SB 1553: Medicaid; specifying certain qualifications for appeals; providing for recovery of certain costs. Effective date. - Oklahoma

Floor (House) → Floor (Senate) · 5 edits

MODERATE

The bill was amended to clarify that appeals for Medicaid adverse determinations must be reviewed by a licensed physician, psychologist, or mental health professional, explicitly prohibiting the use of automated software for these reviews. The Senate version also added a requirement for the reviewing professional to possess specific training and experience relevant to the medical condition in question and to consider all pertinent medical records. Additionally, the bill now allows psychologists and mental health professionals to recover reasonable costs and expenses from the contracted entity if their appeal is successful.

Scope change

The scope of the bill was expanded to include psychologists and mental health professionals as qualified reviewers for appeals, whereas the House version focused primarily on physicians. The applicability of the review process is now strictly limited to human professionals, excluding automated systems.

REQUIREMENT

Added a strict prohibition on using automated claim review software or any automated functionality to conduct appeals.

Added specific qualifications for the reviewing professional, requiring them to have training and experience sufficient to determine if the service is medically necessary or clinically appropriate.

Modified the list of qualified reviewers to explicitly include licensed psychologists and mental health professionals alongside physicians.

FISCAL

Added a provision allowing successful appellants (psychologists or mental health professionals) to recover time and expenses from the contracted entity if the adverse determination is reversed.

DEFINITION

Clarified the criteria for a psychologist's qualifications, requiring current licensure under the Psychologists Licensing Act and specific training in testing and treatment of the condition.

Enrolled (final version) → SB1553 (3-24-26) (KERN) FA1.PDF · 3 edits

MINOR

The bill was amended to remove a specific requirement that appeal reviewers must have board certification or specific training regarding the condition in question, replacing it with a simpler standard of having general training and experience. The amendment also corrects the bill's title to accurately reflect the removal of the certification requirement. This change reduces the qualifications needed for psychologists and mental health professionals reviewing Medicaid appeals, potentially allowing more providers to participate in the review process.

Scope change

The scope of eligible reviewers for Medicaid appeals was broadened by removing specific certification and training requirements for psychologists and mental health professionals.

REQUIREMENT

Deleted the requirement that appeal reviewers must possess board certification for the specific medical condition in question.

Deleted the requirement that psychologists must have specific training and experience in testing for and treating the condition in question.

TITLE

Updated the bill title to remove references to the deleted certification and training requirements.

Engrossed → Enrolled (final version) · 3 edits · May 13, 2026

MINOR

The bill was finalized and enacted into law, adding a new Section F to allow members or providers to request a fair hearing with the Oklahoma Health Care Authority if an appeal is denied. The text was also updated to reflect the final enrolled version, including specific passage dates in March and May 2026 and the effective date of November 1, 2026.

Scope change

The bill's scope was expanded by adding a new subsection (F) that grants the right to a fair hearing after an internal appeal is exhausted, which was not present in the engrossed draft.

REQUIREMENT

Added a new requirement (Section F) allowing members or providers to request a fair hearing from the Authority if an adverse determination is upheld after an internal appeal.

TIMELINE

Updated the effective date to November 1, 2026, and added specific passage dates for the Senate (March 25, 2026) and House (May 6, 2026).

TECHNICAL

Changed the header from 'ENGROSSED SENATE' to 'ENROLLED SENATE' and updated page footers to reflect the final enrolled status.

Introduced → Engrossed · 3 edits · Mar 26, 2026

MINOR

The bill was updated from its initial introduction to its final engrossed version, incorporating signatures from both the Senate and House of Representatives and adding a signature line for the House Presiding Officer. The substantive policy content regarding Medicaid appeal procedures, psychologist qualifications, and cost recovery remains unchanged.

TECHNICAL

The header was updated to reflect the bill's final status as 'Engrossed' with signatures from the Senate and House, indicating it has passed both chambers.

A signature line for the Presiding Officer of the House of Representatives was added to the bottom of the document.

The original 'As Introduced' header and page numbering were replaced with the final 'Engrossed' formatting.

Medicaid; specifying certain qualifications for appeals; providing for recovery of certain costs. Effective date.

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