This bill amends Section 4002.8 of the Oklahoma Medicaid program to enhance the review and appeal process for adverse determinations made by contracted entities. It specifies that the Oklahoma Health Care Authority will establish uniform procedures for these reviews and appeals. The bill introduces qualifications for the professionals reviewing appeals, allowing licensed psychologists and mental health professionals, in addition to physicians, to participate in the review process. It also mandates that these professionals must not have been involved in the original adverse determination and must possess relevant training and experience.

Additionally, the bill allows members or providers to request a fair hearing from the Authority if their appeal is upheld, and it establishes procedures for recovering costs incurred by psychologists or mental health providers if the adverse determination is reversed during the fair hearing. The effective date for this legislation is set for November 1, 2026.

Statutes affected:
Introduced: 56-4002.8