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

Replaced a lengthy, multi-page list of definitions with a streamlined version that redefines 'adverse determination' and 'emergency health care services' to explicitly reference federal EMTALA standards.

Removed the definition for 'Claims denial error rate' and significantly altered the definition of 'Contracted entity' to exclude specific types of organizations previously listed.

Added a comprehensive list of licensed professionals under the new definition for 'Licensed mental health professional,' including clinical social workers, counselors, and advanced practice nurses.

Deleted the original act title and detailed legislative history, replacing them with a standard 'Be It Enacted' format and a new Section 1 that amends the relevant Oklahoma Statutes.

The document structure was updated to include page numbers, request numbers, and committee substitute headers, while the actual legislative text and definitions were preserved without substantive changes.

The bill title and summary were updated to explicitly reference the 'State Medicaid program' and the 'Ensuring Access to Medicaid Act'.

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 'Medically necessary'.

The definition of 'Health care services' was expanded to include mental health and substance use disorder services but explicitly excludes the provision, administration, or prescription of pharmaceutical products.

The definition of 'Adverse determination' was updated to refer to 'contracted entities' and the 'Oklahoma Health Care Authority' instead of generic health carriers.

The definition of 'Health care provider' was removed and replaced with a focus on 'contracted entities' in the context of Medicaid administration.

The definition of 'Emergency health care services' was expanded to include stabilization services provided at independent freestanding emergency departments, ensuring compliance with federal emergency medical treatment laws.

The definition of 'Health care provider' was updated to explicitly list specific licensed mental health professionals (psychiatrists, psychologists, counselors, etc.) and clinical social workers, clarifying their eligibility under the Medicaid program.

The definition of 'Adverse determination' was rephrased to clarify that it applies to any denial, reduction, or termination of a covered benefit based on medical necessity or appropriateness.

The document title and sponsorship were changed from 'Engrossed Senate Amendment' to 'Engrossed House Bill,' reflecting the legislative process stage.

The bill title and summary were changed to explicitly focus on the state Medicaid program rather than general health care.

New definitions were added to protect specific vulnerable populations, including children in foster care, former foster youth up to age 25, juvenile-justice-involved children, and children receiving adoption assistance.

The definition of 'Emergency health care services' was updated to align with federal EMTALA standards for Medicaid beneficiaries.

A new requirement was added to prohibit prior authorization for emergency services.

New definitions were introduced for 'Accountable care organization,' 'Claims denial error rate,' 'Capitated contract,' 'Clean claim,' and 'Commercial plan.'

The definition of 'Licensed mental health professional' was expanded to include professional counselors, clinical social workers, and licensed marital and family therapists.