HB 1810: Medicaid; modifying, adding, and removing certain prior authorization requirements for contracted entities; effective date; emergency. - Oklahoma

Floor (House) → Floor (Senate) · 7 edits

MODERATE

The bill was amended from its House version to a Senate version that significantly broadens its scope from general prior authorization rules to specifically address the state Medicaid program. The Senate version adds extensive definitions related to Medicaid, including new categories for children in foster care and other special populations, and expands the list of contracted entities and services covered under the Medicaid program.

Scope change

The bill's scope changed from general health care prior authorization rules to specifically focus on the state Medicaid program, adding definitions and requirements specific to Medicaid contracted entities and services.

SCOPE

Changed the bill's title and scope from general prior authorization rules to specifically address the state Medicaid program and contracted entities.

DEFINITION

Added new definitions for Medicaid-specific terms including 'Accountable care organization', 'Claims denial error rate', 'Capitated contract', 'Children's Specialty Plan', and expanded 'Contracted entity' definition.

Added detailed definitions for licensed mental health professionals including specific licensure requirements for psychiatrists, psychologists, counselors, social workers, and other mental health practitioners.

Added definition for 'Clean claim' specifying billing requirements and coding standards for Medicaid claims.

ELIGIBILITY

Expanded eligibility definitions for Children's Specialty Plan to include children in foster care, former foster care children up to age 25, juvenile-justice-involved children, children receiving adoption assistance, and specific categories of children in Family Centered Services cases.

REQUIREMENT

Modified requirements to focus on Medicaid contracted entities rather than general health carriers, including provisions for adverse determinations, appeals, and reimbursement specific to Medicaid.

TIMELINE

Added specific implementation timeline for certain children's services starting July 1, 2026, including provisions for Family Centered Services cases.

Senate Committee Substitute for House Bill → Floor (House) · 5 edits

MODERATE

The bill was renumbered and reorganized from a committee substitute version to a floor version for the House of Representatives. The substantive policy content regarding Medicaid prior authorization rules and definitions remains largely the same, though the bill's title and introductory language were updated to reflect its current legislative stage.

Scope change

The bill's scope remains focused on amending Oklahoma Medicaid prior authorization requirements, but the document structure was standardized for floor consideration.

TECHNICAL

Removed 'Committee Substitute' designation and replaced with 'House Bill 1810' as introduced by Newton of the House.

Added 'Floor Version' header indicating this is the version ready for House floor debate.

Removed page numbering and committee amendment markers that were used in the committee version.

DEFINITION

Added new definitions for 'Licensed mental health professional' including professional counselors, clinical social workers, marital and family therapists, behavioral practitioners, advanced practice nurses, physician assistants, and alcohol and drug counselors.

Reorganized and expanded the definition of 'Emergency health care services' to include both emergency medical screening and stabilization services.

Enrolled (final version) → Senate Committee Substitute for House Bill · 3 edits

MINOR

The bill text was reformatted from an enrolled version to a committee substitute version, adding page numbers and committee markings while keeping the substantive legislative content identical. No actual policy changes were made to the Medicaid definitions or requirements.

TECHNICAL

Added page headers, committee substitute markings, and line numbers to the document formatting.

Removed the 'ENROLLED HOUSE' designation and 'SUBJECT' line that appeared in the original enrolled version.

Added 'Committee Substitute for Engrossed House Bill' designation and page numbering throughout the document.

Engrossed → Enrolled (final version) · 8 edits · May 19, 2025

MODERATE

The bill was finalized and enacted into law, moving from its engrossed version to the enrolled version. The text was significantly reorganized and expanded to clarify definitions, modify requirements for prior authorizations under the Medicaid program, and add new provisions related to emergency services, appeals, and reimbursement procedures.

Scope change

The bill's scope was expanded to include additional definitions for Medicaid-related terms, clarify applicability of certain provisions, and add new requirements for contracted entities and emergency services.

DEFINITION

Definitions were updated and renumbered to align with the final enrolled version, including changes to terms like 'Adverse determination', 'Chronic condition', and 'Health care services'.

New definitions were added for 'Accountable care organization', 'Claims denial error rate', 'Capitated contract', 'Children's Specialty Plan', 'Clean claim', 'Commercial plan', 'Contracted entity', 'Dental benefit manager', 'Essential community provider', and others.

Some previously defined terms were removed or consolidated, including certain definitions related to health care providers and services.

REQUIREMENT

Requirements for prior authorizations were modified to include new procedures for emergency services, time periods for determinations, and conditions under which requested services are deemed authorized.

New requirements were added for implementation of application programming interfaces, notice and publication requirements, and certain reimbursement procedures.

ELIGIBILITY

Eligibility criteria were modified to include specific categories of children in the Children's Specialty Plan, such as children in foster care, former foster care children, and children involved in family-centered services cases.

TIMELINE

A new effective date of July 1, 2026 was added for certain provisions related to children involved in Family Centered Services cases and other specific groups.

ENFORCEMENT

Procedures for appeals of adverse determinations were modified, and qualifications for review of appeals were updated.

Amended And Engrossed → Engrossed · 6 edits · May 7, 2025

MODERATE

The bill was amended to change its title and scope from a general Medicaid program amendment to a specific focus on prior authorization requirements. The Senate added a new sponsor (Gillespie) and revised the bill's purpose to emphasize clarifying definitions and modifying requirements for prior authorizations rather than broad Medicaid program changes. The definition of 'Emergency health care services' was expanded to include services required under federal EMTALA laws for independent freestanding emergency departments.

Scope change

The bill's scope narrowed from broad Medicaid program amendments to specifically focus on prior authorization processes and definitions related to emergency care services.

SCOPE

Bill title and purpose changed from general Medicaid program amendments to specifically focus on prior authorization requirements and definitions.

DEFINITION

Added new definition for 'Emergency Medical Treatment and Active Labor Act' (EMTALA) to clarify federal emergency care requirements.

Expanded definition of 'Emergency health care services' to include stabilization services for independent freestanding emergency departments under federal law.

Added new definition for 'Enrollee' to clarify who is covered under the health care plan.

Revised definition of 'Health care provider' to include licensed clinical social workers and behavioral practitioners.

Updated definition of 'Adverse determination' to align with federal standards for medical necessity and coverage decisions.

Introduced → Amended And Engrossed · 7 edits · May 7, 2025

MODERATE

The bill was substantially rewritten and expanded to address prior authorization requirements for the state Medicaid program. The original version focused narrowly on modifying definitions and requirements, while the amended version now includes comprehensive provisions covering adverse determinations, appeals, emergency services, commercial plans, and specific protections for children in foster care and juvenile justice systems.

Scope change

The bill's scope significantly expanded from primarily modifying definitions in existing statutes to establishing comprehensive prior authorization procedures, appeal qualifications, and specific protections for vulnerable populations within the Medicaid program.

SCOPE

Bill title and purpose changed from general prior authorization modifications to specifically address the state Medicaid program with broader provisions including appeals, emergency services, and commercial plan requirements.

ELIGIBILITY

Added specific protections for children in foster care, former foster care children up to age 25, juvenile-justice-involved children, and children receiving adoption assistance to ensure they receive covered Medicaid services.

DEFINITION

New definitions added including 'Accountable care organization', 'Claims denial error rate', 'Capitated contract', 'Children's Specialty Plan', 'Clean claim', 'Commercial plan', and expanded 'Health care services' definition.

REQUIREMENT

Modified adverse determination definition to apply to contracted entities rather than just health carriers, and added requirements for implementation of application programming interfaces and specific time periods for prior authorization determinations.

Added provisions requiring certain opportunity for communication between parties and directing certain reimbursement except under specified conditions.

ENFORCEMENT

Added provisions prohibiting prior authorization under certain conditions and stipulating procedures for emergency services.

TIMELINE

Added effective date provisions and declared an emergency to expedite implementation of the new requirements.

Medicaid; modifying, adding, and removing certain prior authorization requirements for contracted entities; effective date; emergency.

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