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," which outlines the criteria for denying healthcare services based on medical necessity. It also expands the "Children's Specialty Plan" definition to include more categories of children eligible for Medicaid services starting July 1, 2026. Additionally, the bill clarifies the responsibilities of contracted entities, including the implementation of application programming interfaces and establishing timeframes for prior authorization decisions.

The legislation removes certain existing requirements for contracted entities concerning prior authorizations and appeals, while emphasizing the importance of timely determinations and communication, especially in urgent situations. It mandates that prior authorization criteria be accessible on websites and that providers and members be notified of changes at least 60 days in advance. The bill also requires that all adverse determinations be made by licensed professionals with relevant expertise and sets specific timelines for decisions based on the urgency of requests. Furthermore, it establishes a deadline for implementing a Prior Authorization Application Programming Interface by January 1, 2027, and ensures that healthcare services will be deemed authorized if deadlines are not met. The new provisions are 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