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1 STATE OF OKLAHOMA
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2 2nd Session of the 60th Legislature (2026)
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3 SENATE BILL 1953 By: Murdock
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6 AS INTRODUCED
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7 An Act relating to health insurance; creating the
7 Employer Health Plan Transparency Act; providing
8 short title; defining terms; prohibiting certain
8 health plan from entering into certain contract;
9 prohibiting certain contract provisions from limiting
9 or denying certain information; prohibiting certain
10 contracts from containing certain provisions;
10 prohibiting certain contracts from prohibiting or
11 penalizing certain health plans in certain
11 situations; requiring certain contracts in violation
12 of certain provisions to be void; requiring certain
12 insurer or provider to provide certain information
13 consistent with certain Health Insurance Portability
13 and Accountability Act of 1996 (HIPAA) requirements;
14 requiring certain health plan to comply with certain
14 HIPAA requirements; construing provisions; requiring
15 certain claims to be made in accordance with certain
15 regulations; requiring certain information to be
16 unmodified; requiring certain notices to be in
16 certain formats; requiring certain disclosures by
17 certain issuers or providers; requiring itemization
17 of certain costs; requiring certain supports;
18 requiring submission of certain annual declaration;
18 requiring certain submission in certain situations;
19 allowing Insurance Commissioner to asses certain
19 civil penalties; allowing Commissioner to issue
20 certain orders; allowing certain action against
20 license in certain situations; prohibiting certain
21 issuer or provider from retaliating against certain
21 persons; requiring Commissioner to promulgate rules
22 and regulations; providing for noncodification;
22 providing for codification; and providing an
23 effective date.
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2 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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3 SECTION 1. NEW LAW A new section of law not to be
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4 codified in the Oklahoma Statutes reads as follows:
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5 This act shall be known as and may be cited as the "Employer
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6 Health Plan Transparency Act".
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7 SECTION 2. NEW LAW A new section of law to be codified
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8 in the Oklahoma Statutes as Section 5410 of Title 36, unless there
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9 is created a duplication in numbering, reads as follows:
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10 As used in this act:
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11 1. "Auditable material" means claims and encounter information
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12 or data and any documentation supporting claim payments, including
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13 medical records;
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14 2. "Claims and encounter information or data" means all
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15 documents, including electronically stored information containing
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16 claim files, encounter data, remittance and electronic funds
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17 transfer files, medical records supporting payment information,
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18 policy and contract documents, and all documents or electronically
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19 stored information containing information pursuant to 29 U.S.C.,
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20 Section 1185m(a)(1)(B);
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21 3. "Covered service provider" means a service provider that
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22 enters into a contract with a regulated health plan and reasonably
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23 expects One Thousand Dollars ($1,000.00) or more in compensation to
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24 be received in connection with providing, delivering, arranging for,
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1 paying for, or reimbursing any of the costs of health care services
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2 regardless of whether such services will be performed or
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3 compensation received by the covered service provider, an affiliate,
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4 or a subcontractor;
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5 4. "Electronic funds transfer" means the electronic message a
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6 health insurance issuer or covered service provider sends to a
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7 financial institution to order the financial institution to
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8 electronically transfer funds to a health care provider's account to
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9 pay for health care services;
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10 5. "Electronic remittance advice" means a digital document that
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11 a health insurance issuer or covered service provider sends to a
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12 health care provider that supplies information about the payment to
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13 the health care provider, including any adjustments to claims and
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14 other payments based on factors including, but not limited to, any
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15 adjustments to claims or other payments based on factors such as
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16 contractual agreements, patient benefit coverage, expected co-
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17 payments or coinsurance, and capitation payments;
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18 6. "Encounter data" means the information relating to the
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19 receipt of any items or service by an enrollee under a contract
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20 between an employee and a regulated health plan;
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21 7. "Group health plan" means an employee welfare benefit plan
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22 that provides medical care to employees or their dependents directly
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23 or through insurance or reimbursement. Group health plan shall not
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24 include Medicare supplement or accident only, fixed indemnity,
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1 limited benefit, credit, dental, vision, specified disease, or
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2 Tricare supplemental insurance, long-term care or disability income,
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3 workers' compensation, or automobile medical payment insurance or
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4 self-insured employee welfare benefit plan governed by the
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5 provisions of 29 U.S.C., Section 1001 et seq.;
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6 8. "Health care provider" means any person, group, professional
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7 corporation, or other organization including, but not limited to,
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8 medical clinics, medical groups, home health care agencies, health
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9 infusion centers, urgent care centers, or emergency care centers
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10 that are licensed or authorized in this state to furnish health care
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11 services;
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12 9. "Health care services" means health care related items,
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13 products, or services rendered or furnished by a health care
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14 provider within the scope of the provider's license, certification,
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15 or legal authorization for the diagnosis, prevention, treatment,
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16 cure, or relief of a health condition, illness, injury, or disease
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17 including, but not limited to, durable medical equipment, infusion,
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18 imaging, and hospital, medical, surgical, and pharmaceutical
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19 services or products;
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20 10. "Health insurance issuer" means any entity subject to the
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21 insurance laws and regulations of this state or subject to the
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22 jurisdiction of the Insurance Department that contracts or offers to
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23 contract to provide, deliver, arrange for, pay for, or reimburse any
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24 of the costs of health care services. Health insurance issuer shall
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1 include a sickness and accident insurance company, health
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2 maintenance organization, nonprofit hospital and health service
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3 corporation, or other entity providing a plan of health insurance,
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4 health benefits, or health services;
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5 11. "HIPAA" means the Health Insurance Portability and
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6 Accountability Act of 1996, P.L. No. 104-191, and all related
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7 privacy and security regulations pursuant to the Social Security
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8 Act, P.L. No. 74-271, 42 U.S.C., Section 1320d-9;
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9 12. "Public employee health plan" means a governmental plan
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10 pursuant to 29 U.S.C., Section 1002(32), which is sponsored by this
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11 state or any political subdivision of this state, or a health
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12 benefits program administered for the benefit of public employees or
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13 eligible retirees;
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14 13. "Regulated health plan" means a group health plan or a
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15 public employee health plan as defined by this section; and
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16 14. "Self-insured employee welfare benefit plan" means an
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17 employee welfare plan where an employer assumes the financial risk
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18 for providing health care benefits to its employees and such
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19 arrangement shall be subject to the exclusive jurisdiction of the
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20 Employee Retirement Income Security Act of 1974, 29 U.S.C., Section
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21 1001 et seq.
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22 SECTION 3. NEW LAW A new section of law to be codified
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23 in the Oklahoma Statutes as Section 5411 of Title 36, unless there
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24 is created a duplication in numbering, reads as follows:
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1 A. A regulated health plan shall not enter into, extend, or
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2 renew a contract with a health insurance issuer or covered service
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3 provider to provide, deliver, arrange for, pay for, or reimburse any
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4 of the costs of health care services to the regulated health plan's
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5 employees or their dependents unless the contract or arrangement
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6 provides the regulated health plan access to all claims and
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7 encounter information or data, and all documentation supporting
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8 claim payments, including medical records and policy documents
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9 related to regulated health plan enrollee claims, are sufficient to
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10 enable the regulated health plan to comply with applicable law and
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11 plan terms and determine accuracy of payments.
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12 B. No contract provision shall unreasonably:
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13 1. Delay a regulated health plan from accessing all claims and
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14 encounter information or data of its employees or their dependents,
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15 and all documentation supporting claim payments related to regulated
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16 health plan enrollee claims, including records and policy documents,
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17 more than fifteen (15) days from the date of a request for such
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18 information by a regulated health plan to a health insurance issuer;
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19 2. Limit the volume of claims and encounter information or
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20 data, and any documentation supporting claim payments of the
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21 regulated health plan's employees or their dependents, including
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22 medical records and policy documents related to regulated health
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23 plan enrollee claims, which a regulated health plan may access
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1 during an audit or pursuant to any request by a regulated health
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2 plan to a health insurance issuer for such information or data;
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3 3. Limit the disclosure of the payment arrangements of the
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4 health insurance issuer to provide, arrange for, pay for, or
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5 reimburse any of the costs of health care services to the regulated
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6 health plan's employees or their dependents, including payment
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7 calculations and formulas, quality measures, contract terms, payment
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8 amounts, incentive measurement periods, and other payment
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9 methodologies;
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10 4. Limit a regulated health plan's right to select an auditor
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11 to review auditable materials or limit audit frequency to less than
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12 once per month;
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13 5. Limit a regulated health plan from accessing claims and
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14 encounter information or data;
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15 6. Limit disclosure of fees charged to a regulated health plan
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16 related to administration or claims processing, including
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17 renegotiation fees or repricing fees;
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18 7. Limit disclosure of information related to overpayments; or
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19 8. Limit public disclosure of de-identified or aggregate
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20 information that a regulated health plan receives from a health
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21 insurance issuer or covered service provider under this act.
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22 C. No contract between a health insurance issuer or covered
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23 service provider and a regulated health plan shall:
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1 1. Contain any provision that unreasonably delays or limits a
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2 regulated health plan's access to claims and encounter information
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3 or data; or
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4 2. Not prohibit or penalize a regulated health plan for making
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5 Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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6 compliant de-identified or aggregate disclosures of claims and
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7 encounter information or data.
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8 D. Any contract in violation of this section shall be void.
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9 SECTION 4. NEW LAW A new section of law to be codified
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10 in the Oklahoma Statutes as Section 5412 of Title 36, unless there
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11 is created a duplication in numbering, reads as follows:
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12 A. Any health insurance issuer or covered service provider
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13 shall provide information to regulated health plans in a manner that
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14 is consistent with the Health Insurance Portability and
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15 Accountability Act of 1996 (HIPAA) privacy and security rules and
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16 regulations.
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17 B. A regulated health plan that receives a disclosure under
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18 this act from a health insurance issuer or covered service provider
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19 shall comply with HIPAA privacy regulations in handling such
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20 information, regardless of if HIPAA is applicable to the regulated
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21 health plan's activities.
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22 C. Nothing in this act shall be construed to modify HIPAA data
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23 privacy requirements related to the creation, receipt, maintenance,
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24 or transmission of protected health information.
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1 SECTION 5. NEW LAW A new section of law to be codified
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2 in the Oklahoma Statutes as Section 5413 of Title 36, unless there
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3 is created a duplication in numbering, reads as follows:
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4 A. All claims from health care providers shall be made to a
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5 regulated health plan in accordance with transaction standards
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6 adopted by regulation under the Health Insurance Portability and
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7 Accountability Act of 1996 (HIPAA) as follows:
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8 1. Institutional, professional, and dental claims shall be made
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9 consistent with the format provided in 45 C.F.R., Section 162.1102;
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10 or
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11 2. Pharmacy claims shall be made consistent with the National
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12 Council for Prescription Drug Programs or any subsequent standard
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13 under 45 C.F.R., Section 162.1102.
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14 B. All information provided to a regulated health plan pursuant
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15 to this act shall be unmodified copies of the files sent by the
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16 health care provider. Claims sent by the health care provider in a
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17 physical format shall be converted to the appropriate standard
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18 electronic format by the health insurance issuer or covered service
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19 provider and made accessible at no cost to the regulated health
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20 plan.
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21 C. All claims payments, electronic funds transfers, and
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22 electronic remittance advices sent by a health insurance issuer or
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23 covered service provider under a contract with a regulated health
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24 plan to provide, deliver, arrange for, pay for, or reimburse any of
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1 the costs of health care services shall be made available to a
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2 regulated health plan with the format provided in 45 C.F.R., Section
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3 162.1102. Such files shall be unmodified copies of the original
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4 information sent by the health insurance issuer or covered service
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5 provider to a health care provider, accessible at no cost to a
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6 regulated health plan.
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7 D. Any contract between health insurance issuers or covered
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8 service providers and a regulated health plan to provide, deliver,
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9 arrange for, pay for, or reimburse any costs of health care services
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10 shall include disclosures of all calculation formulas, pricing
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11 methodologies, and other information used to determine the value of
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12 reimbursements.
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13 E. All nonclaim costs charged to a regulated health plan shall
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14 be itemized and made available through a web portal, an application
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15 programing interface, and a downloadable Comma-Separated Values
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16 (.CSV) file.
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17 F. Health insurance issuers or covered service providers shall
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18 support automated daily batch delivery of claims, encounters,
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19 remittances, and fee files to the regulated health plan.
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20 SECTION 6. NEW LAW A new section of law to be codified
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21 in the Oklahoma Statutes as Section 5414 of Title 36, unless there
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22 is created a duplication in numbering, reads as follows:
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23 A. All health insurance issuers and covered service providers
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24 offering services to regulated health plans shall submit annually to
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1 the Insurance Department a declaration, under penalty of perjury,
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2 warranting compliance with this act, including attestation that:
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3 1. Information pursuant to this act is available upon request
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4 and is provided to regulated health plans in a timely manner; and
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5 2. No contract contains terms that restrict or delay a
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6 regulated health plan from auditing, reviewing, or accessing
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7 information pursuant to this act.
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8 B. A health insurance issuer or covered service provider shall
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9 not delegate submission of a declaration pursuant to subsection A of
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10 this section to a third party.
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11 C. If a health insurance issuer or covered service provider
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12 cannot obtain information necessary to provide the declaration
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13 pursuant to subsection A of this section, they may submit a written
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14 statement that includes:
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15 1. An explanation of why they were unsuccessful in obtaining
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16 such information, including whether auditing or access was limited;
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17 and
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18 2. A description of all efforts taken to remove any provisions
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19 that violate subsection C of Section 3 of this act.
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20 D. The Insurance Commissioner shall prescribe forms and
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21 submission dates necessary to enforce the provisions of this act.
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22 SECTION 7. NEW LAW A new section of law to be codified
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23 in the Oklahoma Statutes as Section 5415 of Title 36, unless there
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24 is created a duplication in numbering, reads as follows:
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1 A. The Insurance Commissioner may assess a civil penalty not to
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2 exceed Ten Thousand Dollars ($10,000.00) per day, per violation of
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3 any health insurance issuer or covered service provider for
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4 violations of this act.
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5 B. The Commissioner may issue cease-and-desist orders and seek
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6 injunctive relief, contract reformation, restitution of improperly
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7 charged nonclaim costs or fees, and require corrective action plans
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8 for violations of this act.
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9 C. For repeated or willful violations, the Commissioner may
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10 take action against a violator's certificate of authority or
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11 license.
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12 D. A health insurance issuer or covered service provider shall
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13 not retaliate against any person for good-faith reports or
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14 cooperation with the Insurance Department pursuant to this act.
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15 E. The Commissioner shall promulgate rules and regulations to
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16 enforce the provisions of this act.
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17 SECTION 8. This act shall become effective November 1, 2026.
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19 60-2-3071 CAD 1/15/2026 9:09:26 AM
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Req. No. 3071 Page 12Every fact on this page links to its source, starting with the official bill record.