HB 1853: Health care services; terms; documentation; prohibiting certain billing; deductible; codification; effective date. - Oklahoma

Floor (House) → Floor (Senate) · 5 edits

MODERATE

The bill was amended to shift from a House version to a Senate version, with substantive changes to definitions and payment requirements. The Senate version broadens the scope of covered health benefit plans, modifies how out-of-pocket payments are applied to deductibles, and clarifies documentation requirements for enrollees.

Scope change

The bill's scope expanded to include additional types of health benefit plans and clarified the definition of health care services to explicitly include durable medical equipment.

DEFINITION

The definition of 'health benefit plan' was modified to clarify exclusions, including specific language about Medicare supplemental policies and workers' compensation coverage.

The definition of 'health care service' was modified to explicitly include durable medical equipment, whereas the House version did not explicitly state this inclusion.

REQUIREMENT

The requirement for carriers to count out-of-pocket payments toward deductibles was modified to apply to both the deductible and annual maximum out-of-pocket expense, whereas the House version only specified the deductible.

Documentation requirements were modified to specify that the health care provider must provide the final bill or statement to the enrollee upon request before the enrollee can send documentation to the carrier.

TECHNICAL

The codification section was modified to change the statute citation from Section 6060.50 to Section 6060.51 of Title 36 of the Oklahoma Statutes.

House Committee Substitute → Floor (House) · 3 edits

MINOR

The bill was amended to add the names of additional sponsors (Lepak, Sneed, and Frix) and update the document header to indicate this is the House Floor version. The substantive policy language regarding medical expense out-of-pocket payments, documentation requirements, and insurance provider obligations remains unchanged from the Committee Substitute version.

TECHNICAL

Added names of additional House sponsors (Lepak, Sneed) and Senate sponsor (Frix) to the bill header

Changed document title from 'House Committee Substitute' to 'House of Representatives - Floor Version'

Reformatted page headers and footers to reflect floor version with bold face notation for committee amendments

Proposed Policy Committee Substitute 2 → House Committee Substitute · 3 edits

MINOR

The bill was amended by the House Committee to reorganize and clarify the structure of the legislation. The primary substantive change is the reordering of definitions and provisions, with the committee placing the definition of 'health care service' before the main operative section. The core policy - allowing individuals to pay out-of-pocket for negotiated medical services and have those payments count toward deductibles and out-of-pocket maximums - remains intact without substantive policy changes.

Scope change

No change to the scope or applicability of the bill; the amendment is primarily structural.

TECHNICAL

The document header was changed from 'Proposed Policy Committee Substitute' to 'Committee Substitute' to reflect the House Committee's version.

The order of sections was reorganized. Definitions were moved to appear before the main operative section in the committee version.

Page numbering and formatting were adjusted to conform to standard legislative formatting conventions.

Proposed Policy Committee Substitute 1 → Proposed Policy Committee Substitute 2 · 3 edits

MINOR

The bill was revised to reorganize and clarify definitions of 'health benefit plan' and 'health care service' by moving the definitions to a new subsection and renumbering sections. This improves readability and ensures consistent terminology throughout the bill. The substantive policy content regarding out-of-pocket payment options and carrier documentation requirements remains unchanged.

Scope change

The bill's scope remains the same - it applies to health benefit plans providing coverage for children in Oklahoma, but the definitions are now more clearly organized and cross-referenced.

DEFINITION

The definitions of 'health benefit plan' and 'health care service' were moved to a new subsection D and renumbered for better organization and clarity.

TECHNICAL

Section numbering was adjusted throughout the document to resolve duplication and improve the overall structure of the bill.

New page reference numbers and formatting were added to align with committee amendment standards.

Proposed Committee Substitute (full committee) 2 → Proposed Policy Committee Substitute 1 · 3 edits

MINOR

The bill was amended to change the committee type from 'Oversight' to 'Policy' and reorganized the definition of 'health benefit plan' to clarify which insurance products are excluded from the bill's protections. The substantive policy language regarding out-of-pocket payment options and carrier reimbursement remains largely the same, though some formatting and line numbering were adjusted.

Scope change

The bill's scope was narrowed by adding specific exclusions to the definition of 'health benefit plan', such as short-term nonrenewable health insurance (6 months or less) and long-term care policies, which were not explicitly excluded in the previous version.

DEFINITION

The definition of 'health benefit plan' was expanded to explicitly exclude short-term nonrenewable health insurance (6 months or less), long-term care policies, and workers' compensation coverage.

TECHNICAL

The committee designation was changed from 'Proposed Oversight Committee Substitute' to 'Proposed Policy Committee Substitute', and the document header was updated accordingly.

Page numbering and request numbers were updated from 13220 to 12268, and the bill title was adjusted to reflect the new committee designation.

Proposed Committee Substitute (full committee) 1 → Proposed Committee Substitute (full committee) 2 · 3 edits

MINOR

The bill was amended to expand the definition of 'health benefit plan' to include group hospital coverage, individual and group medical insurance, HMO plans, and the State and Education Employees Group Health Insurance Plan. The amendment also reorganized the definition structure and updated the request number from 12954 to 13220. These changes clarify which insurance products are covered under the legislation.

Scope change

The scope of the bill was expanded to include additional types of health insurance plans that were not previously defined as health benefit plans.

DEFINITION

Expanded the definition of 'health benefit plan' to include group hospital coverage, individual and group medical insurance, HMO plans, and the State and Education Employees Group Health Insurance Plan.

Reorganized the structure of the health benefit plan definition from a single paragraph with lettered subsections to a two-part structure with lettered subsections (a-g) for better clarity.

TECHNICAL

Updated the request number from 12954 to 13220 and changed the committee amendment version from FULLPCS1 to FULLPCS2.

Engrossed → Proposed Committee Substitute (full committee) 1 · 5 edits

MODERATE

The bill was completely rewritten and restructured from scratch by the House Oversight Committee. The original text was deleted and replaced with a new version that maintains the same core purpose of allowing individuals to pay for medical services out-of-pocket and have those payments count toward their insurance deductibles and cost-sharing requirements.

Scope change

The scope remains the same - it still applies to health benefit plans and individuals paying for covered medical services out-of-pocket, but the language was substantially reorganized and clarified.

TECHNICAL

The entire bill text was deleted and replaced with a new version, indicating a complete rewrite by the committee rather than incremental amendments.

The effective date section was removed from the visible text, though the original effective date of November 1, 2025 was present in the deleted version.

DEFINITION

The definition of 'health benefit plan' was simplified to mean any insurance company or health maintenance organization that issues coverage to Oklahoma residents, removing detailed exclusions that were present in the original version.

REQUIREMENT

Documentation requirements were streamlined to require only the service received, provider contact information, any required medical orders, and the negotiated cost paid out-of-pocket.

The language specifying what costs count toward deductibles and cost-sharing was clarified to include coinsurance, copayments, and other cost-sharing amounts for both in-network and out-of-network providers.

Introduced → Engrossed · 5 edits · Mar 26, 2025

MODERATE

This bill was amended to clarify and expand definitions of health care services and health benefit plans, while updating language to ensure consistency with current Oklahoma statutes and to better reflect the intent of allowing individuals to pay out-of-pocket for negotiated lower costs. The changes improve clarity on which plans are excluded from the program and refine how out-of-pocket payments are credited toward deductibles and out-of-pocket maximums.

Scope change

The bill's scope was refined by adding explicit definitions for 'health care service' and 'health benefit plan,' and by clarifying exclusions such as short-term insurance and specific types of coverage that do not qualify under the program.

DEFINITION

The definition of 'health care service' was expanded to include mental health and substance use disorder services, and durable medical equipment, while removing the exclusion of emergency medical services.

A detailed definition of 'health benefit plan' was added, listing specific types of coverage that are excluded from the program, including Medicare supplemental policies, workers' compensation, and short-term insurance of six months or less.

REQUIREMENT

Documentation requirements were updated to require that the health care provider accept out-of-pocket payment as payment in full and not bill the enrollee or plan for any balance.

Clarified that out-of-pocket payments count toward both in-network and out-of-network deductibles and annual maximum out-of-pocket expenses, depending on the provider type.

TECHNICAL

Formatting and numbering were updated to align with standard legislative markup conventions, and the bill title was changed from 'Introduced' to 'Engrossed'.

Health care services; terms; documentation; prohibiting certain billing; deductible; codification; effective date.

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