1| HOUSE OF REPRESENTATIVES - FLOOR VERSION | | | 2| STATE OF OKLAHOMA | | | 3| 2nd Session of the 59th Legislature (2024) | | | 4|ENGROSSED SENATE | |BILL NO. 1703 By: Daniels of the Senate | 5| | | and | 6| | | McEntire of the House | 7| | | | 8| | | | 9| An Act relating to the state Medicaid program; | | amending 63 O.S. 2021, Section 5051.2, which relates | 10| to recovery of expenses; prohibiting certain insurers | | and third-party administrators from denying claims on | 11| specified grounds; requiring acceptance of certain | | authorization; requiring response to certain inquiry | 12| within specified time frame; clarifying language; and | | declaring an emergency. | 13| | | | 14| | | | 15|BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA: | | | 16| SECTION 1. AMENDATORY 63 O.S. 2021, Section 5051.2, is | | | 17|amended to read as follows: | | | 18| Section 5051.2. A. Whenever the Oklahoma Health Care Authority | | | 19|pays for medical services or renders medical services, for or on | | | 20|behalf of a person who has been injured or suffered an illness or | | | 21|disease, the right of the provider of the services to reimbursement | | | 22|shall be automatically assigned to the Oklahoma Health Care | | | 23|Authority, upon notice to the insurer or other party obligated as a | | | 24| | | | arsid5987169 SB1703 HFLR Page 1 ___________________________________________________________________________
1|matter of law or agreement to reimburse the provider on behalf of | | | 2|the patient. | | | 3| B. Upon the assignment, the Authority, for purposes of the | | | 4|claim for reimbursement, becomes a provider of medical services. | | | 5| C. The assignment of the right to reimbursement shall be | | | 6|applied and considered valid against any employer or insurer under | | | 7|the Administrative Workers' Compensation Act in this state. | | | 8| D. Each insurer, upon receiving a claim from the Oklahoma | | | 9|Health Care Authority, shall accept the state's right of recovery, | | | 10|to process and, if appropriate, pay the claim to the same extent | | | 11|that the plan would have been liable if it had been billed at the | | | 12|point of sale or by the original provider of services.InsurerThe | | | 13|insurer shall not deny the Authority claims on the basis of the date | | | 14|of submission, the format of the claim, or for failure to present | | | 15|proper documentation of coverage at the point of sale. | | | 16| E. An insurer or third-party administrator, except a Medicare | | | 17|Advantage plan, shall not deny the Authority claims solely on the | | | 18|basis that a claimed item or service did not receive prior | | | 19|authorization under the rules or coverage policies of the insurer or | | | 20|third-party administrator. The insurer or third-party administrator | | | 21|shall accept an authorization provided by the Authority for an item | | | 22|or service covered under the state Medicaid program or under a home- | | | 23|and community-based services waiver for such individual as if such | | | 24| | | | arsid5987169 SB1703 HFLR Page 2 ___________________________________________________________________________
1|authorization was made by the insurer or third-party administrator | | | 2|for such item or service. | | | 3| F. If the Authority submits an inquiry regarding a claim to an | | | 4|insurer or third-party administrator not later than three (3) years | | | 5|after the date of provision of the claimed item or service, the | | | 6|insurer or third-party administrator shall respond to the inquiry | | | 7|within sixty (60) days of receiving the inquiry. | | | 8| G.InsurerAn insurer shall make appropriate payments to the | | | 9|Authority as long as the claim is submitted for consideration within | | | 10|three (3) years from the date the service was furnished. Any action | | | 11|by the Authority to enforce the payment of the claim shall be | | | 12|commenced within six (6) years of the submission of the claim by the | | | 13|Authority. | | | 14| SECTION 2. It being immediately necessary for the preservation | | | 15|of the public peace, health or safety, an emergency is hereby | | | 16|declared to exist, by reason whereof this act shall take effect and | | | 17|be in full force from and after its passage and approval. | | | 18| | | | 19|COMMITTEE REPORT BY: COMMITTEE ON APPROPRIATIONS AND BUDGET, dated | |04/18/2024 - DO PASS. | 20| | | | 21| | | | 22| | | | 23| | | | 24| | | | arsid5987169 SB1703 HFLR Page 3