The bill amends the Oklahoma Right to Shop Act by updating definitions and clarifying the obligations of insurance carriers regarding shared savings incentive programs. Notably, it introduces the term "Average allowed amount," which refers to the mean of all allowed amounts paid for comparable health care services. The bill also modifies existing definitions, such as changing "may" to "shall" in relation to the requirement for insurance carriers to offer shared savings incentive programs and to provide incentives to enrollees who choose lower-cost providers. Additionally, it specifies that if a provider's allowed amount is below the average allowed amount, they must agree to accept a lower amount to participate in the program.
Furthermore, the bill outlines the responsibilities of insurance carriers in administering these programs, including the requirement to notify enrollees about the program's availability and to publish a list of comparable health care services and applicable incentives on their websites. It mandates that shared savings incentives must be at least 25% of the savings generated by the enrollee's participation and establishes reporting requirements for insurance carriers to the Insurance Department. The act is set to take effect on November 1, 2025.