House Bill No. 1810 amends the Oklahoma Medicaid program by updating definitions and requirements related to prior authorizations and appeals of adverse determinations. The bill introduces new terms such as "adverse determination" and "urgent health care service," while expanding the eligibility criteria for the "Children's Specialty Plan." It clarifies the responsibilities of contracted entities, emphasizing the need for timely prior authorization determinations and the implementation of application programming interfaces. The bill also repeals outdated definitions and requirements to streamline the Medicaid program's statutory framework, aiming to enhance clarity and efficiency in accessing health care services.

Additionally, the bill mandates that contracted entities make prior authorization requirements and clinical criteria accessible online and notify members and providers of any changes at least 60 days in advance. It requires that all adverse determinations be made by licensed professionals and establishes strict deadlines for processing requests. The bill also sets a timeline for implementing a Prior Authorization Application Programming Interface by January 1, 2027, and ensures that providers are reimbursed at contracted rates for services rendered under prior authorizations. With an emergency clause for immediate effect upon passage, the bill is set to take effect on November 1, 2025.

Statutes affected:
Introduced: 56-4002.6
Senate Committee Substitute for House Bill: 56-4002.2, 56-4002.6, 56-4002.8
Floor (House): 56-4002.6
Floor (Senate): 56-4002.2, 56-4002.6, 56-4002.8
Engrossed: 56-4002.2, 56-4002.6
Amended And Engrossed: 56-4002.2, 56-4002.6, 56-4002.8
Enrolled (final version): 56-4002.2, 56-4002.6, 56-4002.8