STATE OF OKLAHOMA

1st Session of the 53rd Legislature (2011)

SENATE BILL 35	By:	Wilson

AS INTRODUCED

An Act relating to health care billing; prohibiting health care providers from pursuing certain collection efforts for specified charges; defining terms; directing health care providers to remit certain amount to the Oklahoma Uninsured and Underinsured Revolving Fund; creating the Oklahoma Uninsured and Underinsured Revolving Fund; directing the Oklahoma Health Care Authority to mediate in certain formal dispute resolution process; authorizing the Authority to collect certain fee; directing the Oklahoma Health Care Authority Board to promulgate rules; providing for codification; and providing an effective date.

BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1-1730 of Title 63, unless there is created a duplication in numbering, reads as follows:
A.  No health care provider shall pursue collection efforts, including, but not limited to, liens, litigations and credit agency reporting, for any billed amount in excess of the Medicare reimbursement rate.
B.  For purposes of this section, “health care provider” means any person or entity who provides health care services, including, but not limited to, hospitals, ambulatory surgical centers, physicians, physical therapists, physician assistants, nurses and home health care providers licensed pursuant to the laws of this state.
SECTION 2.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1-1731 of Title 63, unless there is created a duplication in numbering, reads as follows:
A.  Health care providers shall remit any amount billed in excess of one hundred fifty percent (150%) of the Medicare reimbursement rate to the Oklahoma Uninsured and Underinsured Revolving Fund.
B.  There is hereby created in the State Treasury a revolving fund for the Oklahoma Health Care Authority to be designated the “Oklahoma Uninsured and Underinsured Revolving Fund”.  The fund shall be a continuing fund, not subject to fiscal year limitations, and shall consist of all monies received by the Oklahoma Health Care Authority from health care facilities pursuant to subsection A of this section.  All monies accruing to the credit of the fund are hereby appropriated and may be budgeted and expended by the Oklahoma Health Care Authority for the purpose of providing medical assistance to the uninsured and underinsured.  Expenditures from the fund shall be made upon warrants issued by the State Treasurer against claims filed as prescribed by law with the Director of State Finance for approval and payment.
C.  For purposes of this section, “health care provider” means any person or entity who provides health care services, including, but not limited to, hospitals, ambulatory surgical centers, physicians, physical therapists, physician assistants, nurses and home health care providers licensed pursuant to the laws of this state.
SECTION 3.     NEW LAW     A new section of law to be codified in the Oklahoma Statutes as Section 1-1732 of Title 63, unless there is created a duplication in numbering, reads as follows:
A.  If, after three attempts to informally resolve a dispute over a billed charge, a third-party payor and a health care provider cannot agree on the amount owed by the health care consumer, the Oklahoma Health Care Authority shall mediate the dispute through a formal dispute resolution process.
B.  The Authority is authorized to require the health care provider and/or the third-party payor to remit a fee to the Authority for costs of resolving the dispute.
C.  The Oklahoma Health Care Authority Board shall promulgate rules as necessary to implement the provisions of this section, including, but not limited to, the formal processes for dispute resolution and criteria for determining a fee pursuant to subsection B of this section.
D.  For purposes of this section:
1.  “Health care provider” means any person or entity who provides health care services, including, but not limited to, hospitals, ambulatory surgical centers, physicians, physical therapists, physician assistants, nurses and home health care providers licensed pursuant to the laws of this state; and
2.  “Third-party payor" means any entity, other than a purchaser, which is responsible for payment either to the purchaser or the health care provider for health care services rendered by the health care provider.
SECTION 4.  This act shall become effective November 1, 2011.

53-1-83	JM	1/15/2004 3:54:30 AM