Shown verbatim: the complete text as captured from the official PDF posted by the Oklahoma Legislature, fetched 2026-07-23. Page and line markers are part of the official record; nothing is edited or removed. The official bill page.
1 STATE OF OKLAHOMA
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2 2nd Session of the 60th Legislature (2026)
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3 SENATE BILL 1566 By: Stanley
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6 AS INTRODUCED
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7 An Act relating to the state Medicaid program;
7 amending 56 O.S. 2021, Section 1011.12, which relates
8 to applied behavior analysis treatment of autism
8 spectrum disorder; updating statutory language;
9 requiring medical necessity criteria to include
9 certain diagnosis by specified health care provider;
10 prohibiting imposition of certain policy; providing
10 certain construction; requiring in-person provision
11 of certain services; authorizing remote supervision
11 under certain conditions; and providing an effective
12 date.
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15 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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16 SECTION 1. AMENDATORY 56 O.S. 2021, Section 1011.12, is
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17 amended to read as follows:
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18 Section 1011.12. A. The Oklahoma Health Care Authority, in
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19 conjunction with the Department of Mental Health and Substance Abuse
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20 Services, the State Department of Health and the State Department of
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21 Education shall examine the feasibility of a state plan amendment to
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22 the Oklahoma Medicaid Program state Medicaid program for applied
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23 behavior analysis treatment of autism spectrum disorders disorder.
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1 B. On or before December 31, 2016, the Authority and partnering
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2 agencies shall submit a report to the President Pro Tempore of the
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3 Senate, the Speaker of the House of Representatives and the Governor
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4 estimating the potential costs to the state, clinical findings,
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5 reviews of pilot projects and research from other states on the
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6 effects of applied behavioral analysis treatment on autism spectrum
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7 disorders disorder.
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8 C. Beginning July 1, 2017, and subject to the availability of
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9 funding, the Authority and partnering agencies shall draft a state
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10 plan amendment for applied behavior analysis treatment of autism
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11 spectrum disorders disorder. The provisions of this subsection
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12 shall only apply if the report required by subsection B of this
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13 section demonstrates applied behavioral analysis treatment to be
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14 evidence-based and essential to qualifying participants in the
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15 Oklahoma Medicaid Program state Medicaid program.
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16 D. The medical necessity criteria for applied behavior analysis
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17 services covered under the state Medicaid program shall include a
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18 definitive diagnosis of an autism spectrum disorder by one of the
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19 following health care providers, who shall be licensed in this
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20 state:
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21 1. Pediatric neurologist or neurologist;
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22 2. Developmental pediatrician;
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23 3. Psychologist which may include, but is not limited to, a
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24 psychologist working in a school;
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Req. No. 2677 Page 2
1 4. Psychiatrist or neuropsychiatrist;
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2 5. Other licensed physician experienced in the diagnosis and
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3 treatment of autism spectrum disorder; or
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4 6. Interdisciplinary team composed of a licensed psychologist,
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5 physician, physician assistant (PA), or Advanced Practice Registered
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6 Nurse (APRN).
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7 E. The Authority or a contracted entity shall not impose a
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8 general policy that requires all Medicaid members receiving covered
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9 applied behavior analysis services to be re-diagnosed with or
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10 receive subsequent clinical assessments for autism spectrum disorder
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11 as a condition of continuation of coverage after the member has
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12 already been diagnosed with autism spectrum disorder by a health
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13 care provider as described in subsection D of this section. An
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14 initial diagnosis of autism spectrum disorder shall remain accepted
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15 indefinitely unless otherwise clinically indicated including, but
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16 not limited to, by a significant behavioral or developmental change.
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17 Nothing in this subsection shall be construed to prohibit a member
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18 or member's parent or legal guardian from requesting a subsequent
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19 assessment or a qualified provider from conducting a subsequent
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20 assessment if he or she deems it necessary.
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21 F. 1. All applied behavior analysis services delivered by a
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22 contracted provider to a member shall be performed in person by duly
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23 qualified professionals as determined by the Authority.
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1 2. A contracted provider may use telehealth for supervision of
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2 applied behavior analysis treatment professionals by a board-
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3 certified behavior analyst (BCBA) who is licensed or credentialed in
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4 his or her state of residence. The Authority or a contracted entity
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5 shall not require a supervising BCBA to be located in this state to
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6 perform such supervision.
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7 G. As used in this section:
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8 1. "Applied behavior analysis" means the design, implementation
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9 and evaluation of environmental modifications, using behavioral
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10 stimuli and consequences, to produce socially significant
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11 improvement in human behavior, including the use of direct
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12 observation, measurement and functional analysis of the relationship
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13 between environment and behavior;
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14 2. "Autism spectrum disorder" means any of the pervasive
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15 developmental disorders or autism spectrum disorders as defined by
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16 the most recent edition of the Diagnostic and Statistical Manual of
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17 Mental Disorders (DSM) or the edition that was in effect at the time
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18 of diagnosis;
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19 3. "Behavioral health treatment" means counseling and treatment
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20 programs, including applied behavior analysis, that are:
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21 a. necessary to develop, maintain or restore, to the
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22 maximum extent practicable, the functioning of an
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23 individual, and
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1 b. provided by a board-certified behavior analyst or by a
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2 licensed doctoral-level psychologist so long as the
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3 services performed are commensurate with the
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4 psychologist's university training and supervised
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5 experience; and
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6 4. "Treatment for autism spectrum disorder" means evidence-
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7 based care and related equipment prescribed or ordered for an
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8 individual diagnosed with an autism spectrum disorder by a licensed
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9 physician or a licensed doctoral-level psychologist who determines
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10 the care to be medically necessary, including, but not limited to:
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11 a. behavioral health treatment,
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12 b. pharmacy care,
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13 c. psychiatric care,
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14 d. psychological care, and
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15 e. therapeutic care.
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16 SECTION 2. This act shall become effective November 1, 2026.
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18 60-2-2677 DC 1/12/2026 7:36:37 PM
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Req. No. 2677 Page 5Every fact on this page links to its source, starting with the official bill record.