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SENATE FLOOR VERSION - SB1673 SFLR Page 1
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SENATE FLOOR VERSION
February 26, 2026
AS AMENDED
SENATE BILL NO. 1673 By: McIntosh, Guthrie,
Sacchieri, Grellner,
Standridge, Weaver, and
Stanley
[ health benefit plans - treatment - medical
necessity - denials - access to care - reimbursement
- liability - presumption - rules and regulations -
complaints - fines and penalties - requests - civil
action - noncodification - codification - effective
date ]
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law not to be
codified in the Oklahoma Statutes reads as follows:
This act shall be known and may be cited as the “Prosthetic
Access and Accountability Act 2026”.
SECTION 2. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 6060.23 of Title 36, unless
there is created a duplication in numbering, reads as follows:
A. As used in this act:
1. “Covered prosthetic benefit” means any prosthesis, orthosis,
or related service listed as a covered benefit under the enrollee’s
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health benefit plan including, but not limited to, benefits listed
under durable medical equipment, orthotics, and assistive devices;
2. “Health benefit plan” means the same as defined in Section
4405.1 of Title 36 of the Oklahoma Statutes but does not include a
flexible benefit plan provided pursuant to Section 1342 of Title 74
of the Oklahoma Statutes;
3. “Orthosis” means the same as defined in Section 3002 of
Title 59 of the Oklahoma Statutes;
4. “Orthotist” means the same as defined in Section 3002 of
Title 59 of the Oklahoma Statutes;
5. “Physician-prescribed device” means any prosthetic or
orthosis device ordered by a provider who is licensed in this state
to prescribe prosthetics;
6. “Prosthesis” means the same as defined in Section 3002 of
Title 59 of the Oklahoma Statutes;
7. “Prosthetist” means the same as defined in Section 3002 of
Title 59 of the Oklahoma Statutes; and
8. “Unreasonable delay” means any failure to approve, deny, or
respond to a coverage request within two (2) business days if marked
urgent by the prescribing provider, and within ten (10) business
days for standard requests.
B. 1. For a health benefit plan offered in this state that
includes covered prosthetic benefits, the goal of treatment shall be
the restoration of physical function to the greatest extent
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possible, as determined by the treating provider. Treatment shall
not be withheld due to discrimination based on disability.
2. Medical necessity shall be based on the patient’s functional
goals and shall not be limited by diagnosis, age, disability, or
generalized coverage tiers. Medical necessity shall be determined
by the enrollee’s treating provider to meet the medical needs of the
enrollee and return to or maintain full functional abilities
including activities of daily living, essential job-related
activities, showering and bathing, and physical activities.
3. Denials based on cost or classification as deluxe,
convenience, or nonessential shall be presumed invalid if the
physician-prescribed device was prescribed to meet documented
functional needs.
C. A health benefit plan that covers prosthetic benefits shall
ensure access to medically necessary clinical care and to prostheses
and orthoses from an adequate number of orthotists and prosthetists
within the network in this state. If covered prosthetic benefits
are unavailable from an in-network provider due to the geographic
location of the patient, the health benefit plan shall provide
processes to refer a member to an out-of-network provider and shall
fully reimburse the out-of-network provider at a mutually agreed
upon rate less member cost sharing determined on an in-network
basis.
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D. 1. A health benefit plan that covers prosthetic benefits
and denies or unreasonably delays a physician-prescribed device
shall be liable for any personal injury, financial loss, or harm
proximately caused by the denial or delay.
2. If an enrollee suffers a fall, injury, hospitalization, or
other adverse health event during a period in which a physician-
prescribed device was denied or delayed, a rebuttable presumption of
health benefit plan negligence shall apply. The health benefit plan
shall be liable for:
a. compensatory damages, including medical costs and lost
income,
b. noneconomic damages for pain, suffering, or diminished
quality of life to the full extent of current law, and
c. punitive damages in cases of bad faith or willful
disregard of medical judgment.
E. If a health benefit plan or utilization reviewer denies,
modifies, or overrides a claim for a physician-prescribed device and
the patient experiences harm as a result, the insurer shall assume
medical liability as if it were the treating provider. Such
liability includes adherence to the standard of care under this act,
and any applicable governance of provider conduct. A provider shall
not be held liable for any harm resulting from an insurer’s denial,
modification, or override of the claim for a physician-prescribed
device.
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F. The Insurance Commissioner shall have the authority to
promulgate rules and regulations for the implementation of this act.
G. The Commissioner shall:
1. Enforce the provisions of this section;
2. Investigate complaints related to this section; and
3. Maintain and publish annual reports on covered prosthetic
benefit denials, appeals, and adverse patient outcomes, provided no
information in this subsection is in violation of the Health
Insurance Portability and Accountability Act of 1996.
H. Health benefit plans in violation of this section may be
subject to:
1. Fines of up to Five Thousand Dollars ($5,000.00) per
violation;
2. Daily penalties of One Thousand Dollars ($1,000.00) for
unreasonable delays; or
3. Revocation or suspension of certificate of authority in
repeated cases.
I. Coverage requests for prostheses and orthoses shall be
reviewed within two (2) business days if marked urgent by the
prescribing provider, or within ten (10) business days for standard
requests. Failure to respond in writing within such time frames
shall result in automatic approval of the request.
J. Any enrollee harmed by violation of this section shall have
the right to bring a civil action in district court including, but
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not limited to, for actual damages, injunctive relief, and attorney
fees.
SECTION 3. This act shall become effective January 1, 2027.
COMMITTEE REPORT BY: COMMITTEE ON BUSINESS AND INSURANCE
February 26, 2026 - DO PASS AS AMENDED