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STATE OF OKLAHOMA
2nd Session of the 60th Legislature (2026)
SENATE BILL 1654 By: Frix
AS INTRODUCED
An Act relating to mobile integrated healthcare;
defining terms; requiring certain reimbursement by
health care benefit plan; amending 63 O.S. 2021,
Section 1-2503, as amended by Section 1, Chapter 276,
O.S.L. 2022 (63 O.S. Supp. 2025, Section 1-2503),
which relates to the Oklahoma Emergency Response
Systems Development Act; defining terms; amending 63
O.S. 2021, Section 1-2511, which relates to powers
and duties; directing establishment of mobile
integrated healthcare program; updating statutory
language; updating statutory reference; providing for
promulgation of rules; defining terms; directing the
Oklahoma Health Care Authority to establish certain
reimbursement methodology; requiring certain
reimbursement by the Authority or contracted entity;
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 6050.4 of Title 36, unless there
is created a duplication in numbering, reads as follows:
A. As used in this section:
1. “Health care benefit plan” has the same meaning as provided
in Section 6050.2 of Title 36 of the Oklahoma Statutes; and
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2. “Mobile integrated health care” (MIH) and “mobile integrated
health care (MIH) supplier” have the same meanings as provided in
Section 1-2503 of Title 63 of the Oklahoma Statutes.
B. Any encounter between a mobile integrated healthcare (MIH)
supplier and an enrollee that results in a treatment without
transport of the enrollee shall be reimbursed by a health care
benefit plan at a rate not less than the minimum allowable
reimbursement rate under the methodology established for the state
Medicaid program by the Oklahoma Health Care Authority under Section
4 of this act.
C. When an MIH supplier triages, treats, and transports an
enrollee to an alternative destination in accordance with an
approved MIH program protocol, reimbursement by a health care
benefit plan shall be at a rate not less than the minimum allowable
reimbursement rate for basic life support (BLS) services or advanced
life support (ALS) services, as appropriate based on the condition
of the patient, including mileage from the scene to the alternative
destination.
SECTION 2. AMENDATORY 63 O.S. 2021, Section 1-2503, as
amended by Section 1, Chapter 276, O.S.L. 2022 (63 O.S. Supp. 2025,
Section 1-2503), is amended to read as follows:
Section 1-2503. As used in the Oklahoma Emergency Response
Systems Development Act:
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1. “Ambulance” means any ground, air or water vehicle which is
or should be approved by the State Commissioner of Health, designed
and equipped to transport a patient or patients and to provide
appropriate on-scene and en route patient stabilization and care as
required. Vehicles used as ambulances shall meet such standards as
may be required by the Commissioner for approval, and shall display
evidence of such approval at all times;
2. “Ambulance authority” means any public trust or nonprofit
corporation established by the state or any unit of local government
or combination of units of government for the express purpose of
providing, directly or by contract, emergency medical services in a
specified area of the state;
3. “Ambulance patient” or “patient” means any person who is or
will be transported in a reclining position to or from a health care
facility in an ambulance;
4. “Ambulance service” means any private firm or governmental
agency which is or should be licensed by the State Department of
Health to provide levels of medical care based on certification
standards promulgated by the Commissioner;
5. “Ambulance service district” means any county, group of
counties or parts of counties formed together to provide, operate
and finance emergency medical services as provided by Section 9C of
Article X of the Oklahoma Constitution or Sections 1201 through 1221
of Title 19 of the Oklahoma Statutes;
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6. “Board” means the State Board of Health;
7. “Certified emergency medical responder” means an individual
certified by the Department to perform emergency medical services in
accordance with the Oklahoma Emergency Response Systems Development
Act and in accordance with the rules and standards promulgated by
the Commissioner;
8. “Certified emergency medical response agency” means an
organization of any type certified by the Department to provide
emergency medical care and limited transport in an emergency vehicle
as defined in Section 1-103 of Title 47 of the Oklahoma Statutes. A
certified emergency medical response agency shall only provide
transport upon approval by the appropriate online medical control at
the time of transport. Certified emergency medical response
agencies may utilize certified emergency medical responders or
licensed emergency medical personnel; provided, however, that all
personnel so utilized shall function under the direction of and
consistent with guidelines for medical control;
9. “Classification” means an inclusive standardized
identification of stabilizing and definitive emergency services
provided by each hospital that treats emergency patients;
10. “CoAEMSP” means the Committee on Accreditation of
Educational Programs for the Emergency Medical Services Professions;
11. “Commissioner” means the State Commissioner of Health;
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12. “Council” means the Trauma and Emergency Response Advisory
Council created in Section 1-103a.1 of this title;
13. “Critical care paramedic” or “CCP” means a licensed
paramedic who has successfully completed critical care training and
testing requirements in accordance with the Oklahoma Emergency
Response Systems Development Act and in accordance with the rules
and standards promulgated by the Commissioner;
14. “Department” means the State Department of Health;
15. “Emergency medical services system” means a system which
provides for the organization and appropriate designation of
personnel, facilities and equipment for the effective and
coordinated local, regional and statewide delivery of health care
services primarily under emergency conditions;
16. “Letter of review” means the official designation from
CoAEMSP to a paramedic program that is in the “becoming accredited”
process;
17. “Licensed emergency medical personnel” means an emergency
medical technician (EMT), an intermediate emergency medical
technician (IEMT), an advanced emergency medical technician (AEMT),
or a paramedic licensed by the Department to perform emergency
medical services in accordance with the Oklahoma Emergency Response
Systems Development Act and the rules and standards promulgated by
the Commissioner;
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18. “Licensure” means the licensing of emergency medical care
providers and ambulance services pursuant to rules and standards
promulgated by the Commissioner at one or more of the following
levels:
a. basic life support,
b. intermediate life support,
c. paramedic life support,
d. advanced life support,
e. stretcher van, and
f. specialty care, which shall be used solely for
interhospital transport of patients requiring
specialized en route medical monitoring and advanced
life support which exceed the capabilities of the
equipment and personnel provided by paramedic life
support.
Requirements for each level of care shall be established by the
Commissioner. Licensure at any level of care includes a license to
operate at any lower level, with the exception of licensure for
specialty care; provided, however, that the highest level of care
offered by an ambulance service shall be available twenty-four (24)
hours each day, three hundred sixty-five (365) days per year.
Licensure shall be granted or renewed for such periods and under
such terms and conditions as may be promulgated by the Commissioner;
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19. “Medical control” means local, regional or statewide
medical direction and quality assurance of health care delivery in
an emergency medical service system. Online medical control is the
medical direction given to licensed emergency medical personnel,
certified emergency medical responders and stretcher van personnel
by a physician via radio or telephone. Off-line medical control is
the establishment and monitoring of all medical components of an
emergency medical service system, which is to include stretcher van
service including, but not limited to, protocols, standing orders,
educational programs, and the quality and delivery of online
control;
20. “Medical director” means a physician, fully licensed
without restriction, who acts as a paid or volunteer medical advisor
to a licensed ambulance service and who monitors and directs the
care so provided. Such physicians shall meet such qualifications
and requirements as may be promulgated by the Commissioner;
21. “Mobile integrated healthcare” (MIH) means a patient-
centered model of care that:
a. utilizes licensed emergency medical services personnel
including, but not limited to, community paramedics,
paramedics, emergency medical technicians, and other
qualified health professionals,
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b. provides in-home or on-scene assessment, treatment,
and referral services to individuals in nonemergency
or subacute situations,
c. includes, but is not limited to, treat-in-place,
telehealth, and transport to alternative destination
programs,
d. coordinates with hospitals, clinics, mental health
facilities, long-term care providers, and primary care
practitioners to ensure continuity and integration of
care, and
e. operates under approved medical direction and
protocols consistent with standards adopted by the
State Commissioner of Health;
22. “Mobile integrated healthcare (MIH) supplier” means an
ambulance service, fire service, or other agency credentialed by the
State Department of Health to provide MIH services under paragraph
13 of Section 1-2511 of this title;
23. “Region” or “emergency medical service region” means two or
more municipalities, counties, ambulance districts or other
political subdivisions exercising joint control over one or more
providers of emergency medical services and stretcher van service
through common ordinances, authorities, boards or other means;
22. 24. “Regional emergency medical services system” means a
network of organizations, individuals, facilities and equipment
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which serves a region, subject to a unified set of regional rules
and standards which may exceed, but may not be in contravention of,
those required by the state, which is under the medical direction of
a single regional medical director, and which participates directly
in the delivery of the following services:
a. medical call-taking and emergency medical services
dispatching, emergency and routine including priority
dispatching of first response agencies, stretcher van
and ambulances,
b. emergency medical responder services provided by
emergency medical response agencies,
c. ambulance services, both whether emergency, routine
and or stretcher van including, but not limited to,
the transport of patients in accordance with transport
protocols approved by the regional medical director,
and
d. directions given by physicians directly via radio or
telephone, or by written protocol, to emergency
medical response agencies, stretcher van or ambulance
personnel at the scene of an emergency or while en
route to a hospital;
23. 25. “Regional medical director” means a licensed physician,
who meets or exceeds the qualifications of a medical director as
defined by the Oklahoma Emergency Response Systems Development Act,
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chosen by an emergency medical service region to provide external
medical oversight, quality control and related services to that
region;
24. 26. “Registration” means the listing of an ambulance
service in a registry maintained by the Department; provided,
however, registration shall not be deemed to be a license;
25. 27. “Stretcher van” means any ground vehicle which is or
should be approved by the State Commissioner of Health, which is
designed and equipped to transport individuals on a stretcher or
gurney type apparatus. Vehicles used as stretcher vans shall meet
such standards as may be required by the Commissioner for approval
and shall display evidence of licensure at all times. The
Commissioner shall not establish Federal Specification KKK-A-1822
ambulance standards for stretcher vans; provided, a stretcher van
shall meet Ambulance Manufacturers Division (AMD) Standards 004, 012
and 013, and shall pass corresponding safety tests. Stretcher van
services shall only be permitted and approved by the Commissioner in
emergency medical service regions, ambulance service districts, or
counties with populations in excess of five hundred thousand
(500,000) people. Notwithstanding the provisions of this paragraph,
stretcher van transports may be made to and from any federal or
state veterans facility. Stretcher vans may carry and provide
oxygen and may carry and utilize any equipment necessary for the
provision of oxygen;
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26. 28. “Stretcher van passenger” means any person who is or
will be transported in a reclining position on a stretcher or
gurney, who is medically stable, nonemergent and does not require
any medical monitoring equipment or assistance during transport
except oxygen. Passengers must be authorized as qualified to be
transported by stretcher van. Passengers shall be authorized
through screening provided by a certified medical dispatching
protocol approved by the Department. All patients being transported
to or from any medically licensed facility shall be screened before
transport. Any patient transported without screening shall be a
violation of Commissioner rule by the transporting company and
subject to administrative procedures of the Department; and
27. 29. “Transport protocol” means the written instructions
governing decision-making at the scene of a medical emergency by
ambulance personnel regarding the selection of the hospital to which
the patient shall be transported. Transport protocols shall be
developed by the regional medical director for a regional emergency
medical services system or by the Department if no regional
emergency medical services system has been established. Such
transport protocols shall adhere to, at a minimum, the following
guidelines:
a. nonemergency, routine transport shall be to the
facility of the patient’s choice,
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b. urgent or emergency transport not involving life-
threatening medical illness or injury shall be to the
nearest facility, or, subject to transport
availability and system area coverage, to the facility
of the patient’s choice,
c. life-threatening medical illness or injury shall
require transport to the nearest health care facility
appropriate to the needs of the patient as established
by regional or state guidelines, and
d. emergency ambulance transportation is not required
when a patient’s apparent clinical condition, as
defined by applicable medical treatment protocols,
does not warrant emergency ambulance transport, and
nontransport of patients is authorized pursuant to
applicable medical treatment protocols established by
the regional medical director.
SECTION 3. AMENDATORY 63 O.S. 2021, Section 1-2511, is
amended to read as follows:
Section 1-2511. The State Commissioner of Health shall have the
following powers and duties with regard to an Oklahoma Emergency
Medical Services Improvement Program:
1. Administer and coordinate all federal and state programs,
not specifically assigned by state law to other state agencies,
which include provisions of the Federal federal Emergency Medical
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Services Systems Act of 1973 and other federal laws and programs
relating to the development of emergency medical services in this
state. The administration and coordination of federal and state
laws and programs relating to the development, planning, prevention,
improvement and management of emergency medical services shall be
conducted by the Division of Emergency Medical Services, as
prescribed by Section 1-2510 of this title;
2. Assist private and public organizations, emergency medical
and health care providers, ambulance authorities, district boards
and other interested persons or groups in improving emergency
medical services at the local, municipal, district or state levels.
This assistance shall be through professional advice and technical
assistance;
3. Coordinate the efforts of local units of government to
establish service districts and set up boards of trustees or other
authorities to operate and finance emergency medical services in the
state as provided under Section 9C of Article X of the Oklahoma
Constitution or under Sections 1201 through 1221 of Title 19 of the
Oklahoma Statutes. The Commissioner shall evaluate all proposed
district areas and operational systems to determine the feasibility
of their economic and health services delivery;
4. Prepare, maintain and utilize a comprehensive plan and
program for emergency medical services development throughout the
state to be adopted by the State Board Commissioner of Health,
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giving consideration to the recommendations of the Trauma and
Emergency Response Advisory Council created in Section 44 of this
act Section 1-103a.1 of this title, and incorporated within the
State Health Plan. The plan shall establish goals, objectives and
standards for a statewide integrated system and a timetable for
accomplishing and implementing different elements of the system.
The plan shall also include, but not be limited to, all components
of an emergency medical services system; regional and statewide
planning; the establishment of standards and the appropriate
criteria for the designation of facilities; data collection and
quality assurance; and funding;
5. Maintain a comprehensive registry of all ambulance services
operating within the state, to be published annually, and maintain a
registry of critical care paramedics. All ambulance service
providers shall register annually with the Commissioner on forms
supplied by the State Department of Health, containing such requests
for information as may be deemed necessary by the Commissioner;
6. Develop a standard report form which may be used by local,
regional and statewide emergency medical services and emergency
medical services systems to facilitate the collection of data
related to the provision of emergency medical and trauma care. The
Commissioner shall also develop a standardized emergency medical
services data set and an electronic submission standard. Each
ambulance service shall submit the information required in this
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section at such intervals as may be prescribed by rules promulgated
by the State Board of Health Commissioner;
7. Evaluate and certify all emergency medical services training
programs and emergency medical technician training courses and
operational services in accordance with specifications and
procedures approved by the Board Commissioner. Nonaccredited
paramedic training programs shall begin their final paramedic
training class by December 31, 2012. Only paramedic training
programs accredited or receiving a Letter of Review (LOR) by CoAEMSP
the Committee on Accreditation of Educational Programs for the
Emergency Medical Services Professions (CoAEMSP) may enroll new
paramedic students after January 1, 2013;
8. Provide an emergency medical personnel and ambulance service
licensure program to include a requirement that ambulance services
licensed as specialty care ambulance providers shall be used solely
for interhospital transport of patients requiring specialized en
route medical monitoring and advanced life support which exceeds the
capabilities of the equipment and personnel provided by paramedic
life support;
9. Employ and prescribe the duties of employees as may be
necessary to administer the provisions of the Oklahoma Emergency
Response Systems Development Act;
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10. Apply for and accept public and private gifts, grants,
donations and other forms of financial assistance designed for the
support of emergency medical services;
11. Develop a classification system for all hospitals that
treat emergency patients. The classification system shall:
a. identify stabilizing and definitive emergency services
provided by each hospital, and
b. require each hospital to notify the regional emergency
medical services system control when treatment
services are at maximum capacity and that emergency
patients should be diverted to another hospital; and
12. Develop and monitor a statewide emergency medical services
and trauma analysis system designed to:
a. identify emergency patients and severely injured
trauma patients treated in Oklahoma this state,
b. identify the total amount of uncompensated emergency
care provided each fiscal year by each hospital and
ambulance service in Oklahoma this state, and
c. monitor emergency patient care provided by emergency
medical service and hospitals; and
13. Establish and administer a mobile integrated healthcare
(MIH) program, formerly known as the community paramedic program,
for the purpose of improving access to appropriate medical care,
reducing unnecessary emergency department utilization, and enhancing
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coordination between emergency medical services, hospitals, and
community health providers. The Commissioner shall promulgate rules
as necessary to:
a. establish clinical, operational, and reporting
standards for MIH suppliers,
b. define eligibility and credentialing requirements for
participating agencies and personnel,
c. ensure compliance with emergency medical services
licensing and medical oversight requirements,
d. establish procedures for program evaluation, quality
assurance, and outcome reporting, and
e. facilitate participation of MIH suppliers in public
and private reimbursement systems, including the state
Medicaid program and commercial insurance plans, in
collaboration with the Oklahoma Health Care Authority,
the Insurance Department, and the Department of Mental
Health and Substance Abuse Services.
SECTION 4. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 5025.1 of Title 63, unless there
is created a duplication in numbering, reads as follows:
A. As used in this section, “mobile integrated healthcare”
(MIH) and “mobile integrated healthcare (MIH) supplier” have the
same meanings as provided in Section 1-2503 of Title 63 of the
Oklahoma Statutes.
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B. The Oklahoma Health Care Authority shall establish a
reimbursement methodology for encounters between a mobile integrated
healthcare (MIH) supplier and a Medicaid member that result in a
treatment without transport of the member.
C. Any encounter between an MIH supplier and a Medicaid member
that results in a treatment without transport of the member shall be
reimbursed by the Authority or a contracted entity at a rate not
less than the minimum allowable reimbursement rate under the
methodology established under subsection B of this section.
D. Unless the rate described in subsection H of Section 4002.12
of Title 56 of the Oklahoma Statutes applies, when an MIH supplier
triages, treats, and transports a Medicaid member to an alternative
destination in accordance with an approved MIH program protocol,
reimbursement by the Authority or a contracted entity shall be at a
rate not less than the minimum allowable reimbursement rate for
basic life support (BLS) services or advanced life support (ALS)
services, as appropriate based on the condition of the patient,
including mileage from the scene to the alternative destination.
SECTION 5. This act shall become effective January 1, 2027.
60-2-2364 DC 1/13/2026 8:30:54 PM