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 1673 By: McIntosh
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6 AS INTRODUCED
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7 An Act relating to health benefit plans; creating the
7 Prosthetic Access and Accountability Act of 2026;
8 providing short title; defining terms; providing
8 certain goal of treatment for certain health benefit
9 plan; prohibiting certain treatment from being
9 withheld based on certain factors; establishing
10 certain medical necessity; presuming certain denials
10 to be invalid; requiring certain health benefit plan
11 to ensure certain access to care; requiring
11 reimbursement for certain care; establishing certain
12 liability due to certain denial or delay;
12 establishing certain rebuttable presumption in
13 certain case; establishing certain liability;
13 prohibiting certain provider to be held liable due to
14 certain denial, modification, or override; requiring
14 Insurance Commissioner to promulgate certain rules
15 and regulations; requiring Commissioner to enforce
15 certain provisions; requiring Commissioner to
16 investigate certain complaints; requiring
16 Commissioner to maintain and publish certain report;
17 establishing certain fines and penalties; requiring
17 certain requests to be reviewed within certain time
18 frame; requiring certain automatic approval in
18 certain scenarios; allowing certain enrollee to bring
19 certain civil action; providing for noncodification;
19 providing for codification; and providing an
20 effective date.
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23 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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Req. No. 2321 Page 1
1 SECTION 1. NEW LAW A new section of law not to be
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2 codified in the Oklahoma Statutes reads as follows:
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3 This act shall be known and may be cited as the "Prosthetic
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4 Access and Accountability Act 2026".
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5 SECTION 2. NEW LAW A new section of law to be codified
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6 in the Oklahoma Statutes as Section 6060.23 of Title 36, unless
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7 there is created a duplication in numbering, reads as follows:
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8 A. As used in this act:
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9 1. "Covered prosthetic benefit" means any prosthesis, orthosis,
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10 or related service listed as a covered benefit under the enrollee's
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11 health benefit plan including, but not limited to, benefits listed
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12 under durable medical equipment, orthotics, and assistive devices;
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13 2. "Health benefit plan" means the same as defined in Section
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14 4405.1 of Title 36 of the Oklahoma Statutes;
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15 3. "Orthosis" means the same as defined in Section 3002 of
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16 Title 59 of the Oklahoma Statutes;
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17 4. "Orthotist" means the same as defined in Section 3002 of
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18 Title 59 of the Oklahoma Statutes;
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19 5. "Physician-prescribed device" means any prosthetic or
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20 orthosis device ordered by a provider who is licensed in this state
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21 to prescribe prosthetics;
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22 6. "Prosthesis" means the same as defined in Section 3002 of
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23 Title 59 of the Oklahoma Statutes;
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Req. No. 2321 Page 2
1 7. "Prosthetist" means the same as defined in Section 3002 of
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2 Title 59 of the Oklahoma Statutes; and
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3 8. "Unreasonable delay" means any failure to approve, deny, or
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4 respond to a coverage request within two (2) business days if marked
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5 urgent by the prescribing provider, and within ten (10) business
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6 days for standard requests.
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7 B. 1. For a health benefit plan offered in this state that
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8 includes covered prosthetic benefits, the goal of treatment shall be
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9 the restoration of physical function to the greatest extent
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10 possible, as determined by the treating provider. Treatment shall
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11 not be withheld due to discrimination based on disability.
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12 2. Medical necessity shall be based on the patient's functional
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13 goals and shall not be limited by diagnosis, age, disability, or
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14 generalized coverage tiers. Medical necessity shall be determined
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15 by the enrollee's treating provider to meet the medical needs of the
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16 enrollee and return to or maintain full functional abilities
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17 including activities of daily living, essential job-related
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18 activities, showering and bathing, and physical activities.
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19 3. Denials based on cost or classification as deluxe,
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20 convenience, or nonessential shall be presumed invalid if the
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21 physician-prescribed device was prescribed to meet documented
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22 functional needs.
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23 C. A health benefit plan that covers prosthetic benefits shall
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24 ensure access to medically necessary clinical care and to prostheses
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Req. No. 2321 Page 3
1 and orthoses from an adequate number of orthotists and prosthetists
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2 within the network in this state. If covered prosthetic benefits
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3 are unavailable from an in-network provider due to the geographic
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4 location of the patient, the health benefit plan shall provide
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5 processes to refer a member to an out-of-network provider and shall
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6 fully reimburse the out-of-network provider at a mutually agreed
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7 upon rate less member cost sharing determined on an in-network
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8 basis.
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9 D. 1. A health benefit plan that covers prosthetic benefits
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10 and denies or unreasonably delays a physician-prescribed device
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11 shall be liable for any personal injury, financial loss, or harm
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12 proximately caused by the denial or delay.
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13 2. If an enrollee suffers a fall, injury, hospitalization, or
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14 other adverse health event during a period in which a physician-
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15 prescribed device was denied or delayed, a rebuttable presumption of
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16 health benefit plan negligence shall apply. The health benefit plan
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17 shall be liable for:
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18 a. compensatory damages, including medical costs and lost
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19 income,
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20 b. noneconomic damages for pain, suffering, or diminished
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21 quality of life to the full extent of current law, and
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22 c. punitive damages in cases of bad faith or willful
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23 disregard of medical judgment.
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Req. No. 2321 Page 4
1 E. If a health benefit plan or utilization reviewer denies,
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2 modifies, or overrides a claim for a physician-prescribed device and
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3 the patient experiences harm as a result, the insurer shall assume
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4 medical liability as if it were the treating provider. Such
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5 liability includes adherence to the standard of care under this act,
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6 and any applicable governance of provider conduct. A provider shall
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7 not be held liable for any harm resulting from an insurer's denial,
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8 modification, or override of the claim for a physician-prescribed
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9 device.
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10 F. The Insurance Commissioner shall have the authority to
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11 promulgate rules and regulations for the implementation of this act.
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12 G. The Commissioner shall:
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13 1. Enforce the provisions of this section;
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14 2. Investigate complaints related to this section; and
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15 3. Maintain and publish annual reports on covered prosthetic
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16 benefit denials, appeals, and adverse patient outcomes, provided no
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17 information in this subsection is in violation of the Health
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18 Insurance Portability and Accountability Act of 1996.
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19 H. Health benefit plans in violation of this section may be
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20 subject to:
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21 1. Fines of up to Five Thousand Dollars ($5,000.00) per
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22 violation;
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23 2. Daily penalties of One Thousand Dollars ($1,000.00) for
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24 unreasonable delays; or
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Req. No. 2321 Page 5
1 3. Revocation or suspension of certificate of authority in
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2 repeated cases.
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3 I. Coverage requests for prostheses and orthoses shall be
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4 reviewed within two (2) business days if marked urgent by the
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5 prescribing provider, or within ten (10) business days for standard
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6 requests. Failure to respond in writing within such time frames
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7 shall result in automatic approval of the request.
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8 J. Any enrollee harmed by violation of this section shall have
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9 the right to bring a civil action in district court including, but
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10 not limited to, for actual damages, injunctive relief, and attorney
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11 fees.
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12 SECTION 3. This act shall become effective January 1, 2027.
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14 60-2-2321 CAD 1/14/2026 9:43:28 AM
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Req. No. 2321 Page 6Every fact on this page links to its source, starting with the official bill record.