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An Act
ENROLLED HOUSE
BILL NO. 1811 By: Newton of the House
and
Jech of the Senate
An Act relating to insurance; amending Section 10,
Chapter 303, O.S.L. 2024 (36 O.S. Supp. 2024, Section
6570.9), which relates to treatment of chronic
conditions and validity period for prior
authorization of inpatient and non-inpatient care;
modifying timeframe; and providing an effective date.
SUBJECT: Insurance
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. AMENDATORY Section 10, Chapter 303, O.S.L.
2024 (36 O.S. Supp. 2024, Section 6570.9), is amended to read as
follows:
Section 6570.9. A. If a prior authorization is required for a
health care service, other than for inpatient care, for the
treatment of a chronic condition of an enrollee, then the prior
authorization shall remain valid for at least six (6) months from
the date the health care provider receives the prior authorization
approval, unless clinical criteria changes and notice of the change
in clinical criteria is provided as stipulated in this act.
B. If a prior authorization is required for inpatient acute
care for the treatment of a chronic condition of an enrollee, then
the prior authorization shall remain valid for at least fourteen
(14) calendar days from the date the health care provider receives
the prior authorization approval.
1. If an enrollee requires inpatient care beyond the length of
stay that was previously approved by the utilization review entity,
then the utilization review entity shall evaluate any prior
ENR. H. B. NO. 1811 Page 2
authorization requests for the continuation of inpatient care
according to the provisions of this act. A utilization review
entity shall not use any stricter criteria to determine medical
necessity and appropriateness of the continuation of inpatient care
as the utilization review entity used to evaluate the initial
request for authorization of inpatient care. A utilization review
entity shall review any relevant and pertinent literature or data
provided by the health care provider to determine the medical
necessity and appropriateness of the requested length of stay and/or
continuation of inpatient care. A prior authorization for the
continuation of inpatient care shall remain valid for a maximum of
fourteen (14) calendar days from the date the health care provider
receives the prior authorization approval.
2. If a utilization review entity fails to respond to a health
care provider's timely prior authorization request for the
continuation of inpatient acute care before the termination of the
previously approved length of stay, then the health benefit plan
shall continue to compensate the health care provider at the
contracted rate for inpatient care provided until the utilization
review entity issues its determination on the prior authorization
request.
For the purposes of this section, a timely request for
continuation of inpatient care means a request that is submitted at
least seventy-two (72) twenty-four (24) hours prior to the
termination of the previously approved prior authorization and
includes all necessary information for the utilization review entity
to make a determination.
3. If a utilization review entity issues an adverse
determination to a health care provider's prior authorization
request for continuation of inpatient acute care and the health care
provider appeals the adverse determination according to the
provisions of this act, then the health benefit plan shall continue
to compensate the health care provider at the contracted rate for
inpatient care provided until the appeal has been finalized.
C. This section does not require a health benefit plan to cover
care, treatment, or services for a health condition that the terms
of coverage otherwise completely exclude from the policy's covered
benefits without regard for whether the care, treatment, or services
are medically necessary.
SECTION 2. This act shall become effective November 1, 2025.
ENR. H. B. NO. 1811 Page 3
Passed the House of Representatives the 13th day of March, 2025.
Presiding Officer of the House
of Representatives
Passed the Senate the 6th day of May, 2025.
Presiding Officer of the Senate
OFFICE OF THE GOVERNOR
Received by the Office of the Governor this ____________________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________
Approved by the Governor of the State of Oklahoma this _________
day of ___________________, 20_______, at _______ o'clock _______ M.
_________________________________
Governor of the State of Oklahoma
OFFICE OF THE SECRETARY OF STATE
Received by the Office of the Secretary of State this __________
day of ___________________, 20_______, at _______ o'clock _______ M.
By: _________________________________