In the 2017 legislative session, Oklahoma passed the Health Care Choice Act, which allows the state to enter into compacts with other states (approved by the legislature) so that health plans domiciled in those states could be sold to Oklahoma residents without having to obtain an Oklahoma certificate of authority. Blue Cross Blue Shield of Oklahoma was the only carrier offering plans on the exchange in 2017 and continues to be the only carrier on the exchange in 2018. The Oklahoma legislation is intended to provide additional insurance alternatives in Oklahoma. The bill cannot, however, require insurers in other states to offer their plans for sale in Oklahoma, and it’s unclear whether insurers in other states would be willing or able to establish provider networks in Oklahoma.
In past legislative sessions, Oklahoma introduced but did not pass a bill that would have promoted price transparency in the state. In addition, the Oklahoma State Department of Health’s Center for Health Innovation and Effectiveness is spearheading efforts to improve healthcare quality and reign in cost growth. Oklahoma was awarded a CMS State Innovation Model grant in December 2014, which aims to utilize multi-payer value-based payment models to bend the cost curve.
Oklahoma’s current regular legislative session runs from 2/5/2018 – 5/25/2018.
Recent Legislative Developments
|2018||SB 890||OKLAHOMA HEALTH CARE COST REDUCTION AND TRANSPARENCY ACT OF 2018: Medical Procedure Pricing; The Department shall make available to the public on its website the most current price information it receives from hospitals and ambulatory surgical facilities.||Active – Introduced|
|2017||SB 804||OKLAHOMA HEALTH CARE COST REDUCTION AND TRANSPARENCY ACT OF 2017: The Department shall make available to the public on its website the most current price information it receives from hospitals and ambulatory surgical facilities.||Active –carried over to 2018 session|
|SB 788||MEDICAL TRANSPARENCY ACT: The State Department of Health shall publish on the Department’s website a Consumer Guide to Health Care Facilities and Health Care. Among other things, the Department shall include information in the guide to advise consumers that: the average charge for an inpatient admission or outpatient surgical procedure may vary between facilities depending on a health care facility’s cost structure, the range and frequency of the services provided, intensity of care, and payor mix; and the average charge by a health care facility for an inpatient admission or outpatient surgical procedure will vary from the health care facility’s costs or the amount that the health care facility may be reimbursed by a health benefit plan for the admission or surgical procedure.||Inactive –Died in Committee.|
|2015-2016||HB 1940||AN ACT CREATING THE OKLAHOMA HEALTH CARE COST REDUCTION AND TRANSPARENCY ACT OF 2015: Would require the Department of Health to make available to the public, on its website, the 100 most frequently reported admissions by diagnostic-related groups for inpatients, along with CPT and HCPCS codes, for hospitals that bill Medicaid. These hospitals would also be required to report: (i) the amount to be charged to each patient for each diagnostic-related group if all charges are paid in full without a public or private third party paying any portion of the charges; and (ii) the amount of Medicaid and Medicare reimbursements for each diagnostic-related group.
After September 30, 2016, HB1940 would require each hospital and ambulatory surgical center that bills Medicaid to provide information on the total costs of the 100 most common surgical procedures and 50 most common imaging procedures, by volume, performed in hospital outpatient settings or in ambulatory surgical facilities.
HB1940 would require hospitals or ambulatory surgical centers to provide patients—upon patient request and within 3 days of the request—with information regarding the 100 most frequently reported admissions by diagnostic-related groups for inpatients, along with CPT and HCPCS codes, for hospitals that bill Medicaid, and (i) the amount to be charged to each patient for each diagnostic-related group if all charges are paid in full without a public or private third party paying any portion of the charges; and (ii) the amount of Medicaid and Medicare reimbursements for each diagnostic-related group. They would also be required to provide patients with the total costs of the 100 most common surgical procedures and 50 most common imaging procedures, by volume, performed in hospital outpatient settings or in ambulatory surgical facilities.
The State Commissioner of Health may suspend or revoke the license for the operation of a hospital or ambulatory surgical center that violates the provisions of the Oklahoma Health Care Cost Reduction and Transparency Act of 2015.
|Inactive – Died.|
|2018||SB 1381||PRESCRIPTION DRUG SAFTEY AND COST REDUCTION PILOT PROGRAM ACT: Would require the Oklahoma Health Care Authority to submit an application to the Secretary to permit prescription drug importation from Canada by August 2018 that meets federal requirements for drug safety and consumer savings.||Active – Introduced|
|SB 1573||AN ACT RELATING TO PHARMACY BENEFIT PLANS: Would require pharmacy claims payers to specify sources used to determine maximum allowable cost (MAC) reimbursement for generic drugs. Would require payers to update MAC generic pricing list every 7 days and would require readily available access to MAC amounts to be given to providers. Would create an appeals process for providers to contest reimbursement amounts. Would prohibit pharmacy benefit managers from requiring accreditation or licensing of providers other than by State Board of Pharmacy.||Active – Introduced|
|2017||SB 478||HEALTH CARE CHOICE ACT: Allows Oklahomans to purchase insurance from surrounding states, if the final carrier decides to pull out of Oklahoma. However, insurance purchased from surrounding states still requires must still conform to the state’s insurance mandate laws.||Passed – Signed by Governor on 5/31/17.|
We compile state statutes relate to healthcare price and competition, including healthcare transparency, markets, and costs. For a complete listing of all health related statutes visit the State Health Practice Database for Research.
Transparency in Healthcare
- St. Ann. § 63-1-115 et seq., the “Oklahoma Health Care Information System Act,” creates the Division of Health Care Information within the State Department of Health for the purposes of collecting health care information from providers, establishing and maintaining a uniform health care information system, analyzing healthcare data, and disseminating the data and reports. “The act specifies a uniform set of discharge data that will be periodically and routinely compiled,” which is available here.
- St. Ann. § 36-3641, the “Life Accident and Health Insurance Policy Language Simplification Act,” sets a minimum readability standard for health insurance policy forms issued in Oklahoma.
- St. Ann. § 63-7100.1 through 7100.7, the “Oklahoma Health Information Exchange Act,” clarifies provider’s duties with respect to federal and state privacy law by directing the State Board of Health to adopt and distribute a standard authorization form for use in obtaining authorization for the exchange of health information. Persons exchanging health information obtained with the form are immunized from liability based on state privacy or privilege law.
- St. Ann. § 36-309.2 et seq. permits the Insurance Commissioner to conduct financial and market conduct examinations of insurance companies. Insurers must annually file a market conduct annual statement.
- St. Ann. § 36-4415 requires that Oklahoma health carriers (insurers authorized to do business in the state) must submit health plan premium rates to the Insurance Department for information purposes only. Oklahoma is one of the few states that does not have an effective rate review program.
- St. Ann. § 36-1203 et seq. prohibits unfair methods of competition and unfair and deceptive businesses practices in the provision of insurance.
- St. Ann. § 36-1219.1 through 1220, the “Health Care Fraud Prevention Act,” prohibits modifications of existing policies without written consent, among other fraud prevention strictures.
- St. Ann. 63-1-880.1 requires that every person desiring to establish or expand a psychiatric or chemical dependency facility or unit must obtain a certificate of need from the State Commissioner of Health.
- St. Ann. § 63-1-851.1 requires that every person desiring to establish or expand a long-term care facility must obtain a certificate of need from the State Commissioner of Health.
- St. Ann. § 63-5004 through 5027, the “Oklahoma Health Care Authority Act,” establishes the Oklahoma Health Care Authority, which is responsible for purchasing and administering health care for state employees and to administer state-subsidized health care coverage for Medicaid recipients.
- St. Ann § 63-1-711 directs the State Commissioner of Health to conduct a survey and inventory of all existing public and private hospitals, health centers, and related health facilities in the state to evaluate their collective ability to supply the necessarily physical facilities for providing adequate care to the state as a whole.
FY 2018 BUDGET
Oklahoma’s fiscal year begins on July 1 and ends on June 30 in the following year. Oklahoma enacted its FY 2018 Budget during the regular legislative session. To view Oklahoma’s FY 2018 Budget, click here.
- None identified