This bill requires Oklahoma health insurance plans to cover low-dose mammography screenings for breast cancer without cost-sharing (such as deductibles or copays). It mandates coverage once every five years for women aged 35-39 and annually for women 40 and older. The law also requires coverage for necessary diagnostic and supplemental breast exams, including those for high-risk cases like dense breast tissue. The policy takes effect November 1, 2025.
HB 1808, now law in Oklahoma, reforms health insurance prior authorization and step-therapy rules to improve patient access to medications. It requires insurers to grant exceptions to step-therapy protocols (where patients must try cheaper drugs first) if a medication is contraindicated, ineffective based on medical history, or causes harm - covering specific scenarios like prior adverse reactions or stability on a current treatment. The bill mandates insurers respond to urgent prior authorization requests within 24 hours and non-urgent requests within 2 business days, with requests deemed approved if deadlines are missed. It also ensures continuity of coverage for stable treatments when switching plans (90-day protection) and requires insurers to cover at least one readily available asthma controller medication per class without prior authorization.
SB 109 requires Oklahoma health insurance plans to cover genetic testing for inherited cancer risks and evidence-based cancer imaging for individuals with a personal or family history of cancer or increased cancer risk. This coverage must be provided without patient cost-sharing (such as deductibles or copays) when ordered by a healthcare provider following current medical guidelines, including those from the National Comprehensive Cancer Network. The law applies to all health benefit plans offered in Oklahoma starting November 1, 2025, ensuring these preventive services are accessible without financial barriers. It does not affect health savings account eligibility for non-preventive services but guarantees coverage for preventive care under federal guidelines.
SB 146 expands mental wellness services provided by Oklahoma's Department of Public Safety to include retirees of public safety personnel (such as police and firefighters), in addition to current employees. It creates a dedicated revolving fund (Section 9102) to finance these services and strengthens privacy protections by prohibiting the sharing of individual mental health data without consent, while allowing aggregate data use for policy improvements (Section 9101). The bill also mandates that all Mental Wellness Division resources operate separately from other department divisions. These changes took effect November 1, 2025, after becoming law without the Governor's signature on May 29, 2025.
HB 2797 prohibits Oklahoma's Health Care Authority (OHCA) from using statistical methods like extrapolation to audit Medicaid home and community-based service claims, which could require providers to repay overpayments. It invalidates all past audits using these methods (January 2020-November 2025) and voids related repayment demands. The bill requires OHCA and the Department of Human Services to jointly develop new audit standards and provide training for providers by November 2027. It also mandates compliance with existing fraud reporting rules and updates audit responsibilities for Medicaid waiver programs.
HB 2793 allocates $8,000,000 from Oklahoma’s Progressing Rural Economic Prosperity Fund to establish an Emergency Medicine Revolving Fund, as created by prior legislation (HB 2784). This fund will support ongoing emergency medical services, directly affecting hospitals and emergency care providers across the state. The appropriation becomes effective July 1, 2025, and the bill declares an emergency to expedite implementation. The bill does not create new taxes or services but redirects existing state funds to this specific purpose.
HB 2784 creates the Emergency Medicine Revolving Fund to preserve Medicaid supplemental payments for specific hospitals. It directly affects Oklahoma hospitals with American College of Surgeons Level 1 trauma centers, particularly those owned, operated, or partnered with the Oklahoma State University Medical Trust or University Hospitals Trust (including facilities in Oklahoma City and Tulsa). The bill requires annual certification by the Oklahoma State University Medical Authority to ensure trauma centers meet standards for receiving these payments, while also clarifying agreements between medical authorities and healthcare providers. Key provisions include maintaining existing Medicaid funding streams for teaching hospitals, trauma centers, and affiliated medical school providers, and directing the Oklahoma Health Care Authority to develop plans to sustain these payments through federal waivers or state plan amendments.
HB 2777 allocates $20 million from Oklahoma's Opioid Lawsuit Settlement Fund to the state's Opioid Abatement Revolving Fund for opioid-related programs, and $1.25 million to local governments that did not sue opioid manufacturers. The bill directs these funds to be used for opioid abatement efforts, such as treatment and prevention services, without requiring new taxes. It becomes effective July 1, 2025, and was signed into law on May 29, 2025. The legislation uses existing settlement funds rather than creating new spending.
SB 1067 creates a new database for ambulance service providers and changes how health insurers pay for ambulance services in Oklahoma. It requires ambulance providers to report specific data to this database and modifies the rates and criteria insurers use to reimburse ambulance services. This bill directly affects ambulance companies and health insurance providers by establishing new reporting requirements and payment rules. The law became effective without the Governor's signature on May 28, 2025.
SB 789, now effective as of May 28, 2025, restricts how pharmacy benefit managers (PBMs) can audit pharmacies. It requires PBMs to give pharmacies 14 days' notice (30 days for wholesale audits), prohibits recouping funds for simple errors like typos, and allows pharmacies to use hospital/physician records or any drug purchase records (without date/source limits) to validate claims. The law also caps audits at 50 prescriptions per pharmacy annually and mandates that any recouped funds first be refunded to the patient. This directly affects pharmacies, PBMs, and patients by standardizing audit practices and protecting against unfair financial penalties.
