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SENATE FLOOR VERSION - SB1646 SFLR Page 1
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SENATE FLOOR VERSION
February 26, 2026
AS AMENDED
SENATE BILL NO. 1646 By: Gollihare of the Senate
and
Lawson of the House
[ health insurance - mental health and substance use
disorders - benefits or coverage - utilization review
- criteria - authorizations - policy - rules -
codification - 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 6060.11c of Title 36, unless
there is created a duplication in numbering, reads as follows:
A. As used in this section:
1. A “core treatment” for a condition or disorder is a standard
treatment or course of treatment, therapy, service, or intervention
indicated by generally accepted standards of mental health and
substance use disorder care;
2. “Generally accepted standards of mental health and substance
use disorder care” means standards of care and clinical practice
that are generally recognized by health care providers practicing in
relevant clinical specialties such as psychiatry, psychology,
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addiction medicine and counseling, and behavioral health treatment.
Valid, evidence-based sources reflecting generally accepted
standards of mental health and substance use disorder care include
published peer-reviewed scientific studies and medical literature
and recommendations of nonprofit health care provider professional
associations including, but not limited to, patient placement
criteria and clinical practice guidelines;
3. “Health benefit plan” has the same meaning as provided in
Section 6060.4 of Title 36 of the Oklahoma Statutes;
4. “Medically necessary treatment of a mental health or
substance use disorder” means a service or product addressing the
specific needs of that patient, for the purpose of screening,
preventing, diagnosing, managing, or treating an illness, injury,
condition, or its symptoms, including minimizing the progression of
an illness, injury, condition, or its symptoms, in a manner that is
all of the following:
a. in accordance with the generally accepted standards of
mental health and substance use disorder care,
b. clinically appropriate in terms of type, frequency,
extent, site, and duration, and
c. not primarily for the economic benefit of the health
benefit plan or purchaser or for the convenience of
the patient, treating physician, or other health care
provider;
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5. “Mental health and substance use disorder” means a mental
health condition or substance use disorder that falls under any of
the diagnostic categories listed in the mental and behavioral
disorders chapter of the most recent edition of the International
Statistical Classification of Diseases and Related Health Problems,
or that is listed in the most recent version of the American
Psychiatric Association’s Diagnostic and Statistical Manual of
Mental Disorders or the Diagnostic Classification of Mental Health
and Developmental Disorders of Infancy and Early Childhood. Changes
in terminology, organization, or classification of mental health and
substance use disorders in future versions of the American
Psychiatric Association’s Diagnostic and Statistical Manual of
Mental Disorders or the International Statistical Classification of
Diseases and Related Health Problems shall not affect the conditions
covered by this section as long as a condition is commonly
understood to be a mental health or substance use disorder by health
care providers practicing in relevant clinical specialties;
6. “Nonprofit health care provider professional association”
means a not-for-profit health care provider professional association
or specialty society that is generally recognized by clinicians
practicing in the relevant clinical specialty and that issues peer-
reviewed guidelines, criteria, or other clinical recommendations
developed through a transparent process;
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7. “Utilization review” means prospectively, retrospectively,
or concurrently reviewing and approving, modifying, delaying, or
denying, based in whole or in part on medical necessity, requests by
health care providers, insureds, or their authorized representatives
for coverage of health care services prior to, retrospectively, or
concurrent with the provision of health care services to insureds,
or for out-of-network services required pursuant to 6060.11a of
Title 36 of the Oklahoma Statutes; and
8. “Utilization review criteria” means any criteria, standards,
protocols, or guidelines used by a health benefit plan, or any
entity acting on the health benefit plan’s behalf, to conduct
utilization review.
B. 1. Every health benefit plan issued, amended, or renewed in
this state that provides hospital, medical, or surgical coverage
shall provide coverage for medically necessary treatment of mental
health and substance use disorders including services that are
consistent with criteria, guidelines, or consensus recommendations
from nationally recognized not-for-profit clinical specialty
associations of the relevant behavioral, mental health, or substance
use disorder specialty.
2. A health benefit plan shall not limit benefits or coverage
for chronic or pervasive mental health and substance use disorders
to short-term or acute treatment at any level of care placement.
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3. All utilization review concerning service intensity, level
of care placement, continued stay, and transfer or discharge of
insureds diagnosed with mental health and substance use disorders
shall be conducted in accordance with the requirements of subsection
C of this section.
4. A health benefit plan that authorizes a specific type of
treatment by a provider pursuant to this section shall not rescind
or modify the authorization or payment after the provider renders
the health care service in good faith and pursuant to the
authorization for any reason, including, but not limited to, the
health benefit plan’s subsequent rescission, cancellation, or
modification of the insured’s or policyholder’s contract, or the
health benefit plan’s subsequent determination that it did not make
an accurate determination of the insured’s or policyholder’s
eligibility.
5. If services for the medically necessary treatment of a
mental health or substance use disorder are not available in-
network, the health benefit plan shall comply with the out-of-
network care requirements provided by Section 6060.11a of Title 36
of the Oklahoma Statutes.
6. If a health benefit plan provides any benefits for a mental
health or substance use disorder in any classification of benefits,
it shall provide meaningful benefits for that mental health or
substance use disorder in every classification in which medical or
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surgical benefits are provided in accordance with 45 C.F.R., Section
146.136. For purposes of this paragraph, whether the benefits
provided are meaningful benefits shall be determined in comparison
to the benefits provided for medical conditions and surgical
procedures in the classification. At a minimum, the health benefit
plan shall provide coverage of benefits for that condition or
disorder in each classification in which the health benefit plan
provides benefits for one or more medical conditions or surgical
procedures. The health benefit plan shall not be deemed to provide
meaningful benefits unless it provides benefits for a core treatment
for that condition or disorder in each classification in which the
health benefit plan provides benefits for a core treatment for one
or more medical conditions or surgical procedures. If there is no
core treatment for a covered mental health condition or substance
use disorder with respect to a classification, the health benefit
plan is not required to provide benefits for a core treatment for
such condition or disorder in that classification, but shall provide
benefits for such condition or disorder in every classification in
which medical or surgical benefits are provided.
C. 1. In conducting utilization review, a health benefit plan
that provides hospital, medical, or surgical coverage, or an entity
acting on the health benefit plan’s behalf, shall not deviate from,
or apply criteria that deviates from, current generally accepted
standards of mental health and substance use disorder care as
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defined in subsection A of this section. All denials and appeals
shall be reviewed by a professional with the same level of education
and experience as the provider requesting coverage.
2. In conducting utilization review of all covered health care
services and benefits for the screening, diagnosis, prevention, and
treatment of mental health and substance use disorders in children,
adolescents, and adults, a health benefit plan shall apply the
relevant level of care placement criteria and practice guidelines
set forth in the most recent versions of such criteria and practice
guidelines, developed by the nonprofit health care provider
professional association for the relevant clinical specialty.
3. In conducting utilization review relating to service
intensity or level of care placement, continued stay, transfer or
discharge, or any other patient care decisions that are within the
scope of the sources specified in subsection B of this section, a
health benefit plan shall not apply different, additional,
conflicting, or more restrictive utilization review criteria than
the criteria and guidelines set forth in those sources. For all
service intensity or level of care placement, continued stay, or
transfer or discharge decisions, the health benefit plan shall
authorize placement at the level of care consistent with the
insured’s score using the relevant level of care placement criteria
and guidelines as specified in subsection B of this section. If
that level of placement is not available, the health benefit plan
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shall authorize the next highest level of care. If the health
benefit plan’s application of the relevant age-appropriate criteria
is not consistent with the service intensity or level of care
placement requested by the covered person or his or her provider,
any adverse benefit determination notice shall include full details
of the health benefit plan’s assessment under the relevant criteria
to the provider and the covered person.
D. A health benefit plan shall not adopt, impose, or enforce
terms in its policies or provider agreements, in writing or in
operation, that undermine, alter, or conflict with the requirements
of this section.
E. 1. The Insurance Commissioner may promulgate rules to
implement and enforce the provisions of this section including, but
not limited to, rules to:
a. address health benefit plan utilization review
compliance in accordance with subsection C of this
section,
b. specify data testing requirements to determine plan
design and application of parity compliance for
nonquantitative treatment limitations using outcomes
data, and
c. set standard definitions for coverage requirements,
including processes, strategies, evidentiary
standards, and other factors.
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2. If the Commissioner determines that a health benefit plan
has violated this section, the Commissioner may, after appropriate
notice and opportunity for hearing by order, assess a civil penalty
not to exceed Five Thousand Dollars ($5,000.00) for each violation
or, if a violation was willful, a civil penalty not to exceed Ten
Thousand Dollars ($10,000.00) for each violation. The civil
penalties authorized under this paragraph are not exclusive and may
be sought and employed in combination with any other remedies
available to the Commissioner under the Oklahoma Insurance Code.
F. 1. This section applies to:
a. all health care services and benefits for the
screening, diagnosis, prevention, and treatment of
mental health and substance use disorders covered by
an insurance policy, and
b. a health benefit plan that covers hospital, medical,
or surgical expenses and conducts utilization review
as defined in this section, and any entity or
contracting provider that performs utilization review
or utilization management functions on a health
benefit plan’s behalf.
2. This section applies only to covered benefits. Nothing in
this section shall be construed to expand or alter the benefits
available to the insured or policyholder under an insurance policy.
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3. Nothing in this section shall be construed to supersede,
limit, or otherwise affect the provisions of Section 2607.1 of Title
63 of the Oklahoma Statutes.
SECTION 2. This act shall become effective January 1, 2027.
COMMITTEE REPORT BY: COMMITTEE ON BUSINESS AND INSURANCE
February 26, 2026 - DO PASS AS AMENDED