Bill > SB1553

This bill amends Oklahoma's Medicaid program to specify qualifications for psychologists reviewing appeals of adverse determinations, which are decisions made by a contracted entity (like an insurance company) that deny or limit a member's or provider's requested service. The bill clarifies that a licensed psychologist or other mental health professional can review appeals if they meet certain criteria, including having appropriate training and experience related to the condition in question, and not being involved in the original adverse determination or having a financial interest in the appeal's outcome. Importantly, if an adverse determination is overturned during a fair hearing (a formal process for members or providers to challenge decisions), the bill allows psychologists or other mental health providers to recover costs for the time and expenses they incurred during the appeal process, with the calculation of these costs considering the time that could have been spent providing patient services. The bill also updates statutory language and sets an effective date of November 1, 2026.

Budget and Finance, Health and Social Services

http://www.oklegislature.gov/BillInfo.aspx?Bill=sb1553&Session=2600