1 STATE OF OKLAHOMA
1
2 2nd Session of the 59th Legislature (2024)
2
3 HOUSE BILL 3508 By: Sneed
3
4
4
5
5
6 AS INTRODUCED
6
7 An Act relating to the Employee Group Insurance
7 Division; transferring the Employee Group Insurance
8 Division from the Office of Management and Enterprise
8 Services to the Oklahoma Public Employee Retirement
9 System; amending 36 O.S. 2021, Section 6802, which
9 relates to definitions for the Oklahoma Telemedicine
10 Act; transferring the Employee Group Insurance
10 Division from the Office of Management and Enterprise
11 Services to the Oklahoma Public Employee Retirement
11 System; amending 63 O.S. 2021, Section 2-309I, as
12 amended by Section 1, Chapter 257, O.S.L. 2022 (63
12 O.S. Supp. 2023, Section 2-309I), which relates to
13 prescription requirements for opioids and
13 benzodiazepines; transferring the Employee Group
14 Insurance Division from the Office of Management and
14 Enterprise Services to the Oklahoma Public Employee
15 Retirement System; amending 74 O.S. 2021, Section
15 1304.1, which relates to Oklahoma Employees Insurance
16 and Benefits Board; transferring the Employee Group
16 Insurance Division from the Office of Management and
17 Enterprise Services to the Oklahoma Public Employee
17 Retirement System; amending 85A O.S. 2021, Section
18 50, which relates to employer required to provide
18 prompt medical treatment and fee schedule;
19 transferring the Employee Group Insurance Division
19 from the Office of Management and Enterprise Services
20 to the Oklahoma Public Employee Retirement System;
20 providing for codification; providing an effective
21 date; and declaring an emergency.
21
22
22
23
23
24
24
Req. No. 9553 Page 1
 1 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
1
2 SECTION 1. NEW LAW A new section of law to be codified
2
3 in the Oklahoma Statutes as Section 1304.2 of Title 74, unless there
3
4 is created a duplication in numbering, reads as follows:
4
5 Effective July 1, 2024, the Employee Group Insurance Division of
5
6 the Office of Management and Enterprise Services shall be
6
7 transferred to the Oklahoma Public Employees Retirement System. All
7
8 unexpended funds, property, records, personnel, and any outstanding
8
9 financial obligations or encumbrances of the Office of Management
9
10 and Enterprise Services which relate to the Employee Group Division
10
11 Insurance Division are hereby transferred to the Oklahoma Public
11
12 Employees Retirement System.
12
13 SECTION 2. AMENDATORY 36 O.S. 2021, Section 6802, is
13
14 amended to read as follows:
14
15 Section 6802. As used in the Oklahoma Telemedicine Act:
15
16 1. "Distant site" means a site at which a health care
16
17 professional licensed to practice in this state is located while
17
18 providing health care services by means of telemedicine;
18
19 2. a. "Health benefits plan" means any plan or arrangement
19
20 that:
20
21 (1) provides benefits for medical or surgical
21
22 expenses incurred as a result of a health
22
23 condition, accident or illness, and
23
24
24
Req. No. 9553 Page 2
 1 (2) is offered by any insurance company, group
1
2 hospital service corporation or health
2
3 maintenance organization that delivers or issues
3
4 for delivery an individual, group, blanket or
4
5 franchise insurance policy or insurance
5
6 agreement, a group hospital service contract or
6
7 an evidence of coverage, or, to the extent
7
8 permitted by the Employee Retirement Income
8
9 Security Act of 1974, 29 U.S.C., Section 1001 et
9
10 seq., by a multiple employer welfare arrangement
10
11 as defined in Section 3 of the Employee
11
12 Retirement Income Security Act of 1974, or any
12
13 other analogous benefit arrangement, whether the
13
14 payment is fixed or by indemnity,
14
15 b. Health benefits plan shall not include:
15
16 (1) a plan that provides coverage:
16
17 (a) only for a specified disease or diseases or
17
18 under an individual limited benefit policy,
18
19 (b) only for accidental death or dismemberment,
19
20 (c) only for dental or vision care,
20
21 (d) for a hospital confinement indemnity policy,
21
22 (e) for disability income insurance or a
22
23 combination of accident-only and disability
23
24 income insurance, or
24
Req. No. 9553 Page 3
 1 (f) as a supplement to liability insurance,
1
2 (2) a Medicare supplemental policy as defined by
2
3 Section 1882(g)(1) of the Social Security Act (42
3
4 U.S.C., Section 1395ss),
4
5 (3) workers' compensation insurance coverage,
5
6 (4) medical payment insurance issued as part of a
6
7 motor vehicle insurance policy,
7
8 (5) a long-term care policy including a nursing home
8
9 fixed indemnity policy, unless a determination is
9
10 made that the policy provides benefit coverage so
10
11 comprehensive that the policy meets the
11
12 definition of a health benefits plan,
12
13 (6) short-term health insurance issued on a
13
14 nonrenewable basis with a duration of six (6)
14
15 months or less, or
15
16 (7) a plan offered by the Employees Group Insurance
16
17 Division of the Office of Management and
17
18 Enterprise Services Oklahoma Public Employees
18
19 Retirement System;
19
20 3. "Health care professional" means a physician or other health
20
21 care practitioner licensed, accredited or certified to perform
21
22 specified health care services consistent with state law;
22
23 4. "Insurer" means any entity providing an accident and health
23
24 insurance policy in this state including, but not limited to, a
24
Req. No. 9553 Page 4
 1 licensed insurance company, a not-for-profit hospital service and
1
2 medical indemnity corporation, a fraternal benefit society, a
2
3 multiple employer welfare arrangement or any other entity subject to
3
4 regulation by the Insurance Commissioner;
4
5 5. "Originating site" means a site at which a patient is
5
6 located at the time health care services are provided to him or her
6
7 by means of telemedicine, which may include, but shall not be
7
8 restricted to, a patient's home, workplace or school;
8
9 6. "Remote patient monitoring services" means the delivery of
9
10 home health services using telecommunications technology to enhance
10
11 the delivery of home health care including monitoring of clinical
11
12 patient data such as weight, blood pressure, pulse, pulse oximetry,
12
13 blood glucose and other condition-specific data, medication
13
14 adherence monitoring and interactive video conferencing with or
14
15 without digital image upload;
15
16 7. "Store and forward transfer" means the transmission of a
16
17 patient's medical information either to or from an originating site
17
18 or to or from the health care professional at the distant site, but
18
19 does not require the patient being present nor must it be in real
19
20 time; and
20
21 8. "Telemedicine" or "telehealth" means technology-enabled
21
22 health and care management and delivery systems that extend capacity
22
23 and access, which includes:
23
24
24
Req. No. 9553 Page 5
 1 a. synchronous mechanisms, which may include live
1
2 audiovisual interaction between a patient and a health
2
3 care professional or real-time provider-to-provider
3
4 consultation through live interactive audiovisual
4
5 means,
5
6 b. asynchronous mechanisms, which include store and
6
7 forward transfers, online exchange of health
7
8 information between a patient and a health care
8
9 professional and online exchange of health information
9
10 between health care professionals, but shall not
10
11 include the use of automated text messages or
11
12 automated mobile applications that serve as the sole
12
13 interaction between a patient and a health care
13
14 professional,
14
15 c. remote patient monitoring, and
15
16 d. other electronic means that support clinical health
16
17 care, professional consultation, patient and
17
18 professional health-related education, public health
18
19 and health administration.
19
20 SECTION 3. AMENDATORY 63 O.S. 2021, Section 2-309I, as
20
21 amended by Section 1, Chapter 257, O.S.L. 2022 (63 O.S. Supp. 2023,
21
22 Section 2-309I), is amended to read as follows:
22
23 Section 2-309I. A. A practitioner shall not issue an initial
23
24 prescription for an opioid drug in a quantity exceeding a seven-day
24
Req. No. 9553 Page 6
 1 supply for treatment of acute pain. Any opioid prescription for
1
2 acute pain shall be for the lowest effective dose of an immediate-
2
3 release drug.
3
4 B. Prior to issuing an initial prescription for an opioid drug
4
5 in a course of treatment for acute or chronic pain, a practitioner
5
6 shall:
6
7 1. Take and document the results of a thorough medical history,
7
8 including the experience of the patient with nonopioid medication
8
9 and nonpharmacological pain-management approaches and substance
9
10 abuse history;
10
11 2. Conduct, as appropriate, and document the results of a
11
12 physical examination;
12
13 3. Develop a treatment plan with particular attention focused
13
14 on determining the cause of pain of the patient;
14
15 4. Access relevant prescription monitoring information from the
15
16 central repository pursuant to Section 2-309D of this title;
16
17 5. Limit the supply of any opioid drug prescribed for acute
17
18 pain to a duration of no more than seven (7) days as determined by
18
19 the directed dosage and frequency of dosage; provided, however, upon
19
20 issuing an initial prescription for acute pain pursuant to this
20
21 section, the practitioner may issue one (1) subsequent prescription
21
22 for an opioid drug in a quantity not to exceed seven (7) days if:
22
23
23
24
24
Req. No. 9553 Page 7
 1 a. the subsequent prescription is due to a major surgical
1
2 procedure or "confined to home" status as defined in
2
3 42 U.S.C., Section 1395n(a),
3
4 b. the practitioner provides the subsequent prescription
4
5 on the same day as the initial prescription,
5
6 c. the practitioner provides written instructions on the
6
7 subsequent prescription indicating the earliest date
7
8 on which the prescription may be filled, otherwise
8
9 known as a "do not fill until" date, and
9
10 d. the subsequent prescription is dispensed no more than
10
11 five (5) days after the "do not fill until" date
11
12 indicated on the prescription;
12
13 6. In the case of a patient under the age of eighteen (18)
13
14 years, enter into a patient-provider agreement with a parent or
14
15 guardian of the patient; and
15
16 7. In the case of a patient who is a pregnant woman, enter into
16
17 a patient-provider agreement with the patient.
17
18 C. No less than seven (7) days after issuing the initial
18
19 prescription pursuant to subsection A of this section, the
19
20 practitioner, after consultation with the patient, may issue a
20
21 subsequent prescription for the drug to the patient in a quantity
21
22 not to exceed seven (7) days, provided that:
22
23 1. The subsequent prescription would not be deemed an initial
23
24 prescription under this section;
24
Req. No. 9553 Page 8
 1 2. The practitioner determines the prescription is necessary
1
2 and appropriate to the treatment needs of the patient and documents
2
3 the rationale for the issuance of the subsequent prescription; and
3
4 3. The practitioner determines that issuance of the subsequent
4
5 prescription does not present an undue risk of abuse, addiction or
5
6 diversion and documents that determination.
6
7 D. Prior to issuing the initial prescription of an opioid drug
7
8 in a course of treatment for acute or chronic pain and again prior
8
9 to issuing the third prescription of the course of treatment, a
9
10 practitioner shall discuss with the patient or the parent or
10
11 guardian of the patient if the patient is under eighteen (18) years
11
12 of age and is not an emancipated minor, the risks associated with
12
13 the drugs being prescribed, including but not limited to:
13
14 1. The risks of addiction and overdose associated with opioid
14
15 drugs and the dangers of taking opioid drugs with alcohol,
15
16 benzodiazepines and other central nervous system depressants;
16
17 2. The reasons why the prescription is necessary;
17
18 3. Alternative treatments that may be available; and
18
19 4. Risks associated with the use of the drugs being prescribed,
19
20 specifically that opioids are highly addictive, even when taken as
20
21 prescribed, that there is a risk of developing a physical or
21
22 psychological dependence on the controlled dangerous substance, and
22
23 that the risks of taking more opioids than prescribed or mixing
23
24
24
Req. No. 9553 Page 9
 1 sedatives, benzodiazepines or alcohol with opioids can result in
1
2 fatal respiratory depression.
2
3 The practitioner shall include a note in the medical record of
3
4 the patient that the patient or the parent or guardian of the
4
5 patient, as applicable, has discussed with the practitioner the
5
6 risks of developing a physical or psychological dependence on the
6
7 controlled dangerous substance and alternative treatments that may
7
8 be available. The applicable state licensing board of the
8
9 practitioner shall develop and make available to practitioners
9
10 guidelines for the discussion required pursuant to this subsection.
10
11 E. At the time of the issuance of the third prescription for an
11
12 opioid drug, the practitioner shall enter into a patient-provider
12
13 agreement with the patient.
13
14 F. When an opioid drug is continuously prescribed for three (3)
14
15 months or more for chronic pain, the practitioner shall:
15
16 1. Review, at a minimum of every three (3) months, the course
16
17 of treatment, any new information about the etiology of the pain,
17
18 and the progress of the patient toward treatment objectives and
18
19 document the results of that review;
19
20 2. In the first year of the patient-provider agreement, assess