1 STATE OF OKLAHOMA
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2 1st Session of the 59th Legislature (2023)
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3 SENATE BILL 442 By: Montgomery
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6 AS INTRODUCED
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7 An Act relating to health benefit plan directories;
7 defining terms; directing plans to publish certain
8 provider directories on certain website; describing
8 information to be included in directory; requiring
9 directory to be publicly accessible; directing plan
9 to publish certain criteria; requiring print copy of
10 directory be provided to an insured upon request;
10 providing for accessibility of certain directories;
11 requiring certain disclosure; providing for reporting
11 procedure; requiring plan response to report by
12 certain date; directing plan to maintain and update
12 directory; requiring annual audit of certain
13 information; requiring notice to be provided to
13 certain providers by plan; directing plan to remove
14 certain providers after certain time period;
14 directing plan to submit certain information to
15 Insurance Commissioner; establishing procedure for
15 certain use of inaccurate information by insured;
16 requiring reimbursement by plan under certain
16 circumstances for care provided by out-of-network
17 provider; directing Commissioner to promulgate rules;
17 providing for codification; and providing an
18 effective date.
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21 BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
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22 SECTION 1. NEW LAW A new section of law to be codified
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23 in the Oklahoma Statutes as Section 6971 of Title 36, unless there
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24 is created a duplication in numbering, reads as follows:
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 1 A. As used in this section:
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2 1. “Health benefit plan” means a plan as defined pursuant to
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3 Section 6060.4 of Title 36 of the Oklahoma Statutes;
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4 2. “Health care facility” means a facility as defined pursuant
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5 to Section 1-725.2 of Title 63 of the Oklahoma Statutes;
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6 3. “Health care professional” means a professional as defined
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7 pursuant to Section 6802 of Title 36 of the Oklahoma Statutes;
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8 4. “Hospital” means a hospital as defined pursuant to Section
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9 1-701 of Title 63 of the Oklahoma Statutes; and
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10 5. “Provider” means a health care provider as defined pursuant
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11 to Section 6571 of Title 36 of the Oklahoma Statutes.
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12 B. Any insurer of a health benefit plan that is offered,
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13 issued, or renewed in this state on or after the effective date of
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14 this act shall publish an electronic and printed provider directory
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15 for each of its network plans, to be updated every thirty (30) days.
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16 The insurer shall make clear the provider directory that applies to
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17 each network plan as marketed and issued in this state. The
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18 electronic directory shall be published on an easily accessible
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19 website in a standardized, downloadable, and searchable format. The
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20 electronic and printed directory shall include the following
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21 information:
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22 1. For health care professionals:
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23 a. name,
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24 b. gender,
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 1 c. contact information, including a website address,
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2 d. participating office location or locations,
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3 e. specialty, if applicable,
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4 f. board certifications,
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5 g. medical group affiliations,
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6 h. participating facility affiliations,
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7 i. languages spoken other than English by the
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8 professional or clinical staff, if applicable, and
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9 j. whether they are accepting new patients;
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10 2. For hospitals:
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11 a. hospital name,
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12 b. hospital type, including, but not limited to, acute,
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13 rehabilitation, children’s, or cancer,
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14 c. participating hospital location,
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15 d. hospital accreditation status,
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16 e. customer service telephone number, and
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17 f. website address; and
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18 3. For health care facilities other than hospitals:
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19 a. facility name,
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20 b. facility type,
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21 c. types of services performed,
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22 d. participating facility location or locations,
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23 e. customer service telephone number, and
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24 f. website address.
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 1 C. Any insurer of a health benefit plan that publishes a
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2 provider directory pursuant to this section shall ensure that the
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3 general public is able to view all of the current providers for a
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4 network plan, through a clearly identifiable hyperlink or website
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5 tab, without requiring any person to create or sign into an account
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6 or submit a policy or contract number.
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7 D. For each network plan published, an insurer of a health
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8 benefit plan shall include in plain language the following
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9 information:
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10 1. A description of the criteria used to build its provider
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11 network; and
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12 2. If applicable:
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13 a. a description of the criteria used to tier providers,
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14 b. how the plan designates the different provider tiers
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15 or levels, including, but not limited to, by name,
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16 symbols, or grouping, in the network and for each
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17 specific provider in the network, which tier each is
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18 placed for an insured or a prospective insured to be
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19 able to identify the provider tier, and
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20 c. a notice that authorization or referral may be
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21 required to access some providers.
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22 E. 1. An insurer of a health benefit plan shall, upon written
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23 request by an insured or prospective insured, provide a print copy
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 1 of the most up-to-date provider directory or a copy of any requested
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2 provider information from the directory.
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3 2. Provider directories, whether in electronic or print format,
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4 shall be accessible to individuals with disabilities and individuals
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5 with limited English proficiency as defined in 45 C.F.R. Sections
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6 92.201 and 155.205.
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7 3. The plan shall include a disclosure in any print directory
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8 issued under this subsection that the information in the directory
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9 is accurate as of the date of printing and that an insured or
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10 prospective insured should consult the plan’s electronic provider
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11 directory on its website or call the listed customer service
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12 telephone number to obtain current provider directory information.
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13 F. 1. The health benefit plan shall include in both its online
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14 and print directories a clearly identifiable telephone number, email
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15 address, or link to a webpage by which an insured or the general
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16 public may use to report to the plan inaccurate information listed
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17 in the provider directory. Whenever a plan receives a report, it
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18 shall promptly investigate the report and, not later than thirty
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19 (30) days following the receipt of such report, either verify the
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20 accuracy of the information or update the information.
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21 2. A plan shall take appropriate steps to ensure the accuracy
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22 of the information concerning each provider listed in the plan’s
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23 provider directory and shall, no later than January 1, 2024, review
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24 and update the entire provider directory for each network plan
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 1 offered. The plan shall contact providers as necessary to ensure
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2 that the information provided in the directory is up to date.
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3 3. The plan shall, at least annually, audit its provider
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4 directories for accuracy. The plan shall retain documentation of
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5 any audit conducted under this paragraph to be made available to the
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6 Insurance Commissioner. Based on the results of a given audit, the
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7 plan shall verify and attest to the accuracy of the information or
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8 update the information.
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9 G. An insurer of a health benefit plan shall, by certified
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10 mail, return receipt requested, or by electronic mail, read receipt
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11 requested, notify any provider of its removal from the network if
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12 the provider has not submitted claims to the plan or otherwise
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13 communicated intent to continue participation in the plan’s network
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14 within a twelve-month period. If the provisions of the contract
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15 entered between the plan and the provider provides notice terms, the
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16 notice shall be provided in accordance with such terms. If the plan
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17 does not receive a response from the provider within thirty (30)
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18 days of such notification, the plan shall remove the provider from
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19 the network.
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20 H. In accordance with any timeframes and requirements that may
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21 be established by the Commissioner, an insurer of a health benefit
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22 plan shall report to the Commissioner the following:
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 1 1. The number of reports received pursuant to subsection F of
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2 this section, the timeliness of the plan’s response, and the
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3 corrective action or actions taken; and
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4 2. All auditing reports conducted by the plan pursuant to
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5 subsection F of this section.
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6 I. If an insured reasonably relies upon materially inaccurate
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7 information contained in a plan’s provider directory, the
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8 Commissioner may require the plan to provide coverage for all
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9 covered health care services provided to the insured and to
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10 reimburse the insured for any amount that he or she would have to
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11 pay if the services would have been delivered by an in-network
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12 provider under the network plan. Provided, the Commissioner shall
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13 take into consideration that health benefit plan insurers are
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14 relying on health care providers to report changes to their
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15 information prior to requiring any reimbursement to an insured. In
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16 the event that the Commissioner finds that the provider has not
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17 provided updated information for the network directory of the
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18 insurer of a health benefit plan, the Commissioner may require that
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19 the provider be reimbursed at the assignment of benefits rate for
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20 the service if it were conducted in-network. Prior to requiring
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21 reimbursement under this subsection, the Commissioner shall conclude
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22 that the services received by the plan were covered services under
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23 the insured’s network plan. If the services satisfy requirements of
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 1 this subsection, a plan shall not deny reimbursement to an insured
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2 based on the provider of the services being out-of-network.
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3 J. The Commissioner shall promulgate rules to effectuate the
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4 provisions of this section.
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5 SECTION 2. This act shall become effective November 1, 2023.
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7 59-1-515 RD 1/17/2023 9:33:27 AM
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