Bill > SB1673

This bill, known as the "Prosthetic Access and Accountability Act 2026," aims to improve access to and coverage for prosthetic and orthotic devices for individuals with health benefit plans in Oklahoma, excluding flexible benefit plans. It establishes that the primary goal of treatment for these benefits should be to restore physical function to the greatest extent possible, as determined by the treating provider, and prohibits discrimination based on disability. The bill clarifies that medical necessity should be based on a patient's functional goals and not limited by diagnosis, age, or disability, and that denials based on cost or classification as "deluxe" or "nonessential" are presumed invalid if the prescribed device is needed for documented functional needs. Health benefit plans must ensure access to medically necessary clinical care and devices from an adequate number of in-network orthotists and prosthetists, and if an in-network provider is unavailable due to geographic location, the plan must facilitate referral to an out-of-network provider and fully reimburse them. Furthermore, if a health benefit plan denies or unreasonably delays a physician-prescribed device, it can be held liable for any resulting personal injury, financial loss, or harm, with a rebuttable presumption of negligence if an adverse health event occurs during the denial or delay period, potentially leading to compensatory, noneconomic, and punitive damages. The bill also states that insurers will assume medical liability if they deny, modify, or override a claim for a physician-prescribed device and the patient experiences harm, protecting providers from liability in such cases. The Insurance Commissioner is empowered to investigate complaints, enforce the act, and issue rules and regulations, with health benefit plans facing fines, daily penalties for delays, or even revocation of their certificate of authority for violations. Coverage requests for prostheses and orthoses must be reviewed within two business days for urgent requests and ten business days for standard requests, with automatic approval if a response is not provided within these timeframes, and individuals harmed by violations have the right to pursue civil action.

Budget and Finance, Business and Industry

http://www.oklegislature.gov/BillInfo.aspx?Bill=sb1673&Session=2600