including, but not limited to, community |
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21| paramedics, paramedics, emergency medical technicians, |
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22| and other qualified health professionals, |
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23| |
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24| |
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1| b. provides in-home or on-scene assessment, treatment, |
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2| and referral services to individuals in nonemergency |
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3| or subacute situations, |
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4| c. includes, but is not limited to, treat-in-place, |
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5| telehealth, and transport to alternative destination |
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6| programs, |
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7| d. coordinates with hospitals, clinics, mental health |
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8| facilities, long-term care providers, and primary care |
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9| practitioners to ensure continuity and integration of |
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10| care, and |
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11| e. operates under approved medical direction and |
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12| protocols consistent with standards adopted by the |
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13| State Commissioner of Health; |
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14| 22. "Mobile integrated healthcare (MIH) supplier" means an |
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15|ambulance service, fire service, or other agency credentialed by the |
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16|State Department of Health to provide MIH services under paragraph |
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17|13 of Section 1-2511 of this title; |
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18| 23. "Region" or "emergency medical service region" means two or |
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19|more municipalities, counties, ambulance districts or other |
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20|political subdivisions exercising joint control over one or more |
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21|providers of emergency medical services and stretcher van service |
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22|through common ordinances, authorities, boards or other means; |
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23| 22. 24. "Regional emergency medical services system" means a |
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24|network of organizations, individuals, facilities and equipment |
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1|which serves a region, subject to a unified set of regional rules |
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2|and standards which may exceed, but may not be in contravention of, |
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3|those required by the state, which is under the medical direction of |
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4|a single regional medical director, and which participates directly |
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5|in the delivery of the following services: |
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6| a. medical call-taking and emergency medical services |
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7| dispatching, emergency and routine including priority |
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8| dispatching of first response agencies, stretcher van |
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9| and ambulances, |
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10| b. emergency medical responder services provided by |
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11| emergency medical response agencies, |
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12| c. ambulance services, both whether emergency, routine |
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13| and or stretcher van including, but not limited to, |
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14| the transport of patients in accordance with transport |
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15| protocols approved by the regional medical director, |
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16| and |
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17| d. directions given by physicians directly via radio or |
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18| telephone, or by written protocol, to emergency |
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19| medical response agencies, stretcher van or ambulance |
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20| personnel at the scene of an emergency or while en |
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21| route to a hospital; |
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22| 23. 25. "Regional medical director" means a licensed physician, |
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23|who meets or exceeds the qualifications of a medical director as |
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24|defined by the Oklahoma Emergency Response Systems Development Act, |
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1|chosen by an emergency medical service region to provide external |
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2|medical oversight, quality control and related services to that |
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3|region; |
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4| 24. 26. "Registration" means the listing of an ambulance |
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5|service in a registry maintained by the Department; provided, |
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6|however, registration shall not be deemed to be a license; |
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7| 25. 27. "Stretcher van" means any ground vehicle which is or |
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8|should be approved by the State Commissioner of Health, which is |
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9|designed and equipped to transport individuals on a stretcher or |
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10|gurney type apparatus. Vehicles used as stretcher vans shall meet |
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11|such standards as may be required by the Commissioner for approval |
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12|and shall display evidence of licensure at all times. The |
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13|Commissioner shall not establish Federal Specification KKK-A-1822 |
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14|ambulance standards for stretcher vans; provided, a stretcher van |
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15|shall meet Ambulance Manufacturers Division (AMD) Standards 004, 012 |
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16|and 013, and shall pass corresponding safety tests. Stretcher van |
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17|services shall only be permitted and approved by the Commissioner in |
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18|emergency medical service regions, ambulance service districts, or |
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19|counties with populations in excess of five hundred thousand |
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20|(500,000) people. Notwithstanding the provisions of this paragraph, |
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21|stretcher van transports may be made to and from any federal or |
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22|state veterans facility. Stretcher vans may carry and provide |
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23|oxygen and may carry and utilize any equipment necessary for the |
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24|provision of oxygen; |
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1| 26. 28. "Stretcher van passenger" means any person who is or |
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2|will be transported in a reclining position on a stretcher or |
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3|gurney, who is medically stable, nonemergent and does not require |
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4|any medical monitoring equipment or assistance during transport |
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5|except oxygen. Passengers must be authorized as qualified to be |
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6|transported by stretcher van. Passengers shall be authorized |
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7|through screening provided by a certified medical dispatching |
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8|protocol approved by the Department. All patients being transported |
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9|to or from any medically licensed facility shall be screened before |
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10|transport. Any patient transported without screening shall be a |
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11|violation of Commissioner rule by the transporting company and |
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12|subject to administrative procedures of the Department; and |
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13| 27. 29. "Transport protocol" means the written instructions |
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14|governing decision-making at the scene of a medical emergency by |
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15|ambulance personnel regarding the selection of the hospital to which |
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16|the patient shall be transported. Transport protocols shall be |
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17|developed by the regional medical director for a regional emergency |
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18|medical services system or by the Department if no regional |
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19|emergency medical services system has been established. Such |
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20|transport protocols shall adhere to, at a minimum, the following |
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21|guidelines: |
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22| a. nonemergency, routine transport shall be to the |
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23| facility of the patient's choice, |
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24| |
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1| b. urgent or emergency transport not involving |
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2| life-threatening medical illness or injury shall be to |
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3| the nearest facility, or, subject to transport |
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4| availability and system area coverage, to the facility |
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5| of the patient's choice, |
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6| c. life-threatening medical illness or injury shall |
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7| require transport to the nearest health care facility |
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8| appropriate to the needs of the patient as established |
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9| by regional or state guidelines, and |
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10| d. emergency ambulance transportation is not required |
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11| when a patient's apparent clinical condition, as |
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12| defined by applicable medical treatment protocols, |
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13| does not warrant emergency ambulance transport, and |
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14| nontransport of patients is authorized pursuant to |
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15| applicable medical treatment protocols established by |
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16| the regional medical director. |
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17| SECTION 3. AMENDATORY 63 O.S. 2021, Section 1-2511, is |
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18|amended to read as follows: |
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19| Section 1-2511. The State Commissioner of Health shall have the |
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20|following powers and duties with regard to an Oklahoma Emergency |
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21|Medical Services Improvement Program: |
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22| 1. Administer and coordinate all federal and state programs, |
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23|not specifically assigned by state law to other state agencies, |
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24|which include provisions of the Federal federal Emergency Medical |
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1|Services Systems Act of 1973 and other federal laws and programs |
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2|relating to the development of emergency medical services in this |
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3|state. The administration and coordination of federal and state |
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4|laws and programs relating to the development, planning, prevention, |
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5|improvement and management of emergency medical services shall be |
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6|conducted by the Division of Emergency Medical Services, as |
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7|prescribed by Section 1-2510 of this title; |
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8| 2. Assist private and public organizations, emergency medical |
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9|and health care providers, ambulance authorities, district boards |
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10|and other interested persons or groups in improving emergency |
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11|medical services at the local, municipal, district or state levels. |
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12|This assistance shall be through professional advice and technical |
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13|assistance; |
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14| 3. Coordinate the efforts of local units of government to |
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15|establish service districts and set up boards of trustees or other |
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16|authorities to operate and finance emergency medical services in the |
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17|state as provided under Section 9C of Article X of the Oklahoma |
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18|Constitution or under Sections 1201 through 1221 of Title 19 of the |
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19|Oklahoma Statutes. The Commissioner shall evaluate all proposed |
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20|district areas and operational systems to determine the feasibility |
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21|of their economic and health services delivery; |
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22| 4. Prepare, maintain and utilize a comprehensive plan and |
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23|program for emergency medical services development throughout the |
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24|state to be adopted by the State Board Commissioner of Health, |
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1|giving consideration to the recommendations of the Trauma and |
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2|Emergency Response Advisory Council created in Section 44 of this |
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3|act Section 1-103a.1 of this title, and incorporated within the |
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4|State Health Plan. The plan shall establish goals, objectives and |
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5|standards for a statewide integrated system and a timetable for |
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6|accomplishing and implementing different elements of the system. |
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7|The plan shall also include, but not be limited to, all components |
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8|of an emergency medical services system; regional and statewide |
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9|planning; the establishment of standards and the appropriate |
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10|criteria for the designation of facilities; data collection and |
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11|quality assurance; and funding; |
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12| 5. Maintain a comprehensive registry of all ambulance services |
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13|operating within the state, to be published annually, and maintain a |
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14|registry of critical care paramedics. All ambulance service |
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15|providers shall register annually with the Commissioner on forms |
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16|supplied by the State Department of Health, containing such requests |
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17|for information as may be deemed necessary by the Commissioner; |
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18| 6. Develop a standard report form which may be used by local, |
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19|regional and statewide emergency medical services and emergency |
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20|medical services systems to facilitate the collection of data |
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21|related to the provision of emergency medical and trauma care. The |
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22|Commissioner shall also develop a standardized emergency medical |
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23|services data set and an electronic submission standard. Each |
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24|ambulance service shall submit the information required in this |
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Req. No. 2364 Page 14
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1|section at such intervals as may be prescribed by rules promulgated |
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2|by the State Board of Health Commissioner; |
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3| 7. Evaluate and certify all emergency medical services training |
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4|programs and emergency medical technician training courses and |
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5|operational services in accordance with specifications and |
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6|procedures approved by the Board Commissioner. Nonaccredited |
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7|paramedic training programs shall begin their final paramedic |
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8|training class by December 31, 2012. Only paramedic training |
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9|programs accredited or receiving a Letter of Review (LOR) by CoAEMSP |
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10|the Committee on Accreditation of Educational Programs for the |
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11|Emergency Medical Services Professions (CoAEMSP) may enroll new |
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12|paramedic students after January 1, 2013; |
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13| 8. Provide an emergency medical personnel and ambulance service |
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14|licensure program to include a requirement that ambulance services |
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15|licensed as specialty care ambulance providers shall be used solely |
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16|for interhospital transport of patients requiring specialized en |
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17|route medical monitoring and advanced life support which exceeds the |
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18|capabilities of the equipment and personnel provided by paramedic |
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19|life support; |
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20| 9. Employ and prescribe the duties of employees as may be |
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21|necessary to administer the provisions of the Oklahoma Emergency |
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22|Response Systems Development Act; |
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23| |
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24| |
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1| 10. Apply for and accept public and private gifts, grants, |
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2|donations and other forms of financial assistance designed for the |
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3|support of emergency medical services; |
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4| 11. Develop a classification system for all hospitals that |
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5|treat emergency patients. The classification system shall: |
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6| a. identify stabilizing and definitive emergency |
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7| services provided by each hospital, and |
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8| b. require each hospital to notify the regional |
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9| emergency medical services system control when |
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10| treatment services are at maximum capacity and that |
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11| emergency patients should be diverted to another |
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12| hospital; and |
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13| 12. Develop and monitor a statewide emergency medical services |
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14|and trauma analysis system designed to: |
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15| a. identify emergency patients and severely injured |
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16| trauma patients treated in Oklahoma this state, |
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17| b. identify the total amount of uncompensated emergency |
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18| care provided each fiscal year by each hospital and |
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19| ambulance service in Oklahoma this state, and |
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20| c. monitor emergency patient care provided by emergency |
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21| medical service and hospitals; and |
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22| 13. Establish and administer a mobile integrated healthcare |
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23|(MIH) program, formerly known as the community paramedic program, |
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24|for the purpose of improving access to appropriate medical care, |
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Req. No. 2364 Page 16
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1|reducing unnecessary emergency department utilization, and enhancing |
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2|coordination between emergency medical services, hospitals, and |
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3|community health providers. The Commissioner shall promulgate rules |
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4|as necessary to: |
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5| a. establish clinical, operational, and reporting |
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6| standards for MIH suppliers, |
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7| b. define eligibility and credentialing requirements for |
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8| participating agencies and personnel, |
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9| c. ensure compliance with emergency medical services |
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10| licensing and medical oversight requirements, |
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11| d. establish procedures for program evaluation, quality |
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12| assurance, and outcome reporting, and |
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13| e. facilitate participation of MIH suppliers in public |
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14| and private reimbursement systems, including the state |
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15| Medicaid program and commercial insurance plans, in |
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16| collaboration with the Oklahoma Health Care Authority, |
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17| the Insurance Department, and the Department of Mental |
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18| Health and Substance Abuse Services. |
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19| SECTION 4. NEW LAW A new section of law to be codified |
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20|in the Oklahoma Statutes as Section 5025.1 of Title 63, unless there |
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21|is created a duplication in numbering, reads as follows: |
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22| A. As used in this section, "mobile integrated healthcare" |
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23|(MIH) and "mobile integrated healthcare (MIH) supplier" have the |
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24| |
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Req. No. 2364 Page 17
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1|same meanings as provided in Section 1-2503 of Title 63 of the |
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2|Oklahoma Statutes. |
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3| B. The Oklahoma Health Care Authority shall establish a |
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4|reimbursement methodology for encounters between a mobile integrated |
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5|healthcare (MIH) supplier and a Medicaid member that result in a |
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6|treatment without transport of the member. |
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7| C. Any encounter between an MIH supplier and a Medicaid member |
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8|that results in a treatment without transport of the member shall be |
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9|reimbursed by the Authority or a contracted entity at a rate not |
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10|less than the minimum allowable reimbursement rate under the |
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11|methodology established under subsection B of this section. |
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12| D. Unless the rate described in subsection H of Section 4002.12 |
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13|of Title 56 of the Oklahoma Statutes applies, when an MIH supplier |
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14|triages, treats, and transports a Medicaid member to an alternative |
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15|destination in accordance with an approved MIH program protocol, |
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16|reimbursement by the Authority or a contracted entity shall be at a |
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17|rate not less than the minimum allowable reimbursement rate for |
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18|basic life support (BLS) services or advanced life support (ALS) |
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19|services, as appropriate based on the condition of the patient, |
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20|including mileage from the scene to the alternative destination. |
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21| SECTION 5. This act shall become effective January 1, 2027. |
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22| |
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23| 60-2-2364 DC 1/14/2026 6:44:49 AM |
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24| |
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Req. No. 2364 Page 18
